Because we were not on the American Psychiatric Association’s media list, we didn’t receive a copy of the news releases that the mainstream media will be basing a lot of their stories around that will be published tomorrow. We also weren’t invited to the conference call today, despite our repeated attempts to contact the APA’s media office.

This turns out to be good news for our readers. I’m free to talk about what I suspect will be in the draft that appears on the dsmv.org website tomorrow. I gathered this information from numerous anonymous sources, both online and off. Here’s what you’re likely to find in tomorrow’s draft release of the DSM V:

Autism Spectrum Disorders

As we first noted back in November, Asperger’s Syndrome is slated for the chopping block in the DSM-V. Instead, all the autism-related disorders — including Asperger’s — will be placed into a general category known as Autism Spectrum Disorders. Asperger’s will probably be known as something similar to “mild autism” in this new category in the DSM-V.

Behavioral Addictions

Yes, you heard me right — behavioral addictions as a category has made it into the draft revision (according to our sources). The only behavioral addiction that will be recognized, however, will be pathological gambling. Sex addiction and Internet addiction (which, remember, started off as a joke in 1995) will instead appear in the Appendix under the Criteria Sets and Axes Provided for Further Study. In other words, the concept of a “behavioral addiction” will be recognized, but most specific behavioral addictions simply do not have the robust research base to be included at this time. So while technically in the DSM V, Internet addiction and sex addiction are not disorders that can be diagnosed at this time (by providing an agreed-upon set of criteria, the DSM V publishers hope researchers can use the criteria to further research in those areas).

Substance & Alcohol Dependence Gone

For a long time now, the DSM-IV has made the distinction between someone who was “abusing” alcohol or illegal substances like cocaine, and those who were “dependent” upon them. It was a difference with very little distinction or use amongst clinicians, since substance abuse and alcohol abuse treatment were largely the same no matter which of the two diagnoses you received. DSM-V will rectify this confusing two sets of diagnoses and combine them into one that will have a set of specifiers to note severity and length.

Binge Eating Disorder

Languishing in the categories needing further research for 16 years, binge eating disorder will now be a recognized eating disorder in the regular section of the DSM V. This will come as a relief to tens of thousands of people every year who have this concern, but have not had it officially recognized by the American Psychiatric Association until now.

Dimensional Assessments

As we noted way back in May of last year, one of the most significant changes in the DSM-V draft will be the inclusion of dimensional assessments for depression, anxiety, cognitive impairment and reality distortion that span across most mental disorders. So a clinician might diagnose schizophrenia, but then also rate these four dimensions for the patient to characterize the schizophrenia in a more detailed and descriptive manner. We’re not certain how well these catch on with clinicians unless they become required by insurance companies, as past efforts to supplement diagnoses with additional patient functional information have been failures.

Assessing Risk

Prodromal signs is a fancy psychobabble term for assessing risk and looking for the signs of a disorder before it turns into a full-blown disorder. Imagine if we could more reliably and consistently assess risk for depression, actually preventing some people from becoming full-blown depressed? I’m not certain exactly how this is showing up in the draft, but there will be more of an emphasis in the DSM V draft in assessing risk.

Temper Dysregulation

High emotional reactivity, high temper, emotional over-reactivity and affective lability. Now there’s a mouthful! What did I just say? The interpretation of this new proposed disorder for the DSM-V is basically someone who can’t control their temper (you probably know someone like this in your life), and because of the way their anger spills out into their lives, they suffer from depression. So this new disorder will be known as “Temper Dysregulation with dysphoria” or something like that in the DSM V.

So there you have it — a quick rundown of the highlights that you’ll see in the draft public release of the DSM-V tomorrow. Look for it at www.dsmv.org. We’ll have a more in-depth run-down tomorrow about the biggest changes.

In his classic, “The Prophet,” Kahlil Gibran writes:

Always you have been told that work is a curse … But I say to you that when you work you fulfill a part of earth’s furthest dream, assigned to you when that dream was born.

Unfortunately Kahlil’s words don’t jibe with a new Australian study that found almost one in six cases of depression among working people caused by job stress, that nearly one in five (17 percent) working women suffering depression attribute their condition to job stress and more than one in eight (13 percent) working men. In the last decade, the number of American workers that say job stress is a major problem in their lives has doubled. In fact, the US Department of Health reported that 70 percent of physical and mental complaints at work are related to stress.

What do we do? Bring our Kleenex to work and hope we don’t get caught crying, or give our notice with no other job in reach? Thankfully, we have a few steps between these two extremes. Here are 12 techniques that have helped me manage the work blues.

1. Don’t quit yet.

Let me just say this first. Chances are higher that you will feel worse if you quit than if you keep on showing up to a job that you hate. Why? If you’re not working, you will have even more time to think about how much you hated your job. On top of the acute anxiety you feel when you think about how you are going to pay off your next phone, electric, and mortgage bill without the regular paycheck being deposited automatically into your bank account. And then there’s the isolation of having no one to talk to during the day, because … one small detail … everyone else is working. So just sit tight until you read through like ten of these before you gladly give your notice, okay?

