depression

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When My Mother Died: A Story Of ‘Incomplete Mourning’

By Sarah Baker

I was 8 years old and the sky was black the day my mother died.

That morning, after a five-year struggle with a brain tumor, she’d passed away at Bethesda Naval Hospital, where she had been admitted a couple of days earlier. I hadn’t seen her since.

Grieving wasn’t an option in our house. We were a “chin up, shoulders back” group led by Dad, a rising star in the Navy. At my mother’s graveside in Arlington National Cemetery, my 10-year-old brother and I stood like little replicas of John F. Kennedy Jr. 12 years earlier when he saluted his father’s coffin. There were no tears, no signs of weakness. Long periods of mourning or sadness were not in our family culture — our grief was put on hold. There were bags to pack, and new ports of call. I was Soldiering On.

The Hardest Thing

According to the advocacy group SLAP’D (Surviving Life After a Parent Dies), 1 in 9 Americans loses a parent before age 20. Of those, nearly half said it was difficult to talk about their grief and only 7 percent said a guidance counselor helped. Six out of 10 adults interviewed, who lost a parent when they were children, said it’s the hardest thing they’ve had to deal with.

Sarah Baker at age 6, two years before her mother died (Courtesy)

Sarah Baker at age 6, two years before her mother died (Courtesy)

For us, the coping mechanism of Soldiering On worked splendidly for years, even decades. I survived all of the moves due to Dad’s deployments, even thrived, people might say. I went to college, graduate school, found great jobs, married a wonderful man, and had two beautiful children. All seemed well, at least on the surface.

But years of anxiety and disassociation gripped me. Recently, though, I felt all that emotional baggage was not sustainable. My external world appeared blissful (and it was!) but my internal world reeled. I had periods of blankness, inability to focus, sleeplessness, feelings of isolation when I was surrounded by loving people; despair, longing for something else, numbness, repeating negative loops in my mind, and sensations of being half dead. These feelings came in waves — days of it followed by lightness and connection. The longest darkness lasted three months — the world drained of its colors and none of my usual “reset,” or coping, tools seemed to work.

Necessary Grief

Importantly, coping is not grieving. “There is a kind of sanity to grief,” says Kay Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine and author of “An Unquiet Mind.” “It provides a path — albeit a broken one — by which those who grieve can find their way. Grief is not a disease; it is a necessity.”

Funerals and other rituals bring people together and defend against loneliness. But if the grief lingers too long, is too severe, or unprocessed, it might begin to resemble depression. It’s a fine line indeed.

I now know I had never fully experienced the pain and sorrow of my grief. Continue reading

Researchers Say They Can Lift Depression In Mice By Activating Happy Memories

(katiebordner/Flickr)

(katiebordner/Flickr)

You know when you’re feeling really down, or worse, in the throes of depression, and there’s always that chirpy person who earnestly says: “Just try to focus on happy thoughts; think positive!” Well, it turns out, that unshakeable optimist may have a point.

MIT scientists report that they are able to “cure” the symptoms of depression — in mice — by artificially activating happy memories that were formed before the depression took hold.

The findings, published in the journal Nature, hint at a future in which depression might be treated by manipulating brain cells where memories are stored.

MIT graduate student Steve Ramirez, the lead author on the paper, explains that while the work is tantalizing, it’s a long way from any real-world application in people:

“We’re doing basic science that aims to figure out how the brain works and how it can produce memory,” Ramirez said in an email. “The more we know about how the brain works, the better equipped we are to figure out what happens when brain pieces break down to give rise to broken thoughts. In my opinion, we’re a technological revolution away from being able to do this in humans; everything that exists currently is too invasive and not targeted enough. That said, the underlying proof-of-principles are there, as we can do these kinds of manipulations in animals. The question is how we can do this in humans in an ethically responsible and clinically-relevant manner.”

