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January 2011



Recent Posts


Excessive Internet Use Is Linked to Depression

ScienceDaily (Feb. 2, 2010) — People who spend a lot of time browsing the Internet are more likely to show depressive symptoms, according to the first large-scale study of its kind in the West by University of Leeds psychologists.

Researchers found striking evidence that some users have developed a compulsive internet habit, whereby they replace real-life social interaction with online chat rooms and social networking sites. The results suggest that this type of addictive surfing can have a serious impact on mental health.

Lead author Dr Catriona Morrison, from the University of Leeds, said: “The internet now plays a huge part in modern life, but its benefits are accompanied by a darker side.

“While many of us use the internet to pay bills, shop and send emails, there is a small subset of the population who find it hard to control how much time they spend online, to the point where it interferes with their daily activities.”

These ‘internet addicts’ spent proportionately more time browsing sexually gratifying websites, online gaming sites and online communities. They also had a higher incidence of moderate to severe depression than non-addicted users.

“Our research indicates that excessive internet use is associated with depression, but what we don’t know is which comes first — are depressed people drawn to the internet or does the internet cause depression?

“What is clear, is that for a small subset of people, excessive use of the internet could be a warning signal for depressive tendencies.”

Incidents such as the spate of suicides among teenagers in the Welsh town of Bridgend in 2008 led many to question the extent to which social networking sites can contribute to depressive thoughts in vulnerable teenagers. In the Leeds study, young people were more likely to be internet addicted than middle-aged users, with the average age of the addicted group standing at 21 years.

“This study reinforces the public speculation that over-engaging in websites that serve to replace normal social function might be linked to psychological disorders like depression and addiction,” added Dr Morrison. “We now need to consider the wider societal implications of this relationship and establish clearly the effects of excessive internet use on mental health.”

This was the first large-scale study of Western young people to consider the relationship between internet addiction and depression. The internet use and depression levels of 1,319 people aged 16-51 were evaluated for the study, and of these, 1.2% were classed as being internet addicted. While small, this is larger than the incidence of gambling in the UK, which stands at 0.6%. The research will be published in the journal Psychopathology on 10th February.

Journal Reference:

  1. 1.  Morrison et al. The Relationship between Excessive Internet Use and Depression: A Questionnaire-Based Study of 1,319 Young People and Adults. Psychopathology, 2010; 43 (2): 121 DOI: 10.1159/000277001


Source: http://www.sciencedaily.com/releases/2010/02/100202193605.htm

Many Physicians Not Using Established Criteria When Diagnosing Major Depressive Disorder in Patients, Study Finds

ScienceDaily (Feb. 2, 2010) — A new study led by Mark Zimmerman, MD, of Rhode Island Hospital indicates that a majority of non-psychiatrist physicians and a substantial minority of psychiatrists reported that they often do not use the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) when diagnosing major depressive disorder (MDD) in patients.

The study appears online ahead of print in the Journal of Clinical Psychiatry.

The criteria for MDD in DSM-IV have remained relatively unchanged for nearly 30 years. In a previous study, Zimmerman and colleagues questioned the clinical utility of the criteria. This study looks at the habits of physicians in using the criteria. The researchers asked physicians attending a continuing medical education conference to complete a brief questionnaire. A total of 291 physicians responded to the six questions, with one question asking about the use of the diagnostic criteria for depression.

The question read: “When diagnosing depression, how often do you determine whether the patients meet the DSM-IV diagnostic criteria for major depressive disorder?” A multiple choice response offered the following answers: a) less than 25% of the time; b) 26-50% of the time; c) 51-75% of the time and d) more than 75% of the time.

Nearly 25 percent of the psychiatrists indicated that they used the DSM-IV MDD criteria to diagnose depression less than half of the time. In contrast, more than two-thirds of the non-psychiatrist physicians indicated that they used the DSM-IV MDD criteria less than half of the time when diagnosing MDD. The difference between the psychiatrists’ and the non-psychiatrists use of the criteria was significant.

Read More …  http://www.sciencedaily.com/releases/2010/02/100202111101.htm

Antidepressant Aids Mental Recovery after Stroke


By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on February 3, 2010


A new report indicates an antidepressant medication appears to help individuals recover cognitive skills following a stroke.