2. Learn some calming techniques.

You know what’s cool about most relaxation techniques? You can do them AS you are listening to your boss give you your next assignment. Let’s say, as he is telling you that he hired a nice woman half your age that you now report to, that you suddenly feel lots of tight pressure in your shoulders–naturally, because you have the desire to slug him. You relax your shoulders in a way that relieves some of that tension and tells your body that slugging him isn’t an option (right now, anyway).

Then, as you walk back to your desk, where the kid right out of college hands you five assignments due by the end of the day, you can take ten deep breaths: counting to four as you inhale and to four million as you exhale. If you are allowed to listen to music or noise at work (or if you work from your home as I do), you might want to invest in a CD of ocean waves. Whenever I listen to mine, I take a few seconds to visualize myself on the sandy beach of Siesta Key, Florida, hunting for sea shells, a short moment to catch my sanity.

3. Turn the thing off.

I’m not talking about your sex drive, although if you’re depressed, chances are that that’s off, too. I mean your BlackBerry or iPhone, or at least the “ding” noise alerting you to every new (URGENT) e-mail that you don’t think drives you crazy but does. Trust me. When you turn it off for a day–even commit to a weekend without it!–you will see that it is responsible for a sizable chunk of your madness.

It’s ironic that very technological advances that were supposed to free us end up imprisoning us to our work, argues integrative doctor Roberta Lee in her astute book “The Superstress Solution.” In her introduction, she cites a recent survey commissioned by Support.com: 40 percent of 18- to 25-year-olds said they couldn’t cope without their cell phone, yet the same students reported less stress and had lower heart rates and blood pressure when they stopped using them for three days.

You need not join the monastery. Just try turning the thing off for a few evenings and see how you feel.

4. Make a schedule, and stick to it.

Yes, I’m a tad obsessive-compulsive, but I can feel the stress in me rise and want to explode if I don’t have a handy dandy schedule in front of me that I can follow. No one gives it to me. I make it up, and therein lies its power–I am taking control back in to my own anxious hands! So, upon getting five assignments due the same week from a supervisor, I do the panic dance for 15 or 20 minutes. Then I take out my work calendar and start nailing down my deadlines. Assignment One needs to be done by lunchtime on Tuesday. Assignment Two needs to be done by Thursday morning, so that I have two full days to complete Assignment Three before the week is over. Get it? Things don’t run that smoothly, of course, but by breaking down the goals or tasks into manageable bites, I stress less and produce more.

5. Improve your working conditions.

As a highly sensitive person, I can’t work in certain atmospheres. I need a window … and proper lighting … and an assistant who will fetch me ice-tea whenever I want, with lemon and not too much ice (kidding on that). But there are simple ways you can improve even the most sterile and miserable working conditions: putting a nice plant in your cubicle, hanging or framing personal photos (a recent study say that looking at pictures of loved ones reduces pain), using a 10,000 lux daylight balanced light (a lamp used for seasonal affective disorder, but doesn’t look any differently than an average desk light). Keeping a clean desk will also help you feel less overwhelmed. I’m not going to say anything further on that. If you’ve ever seen my desk you know why.

6. Get a life. Outside of work.

If I were to name the single most important lesson I learned inside the psych ward, it would be this: to get a life outside of work. You see, pre-psych ward, I invested all of my self-esteem into my profession. Thus, each career flop set me back a considerable chunk. If a book bombed, so too did my self-confidence. My goal leaving the inpatient psych program in 2006 was to get a life and to sustain that life.

I’m doing better today. I swim in a masters program. I joined a book group. I’m involved with a moms’ group at the kids’ school. None of these things are related to my job. I have met a whole other set of friends aside from my fellow bloggers, editors, and writers. This gives me some cushion and insurance for the days I get crappy traffic numbers and red royalty statements, as well as inviting me to join the human race on the days I can’t produce a single thing.

7. Get into the (right) zone.

No doubt you’re behind at work and feel like no matter how much you get done the day before, you always begin the next day at the foot of a mountain. You may very well have more work than is humanly possible for one person to accomplish. However, according to Elisha Goldstein, psychologist and author of the meditative CD “Mindful Solutions for Success and Stress Reduction at Work,” identifying the four zones of your work day can help you do your job in less time, which will lower your stress.

This “Attention Zones Model” was developed by Rand Stagen of the Stagen’s Leadership Academy, who maintains that during our day, we are in one of four zones: a reactive zone, a proactive zone, a distracted zone, or a waste zone. The goal is to stay out of the distracted and waste zones: responding to unimportant calls and emails or killing time by surfing the web, etc. Explains Goldstein: “The cultivation of mindful awareness allows you to nonjudgmentally name what is happening right now, and turn your attention to your top priorities in the moment.”

Click here for five more office depression busters!

Johannah Cousins is a senior English major at Yale University with a focus on gender studies and contemporary popular culture. She recently completed her senior thesis, an analysis of the cultural and feminist context of the Twilight series. She is a film and music critic and staff writer for the Yale Herald Arts & Entertainment Section.

Please head on over to Pop Psychology and check it out today!