Still, he says, researchers did not expect such clear results:

“The finding that stimulating positive memories over and over actually forces the brain to make new brain cells was surprising,” he wrote. “We did not expect to have such a clean result demonstrating that artificially activated positive memories correlates with an increase in the number of new brain cells that are made.” Continue reading

Study: Even After Depression Lifts, Sufferers Face Higher Stroke Risk

(mac keer/Flickr)

(mac keer/Flickr)

In case you missed this piece on NPR today, it’s worth a listen: Harvard researchers have found that long after the dark symptoms of depression have lifted, those of us who suffered from the disorder have an increased risk of stroke later in life.

Patti Neighmond reports on the new study, published in the Journal of the American Heart Association:

Medical researchers have known for several years that there is some sort of link between long-term depression and an increased risk of stroke. But now scientists are finding that even after such depression eases, the risk of stroke can remain high.

“We thought that once people’s depressive symptoms got better their stroke risk would go back down to the same as somebody who’d never been depressed,” says epidemiologist Maria Glymour, who led the study when she was at Harvard’s T.H. Chan School of Public Health. But that’s not what her team found.

Even two years after their chronic depression lifted, Glymour says, a person’s risk for stroke was 66 percent higher than it was for someone who had not experienced depression.

The study authors conclude that to mitigate this risk of stroke, depression should be identified and treated early:

This study, in conjunction with other work confirming that depressive symptoms are causally related to stroke risk, suggests that clinicians should seek to identify and treat depressive symptoms as early as possible relative to their onset, before adverse consequences begin to accumulate.

Continue reading

Traumatic Turning Point: How The Marathon Bombing Shifted One Woman’s Depression

By Annie Brewster, M.D.

Jennifer on Marathon Monday 2013, before the runners started coming in (Courtesy)

Jennifer on Marathon Monday 2013, before the runners started coming in. (Courtesy)

Jennifer’s depression was deep and at times debilitating. For years, she tried various treatments but success was always temporary.

Something changed on the finish line at the Boston Marathon in 2013. It was, Jennifer says, “a turning point” in her life, but not in the ways you might expect.

As a marathon volunteer stationed a block from where the first bomb exploded, she witnessed the confusion and terror that ensued, and played an important role in helping one scared runner reunite with his family.

After the ordeal, Jennifer felt lucky to walk away alive. Her life goals changed that day and she says she now feels it’s her responsibility to help others. She continues to find concrete ways to do so.

Listen to Jennifer here:

She had already signed up to participate in a program at the  Benson-Henry Institute of Mind-Body Medicine at Massachusetts General Hospital the week following the bombing. Primed by her experience during and after the race, Jennifer devoured the class, which focused on relaxation techniques.  It deepened her sense of self-acceptance and gave her skills to manage her own depression, but also strengthened her resolve to help others. She ultimately went on to become a peer counselor at the institute.

Now, her central message is this: while we can’t necessarily control what happens to us in life, we can control the meaning we make of our experiences.

Jennifer says she’s determined to make the events of April 15, 2013, mean something, and to translate this meaning into action. As far as her depression, she has come around to recognizing “some of the good things about depression” — namely her appreciation for the small things in life, and her increased sense of empathy for others. “It’s like any other illness,” she says. “It doesn’t have to limit you. It’s all about making it mean something.”

Dr. Annie Brewster, M.D., is founder and executive director of Health Story Collaborative, a nonprofit in Boston.

Predicting The Next Mental Health Crisis: Sometimes We Just Can’t Know

Chris/flickr

Chris/flickr

By Steve Schlozman, M.D.

When tragedies hit, it is in our nature to ask why. The co-pilot in the horrific Germanwings crash had serious mental health problems, according to reports. How could no one have known how serious his challenges were? How could no one have predicted this terrible outcome?  On its surface this line of questioning seems even a bit ludicrous.  After all, even in the murky face of mental illness, the potentially deliberate and fatal nose-dive of a commercial aircraft seems impossible to imagine.  Nevertheless, this is exactly the question that we’re seeing over and over in the coverage of the crash.

How could we not have known?

