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December 2010



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First Published Friday, 22nd August, 2008.

The Soul Remains

Autism/AS and Depression – Self Help Interventions(Abstract+)

With the approval and publication just this week of “Self-help interventions for depressive disorders and depressive symptoms”, it would seem that now’s as good a time as any to shine the spotlight on a subject that plagues many on the spectrum.

The high incidence of depression or affective disorder in the Asperger population is widely recognized and acknowledged. Lorna Wing paid reference in her original paper(1981) to the fact, and many with clinical experience will confirm there is high risk with up to 15% of adults having experienced depression(Tantum 1991) as well as the genuine risk of suicide(Wolff 1995).

In early childhood there tends to be less concern about differences to other children and differences may well go completely unnoticed by others for a time depending on various factors. Social contact tends to have limited value or interest to the young on the spectrum. However, it’s during adolescence when difficulties tend to emerge for many on the socialisation front. Exclusion, teasing and ridicule are common. Though depression may be an understandable reaction to an inability to ‘fit in’, in some cases there may well be a biological predisposition. Research suggests that there is a marginally greater incidence of depression or manic depression(bi-polar effective disorder) in families where autism/AS is present(DeLong and Dwyer 1988).

In most cases of depression the classic signs are evident with clear changes in mood, appetite, sleep, and suicidal thoughts and actions. However, all may not be straightforward, where there is a history of flat effect and limited range of emotional expression. Depression may well be expressed via aggression or alcoholism. Introspection and self-critical behaviour in relation to daily events and the seeking of relaxation and emotional blunting via alcohol as a form of self-medication may occur.

Seeking a referral to a professional knowledgeable in autism/AS and obtaining treatment as necessary may well, for some, be life saving.

Programs that deal with the source of the depression, usually poor social skills, lack of friends and limited success at school or work may assist. Guidance in learning social skills, access to meeting people with similar interests and values as well as valuable connections made via the internet, may help prevent the recurrence of depression.

Some on the spectrum are self-professed veterans of self-management in times of depression with exercise, art, music, film, written expression, chocolate therapy etc as part of the regimen for emerging from those darker days. The following extract provides us with some such ‘interventions’ and more food for thought…

Depression...the tears...

Self-help interventions for depressive disorders and depressive symptoms: A systematic review

Morgan AJ, Jorm AF.

Background: Research suggests that depressive disorders exist on a continuum, with subthreshold symptoms causing considerable population burden and increasing individual risk of developing major depressive disorder. An alternative strategy to professional treatment of subthreshold depression is population promotion of effective self-help interventions that can be easily applied by an individual without professional guidance. The evidence for self-help interventions for depressive symptoms is reviewed in the present work, with the aim of identifying promising interventions that could inform future health promotion campaigns or stimulate further research.

Methods: A literature search for randomised controlled trials investigating self-help interventions for depressive disorders or depressive symptoms was performed using PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Reference lists and citations of included studies were also checked. Studies were grouped into those involving participants with depressive disorders or a high level of depressive symptoms, or non-clinically depressed participants not selected for depression. A number of exclusion criteria were applied, including trials with small sample sizes and where the intervention was adjunctive to antidepressants or psychotherapy.

Results: The majority of interventions searched had no relevant evidence to review. Of the 38 interventions reviewed, the ones with the best evidence of efficacy in depressive disorders were S-adenosylmethionine, St John’s wort, bibliotherapy, computerised interventions, distraction, relaxation training, exercise, pleasant activities, sleep deprivation, and light therapy. A number of other interventions showed promise but had received less research attention. Research in non-clinical samples indicated immediate beneficial effects on depressed mood for distraction, exercise, humour, music, negative air ionisation, and singing; while potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalise to self-help without professional guidance.

Conclusions: A number of self-help interventions have promising evidence for reducing subthreshold depressive symptoms. Other forms of evidence such as expert consensus may be more appropriate for interventions that are not feasible to evaluate in randomised controlled trials. There needs to be evaluation of whether promotion to the public of effective self-help strategies for subthreshold depressive symptoms could delay or prevent onset of depressive illness, reduce functional impairment, and prevent progression to other undesirable outcomes such as harmful use of substances.