In two experiments, researchers (Schnall et al., 2010) tested the level of altruistic behaviors amongst female students by asking them to view TV clips of three kinds — a neutral clip showing scenes from a nature documentary, an uplifting segment from “The Oprah Winfrey Show” showing musicians thanking their mentors, or a clip from a British comedy, intended to induce mirth.

When asked if they wanted to participate in another study (in the first experiment), or if they would be willing to complete a boring questionnaire (in the second study), the subjects who watched the uplifting clip from the Oprah Winfrey Show were nearly twice as likely to agree than people who watched the neutral or funny clip.

Simply watching others do something good and uplifting encouraged more altruistic behavior.

Another study (Liljenquist et al., 2010) looked at the impact of scent on our altruistic behavior. Ninety-nine undergraduate students were individually assigned to either a clean-scented room (sprayed with Windex) or a baseline, no-scent room and were asked to work on a packet of unrelated tasks.

“Included in the packet was a flyer requesting volunteers for Habitat for Humanity, a charitable nonprofit organization. Participants reported their interest in volunteering for future Habitat efforts, specified the activities they would like to assist with, and indicated whether they wanted to donate funds to the cause,” noted the researchers. The researchers also controlled for subjects’ current mood, to rule that out as a possible explanation for their findings.

Participants in the clean-scented rooms expressed greater interest in volunteering and donating money to the charity than control participants did. Room scent had no impact on either positive or negative affect, and in analyses controlling for the participants’ current mood, room scent continued to have a significant effect on volunteerism and donation rate.

Isn’t human behavior amazing?

Limitations of the studies were that subjects were all college students, who may be different than older adults who may view the world differently (or more cynically). And since all of the subjects of the first study were female, we also can’t be sure if the first study’s findings would hold true for men.

Motivating individuals to “do good” imay be surprisingly simple and uncomplicated. Show them an uplifting TV clip in a clean-scented room, and you’ll have a group of individuals primed and ready to be altruistic.

Read the full story: Observe a Good Deed, Perform a Good Deed

References:

Liljenquist, K., Zhong, C-B., & Galinsky, A.D. (2010). The Smell of Virtue: Clean Scents Promote Reciprocity and Charity. Psychological Science. doi:10.1177/0956797610361426

Schnall, S., Roper, J., & Fessler, D. (2010). Elevation Leads to Altruistic Behavior Psychological Science DOI: 10.1177/0956797609359882

Oh, sorry, I meant to say that while 7 out of 10 (73% to be exact) teens use social networking websites like Facebook, only 1 in 12 teens use Twitter. Clearly, the still-in-place-to-be is on Facebook and other social networking websites like it.

The new data comes from our friends over at the Pew Internet and American Life Project, who conducted a phone survey in the middle of last year of 800 adolescents between the ages of 12 and 17.

And while teens continue to embrace social networking, they seem to be abandoning their use of blogs. Blogging amongst teens has been slashed in half in just 3 years, according to the Pew data (from a high of 28% in 2006 to a current 14% of teens surveyed).

Why the decline in blogging? As most first-time bloggers learn, blogging is hard work. It seems easy enough at first — write an entry a few times a week about something you find interesting (or a specific topical theme, like psychology and mental health here on this blog). But 4 weeks or 4 months into it, and you find that it takes some time to compose literate, interesting entries. Regularly and constantly. Most bloggers simply burn out (usually pretty early on), or wind up forgetting about their blog and leaving it to languish.

Social networking sites like Facebook are much easier, and you can take or leave them on your own terms. If you update regularly, great! Your friends and such appreciate it. But if you don’t bother with it for a few days or whatever, it’s not the end of the world. You don’t lose readers by not updating, because the paradigm is different — you have “friends,” not readers. Your Facebook “friends” will still be there, no matter how often or little you update. And while it may be nice to grow your friends list, it’s not the end of the world if you keep it small.

On Facebook, there’s so much more you can do that just update your status. You can check out what your other friends are doing, review new photos they’ve posted, enjoy one of the countless apps, or play one of the countless games. You can join a cause or a support group. And you never leave Facebook. It’s all there.

Twitter combines Facebook’s “friends” (called “followers”) with blogging’s reinforcement of writing something interesting regularly. So while it’s like Facebook in that you won’t lose your followers by not updating, it is only about the updating. You can’t really play a lot of interesting games on Twitter, or join in a very coherent group conversation (it’s all very much dependent upon what kind of software, if any, you use to access Twitter). Twitter is simply not as rich a universe or platform for sharing as Facebook is.

I suspect that we’ll continue to see trends like this, where Twitter will always be relegated to a niche status in the world of networking.

Read the full article: The young prefer Facebook to blogging, Twitter

Then I may as well kill myself.

That’s how I would have read the article four years ago, before I started questioning all the information available today on mood disorders and drug treatment, before I started working with a physician from Johns Hopkins who could help me tease out the hope from articles like this, so I wasn’t tempted to take my life upon reading there was no way out of the darkness.

