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.


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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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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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.


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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Depression screening in adolescents

Depression screening in adolescents

The Harvard Mental Health Letter is reporting that the US Preventive Services Task Force is recommending that 12-19 year olds get screened for depression.

BUT, they stress, ONLY if there are adequate systems in place for treatment and follow up care. Which I am sure is comforting for those who live in rural and remote, or extremely poor, areas where such services and systems are lacking.

According to the Harvard Mental Health Letter, major depression affects nearly 3% of children younger than 13, and 5.6% of those ages 13 to 18.

They also note that major depression is so disabling, with long-term consequences, and yet most youngsters who are depressed go undiagnosed and untreated. I am sure I am not alone amongst us all in knowing from personal experience how true that is.

It's also interesting to note that the US Task Force recommended NOT screening pre-teens for depression, on the very sound grounds that there is not enough research into how effective screening tools are, nor is there enough research into how effective therapeutic and psychopharmacological treatment programmes are and what longer-term side effects medicines in particular may generate.

Source: U.S. Preventive Services Task Force. "Screening and Treatment for Major Depressive Disorder in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement," Pediatrics(April 2009): Vol. 123, No. 4, pp. 1223-28.; cited in Depression screening in adolescents, Harvard Mental Health Letter, September 2009, p.7

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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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Bipolar disorder and family-focused treatment in Turkey

Bipolar disorder and family-focused treatment in Turkey

Ten Turkish patients with either DSM-IV I or II bipolar disorder and their families attended a 9-month, 21-session psychoeducational treatment plan that ran alongside more traditional medication treatment plans.

The plan, called 'Family Focused Therapy' (FFT), has been successful as an adjunct to medication within North America, but had never been tested outside of US borders. So it was interesting to see if the same positive results could be replicated in a non-Western culture.

It turns out that very few changes were needed to be made to 'fit' Turkish culture (principally in turning some of the written assignments into more a more culturally appropriate oral communication) and patients improved their Global Assessment of Functioning scores and Clinical Global Impression scores, pre- and post-treatment.

FFT is a family intervention for bipolar disorder designed by Miklowitz & Goldstein (1997) and runs for 21 sessions over a 9-month period. It has been been shown to be more effective than crisis management in longer-term survival without mood disorder relapse, as well as reducing the severity of depressive and manic symptoms, over a two-year period. It has also allegedly hastened the time to recovery from acute depressive episodes compared to other psychoeducative treatments.

The Turkish FFT therapist was trained by Dr Miklowitz during a weekend workshop, followed by email-based supervision. The therapist's manual was translated into Turkish by a colleague of Dr Miklowitz and reviewed and approved by other clinicians experienced in FFT.

It showed that FFT can be effectively used outside of a North American, Western culture as long as care is taken to 'fit' the therapy into the local culture, including use of language appropriate to the local culture.


Miklowitz, D.J., & Goldstein, M.J. (1997). Bipolar disorder: A family-focused treatment approach. New York: Guilford Press

Ozerdem, A., Oguz, M., Miklowitz, D., & Cimilli, C. (2009). Family Focused Treatment for Patients with Bipolar Disorder in Turkey: A Case Series. Family Process, Sep2009, Vol. 48 Issue 3, p417-428

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On depression, anxiety, and 40 days and nights

A Second Life avatar relaxing at the beach

One of the thoughts that crossed my mind during the week was how we rarely if ever take a break.

I’m not talking about holidays – although most of us don’t take our full allotment of holidays in one go, and when we do we invariably fill those days with adventure, excitement and stimulation.

No, I’m talking about the ‘40 days in the wilderness’ stuff, the retreat (religious or otherwise) that allows us to go somewhere quiet and do little else except recharge our thoroughly depleted batteries and spend days and nights in quiet alcohol-free contemplation.

There are so many competing demands on our time, even away from the hurly-burly of work, that the opportunity to escape for any period longer that a long-weekend is sadly not an option for the vast majority of us.

Yet how different might our mental health be if we allowed ourselves the luxury (and it IS a luxury) of unplugging from the world for two or more weeks whilst still having our basic needs of food, shelter and personal safety met? How less anxious might we become? How less stressed might we return?

Perhaps only those who are stressed, depressed or anxious might understand the need to ‘disappear’ from view for a little while… our already over-worked families and friends would, I’m sure, be less than impressed by our desire to unhitch ourselves from our responsibilities and dump even more of a load on them. I can’t say I blame them.

But in an ideal world wouldn’t it be lovely to have the freedom to be able to leave all one’s worldly cares and possessions behind and disappear for ‘forty days and forty nights’ in order to face one’s demons and peer into the murky depths of one’s own black soul?