Full text… (PDF)

© 1999-2008 BioMed Central Ltd

Some Over-The-Counter (OTC) supplements may interact with prescription medications or be affected by them. Check with your doctor or pharmacist before taking any herbal or OTC supplement while on medication.

Most governments do not require dietary supplement makers to demonstrate the safety or effectiveness of their products. Ask your healthcare provider for advice on selecting a brand.


Link to Metanoia suicide support

Johns Hopkins Health Alert

Antidepressants and Personality Changes

If you take antidepressant medication, you may wonder: Will medication change my personality or who I am? In this Health Alert, Dr. Karen L. Swartz, Director of the Mood Disorders Clinic at Johns Hopkins, answers this important question that’s on the minds of many patients.

Dr. Swartz answers: Antidepressant and antianxiety medications don’t alter your personality, but they may change your interactions with others. For example, depending on your initial symptoms, they may make you feel less anxious, sad, moody, irritable, or lethargic. That can help you get along with others better and be more productive and engaged in life.

The medications don’t artificially make you go from sad to happy; rather, they correct the chemical imbalance that, in turn, has thrown your emotional reactions out of balance. You should still be able to experience mood changes.

Sometimes, individuals taking antidepressant medication experience a sense of numbness, apathy, or dulling of moods. This side effect is not a goal of the medication. It may mean that your depression has been partially treated and the dull mood will lift with time, or that you need to adjust your dosage.

It could also mean that this particular medication is not the right one for you, and switching to another medication might produce better results. You also may not have received the correct diagnosis: For instance, you may have been diagnosed with depression when you are actually suffering from bipolar disorder, which requires a different approach to treatment. That’s why it’s imperative to be aware of your moods. If you feel like you’re just not yourself when you’re taking a medication, be sure to discuss it with your doctor.

Suicide Warning Signs

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Suicide is a major public health problem, with more than 32,000 persons dying by suicide each year in the United States, or about 80 suicides per day. In addition to completed suicides, another 1,500 unsuccessful suicide attempts occur each day. In the 18- to 65-year age group, suicide is the fourth leading cause of death in the United States.

Suicide occurs in persons of all ages and backgrounds, but certain groups of people are at increased risk for suicide attempts. These include persons with a psychiatric illness and a past history of attempted suicide. Males are more likely than females to commit suicide, although attempts are more common among females. A family history of, or exposure to, suicide; altered levels of neurotransmitters in the brain; and impulsivity are other factors that may increase an individual’s risk of suicide.

While suicide is not universally preventable, it is possible to recognize some warning signs and symptoms that may enable you or your loved ones to access treatment before a suicide attempt. It has been estimated that up to 75% of suicide victims display some warning signs or symptoms.

Warning signs of suicide are varied. They may include:

  • Talk of, or preoccupation with, suicide or death; threatening suicide; writing about death or suicide
  • Signs of serious depression, including desperation; feelings of hopelessness; feeling no sense of purpose; loss of interest in things one used to care about; trouble sleeping
  • Withdrawal from family and friends
  • Reckless behavior, increased risk-taking, irritability
  • Making statements about life not being worth living, hating life, that the “world would be better off without me,” and similar feelings
  • Increased alcohol or drug use
  • Feelings of rage or uncontrolled anger
  • Seeking access to firearms, pills, or other methods to commit suicide
  • Changing wills, preoccupation with putting one’s affairs in order
  • Dramatic changes in personality

If you suspect suicidal thoughts in yourself or anyone, seek professional help immediately. Go to a clinic, emergency room, or psychiatric facility. Do not leave an individual alone who has expressed thoughts of suicide. In the United States, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK.

Suicidal Thoughts and Behaviors - 1st Aid Guidelines
Suicide Prevention Help / The friendship Letter / Global Web Directory

Johns Hopkins Health Alert

Managing Your Weight on Antidepressants

While recovery from mood disorders such as anxiety and depression can be lifesaving, weight gain often can be an unwanted side effect of treatment for many people. In this Health Alert, Johns Hopkins provides nine practical strategies to head off unwanted weight gain.