In fact, on the way to my consultation at the Johns Hopkins Mood Disorders Clinic, I read a similar article in O magazine: a compilation of interviews with folks about how antidepressants zap creativity, dull emotions, destroy creativity, flatten libidos, and a list of other things. Shaking with anxiety and tears coming down my face, I almost told Eric to turn around, that I was foolish to think that there was hope for me, that I was a lost case, and that, if the article was right, I would only be making matters worse.

Thank God I threw the article into the backseat and went on with my consultation.

I don’t know why the main body of research behind the article is so surprising: antidepressants work better for those with severe depression than for those who suffer from mild to moderate depression. Can’t we say that as part of the subtitle, to help out the folks who are banking on medical intervention to lighten their crushing and burdensome load?

I’ve always maintained that if a person has mild to moderate depression, then he should start with his diet, sleep, exercise. Try yoga or some acupuncture sessions. In many cases, that’s enough!

For folks like me, though, who are/were hanging on to life by a very thin and fraying thread, antidepressants can save lives. They have certainly given me back my life. I know that. Because I tried absolutely everything else I could to make the death thoughts go away, and they continued to stalk me until I found the right medication combination. Now, instead of putting 95 percent of my energy into NOT taking my life, I can invest it into helping others not take their own lives and to giving back. Which is why I think magazines like Newsweek, with so much power over the information we process, should be more careful than to say: Sorry folks, for those of you so desperate, well, you may as well give up and take a gun to your head.
John Grohol always provides a number of insights to media stories with unfortunate sticking power. In a recent post, “Are Antidepressants Really That Ineffective?” he writes:

Newsweek’s Sharon Begley has a lengthy article discussing the growing body of evidence that calls into question decades’ worth of prescriptions. 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.)

In other words, can we please get back to a forest view of mood disorders so that, while we’re busy analyzing the lady bug on the bark of a tree, we don’t miss the guy with one leg off the bridge? Antidepressants aren’t fool proof. Unfortunately. Sometimes you have to try a few before you feel relief, and for some people (especially those who suffer from mild to moderate depression, that can benefit more from other kinds of therapies), SSRIs might not work at all.

But let me say this loud and clear: There is hope. Depression is treatable. It is, as William Sytron wrote in his classic, “Darkness Visible,” “conquerable.” And much of that has to do with the drugs that are available today.

It’s that time again… When Super Bowl Sunday dominates the U.S. headlines, and people plan their Sunday evenings around a get-together, party, or the game. It’s also a good time to look at two stories related to Super Bowl Sunday.

The first is the largely debunked myth that domestic violence calls spike around Super Bowl Sunday and other drinking holidays of the year (like New Year’s). Snopes originally tracked down the myth and showed it to be nothing more than another urban legend. Since their last update on the myth in 2005, however (and our article 4 years ago), there’s been further research examining the myth.

A 2007 study by Oths & Robertson examined 2,387 crisis call records covering a previous 3-year period. They supplemented the call records with both formal and informal interviews with abused women and staff. What did they find?

The widely held belief that more women seek shelter during “drinking holidays” such as New Year’s and the Super Bowl was unsubstantiated, while the contention that women with school-aged children time their leaving to coincide with breaks in the academic schedule was supported.

What about other mental health issues, like suicide? Do they spike on Super Bowl Sundays? Psychologist Thomas Joiner had a hypothesis about serious suicidal behavior — that the need to belong is so powerful that, when satisfied, it can prevent suicide. Joiner and fellow researchers (2006) investigated whether perceived membership in a valued group — like a sports team — meets that “need to belong” and can negate suicidal tendencies. They found that, indeed, fewer suicides occurred on Super Bowl Sundays than during non-Super Bowl Sundays. So no spike there either.

What about other behaviors surrounding Super Bowl Sunday, like driving fatalities? On Super Bowl Sundays, compared to non-Super Bowl Sundays, Redelmeier & Stewart (2003) found a 41% relative increase in the average number of fatalities after the telecast on Super Bowl Sunday. So if there’s one piece of actionable advice you can take from the research, it’s to be very careful driving home after a Super Bowl Sunday get-together or party.

But in my opening, I said “largely debunked” myth. That’s because there is one set of data that has found a connection between football and domestic violence, and in turn, Super Bowl Sunday. However, that data was not published in a peer-reviewed journal — the usual standard for research — so it should be taken with a grain of salt. The study appeared in the Handbook of Sports and Media (Gantz et al., 2006) and examined domestic violence police dispatches by day in 15 NFL cities, which resulted in 26,192 days worth of data (and 1,366,518 domestic violence calls). The researchers found a tiny positive effect for a rise in domestic violence dispatches on or after Super Bowl Sunday. By comparison, they found a much bigger effect for a rise in domestic violence calls around major holidays like Christmas though — nearly fives times as many. So while they did find a small but significant relationship there, it must be tempered by the fact that this was never peer-reviewed research and that most major holidays throughout the year have a much bigger domestic violence impact.