In the study, patients who received the antidepressant escitalopram (Lexapro) following a stroke appeared to recover more of their thinking, learning and memory skills than those taking placebo or participating in problem-solving therapy.

Antidepressants are believed to stimulate nerve cell growth.

The research is found in the February issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Stroke is a major health care problem and is the third leading cause of death in America behind heart disease and cancer. Strokes prevent blood flow to parts of the brain, damaging brain tissue. Since the brain controls all activity within the body, body functions are impaired, at times dramatically.

Significant recent advances in the treatment of stroke include the administration of clot-dissolving therapy, which needs to be administered within the first few hours after symptoms begin.

“Consequently, besides the efforts currently undertaken to increase the number of patients treated with thrombolytic agents, there is growing interest in restorative therapies that can be administered during the first few months after stroke, the period within which we observe the greatest degree of spontaneous recovery of initial motor and cognitive deficits,” the authors write.

One line of research has focused on antidepressants, which may be effective in part because of their ability to stimulate production of compounds essential for nerve cell growth.

Ricardo E. Jorge, M.D., and colleagues at the University of Iowa, Iowa City, studied the effects of one antidepressant—a selective serotonin reuptake inhibitor (SSRI), escitalopram—among 129 stroke patients.

Within three months of their stroke, 43 patients were randomly assigned to take 5 to 10 milligrams of escitalopram daily, 45 to take a placebo daily and 41 to participate in a problem-solving therapy program developed for treating patients with depression.

After 12 weeks of treatment, patients taking escitalopram had higher scores on neuropsychological tests assessing overall cognitive (thinking, learning and memory) function and on those measuring verbal and visual memory.

“Importantly, the reported changes in neuropsychological performance resulted in an improvement in related activities of daily living,” the authors write.

“The beneficial effect of escitalopram on cognitive recovery was independent of its effect on depressive symptoms and was not influenced by stroke type or mechanism of ischemic stroke,” they continue.

“In addition, escitalopram was well tolerated and the frequency of adverse effects related to its administration was not different than that observed among patients receiving placebo.”

Increasing evidence suggests that antidepressants cause changes in brain structure, including the visual cortex, hippocampus and cerebral cortex. These structural changes, although not yet proven to affect behavioral performance, may underlie the improvements in verbal and visual memory observed in this trial, the authors note.

“Overall, whatever may be the mechanism of improved cognitive recovery, this study has shown, for the first time, that escitalopram, an SSRI, is associated with improved cognitive recovery following stroke compared with placebo and Problem-Solving Therapy,” they conclude.

“The utility of antidepressants in the process of post-stroke recovery deserves to be further investigated.”

Source: JAMA and Archives Journals



Stimulate Brain Pleasure Centers for Depression


By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on February 1, 2010


Currently, over a third of patients do not respond to conventional depression treatments. For these individuals, a new form of therapy involves deep brain stimulation (DBS).

The technique, a form of targeted electrical stimulation in the brain via implanted electrodes, is now undergoing careful testing to determine whether it could play a role in the treatment of patients who have not sufficiently improved during more traditional forms of treatment.

A major challenge of this work is determining the best region of the brain to stimulate.

Some researchers stimulate the subgenual prefrontal cortex, a brain region implicated in depressed mood states, while others stimulate a region called the “anterior limb of the internal capsule,” a nerve pathway that passes through the basal ganglia, a lower brain region.

Physicians publishing a new report in Biological Psychiatry now describe findings related to the stimulation of the nucleus accumbens, a brain region the size of a hazelnut associated with reward and motivation that is implicated in processing pleasurable stimuli, sometimes referred to as the “pleasure center” of the brain.

The inability to experience pleasure is a key symptom of depression and previous studies have shown that functioning of the nucleus accumbens is impaired in depressed individuals.

Bewernick and colleagues administered DBS treatment in 10 patients with severe long-term depression who had not responded to multiple other antidepressant treatments, including psychotherapy, drug treatments and electroconvulsive treatment.