Psychiatric medications including antidepressants, mood stabilizers, and antipsychotics may increase weight by stimulating the appetite or slowing the body’s metabolism, and that gain can range from minimal (a few pounds) to significant (up to 50 pounds).

Such rapid weight gain may increase the risk of many health conditions associated with being overweight, such as high blood pressure, diabetes, heart disease, arthritis, and some types of cancer. Despite the fact that many psychiatric medications have weight gain as a side effect, that does not mean it’s a fait accompli. Be aware of the potential for weight gain and follow these strategies to head off extra pounds:

  • Weight Loss Strategy 1: Weigh yourself weekly and keep a diary of your weight so you can notice small increases quickly and take steps to counter further gains. Also keep a food diary for an accurate gauge of how much you’re really eating on a daily basis.
  • Weight Loss Strategy 2: Avoid or limit high-calorie, high-fat foods.
  • Weight Loss Strategy 3: Eat smaller portions — and smaller meals and snacks overall.
  • Weight Loss Strategy 4: Don’t keep large quantities of junk foods in your home. If you need to snack, choose healthy foods such as fresh fruit or vegetables or unbuttered popcorn.
  • Weight Loss Strategy 5: Eat slowly. Many people eat too quickly — the brain needs about 20 minutes to recognize that the stomach is full , so if you eat too fast, you’ll be apt to consume more calories than you need to satisfy your hunger.
  • Weight Loss Strategy 6: Don’t skip meals. Going for long periods of time without food only serves to make you hungrier in the long term and more likely to overeat once you do eat.
  • Weight Loss Strategy 7: Exercise every day to counteract any extra calories you’re consuming and give a boost to your metabolism. Try resistance training and aerobic exercise. To build muscle, lift weights or use resistance machines three times a week.
  • Weight Loss Strategy 8: Drink frequently. Hunger is one of the symptoms of dehydration, so quench your thirst with calorie-free beverages such as water, seltzer, diet soda, and decaffeinated coffee and tea.
  • Weight Loss Strategy 9: If all else fails, talk to your healthcare provider about switching to a medication that is less likely to cause weight gain or adding another one that might help avoid weight gain. Don’t stop taking your medication without discussing it with your doctor, as your depression or anxiety may return or you may experience withdrawal side effects.
  • Source:

Depression Increases Sensitivity to Pain

The brains of individuals with major depressive disorder appear to react more strongly when anticipating pain and also display altered functioning of the neural network that modifies pain sensitivity, according to a report in the November issue of Archives of General Psychiatry.

Chronic pain and depression are common and often overlapping syndromes,” the authors write as background information in the article. Recurring or chronic pain occurs in more than 75 percent of patients with depression, and between 30 percent and 60 percent of patients with chronic pain report symptoms of depression “Understanding the neurobiological basis of this relationship is important because the presence of comorbid pain contributes significantly to poorer outcomes and increased cost of treatment in major depressive disorder.

Irina A. Strigo, PhD, of the University of California San Diego, La Jolla, and colleagues studied 15 young adults with major depressive disorder (average age 24.5) who were not taking medication and 15 individuals who were the same age (average 24.3 years) and had the same education level but did not have depression. Patients with depression completed a questionnaire that evaluated their tendencies to magnify, ruminate over or feel helpless in the face of pain.

All participants underwent functional magnetic resonance imaging (fMRI) while their arms were exposed to a thermal device heated to painful levels (an average of 46.4 degrees to 46.9 degrees Celsius, or about 115 degrees to 116 degrees Fahrenheit) and also to non-painful temperatures. Visual cues (a green shape for non-painful warmth and a red shape for painful warmth) were presented before the heat was applied.

Compared with the controls, patients with depression showed increased activation in certain areas of their brain – including the right amygdala – during the anticipation of painful stimuli. They also displayed increased activation in the right amygdala and decreased activation in other areas, including those responsible for pain modulation (adjusting sensitivity to pain), during the painful experience.