Last, two years ago we reported that watching the Super Bowl may be hazardous to your health. In that article, we noted research published in the New England Journal of Medicine that examined 4,279 heart cases that occurred during the World Cup games. The researchers found that men’s risk of having a heart attack was 3x higher while watching their team play, while women’s risk was 2x higher. Something to keep in mind while watching the game this year — be aware of heart attack symptoms and take them seriously if your heart suddenly doesn’t feel right.

Enjoy the game! We will.

References:

Gantz, W., Bradley, S.D. & Wang, Z. (2006). Televised NFL Games, the Family, and Domestic Violence. In: Handbook of sports and media. Raney, Arthur A. (Ed.); Bryant, Jennings (Ed.); Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers, pp. 365-381.

Joiner, T.E., Jr., Hollar, D. & Van Orden, K. (2006). On Buckeyes, Gators, Super Bowl Sunday, and the Miracle on Ice: ‘Pulling together’ is associated with lower suicide rates. Journal of Social & Clinical Psychology, 25(2), 179-195.

Oths, K.S. & Robertson, T. (2007). Give me shelter: Temporal patterns of women fleeing domestic abuse. Human Organization, 66(3), 249-260.

Redelmeier, DA & Stewart, CL. (2003). Driving fatalities on Super Bowl Sunday. The New England Journal of Medicine, 348(4), 368-369.

Psychologists from Leeds University found what they said was “striking” evidence that some avid net users develop compulsive internet habits in which they replace real-life social interaction with online chat rooms and social networking sites.

“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,” the study’s lead author, Catriona Morrison, wrote in the journal Psychopathology.

“This type of addictive surfing can have a serious impact on mental health.”

Indeed. When a depressed person turns to the Internet to socialize, I’m not at all surprised that they use it for social interaction in chat rooms and on social networking websites. What else would you expect? People who are depressed don’t want to socialize, but the Internet makes it so much easier to do it. It may make a depressed individual feel more “connected” and help them make it through every day with their depression.

But what the researchers found and didn’t really comment on is just as interesting. If we know that approximately 5% of the population suffers from depression at any given time, most people who are depressed are not mis-using or over-using the Internet. Far less sexier headline, but information one can just as readily conclude from the researchers’ findings.

Limitations of the current study include the usual problems we see in studies like this. First, it was not a randomized, controlled sample — a significant problem with so many “Internet addiction” studies. Instead the researchers posted a questionnaire online and received responses from 1,319 Britons aged between 16 and 51. (It’s not clear how many people saw an announcement for the study and decided not to participate — another sampling problem.) Of those 1,319 people, 18 — yes, that’s eighteen — met the criteria for “Internet addiction” using the Internet Addiction Test. The test itself has only had a single validation study, despite calls for more research to be conducted to verify its validity (“The IAT’s reliability and validity need to be further tested using a larger sample. Once a valid and reliable measure has been devised, more can then be researched about the nature of Internet addiction.”). Despite the fact that this test is still not very robust, researchers continue to use it as though it were a valid and robust psychological measure.

Is this a “darker side” of the Internet, as the news release claims? Well, gee, I guess. But that’s making an assumption about which way the relationship goes — one that data can’t tell us anything about. So when researchers start making subjective comments like that, it raises the suspicion that the scientist isn’t exactly being objective.

It may be that the Internet has an empowering side — one that allows people suffering from clinical depression to reach out and find human social contact. That’s just as valid interpretation of data, but not one the researchers suggested, nor emphasized in their comments about the study. Is the glass half empty, or half full?

So given the study was a correlation survey and could not show any type of causal relationship, how did the mainstream media do with getting the story right? Surprisingly well.

Ones who got it right:
• Internet Addicts More Prone to Depression (HealthDay)
• Excessive internet use linked to depression, research shows (The Guardian)
• ‘Internet addiction’ linked to depression, says study (BBC)
• Study links excessive Internet use to depression (Reuters)

Ones who got it wrong:
• Heavy Internet use may cause depression: Study (TheMedGuru)
• Too much net surfing can depress you (The Times of India)
• Additional foreign (mostly India-based) “news” sites

The study appears in the Feb. 2010 issue of the journal, Psychopathology.

Read the full news article: Study links excessive internet use to depression

How To Monitor and Stabilize Depression in Teens and Children

Each time I write a prescription, I have a certain amount of trepidation. Although I know that medications can help, I am also aware of their limitations. It is also important to be vigilant as to whether there are other key factors that are causing a teenager to be overwhelmed (i.e., trauma, substance abuse). However, when children and adolescents are having difficulty functioning because of how impaired they are, medication can be critical. If a teenager is so depressed that she is thinking of tying a phone cord around her neck or jumping out a window, or if she finds it impossible to find the energy to get out of bed, or can’t concentrate long enough to read one page and her grades are dropping, an antidepressant along with therapeutic support can be vital.

Medication may require trial and error. Each time a patient agrees to a “trial” it’s very heroic because often he has already experienced his difficulties as a sign of failure, and if he doesn’t “respond” to a medication he can take it as further confirmation that his life is hopeless. Sometimes, if there is truly a biologic component to the depression, the change can be impressive after four to six weeks. Yet ironically, a positive outcome can be unsettling to a teenager who has come to see himself as permanently disgruntled and irritable. In addition, the wait time involved for most medications to begin to work can seem interminable, particularly because when people are depressed they may have a hard time remembering when they didn’t feel that way. When they start to improve, their mood can brighten, life can feel more manageable and they are less exhausted.

