Depression and Bipolar info explaining the latest research in everyday English

Predicting a response to medication and cognitive therapy for moderate to severe depression

Predicting a response to medication and cognitive therapy for moderate to severe depression

The hefty research literature around cognitive therapy and pharmacotherapy therapy confirms that both are really good ways of treating depression.

But are there some symptoms and variables that would predict a superior response of one treatment over another?

This is the research question that Jay C. Fournier and colleagues decided to investigate. To do so they randomly assigned 60 depressed outpatients to cognitive therapy and 120 to antidepressant medications. Both groups were given a treatment regimen that lasted for 16 weeks.

They found that chronic depression, older age and lower intelligence didn't augur well for either type of treatment. Conversely, marriage, unemployment and having experienced a greater number of recent life events predicted a better response to cognitive therapy than pharmacological.

By the way, 'life event' is the total number of life events reported on the Psychiatric Epidemiology Research Interview Life Events scale, a 102-item self-report measure (Dohrenwend, Krasnoff, Askenasy, & Dohrenwend, 1978). This instrument is agnostic as to whether life events are positive, negative, or neutral.

Previous studies of depression and age had found (albeit not conclusively) that the older the sufferer was, the less likely they were to recover quickly from their depression.

Interestingly, dropout rates were lower for those who suffered from chronic depression; someone with nonchronic depression was approximately four times more likely to drop out of treatment. Although chronically depressed patients were likely to report less symptom relief, they at least 'stayed the course' -- although exactly why they stayed is open to discussion. There is the possibility that the chronically depressed were more motivated to complete their treatment course in the hope of achieving some degree of relief from their long-standing pain.

The researchers also found that those who were married/cohabiting, had a greater number of significant events in their lives and those who were unemployed were far more likely to benefit from cognitive therapy than medication. To me, that's interesting. I have tried CBT but had so little success with it that I dropped out after four weeks of a ten week program. Something to be discussed with my psychiatrist the next time I see them, methinks.

Sources:

Fournier, J.C.; DeRubeis, R.J.; Shelton, R.C.; Hollon, S.P.; Amsterdam, J.D.; & Gallop, R. (2009). Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression. Journal of Consulting & Clinical Psychology, Aug, Vol. 77 (4), 775-787

Dohrenwend, B. S., Krasnoff, L., Askenasy, A. R., & Dohrenwend, B. P. (1978). Exemplification of a method for scaling life events: The PERI Life Events Scale. Journal of Health and Social Behavior, 19, 205-229

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Technorati : antidepressant, cognitive therapy, depression, medication, moderator, outcome, prediction, predictors, treatment
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Facebook Therapy: Emotional self-disclosure issues for young adults

Facebook Therapy: Emotional self-disclosure issues for young adults

This is the internet age, where instant access to just about everything is but a mouse-click away.

It is also an age where face-to-face access to mental health professionals is harder and harder to gain, most especially in times of crisis. So it makes sense to turn to a more readily-available source of counselling, support and encouragement, doesn't it?

That was the question that Vicki L. Rogers and some of her colleagues posed to 328 Facebookers via an online survey.

And the result? Unsurprisingly, the vast majority (263:65) preferred face-to-face interaction. But that assumes that face-to-face is a readily-available option, which I can confirm is not the situation here in Australia, especially in rural and remote regions, and if you are aboriginal. I am not based in a rural and remote area, nor am I aboriginal, but getting any F2F (face-to-face) time with a competent practitioner able to deal at the required level of care and intervention is not something easily achieved.

Between the F2F group and the online group there were significant differences for the emotional self-disclosure subscales of depression, jealousy, anxiety, and fear, but no differences between them for subscales of happiness, anger, calmness and apathy.

However, of value to practitioners at low-level and early-intervention stages, both the F2F and online groups self-reported moderate to high willingness to disclose their emotions to a therapist, to the researchers suggesting that either format would be a viable option for nurses to provide individual therapy.

As they conclude,

Given the high number of participants reporting a history of therapy it would seem there is a need for psychiatric nurses to expand their repertoire of therapy delivery modes to include Internet based approaches. This would better equip them to serve clients in the younger Internet savvy age group. The emerging field of IT therapy offers nurse researchers and practitioners many opportunities to advance their knowledge and expertise in this field, thus allowing for delivery of quality care to those who would prefer this therapy format.