To examine whether the activation of the amygdala was associated with passive coping styles, the researchers compared the percentage change in the activations of the amygdala with the helplessness, rumination and ramification reported by the participants with depression. “Significant positive correlations were observed in the major depressive disorder group between greater helplessness scores and greater activity in the right amygdala during the anticipation of pain,” the authors write.

The anticipatory brain response may indicate hypervigilance to impending threat, which may lead to increased helplessness and maladaptative modulation during the experience of heat pain,” the authors write. “This mechanism could in part explain the high comorbidity of pain and depression when these conditions become chronic.

Future studies that directly examine whether maladaptive response to pain in major depressive disorder is due to emotional allodynia [a pain response to a non-painful stimulus], maladaptive control responses, lack of resilience and/or ineffectual recruitment of positive energy resources will further our understanding of pain-depression comorbidity,” they conclude.

The study was supported by Barrow Neurological Foundation, grants from the National Institute of Mental Health, the National Association for Research in Schizophrenia and Depression and the University of California San Diego Center of Excellence for Stress and Mental Health.

Strigo IA, Simmons AN, Matthews SC, et al. Association of Major Depressive Disorder With Altered Functional Brain Response During Anticipation and Processing of Heat Pain. Arch Gen Psychiatry. 2008;65(11):1275-1284.   [Abstract]

Just Like A Pill
Ann Intern Med. 2008 Nov 18; 149 (10)734-750

Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians

Gartlehner G, Gaynes BN, Hansen RA, Thieda P, DeVeaugh-Geiss A, Krebs EE, Moore CG, Morgan L, Lohr KN.

Background: Second-generation antidepressants dominate the management of major depressive disorder, dysthymia, and subsyndromal depression. Evidence on the comparative benefits and harms is still accruing.

Purpose: To compare the benefits and harms of second-generation antidepressants (bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine) for the treatment of depressive disorders in adults.

Data Sources: MEDLINE, EMBASE, PsychLit, Cochrane Central Register of Controlled Trials, and International Pharmaceutical Abstracts from 1980 to April 2007, limited to English-language articles. Reference lists of pertinent review articles were manually searched and the Center for Drug Evaluation and Research database was explored to identify unpublished research.

Study Selection: Abstracts and full-text articles were independently reviewed by 2 persons. Six previous good- or fair-quality systematic reviews or meta-analyses were included, as were 155 good- or fair-quality double-blind, placebo-controlled, or head-to-head randomized, controlled trials of at least 6 weeks’ duration. For harms, 35 observational studies with at least 100 participants and follow-up of at least 12 weeks were also included.

Data Extraction: Using a standard protocol, investigators abstracted data on study design and quality-related details, funding, settings, patients, and outcomes.

Data Synthesis: If data were sufficient, meta-analyses of head-to-head trials were conducted to determine the relative benefit of response to treatment and the weighted mean differences on specific depression rating scales. If sufficient evidence was not available, adjusted indirect comparisons were conducted by using meta-regressions and network meta-analyses. Second-generation antidepressants did not substantially differ in efficacy or effectiveness for the treatment of major depressive disorder on the basis of 203 studies; however, the incidence of specific adverse events and the onset of action differed. The evidence is insufficient to draw conclusions about the comparative efficacy, effectiveness, or harms of these agents for the treatment of dysthymia and subsyndromal depression.

Limitation: Adjusted indirect comparisons have methodological limitations and cannot conclusively rule out differences in efficacy.

Conclusion: Current evidence does not warrant the choice of one second-generation antidepressant over another on the basis of differences in efficacy and effectiveness. Other differences with respect to onset of action and adverse events may be relevant for the choice of a medication.

Source + Full text… © 2008 American College of Physicians


No antidepressant is intrinsically more effective than another, however, one may be for an individual. The hard part is finding it. While we’ve covered a number of promising technologies that may make this easier in the future, at the moment ‘trial and error’ is the only option.
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