Even when there is improvement, I always invite teenagers to share the understandable ambivalence they may feel about taking medication. Sometimes a child may resent that her parents suggested medication because it implies that she needs to be “fixed.” Or, a teenager may identify with being miserable and become unsettled that medication is changing her core sense of who she is. Other times, particularly in kids who have grown up with a sense that their parents abandoned them, improvement can lead to a fear of dependence on a pill or a clinician. And if a parent has mental illness, a teen may fear that taking medication may make her more like her parents.

The toughest decision is regarding a trial of an antidepressant for a patient who is suicidal. Whereas in a small percentage of patients the antidepressant can make them more agitated and increase suicidal ideation, the medication can also alleviate incessant thoughts and planning about suicide. This is high stakes, so it’s key to share the responsibility with the parents and the teenager. The child needs to tell her parents or doctor if the medication is making her feel worse, and there must be a plan of how to access the doctor quickly and to monitor if there are troubling signs of worsening agitation, depression, or sleep.

A patient whose life has improved with medication will often feel so well that he forgets how bad he used to feel, and stops taking it. I anticipate this and ask that patients be open with me about this. I am working with a patient to see if medication will be helpful but it is always ultimately the patient’s choice. If he decides to transition off of medication, it is important to monitor him and to discuss how we will identify if he is having trouble again. I always encourage the patient to understand about why things reached a crisis, what may need to improve about how he manages stress, family dynamics and his sense of hope and belief in his future.

When I make a recommendation for a trial of medication, I do so as if the child were my own child. Parents should expect the psychiatrist to care deeply about the family, to be transparent about what he knows and doesn’t know and to share how he is making the decision.

Once teenagers who have come to me for help have stabilized, and adequate medication and therapeutic support are in place, it is not uncommon to see them come sauntering into my office, back on track, catching me up with what is going on in their lives — concerts, friends, classes. To me, it is always a blessed miracle that the suicidal feelings, bleak sense of hopelessness and depression was a temporary detour, the crisis was averted and the family left intact.

Editor’s note: This is part three of a three-part series about kids and depression. Feel free to read part one and part two if you missed them.

In less than two weeks, I will be contacting my very first clients to set up appointments. Bless these people for actually volunteering to share their stories with me, someone who has been told she is a “good listener,” but isn’t really sure at this point what else she can offer another person therapeutically. We’ve been told silence is golden. I’m hoping it isn’t also awkward.

Yes, I did read my theory textbook last semester, and have my “favorite,” although by no means am I an expert in any of them! I was in attendance at every Helping Relationships class, where we learned specific skills to use with clients. I definitely paid attention in my ethics class—don’t want to lose my license before I even have one! I did my best when role-playing counseling scenarios with my classmates, and received lots of positive feedback. But does that make me ready to begin working with “real” people with “real” problems?

I take some comfort in knowing that experienced clinicians, even some who have been in practice longer than I’ve been alive, still get nervous when they meet new clients. I opened a newly published textbook earlier this week, and the first sentence of Chapter One is, “Embarking on the therapeutic journey with a new patient is a more anxiety provoking experience than most clinicians would ever like to admit to our patients.” If someone who is well known in the field can still feel this way after 30+ years of practice, I guess I can cut myself some slack.

One of the opening rituals of establishing a counseling relationship is the disclosure statement. This little piece of paper explains the therapist’s qualifications, procedures for diagnosis, filing insurance, and more. A seasoned therapist probably has hers pared down to a page, maybe two. Mine was seven pages long. To his credit, my professor did suggest I edit it down a bit. But what to leave out? It’s all important! On the other hand, my professor also did tell us in class that less than 10% of all clients remember being given a disclosure statement, let alone actually reading it. So…cover my bases or save the trees? (It’s down to four pages now.)

Since I am a student, and this is my first clinical experience, I will be working at our counseling department clinic that is exclusively staffed by students, with faculty oversight. Given the age population our clients will mostly be from—traditional undergrads—I anticipate there will be interesting communication challenges, both inside and outside the clinic.

It is no secret that today’s students are technologically savvy, and therefore, I’m fair game for a Google search or two. I know it’s good practice these days to Google yourself to make sure there’s nothing disparaging about yourself online, but even with a clean slate, like I have, I have to make sure it stays that way! (See note above about “not losing license before I have one.”)

Another challenge is Facebook. I’m very grateful for the recent security parameters the site has put in place, restricting who gets to see what on my profile. Even so, it’s out there and anybody can find out at least basic info about me. I know I always have the choice to deactivate my account, but I do occasionally enjoy checking in to see what my friends who are scattered across the country are up to. “Friending” clients—present or past, once we have completed our time together—is a big no-no. I anticipate that will be a conversation I will have to have many times over the next few years.
Face to face with clients, I know I will be surprised by what I don’t know, and I’m not just talking about counseling technique. Much has changed for the college population since I was an undergrad, and I hope I don’t have too many moments where I have to say, “Tell me more about that,” when I really mean “I have no idea what you are talking about.”

