depression

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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

Report: More College Freshmen Say They’re ‘Frequently’ Feeling Depressed

If you envision college life as an idyllic, carefree time filled with studies of classic literature and pondering the meaning of life at 2 a.m., think again. The reality of college today can be harsh.

For freshmen, in particular, navigating a new social, emotional and academic landscape can be extremely stressful. So it’s not terribly surprising that a new national survey of first-year college students finds, among other things, that more freshmen say they’re “frequently” feeling depressed.

According to the survey of more than 150,000 U.S. students conducted by researchers at UCLA, the emotional state of these young adults appears to be deteriorating:

In 2014, students’ self-rated emotional health dropped to 50.7%, its lowest level ever and 2.3 percentage points lower than the entering cohort of 2013. Additionally, the proportion of students who “frequently” felt depressed rose to 9.5%, 3.4 percentage points higher than in 2009 when feeling “frequently” depressed reached its lowest point. Self-rated emotional health and feeling depressed are very highly correlated…”

(Chrissy Hunt/Flickr)

(Chrissy Hunt/Flickr)

The survey suggests that students who say they’re depressed also tend to be more disconnected with college life in general:

Students who felt depressed more frequently reported behaviors reflecting disengagement. While these behaviors were not as widespread, students who were “frequently” depressed were about twice as likely to “frequently” come late to class (13.9%, compared to 7.2% for “occasionally” depressed and 5.5% for “not at all” depressed) and “frequently” fall asleep in class (14.1%, compared to 6.2% “occasionally” and 4.4% “not at all”). Further, more than half (56.6%) of the “frequently” depressed students reported that they were “frequently” bored in class, compared to 39.9% of those who reported being “occasionally” depressed and only 31.3% of those who were “not at all” depressed. They were also less likely to “frequently” engage with their classmates by studying with other students or working with other students on group projects.

I asked Steve Schlozman, associate director of The MGH Clay Center for Young Healthy Minds and an assistant professor of psychiatry at Harvard Medical School, for his thoughts on these findings. First he said, the word “depression” has become so ubiquitous in the popular vernacular that it’s not always clear in these kinds of surveys whether kids are describing clinical depression or simply the normal ebb and flow of emotional stress. Even so, he says, with regard to increased distress among college kids, “we are reaping what we sow.”

He explains further:

The pressure we put on high school kids to get into college and the pressure then that college follows up with is highly correlated with increased rates of emotional distress that can become full-blown depression. Also, the age of onset of depression is the exactly the age of onset of college — there’s a perfect storm of stressors. Finally, there’s a greater willingness to come forward, which is good. So, despite the fact that we’re using the word ‘depression’ a little more glibly, I’d rather have that and then rule out clinical depression through appropriate channels, like college health services, than miss cases that can lead to real suffering and possibly even death.

Continue reading

2014: CommonHealth Year Of The Brain, From Depression To Dyslexia

 

A map of nerve fibers in the human brain (. (Courtesy of Zeynep Saygin/Massachusetts Institute of Technology.)

A map of nerve fibers in the human brain (. (Courtesy of Zeynep Saygin/Massachusetts Institute of Technology.)

Happy almost 2015. Instead of doing our usual “Top 10 CommonHealth stories of the year” post, we’ve decided instead to look back at our tip-top, far-and-away #1 organ of the year for 2014.

Hint: It’s well above the waist. The brain is, to quote Pink Floyd: “All that you touch/All that you see/All that you taste/All you feel./All that you love/All that you hate/All you distrust/All you save.”

Etcetera. The brain is also the focus of some of the most fascinating research in modern-day science.

Our 2014 series, “Brain Matters: Reporting from the Front Lines of Neuroscience,” tried to capture a partial snapshot of this pivotal moment in brain science, a time of new tools and insights so promising that scientists themselves are saying this is the most exciting time ever to work on the brain.

The series included the set of gorgeous images below, compiled by former intern Suzanne E. Jacobs, and a collection of short video interviews with young neuroscientists, produced by WBUR’s Jesse Costa: 11 Young Neuroscientists Share Their Cutting Edge Research.

The individual “Brain Matters” pieces, in reverse chronological order:

Wishing you a wonderful new year. Special thanks to WBUR’s Iris Adler, who supervised the “Brain Matters” series. And now, for your visual pleasure, the wondrous view inside your head: Continue reading

Persistent Stigma, Skepticism About Mental Illness Causes Real Harm

By Dr. Steve Scholzman
Guest Contributor

Profound misunderstanding about mental illness — its causes, its legitimacy and its treatment — permeate our culture. And the stigma that accompanies this lack of understanding hurts, a lot. Take this example — hardly original or rare.

Imagine a 15-year-old adolescent girl with fairly severe depression. She may be a classmate of your child, or the daughter of a friend. Let’s call her Sally.