The fact is, however, that this particular question glosses over a profoundly uncomfortable quandary that is by no means unique to psychiatry. For all of modern medicine, predictions are surprisingly fraught with difficulty.  For all of medicine’s miracles, for all of its technological wonders and advances, medicine remains a quintessentially human endeavor.  You might even argue that phrases like “medical miracle” are indeed part of the problem.  This more we grant medicine undue and mystical prowess, the more resistant we grow to the grueling trial and error that characterize everyday medical practice.  Doctors are wrong all the time.  That’s a fact.

Nevertheless, physicians are asked to prognosticate. That’s the verb form of “prognosis.” As patients and families, we look to our doctors daily for prognostic estimates.  (Emphasis on estimates.)  These estimates are really hypotheses necessarily based on incomplete data. Rare complications and twists of fate befuddle even the best.

For psychiatry this truth can be especially hard to swallow.  A neurologist might not be able to predict every migraine, but it is the rare migraine that results in tragedy.  Still, remember that psychiatrists cannot read minds. Like all physicians, psychiatrists will try their best to understand what is the cause of suffering.  And, as with all clinicians, psychiatrists will sometimes be right and sometimes not.  Medicine remains an art even as the science continues to improve.

The fact that someone suffers a psychiatric disorder, even a recurrent psychiatric disorder, is not remarkable when compared to the rest of medicine.  The same occurs with ulcers, asthma, allergies, orthopedic injuries, sinus infections and so forth. Most medical illnesses are chronic and many are intermittent. No medical professional can predict with absolute certainty when an episode is going to occur or how severe it may be. To be fair, physicians can and do identify triggers, but the intensity of a presumed reaction is outside anyone’s ability to predict.

And this is where society gets especially flummoxed. No one would argue that the art of medicine is infallible. No one would suggest that medical practice is right 100% of the time. But faced with tragedy, we are much more comfortable as a species pretending that our predictions are foolproof and that our mishaps are exceedingly rare.

Why can’t we always know? Medicine is post-modern. We cannot know because we can’t. Continue reading

Medicated (And Unmedicated) Women Are Talking

By Alicair Peltonen
Guest Contributor

I think a crucial step in decreasing the stigma surrounding mental illness is talking about it openly. And it seems readers want to talk.

My post, “The Medicated Woman: A Pill To Feel Better, Not Squelch Feelings,” on mental health and medication, was shared on Facebook more than 15,000 times and now has over 200 comments, so I thought it was worth a follow-up.

One thing readers wanted to discuss is the safety of antidepressants during pregnancy, a complicated topic which has been covered here and here on CommonHealth. Safety studies are mixed in many cases so women should consult their doctors. Here’s what it says on the Mayo Clinic website:

A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe without question during pregnancy, and some types of antidepressants have been associated with health problems in babies.

Other comments underscored that stigma still exists but may be slowly diminishing.

(Flickr Creative Commons)

(Flickr Creative Commons)

Jackie wrote: “It took me until I was in my 50’s to accept that medication wasn’t the ‘weak”‘ way. I now see how much I lost and am living through a tremendously stressful life without those urges to accelerate into other cars or cement walls.”

“It’s in our family, but I was the first to seek help, and was probably the worst off. It was a secret that my grandfather had committed suicide,” wrote lilycarol.

And here’s a comment from helentroy4: “My mother was much like me. But to her dying day she never acknowledged that her behaviors were anything but ‘perfect mothering.’ I think had she been able to take advantage of this medication (or others of its kind), she would have been able to have the calming of her heart and soul that I have been blessed to have.”

There were many who suggested that lifestyle changes, including more exercise and sleep, meditation or yoga might be safer and more beneficial than medication. Continue reading

The Medicated Woman: A Pill To Feel Better, Not Squelch Emotions

By Alicair Peltonen
Guest Contributor

I am a medicated woman. I take 50mg of Sertraline (the generic form of Zoloft) a day. I don’t take it to be more tolerable to my husband. I don’t take it because I’m embarrassed by my emotions. And I definitely don’t take it to quietly fit into a polite societal mold. I take an anti-depressant every day to quell my anxiety simply because it feels better. I feel better.