This semester, I hope to share with you stories of my journey from absolute neophyte to someone who is ready for an internship outside the safe confines of the university counseling clinic. Wish me luck in making good clinical decisions, taking risks and making mistakes, and maintaining my sense of humor—I’ll need it!

What Is Psychiatric Treatment?

Although we occasionally read about psychiatrists who are accused of overprescribing medications, and antidepressant usage is hotly debated, in most cases a patient’s quality of life is a psychiatrist’s number one priority (as it is with all medical doctors), and restoring a patient to optimum health is our goal. Parents whom I see for the first time are often rightfully concerned about treatment; they want to know what I can offer their child and how they can convince their child to see me.

Teenagers are understandably reluctant to see a “shrink” or talk to a stranger about their problems. At a time when they are incredibly self-conscious and want to blend in, teenagers can worry that people will think “they are nuts.” How parents communicate with their child about why they are asking for outside help is critical; often a parent’s plan to seek the help of a therapist slips out in the heat of exasperation or anger, and it sounds like a punishment.

It is not uncommon for teenagers to get angry when asked if they are depressed, as if depression is a sign of weakness. But a child may be more receptive if a parent says, “I notice you are pissed off (or angry) a lot of the time and I am not sure how to make things easier. It might be helpful for us to talk with a doctor to figure out what is making things so difficult and try to make things easier for you.”

Usually when I ask teenagers why they have come to my office, they give very different responses from their parents. It’s critical within the first session to let the patient know that my focus is to alleviate stress in his life because “things are hot” — which may include failing grades, suspensions, fighting with parents, or a suicide attempt. The first interview with the child has three main purposes: I learn who the patient is, try to form some sort of relationship with him, and seek to obtain crucial information (like a detective looking for clues).

Although teenagers may initially be wary, I tell them that they are free to fire me after the first session if they don’t feel it is the right fit, partly to communicate in a fundamental way that they are in the driver’s seat about making choices about what is best for them. It is imperative that the therapist and patient are able to find a common ground and work together to figure out what’s making life so difficult and how to improve it.

A major issue to decipher is whether or not there is an existing family history of depression or bipolar disorder — if there is a biological component or mental illness. If there is trauma or a learning disorder, this may also make a teenager less motivated and susceptible to withdrawing from treatment. A careful assessment is critical, and my approach is always to inform families that I am a “consultant” to the family and they need to make an informed decision based on my findings.

I am never cavalier about suggesting or prescribing a medication; we psychiatrists are usually making diagnostic assessments on “moving targets,” as children and adolescents are constantly evolving, and the decision is not always absolutely clear. With a careful explanation of the risks and benefits, of the various options (including no medication), and of what to look for to tell if medications are helping and what kind of time frame might be needed to see improvement, patients and families will always have a chance to share their questions and concerns.

Untreated depression and mental illness is highly debilitating and very difficult to live with. Outside help is essential, and medication can be lifesaving — just as insulin is to a child with diabetes.

Editor’s note: This is part two of a three-part series about kids and depression. Stay tuned for part three tomorrow, or feel free to read part one if you missed it.

This month Guideposts magazine published my story about the morning I met Dr. Smith at the Johns Hopkins Mood Disorders Center. It read a little bit like a fairy tale … as soon as I met the right psychiatrist, I was fixed for good! And I never, ever cried again.

I didn’t have room to give all the details … like that it took a few months to feel good again … and there was a lot of work being done on my end … and that even today I have plenty of bad days. I suspect that because the story was so simplistic and ended with glass slippers fitting perfectly on my dainty feet that it has been generating a lot of mail for me, most of the notes asking this question: “How do I get myself one of those good doctors who can fix me?”

Dr. Smith told me during one session that it can be as long as 10 years before someone with depression or bipolar disorder seeks care. Treatment is often successful pretty quickly, but not always. It is more common for someone to have a delay in getting the correct diagnosis if they have bipolar disorder rather than unipolar depression, and especially if their illness presents mainly, or almost exclusively, as depression, as mine did. I am certainly not the only depressive who has had to shop around for the right psychiatrist like a working mother does a suitable nanny, and who has tried on a few too many misdiagnoses.

Have I learned anything in my psychiatric odyssey that could be useful information for the depressed Joe?

Yes, actually, I have.

I’ll spare you all of the details and get to the point:

1. Go to a teaching hospital to get a psychiatric consultation.

Try the psychiatry department of a large university or college. Because the psychiatrists there will be less likely to take the samples from the cute pharmaceutical reps and be lazy about reading all the research today on which drugs work and why. Like my doctor, these psychiatrist will probably be more willing to stick with the older, dependable, well-researched drugs like lithium and the older tricyclic antidepressants that won’t get them rich but that have an impressive track record.

2. I found the right treatment at the Johns Hopkins Mood Disorders Center. You could start there too. Because they have a list of referrals–trained psychiatrists all over the country.