Sally’s not so ill that she needs to be in the hospital, but she’s close. Her family and I — her psychiatrist — are doing our best to get her better as quickly as possible so she can get back to school. She’s been out now for about three days. Why? She literally lacks the capacity to think clearly. It’s all she can do to drag herself out of her bed and run a toothbrush across her teeth.

(Michael Summers/Flickr)

(Michael Summers/Flickr)

There’s a big family history of depression so Sally’s parents are both familiar with and frightened by her struggles.

“Can you call the school and ask them to give her more time on some work?” the parents ask.

“Sure,” I say, and I get in touch with the school administrator.

“Well,” I’m told by the very well-meaning administrator, “It IS a tough time of year. The other kids are getting through it somehow. I don’t see why she should get special treatment.”

“Because she has the equivalent of the flu,” I say. I like to use analogies at these crossroads.

“But the flu feels awful. Does she have a fever? Because if she does, she shouldn’t come to school…”

“No, she doesn’t have a fever,” I say. I try another analogy. “What if she had been in a car accident, God forbid?”

“Well, that’s pretty different, isn’t it?”

“How?” I ask.

“She’d be hurt,” I’m told. “This is an entirely different thing. You’ll need to get her pediatrician to call.”

I ask the pediatrician to call, and I can feel his discomfort over the phone. “I’m not very good at making this case,” he acknowledges. “It’s probably better if you just call them back.”

(I have to wonder whether he’d be so uncomfortable if I were a gastroenterologist asking him to call the school about a patient with ulcerative colitis?) Continue reading

The Bionic Mind: Building Brain Implants To Fight Depression, PTSD

Liss Murphy this summer, with husband Brian, son Owen and sheepdog Ned. (Courtesy)

Liss Murphy, who had surgery to implant Deep Brain Stimulation for depression in 2006 and got much better, on Cape Cod in summer, 2014, with husband Scott, son Owen and sheepdog Ned. (Courtesy)

Ten years ago, with little warning, Liss Murphy fell victim to paralyzing depression, a “complete shutdown.”

She was 31, living in Chicago and working in public relations. The morning of Aug. 13, 2004, she had gone in to the office as usual. “It was Tuesday, and I remember the day so clearly,” she says. “The sun — everything — and I walked out — it was about 11 o’clock — and I never went back. The only time I left the house was to see my psychiatrist, who I saw three times a week.

“I have a hard time believing it was depression, in a way, because it was so pervasive and powerful,” she says. “It invaded every aspect of my life. It took so much away from me. And it happened so fast, and it was so degrading — it took everything from me.”

Murphy came home to Boston, and she tried everything — medications, talk therapy, even repeated rounds of electroshock. But she was barely able to get out of bed for months — then years. Her husband and family and top-flight doctors cared for her, but she sank so low she tried twice to commit suicide.

Finally, a psychiatrist told her about a cutting-edge trial to implant stimulation devices deep in the brains of patients with severe depression. She signed up. In June of 2006, she had the operation.

“My greatest hope that day was to have something go horribly wrong and die on the table,” she says. “I didn’t care.”

She didn’t die. Over the next few months, she got better. These days, eight years after the surgery, if you saw Liss Murphy walking her Old English Sheepdog, Ned, or playing with her 3-year-old son, Owen, only the faint silver scars on her clavicles would hint at anything unusual: That’s where the batteries that power her brain stimulator are implanted.

“We’re taking a wall of computers, basically, and putting it into something that would easily fit inside a box of Tic-Tacs.”

– Jim Moran, Draper Laboratory

But though the surgery changed Murphy’s life, “the trial, on average, didn’t work,” says Dr. Emad Eskandar, the Massachusetts General Hospital neurosurgeon who operated on her. “When you pooled everyone together it didn’t work. But there were like five people out of the 10 we did that had remarkable benefits and went into complete remission. We couldn’t continue with the study because on the average it failed, but for those people in whom it worked, boy did it work.”

Now, as part of a $70-million project funded by the military, researchers are aiming to take brain implants for psychiatric disorders to the next level.

Over the next five years, they aim to build a device that can sit inside a patient’s head, pick up the onset of depression or post-traumatic stress disorder, and head it off before it hits. One implant researcher calls it “a moonshot for the mind.” Continue reading

What Depression Stole From Me, What A Brain Implant Restored

Liss Murphy of Boston was one of the first people in the world to be successfully treated for severe depression with Deep Brain Stimulation, an electrical device implanted deep inside her brain. Now, researchers funded by the Department of Defense are trying to bring that technology to the next level, and use it to treat depression and PTSD. Here, she describes her own experience before and after the operation that changed — perhaps saved — her life.

By Liss Murphy
Guest contributor

What is depression?  After all this time, I should know. I don’t.

I know some things about depression, though. Depression is the ultimate subtractor, a thief. It erodes just about everything you are, you were, you have, you want. It takes the promise out of your existence. It destroys any semblance of hope or potential or desire or goodwill. Gone, it just is gone. It is utterly corrosive in a way that I still cannot understand.