After one year of DBS, all patients showed some improvement, and half of them experienced significant improvement in their symptoms of depression, astonishing considering they had not responded to any prior antidepressant treatment.

In addition, the patients showed reduced ratings of anxiety and had only minor side effects. Importantly, none of their overall brain functioning was impaired by the DBS treatment.

“The nucleus accumbens is a brain region that animals will seek to stimulate even if they do not appear depressed and this is one reason that it is sometimes referred to as a reward center.

“It is interesting to note that the patients in this study did not simply feel stimulated or euphoric; instead, there appeared to be reductions in depressed mood that paralleled an increase in the capacity for pleasure,” commented Dr. John Krystal, editor of Biological Psychiatry.

“This finding will stimulate further study on the role of the nucleus accumbens in depression and its treatment.”

The authors caution that because they studied only a small number of people, further research is necessary before DBS could be considered a clinically useful treatment for treatment-resistant depression.

There are also important ethical considerations, since DBS treatment first requires potentially risky brain surgery. However, these preliminary findings are promising that DBS may provide relief to individuals with severe treatment-resistant depression.

Source: Elsevier


Are Antidepressants Really That Ineffective?


By John M Grohol PsyD

The more researchers delve into the research behind antidepressants — the class of drugs commonly prescribed to treat depression — the more they find that perhaps the majority of antidepressants’ treatment effect is based upon the simple belief that the drug will help.

Newsweek’s Sharon Begley has a lengthy article discussing the growing body of evidence that calls into question decades’ worth of prescriptions. It’s a story that we’ve covered previously, that TIME covered nearly a year ago, and that Therese Borchard had a response to. It seems to be journalists’ favorite “go to” story now in mental health, because there’s a black-and-white controversy — do antidepressants work or don’t they?

People mistakenly believe that one type of research is somehow superior to another form of research. However, data is data and research is research. All things being equal, if it’s done in as objective a manner a human being can do it, then it’s all good and informative. A study conducted 20 years ago is just as valid today, as long as the design of the study was solid and unbiased. And a single-case experimental design, while not very generalizable, can still lead — and has led — to valuable insights into human behavior.

So I get a little concerned when we do give more weight to the most recent study, or the most recent meta-analysis. They have their place, but their place is in context — understanding the body of research as a whole. (Because meta-analyses never take into account the entire body of research on a drug or topic — they always have inclusion and exclusion criteria, criteria that can directly impact the results they find.)

To see another article about this issue go ’round and ’round the bend with both sides, but not really bringing anything new to the discussion, is a little frustrating. I think it’s pretty obvious that if a drug was supposed to help people, but didn’t, people would stop taking it and doctors would eventually stop prescribing it. Since it’s unethical to prescribe placebos to patients outside of a research study, what choice do doctors and patients have — the drug works. (Well, not always, of course, but in many people who take it, and who keep trying a different antidepressant if the first one doesn’t work, according to the results of the STAR*D study.)

Why antidepressants work is an important academic question. If it’s mostly the “placebo effect,” then that’s a sign that a lot of research is wrong. A lot. Drug studies that found significant clinical differences (not just statistical differences) have to be better explained. And those that found virtually no clinical differences need to better see the light of day. We certainly need to understand why we’ve been prescribing an entire class of medications for decades if we honestly believe they are no better than a sugar pill.

But back to the article… As I said, it’s basically a rehash of this question — Are antidepressants effective or not? — which I suspect we’ll see appear in a mainstream media outlet from now on at least once or twice a year. The answer is simple — yes, they can be effective. But perhaps not always for the reasons we thought.

Begley also seems a little confused, telling readers that only psychiatrists conduct psychotherapy (when, of course, there are psychologists, clinical social workers, marriage and family therapists, and a host of other professions that provide psychotherapy):

It’s all well and good to point out that psychotherapy is more effective than either pills or placebos, with dramatically lower relapse rates. But there’s the little matter of reality. In the U.S., most patients with depression are treated by primary-care doctors, not psychiatrists. The latter are in short supply, especially outside cities and especially for children and adolescents. Some insurance plans discourage such care, and some psychiatrists do not accept insurance. Maybe keeping patients in the dark about the ineffectiveness of antidepressants, which for many are their only hope, is a kindness.