3. Also, you might consider some of the other steps in my recovery program that I describe in my post “The Lessons of Depression,” like paying attention to diet, sleep, and exercise. I would advise anyone struggling with depression to start there. Sometimes those three adjustments are enough.

4. And if you are having a hard time hanging on, you might want to read “12 Ways to Keep Going” or watch my video called “I WILL Get Better.”

5. Many of you may need some support. I urge you to join a support group. I formed Group Beyond Blue about two years ago as a place where depressives and persons suffering from all kinds of mood disorders could exchange information on doctors, med side-effects, insurance hassles, work situations, and relationship complications. You may want to start there to find out about other support groups that people are involved in.

6. Keep these hotlines handy, and call them if you are experiencing suicidal thoughts:

• Suicide Prevention Lifeline 1-800-273-TALK
• Suicide & Crisis Hotline 1-800-999-9999
• Panic Disorder Information Hotline 800-64-PANI

Other helpful numbers:

• Mental Health InfoSource 1-800-447-4474
• National Alliance on Mental Illness (NAMI) 1-800-950-NAMI (6264)

7. Whatever you do, do not lose hope. The right psychiatric care is available.

I want all of you who have written to me to know that I keep you in my prayers, that I am rooting for you, and that I wish you peace and serenity.

The cause was cancer, said her husband, Ronald Cohen.

Ms. Ross was a 25-year-old teacher on vacation in Salzburg, Austria, when she was struck by a sudden fear of heights — a fear that would, in time, make her a public figure. After learning to manage this dread in 1978, Ms. Ross joined the practice of Dr. Robert DuPont, a prominent psychiatrist in the Washington area, to help others do the same.

A skilled therapist and exuberant optimist, she soon had her own radio show, in the 1980s, where she became known as the “phobia lady.”

Ms. Ross testified before Congress on behalf of those with mental illnesses. She appeared on “The Oprah Winfrey Show” seven times over the years. And in countless newspaper and magazine articles, she explained persistent anxiety and how to live with and manage it. She was equal parts therapist, fellow sufferer and inspiration.

In 1980, with Dr. DuPont, she founded the organization that would become the Anxiety Disorders Association of America, which was integral in raising public awareness of, and research money for, problems like social anxiety, post-traumatic stress and obsessive-compulsive disorder. Ms. Ross was the director of the association until her death.

“The reality is, when we started that group, anxiety disorders were nowhere on mental health geography, period; they were thought of as trivial and rare,” Dr. DuPont said in an interview on Wednesday. “Well, that one woman carried the cause, got research funding” and put the disorders on the map.

Researchers now estimate that 30 million to 40 million Americans suffer from some form of nagging anxiety, from mild to severe.

Jerilyn Ross was born in the Bronx on Dec. 20, 1946. After graduating from the State University of New York, Cortland, in 1968, she worked as an elementary school math teacher in New York City. She earned a master’s in psychology at the New School for Social Research in 1975.

In 1994 Ms. Ross and the former first lady Rosalynn Carter published “Triumph Over Fear,” about anxiety disorders. Her book “One Less Thing to Worry About,” written with Robin Cantor-Cooke, was published last year.

In addition to her husband, she is survived by three children, Alan Cohen of Bethesda and Crain Cohen and Sue-Ann Siegel of Potomac; and seven grandchildren.

“Each of us has a different relationship with anxiety, just as each of us has a different relationship with our mothers, our fathers, our children, and everyone else in our lives,” she wrote in her second book. “What’s important is not learning the ‘right’ way to respond to anxiety but learning how you relate to it and whether or not the relationship is working.”

When I do interviews or public readings parents often ask me about warning signs in children for depression and even suicidality. They may be worried about a daughter who is withdrawing, or a son who sleeps for hours on end and is failing in school. These behavioral changes can be signs of a biology gone awry and parents should take their observations seriously.

When considering whether a child is suffering from mental illness, the question you should ask yourself is, “how is my child functioning?” If your child is at an impasse, that’s when you should worry. Warning signs vary, but generally when kids can’t go to school, are up all night, are irritable, isolate or have prolonged periods of crying (such as bursting into tears and locking themselves in a room for 2-3 hours), these are signs that something is wrong and that parents need to act. Changes in eating patterns are also red flags. And if children talk about suicide or hopelessness, always take them seriously. Slow down, listen to figure out what’s going on, and mobilize to get help when needed. If another child comes to you with concerns about a friend or family member, it is important to take them seriously. Remember, it takes a lot of courage for kids to approach adults with their concerns and override the sense that they are betraying their friends.

Often parents can chalk up their child’s high-risk behavior, such as hanging out very late at night, running away, or experimenting with drugs or alcohol, to typical teenage conduct. Although it can be challenging to figure out when moodiness and risk-taking is appropriate, it’s key to decipher when a teenager is on a self-destructive path. Talking to your children with an open mind and an understanding ear, and getting outside support, is the first step in helping a struggling child.

Editor’s note: This is part one of a three-part series about kids and depression. Stay tuned for part two tomorrow.

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