With thanks to Drinda for the inspiration behind this post.

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More on caffeine and depression

Further to the research into caffeine and adolescent anxiety, I have noticed that my own health has been impacted by caffeine.

In the last few weeks I have been drinking a lot of fresh coffee (I can't stand the instant stuff) and I've found that my medication hasn't been as effective as normal.

Normally, I could take my medication in the morning and it would last 24 hours; over the last few weeks and coinciding with my increased coffee intake my meds only seem to last until early evening. Certainly my night-time dreaming has been wacko-weird as a result of the medication not 'protecting' me as long as it normally does; and whilst the dreams are certainly entertaining and vivid, the headaches that I am suffering before and after sleep are equally as vivid and definitely not welcome.

So last week I reduced my caffeine intake. Result: 24 hour cover and a lot less headaches. The dreaming is no longer vividly technicolour, alas, but that is a price I am prepared to pay. Perhaps when I come to write the 'Great Australian Novel' I may revisit that decision... [smile]

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Does caffeine and kids equal depression?

Caffeine use among children and adolescents may have harmful effects, including depression.

Caffeine is the only legal psychoactive drug that everyone can use. Teens and pre-teens are regular drinkers of drinks such as Diet Coke, Mountain Dew, Pepsi, and other pre-packaged coffee drinks. Anyone in the vicinity of cafes will also notice a number of teenagers regularly having a fresh-brew coffee before or after school.

But research just published by the American School Health Association shows strong negative outcomes when youth drink caffeine, and the younger they are the stronger the psychological effect.

One hundred and thirty five 5th graders and 79 teenagers were studied for their caffeine use, and both groups showed frequent caffeine use. Worryingly, both groups were more likely to self-report depressive symptoms the more caffeine they ingested.

There didn't appear to be any impact on 'anxiety' with increased caffeine use, but certainly there are strong effects on depression, which impacts on the student's sleep patterns and academic and social performance.

The authors certainly recognise limits with their study, which are important but not massively so, and end their paper with two suggestions:

  1. That direct education about the risks of over-indulgence with caffeine (and what are 'safe levels) would be beneficial; and
  2. That research be conducted on the effect of caffeine on not only depression and anxiety, but also sleep, academic performance, social functioning and social interaction with peers and adults.

I don't know about teenagers (it's a long time since I was one), but the paper certainly makes me question whether the large amount of fresh-brew coffee I take daily is doing my mental health any good...

Source: Luebbe, A.M., & Bell, D.J. 2009. Mountain Dew or Mountain Don't?: A pilot investigation of caffeine use parameters and relations to depression and anxiety symptoms in 5th- and 10th-grade students. Journal of School Health, 79(8); 380-387

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Do SSRIs erode your bones?

There's a growing body of evidence that SSRIs are eroding bones, resulting in increased risks of osteoporosis and fractures.

The Harvard Mental Health Letter for August 2009 reports on a ten-year history of research that noticed a disturbing correlation (a seeming relationship between two sets of data): depressed patients had lower bone strength and a greater risk of fractures.

Although the earlier studies left the door open to a pharmaceutical reason for increased risk of fracture (as in, the medications used may have caused dizziness, resulting in falls and fractured bones), later studies have been better-designed and seem to implicate SSRIs are causing bone erosion.

Two recent significant studies appear to conflict. One finds that inhibiting 5-HTT, which SSRIs do better than any other antidepressants, slows bone formation and accelerates bone resorption (which is when calcium and other minerals are released into the bloodstream, leaving trenches behind in the bones); the other finds that inhibiting 5-HTT actually increases bone mass.

5-HTT is the transporter mechanism for 5-HT, which you might know as serotonin; SSRIs enhance serotonin activity.

Despite the conflict between the two aforementioned studies, the Canadian Multicentre Osteoporosis Study Research Group followed 5,008 men and women who were aged 50 and over for five years, finding that the patients who were taking SSRIs everyday had lowered bone mineral density measurements, particularly in the hip. They were also twice as likely as non-SSRI-taking patients to suffer a bone fracture.

Ways to overcome any risk of bone erosion include increasing the intake of calcium, increasing the intake of vitamin D, reducing the amount of caffeine and alcohol taken, and exercising in a way that bears weight on bones (such as walking, weight lifting, stair climbing). It also seems that some medications help slow bone resorption: alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva) are mentioned positively.

Of equal significance is that no one has yet taken a look at how SSRIs might affect the bones of children or teenagers.

Source: Harvard Mental Health Letter, August 2009 -

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