I grew up in a talk therapy household. My father began group therapy for anger management issues in 1984, when I was 10, breaking a cycle of rage and avoidance that tends to swallow people whole, particularly men. He would come home feeling calmer and then he would implore my sister and me to explore our feelings and talk about our problems. Begrudgingly at times, I learned to think analytically. And thankfully, I learned that asking for help is not only acceptable, it’s downright healthy.

I started seeing therapists here and there in my 20s and then regularly several months after my first daughter was born. Medication had never been suggested by any of my previous therapists but this time was different. I couldn’t shake the feelings of inadequacy, the certainty that my daughter didn’t like me and I was just a glorified dairy cow. Post-partum depression is a hell of a thing.

(Rachel Zimmerman/WBUR)

(Rachel Zimmerman/WBUR)

When my therapist suggested I see a psychiatrist to discuss the possibility of medication, I went home and cried for an hour. I felt ashamed, defeated, embarrassed, weak. Even though I had seen medication transform my father from a man who growled and dragged to one who laughed and hugged, it still stung to feel like I couldn’t pull myself together.

But, remembering my father’s bravery, I thought I should at least give it a try. If I didn’t like it, I could always stop taking it. The first pill was swallowed through tears. And each successive pill went down easier. For a full year, I could go days without yelling or wanting to break things and entire weeks without crying. And I felt better.

After a year, I decided to go off the medication. Things had been much better and I wanted to see if I could “go back to normal.” And things did go back to normal. But it turns out my normal wasn’t very comfortable.

There have been many discussions and articles recently asking if modern psychiatry is over-medicating women. A recent op-ed in the New York Times by psychiatrist Julie Holland suggested that many of the symptoms for which women are treated with antidepressants are natural and healthy. “We have been taught to apologize for our tears,” she writes, “to suppress our anger and to fear being called hysterical.”

Here’s the thing, though. Breaking down into uncontrollable tears because you stubbed your toe and it’s the straw that broke the stress-camel’s back doesn’t feel good. Continue reading

A Podcast For Your Brain: The Checkup, Episode 8

It’s the only organ in the human body that tries to understand itself (though not always successfully).

Still, the brain is on our brains in the latest episode of The Checkup, our recently relaunched health news podcast, a joint venture between WBUR and Slate.

Can you enhance your brain through music? Detect dyslexia even before kids learn to read? Alleviate the symptoms of deep depression with a brain implant?

Carey and I explore these and other questions as we delve into some of the latest advances in brain research.

And in case you missed our last episode, “Scary Food Stories,” where we tell the tale of a recovering sugar addict and offer sobering news to kale devotees, you can listen now, or download it anytime.

Make sure to tune in next week, when we present: “Grossology,” an episode on how the dirty corners of your life might benefit your health.

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.

Growing Burden: Toll Of Major Depression Now Put At $210 Billion A Year

(Wikimedia Commons)

(Wikimedia Commons)

For more than two decades, Boston economist Paul Greenberg has been calculating the costs of depression — the mood disorder, that is, not the economic downturn.

His latest study, now out in the Journal of Clinical Psychiatry, finds that major depression is costing the American economy $210.5 billion a year — boosted dramatically by the toll of the recent recession. And rates of depression particularly shot up among people over 50.

I asked Greenberg, head of the health care practice at the Boston economic consulting firm Analysis Group, to elaborate. Our conversation, lightly edited:

First, what would you most highlight from your latest findings?

There are many highlights but I’d focus on two. The first is that the costs of depression are large and growing. And the second is that costs of depression are borne in the workplace in a very dramatic way. There’s no employer that’s exempt from the costs of depression. And I think both the magnitude of costs generally, as well as the costs that are specific to the workplace, are worthy of further attention, further thought, further research.

What are a couple of the specific numbers that you find most striking?

Let’s start with the overall finding: We find the costs of depression to be approximately $210 billion per year. One of the interesting aspects is that only 40 percent of those costs are actually attributable to depression itself.