This would have also been a great time to mention the mental health parity act that just went into effect, guaranteeing that most insurance plans can no longer “discourage” psychotherapy treatment. But this wouldn’t be the first time Begley doesn’t quite understand what she’s talking about when it comes to mental health. She’s the journalist who took the Association for Psychological Science’s press release about a new training model they were advancing (in the form of a journal article in one of their own journals) and turned it into an uncritical look at Why do psychologists reject science?. We had a far more critical take on this pseudo-science.

But it’s that last line of that paragraph that is especially troubling and paternalistic. People should know whether the treatment they are receiving has research data to back up its effectiveness. But then they should also know and be able to put that into some kind of context. Like the fact that a lot of common medical procedures are only now starting to gain an evidence base, yet they continue to be done (and have been done for decades) with little scientific evidence that they work. Why hold mental health to the fire, when health care in general has been lacking a scientific evidence base for nearly all of the last century?

As for Kirsch, he insists that it is important to know that much of the benefit of antidepressants is a placebo effect. If placebos can make people better, then depression can be treated without drugs that come with serious side effects, not to mention costs. Wider recognition that antidepressants are a pharmaceutical version of the emperor’s new clothes, he says, might spur patients to try other treatments. “Isn’t it more important to know the truth?” he asks. Based on the impact of his work so far, it’s hard to avoid answering, “Not to many people.”

Let’s get real. People choose antidepressants over psychotherapy because antidepressants — placebo or not — take 2 seconds to take and require virtually no thought as a treatment. Psychotherapy, on the other hand, takes an hour every week out of your schedule, and requires not only thought, but active, often difficult changes to be made in the way you think and feel. It’s hard work. That’s why most people will continue to opt for the pill, no matter it’s effectiveness — it’s easier and for those who benefit from its effects, it works.

I am, of course, all in favor of more people giving psychotherapy a try. But I’m also a pragmatist and know that many people have already given psychotherapy a try, and unfortunately it didn’t work out for them. Whether it was due to a bad therapist, a misunderstanding of the expectations of therapy, or whatever. People don’t only want options — they need them.

So yes, let’s figure out the important question of why antidepressants work. But let’s also continue to give people the treatment options they need, and not pretend there’s a single answer to someone overcoming depression. There isn’t.

Read the full article: The Depressing News About Antidepressants


The Lawyer

Lawyers and Depression: An Interview with Daniel Lukasik


By Therese J. Borchard

Today I have the honor of interviewing Daniel Lukasik, a distinguished attorney and the creator of the very cool website LawyersWithDepression.com. Daniel also writes the Lawyers With Depression blog, which covers a range of different topics, from spirituality to how to make smart decisions as professionals.

Question: Why are so many lawyers depressed?


1. Lawyers are Pessimistic Thinkers.

According to Professor Martin Seligman, lawyers have a “pessimistic explanatory style.” This is not the same thing as seeing the glass as “half empty.” Rather, pessimistic lawyers tend to attribute the causes of negative events as stable and global factors (It’s going to last forever, and it’s going to undermine everything.) The pessimist views bad events as pervasive, permanent, and uncontrollable while the optimist sees them as local, temporary and changeable (”Oh well, I didn’t win this one, but tomorrow’s a new day and I will get a fresh start.”). Pessimism is seen as a plus among lawyers, because seeing troubles as pervasive and permanent is a component of what the law profession deems prudence. They have to foresee every possible snare and catastrophe. While this might help them be better lawyers, this trait does not always make them happy human beings. In fact, pessimistic thinking is seen by cognitive behavioraltherapy as a hallmark of depression.

2. Negative Behavior Patterns.

According to Professor Andrew Benjamin, lawyers take on too much work and have trouble maintaining healthy relationships. This, in turn, precipitates career dissatisfaction, loss of intrinsic motivation, and abandonment of personal values. These behavior patterns leave many lawyers suffering from high levels of depression and from chronically elevated levels of hostility, cynicism, and aggression.