Liss Murphy (Courtesy)

Liss Murphy (Courtesy)

Depression stripped my life of many things, of everything I knew at the time. It took away the promise of a normal day; the ability to enjoy and progress in my career and interests and relationships; the ability to think.

What follows is an attempt to make sense of the unknowns, of which there are many.  But also, what follows is a story of sickness, recovery, healing and acceptance.

What was it about August 13, 2004 that made the day what it was?

I have been told that I’d had depression before. Sure, I’d felt lousy, hopeless, tormented. But I was able to function. I could and did go on, as I needed to. It was not a roadblock.

This 2004 episode was different in every possible way. It descended on me overnight, it seems. Yes, I had been tearful and unhappy for a few weeks leading up to my crash, upset that my husband and I had separated. But so what?

It was the beginning of a complete system meltdown — a mental, physical, psychological, physiological meltdown. A total shutdown.

The details are foggy, though some of it seems so clear and vivid. It was a Tuesday, a gorgeous sunny August day. My office had a view of Lake Michigan. I walked out of the office mid-morning and never returned.  My computer was on, my running clothes, sneakers, other personal belongings in my office – waiting for me to return. But I never went back.

One important detail I cannot recall is whether I drove to work or took the subway.  I think I drove but … I am hung up on those details now. Because that day I did not just have a mental meltdown; it was the beginning of a complete system meltdown — a mental, physical, psychological, physiological meltdown. A total shutdown.

I can still see each room in my Chicago apartment as it was back then, as confused as I was. Each day, the rooms got more confusing, more messy, until it all blended into a universal squalor. I see images of brown rice boxes on the kitchen counter, dull steak knives, the tips of burning cigarettes against the hue of a bluish-purple sky just before nightfall. I slept on the couch. I stopped running, started smoking. After that day in August, I only left to see my psychiatrist, three or four times a week, until I came home to Boston.

It wasn’t feeling sad. It was feeling nothing. It was a total void of feeling. For two years, I was basically mute — totally withdrawn from everything. Continue reading

Opinion: Time To Lift The Black Box Warning On Antidepressants

Paxil, or paroxetine, an antidepressant that raised early alarms about possible suicidal effects in the United Kingdom. (Wikimedia Commons)

Paxil, or paroxetine, an antidepressant that raised early alarms about possible suicidal effects in the United Kingdom. (Wikimedia Commons)

By Drs. Steve Schlozman and Gene Beresin
Guest contributors

In 2004, the Food and Drug Administration made the difficult decision to apply a “black box” warning to virtually all antidepressant medications.

A few months earlier, British health officials had issued a similar warning for paroxetine, or Paxil, a frequently used antidepressant. Both the United States and the United Kingdom were worried about the possibility of antidepressant use in some people causing an increase in agitated, and even suicidal, behavior. The warnings, still in effect, apply particularly to adolescents.

But recent research suggests that perhaps the black box warning should itself have a black box warning. A new Harvard study suggests the warning has actually led to an increase in suicides because it caused a decrease in the treatment of depression through antidepressant prescriptions. Similar studies published back in 2007 showed a fairly dramatic increase in suicide attempts by adolescents, corresponding to a decrease in prescriptions for antidepressants. The Harvard study is a reiteration of these previous findings.

We believe it is time for the black box warning to be lifted. And we suspect that bias and ignorance may play a role in the fact that it has not been.

First, some background information.

A “black box warning” is a written message that by U.S. law must accompany every prescription for which the warning is indicated. Continue reading

Meditation ‘Overrated’? Not So Fast.

(RelaxingMusic/Flickr via Compfight)

(RelaxingMusic/Flickr via Compfight)

My doctor recently suggested I stop multi-tasking. Focus on one thing at a time, she said: our brains aren’t wired to take on the kind of intense juggling — from chauffeuring to food prep, extracurricular logistics, work strategies, worry over aging parents, anxiety about climate change — that many of us attempt (with varying degrees of success) every day.

For me, meditation and yoga offer a lifeline: a quiet sanctuary where focusing on one thing is the only thing required.

So I was slightly annoyed by the headline of a recent Scientific American story: “Is Meditation Overrated?”

The premise of the piece is this: Many people report that meditation improves their mood and relieves various symptoms of chronic stress and other health problems, BUT the data on this isn’t terribly robust. So, the story continues, “Johns Hopkins University researchers carefully reviewed published clinical trials and found that although meditation seems to provide modest relief for anxiety, depression and pain, more high-quality work is needed before the effect of meditation on other ailments can be judged.”

So shouldn’t the headline be: “Meditation Relieves Some Modern Woes; More Research Needed To Conclusively Prove Further Benefits?”

Or, my own personal headline: “Meditation Helps Me Scream At My Kids Less And Not Attack My Husband When There’s Yet Another Wet Towel On The Bed.” (See also, a new study, entitled: “I Am A Nice Person When I Do Yoga!!!)Continue reading