Source: Rogers, Vickie L., Griffin, Mary Quinn, Wykle, May L. and Fitzpatrick, Joyce J.(2009) 'Internet versus Face-to-Face Therapy: Emotional Self-Disclosure Issues for Young Adults', Issues in Mental Health Nursing, 30:10, 596 - 602

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Technorati : adolescent, anger, anxiety, apathy, calmness, depression, emotion, facebook, fear, happiness, jealousy, mental health, self-disclosure, therapy, young adult
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African American Men and Mental Health: Is the Climate Changing?

African American Men and Mental Health: Is the Climate Changing?

"If you're African American, male, and you live in the United States, depression is a fact of life." (Kendrick et al., 2007)

That is a quote from an African American male and it is changing the way research into depression is being conducted with minorities.

Prior to the study and resultant paper by Lorna Kendrick and her colleagues research into the life and experiences of minority groups was very often conducted according to the whims and research interests of the researcher. As one of the authors of the current paper (Kendrick et al., 2009) notes,

"too often when members of minority groups are asked to participate in research, we are expected to answer questions the researcher believes are important. On many occasions we have attempted to tell a researcher that none of the questions and/or answers fit our experiences. Yet in most situations, we have been told "just choose the answer that comes 'closest' to the way you feel." Well the truth is none of the questions or answers were ever close to how we feel or experience life."

They expand on this...

"Many of the questions we were asked were presented as though the therapist/doctor did not believe what we were saying.

...

We do not respond well when health care providers quote research findings and make general statements about how we as African Americans should feel or respond. We "the patients" are sitting right in front of them, reporting what we feel, yet they did not seem to focus on us but on their "diagnostic criteria" which often we do not fit."

I have no doubt that it is not just African American males who can report feeling this way; I'm sure our own Aboriginal men, as well as the men from any number of minority non-white populations from around the Western world, can empathise with their African American peers.

With the election of Barak Obama as U.S. President there has been many expressions within popular media of a feeling of 'hope', not just among African Americans but the world in general, a much-reported feeling that [positive] 'change is in the air'. One of the changes the authors wish for is that research moves from a position they believe is only the post-hoc justification of false beliefs and predetermined thoughts and ideas.

It is hoped by Kendrick and her co-authors that research is needed that actually uncovers the 'real', not the 'imagined' or proscribed experiences of ethnic minorities and their mental health concerns really are. In turn, they hope, data will be more truthful and from that data more successful interventions and programs can be designed.

I am sure they are not alone in wishing, in this new era for the globe, for research that is more accurate, based on actual life experiences and not predetermined, white ethno-centric research questions.

Sources:

Kendrick. L., Anderson, N.L.R., & Moore, B. (2007). Perceptions of depression among young African American men. Family and Community Health, 30(1), 63-73

Kendrick. L., Moore, B., Thomas, C., & Matlock, J. (2009). African American Men and Mental Health: Is the Climate Changing. Issues in Mental Health Nursing, 30, 587-588

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Chronic Fatigue, M E, and functioning in a crisis

Chronic Fatigue Syndrome, Myalgic Encephalmoyelitis and functioning in a crisis

The journal Evaluation & the Health Professions reports in their latest edition of the result of 111 patients with ME/CFS.

The patients were grouped into three categories: Crisis, Stabilisation and Resolution, and the study looked at how accurate the Fennell Phase Inventory (FPI) was in relation to the patient's coping style and functioning (both physical and psychological).

The results suggest that the FPI is a useful tool for assessing which phase a ME/CFS sufferer is in (there are four phases -- the above three and 'Integration'). According to the researchers, patients with ME/CFS often experience remission and relapse, and the FPI appears to measure quite accurately how they will respond psychologically to the unpredictable and inconsistent nature of their disease.

Furthermore, the study indicates that there are differences in how patients experience and cope with their illness when in the different phases. So understanding how any physical disability is experienced and coped with in the various phases is beneficial in creating a coping strategy that reflects and accommodates each different phase.

Source: Reynolds, N.L., Brown, M.M., & Jason, L.A. (2009). The Relationship with Fennell Phases to Symptoms Among Patients With Chronic Fatigue Syndrome. Evaluation & the Health Professions, Vol. 32 (3), 264-280

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