3. High Levels of Stress.

The adversarial nature of the profession repeatedly triggers the physiological
fight-or-flight response in our bodies. When confronted with a threat -whether real or perceived – this response kicks in and floods our bodies with the powerful hormones cortisol and adrenaline, which propel us into action. Over time, this chronic anxiety causes the release of too many fight-or-flight hormones. Research has shown that prolonged release of cortisol damages areas of the brain that have been implicated in depression: the hippocampus (involved in learning and memory) and the amygdale (involved in how we perceive fear). Indeed, Richard O’Connor – an expert on depression – has concluded that depression “is stress that has gone on too long.”

Question: what can lawyers do on a daily basis to help their depression?


1. You will need to learn to confront your negative thinking.

I carry a 3 x 5 inch index card in my pocket every day. On it, I list 3 problems that I think I’ll confront that day which are factually based (e.g. I have a legal brief due at 5 pm). Then, I jot next to it a typical depressive reaction of mine (e.g. “I’ll never get this done”). Finally, I write down a healthier, more constructive response that I can choose (e.g. “I have the whole day, take it in parts and it will get done.”). This is not easy because our depressive thinking comes so naturally and is so entrenched, that we think that our depressive approach to problems is “normal.” However, it’s a destructive habit and it only reinforces depression.

2. Practice gratitude on a daily basis.

On the back of the same 3 x 5 index card, I practice gratitude. During the day, as good things happen, I jot them down. I think it’s important for someone dealing with depression to write down concrete things rather than conceptual ones. For example, a concrete thing may be, “A child gave me a beautiful smile today” (i.e. this actually happened) rather than, “My life isn’t so bad.”(i.e. too broad and ambiguous). People with depression spend a lot of time in their heads; lawyers even more so. As such, we need to anchor ourselves in short, concrete examples that reflect daily events that we can be grateful for.

3. If you have a spiritual practice, do it. If you don’t, think about starting one.

This could include anything from a formal meditation practice, going to Mass or walking in the woods. Research suggests that people who have a spiritual practice do better with depression. If you believe in God or a higher power (I’m Catholic), you can avail yourself of help and support from Someone who is bigger than your depression. If you do not believe in God, maybe you embrace some other form of spirituality you can tap into. Spiritual growth and development, in my opinion, is an important pillar of recovery.

4. Joining a support group.

Joining a support group is – in my experience – an invaluable way to see that you are not alone in your depression. Depression is a very isolating condition. When we feel bad, we just don’t feel like dealing with people and ruminate, “No one will understand anyway.” So we close the door and feel immobilized by our depression. We need to get out with people. It’s helpful if it’s structured, regular and something you can commit to. There are support groups around the country for lawyers who are suffering from depression. I think it’s helpful to join a lawyer group because you don’t have to explain to others what it’s like to deal with depression AND practice law. Such groups are usually run by local Bar Associations or Lawyers Assistance Programs. Go to the web or call to check out what is available. If there is no such support group for lawyers, tell your Bar Association or Lawyers Assistance Program them that you want to participate in one Ask them if they could work to start one.

If you feel uncomfortable about disclosing your depression in front of other lawyers, there are other depression support groups around the country. The list of such groups near you can be found by accessing The Depression and Bipolar Support Alliance website.

5. Practice mindfulness.

A lot of attention has been focused recently on the use of mindfulness meditation to help depression. In such meditation, we sit quietly, pay attention to our breath and watch our thoughts float by our stream of consciousness. Usually, we habitually react to all our thoughts and feelings (”I will never get this brief done”). In mindfulness meditation, we learn – slowly – to let the thoughts and feelings float by without reacting to them. What we are really doing is creating a space for ourselves where we don’t have in our doing mode; where our chief objective is to get things done and succeed. Think of it as a restful timeout during your day. I highly recommend reading the best-selling book, “The Mindful Way through Depression” for more guidance and exercises.

If we feel that we don’t have time for meditation, or have a difficult time sitting still, we can anchor ourselves in our bodies. When I am feeling stressed and need to take myself out of my depressive mind, I focus on some simple physical sensations. For example, I will try to pay attention to my walking for a period of time – say 20 minutes. I feel my feet touching the carpet or concrete as a walk. It’s incredibly simple, grounding and calming to our anxious and depressed mind.


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