Could you explain that?

That means that 60 percent is attributable to elevated costs that, in the data, don’t show up as directly connected to depression, but they’re associated with depressed people to a greater extent than with non-depressed people.

Economist Paul Greenberg (Courtesy)

Economist Paul Greenberg (Courtesy)

To be more concrete, on the mental-illness side, there are an awful lot of co-morbid anxiety disorders, a lot of co-morbid PTSD-associated costs — those are examples where the same person who suffers from depression tends to have a higher likelihood of also incurring costs in these co-morbid categories.

But should those costs really count toward depression, when it’s technically another disorder that’s causing them?

Fair enough. That’s part of the age-old question of to what extent is this cause and what’s effect. Take the example of someone who suffers from cancer. It could be that in some instances, there’s an elevated cost of depression when you suffer from cancer. That’s one causal pathway where the depression likely follows the physical disorder. But in another instance, it could be that back pain or sleep disorders or migraines – those are examples of elevated physical disorder costs that accrue to depressed patients, likely as a result, at least in part, of the depression.

Here’s why it matters. If we’re more successful at treating the depression, there’s little or no hope it will alleviate any of the cancer costs. But if we’re more successful at treating depression, there’s a great opportunity to alleviate some or even a large part of those back pain, sleep disorder and migraine kinds of costs that are currently co-morbid with depression. Continue reading

On ‘Radio Open Source,’ An Intimate Look At Decades Of Depression

I’ve never met the Cambridge-based writer George Scialabba, but now I can’t stop thinking about him.

About his personal psychiatric records, from his decades of treatment for depression, so courageously shared in a recent piece he wrote in The Baffler: “The Endlessly Examined Life,” subtitled “A Most Chronic Depression.” And about his extraordinary recent interview with his friend, Christopher Lydon, on “Radio Open Source.” You can hear it in the podcast above.

Writer George Scialabba (Courtesy Radio Open Source)

Writer George Scialabba (Courtesy Radio Open Source)

The conversation is interspersed with dramatic readings of excerpts from George’s medical records, and it includes a bit of kind encouragement from one who knows:

One of the things that hurts most about depression is that you don’t really believe that it’s ever going to go away, get better. It just doesn’t seem like something with a plausible cause. So you can’t imagine what the remedy is. So people should tell you: “Look, eventually, everybody gets a little better. Some people are still mildly depressed, but virtually no one is acutely depressed for decades and decades — their whole life. It’ll get a little better, and probably a lot better. So hang on.”

So many of us know depression personally — one in 10 Americans, by an estimate that must set the bar very high — that I expect this powerful, double-platform exploration of George Scialabba’s experience will elicit very varying personal responses. “Radio Open Source’s” post about the interview includes just one comment, at last look, but it’s a gorgeous one, including this:

Well, you would think that this subject is not where you want to go in this particular winter of 2015. But it’s not about depression. Or not about only that. What it’s really about is what happened in spite of it or because of it; what happens climbing out of it, or trying to. I have had to learn and will probably have to learn again that we are not only our particular illness. It’s the illness, the suffering, the pain, which you can never convey (but need to try) even to the most sympathetic, that pain itself that is the door through which you walk to somewhere else. But also I think one needs to have something to grab onto — maybe the rope of creative expression and reaching out. Something.

One brief personal reaction: I like George’s theory that depression may be the result of faulty emotional “shock absorbers.” But I was most struck by the possibility that, after he ended his intense involvement in the religious order Opus Dei, he never fully recovered because he needed that involvement, perhaps that faith, to face life. He had a great big Human Condition problem more than a personal psychological problem. Just a thought. But it’s what I find most echoing in my mind. That, and the fact that his psychiatrists seemed to mean very well, and some surely did help him, but they came nowhere near a solution to the enduring mystery of his long emotional suffering.

Read excerpts of George’s medical records in the Baffler piece here, listen to the podcast above, and please share what echoes most for you.

Further listening: “Radio Open Source: The Untethered, Untenured Mind