8 Reasons Why Your Depression May Not Be Getting Better

Psych Central Article Here

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You’ve been to four psychiatrists and tried over a dozen medication combinations. You still wake up with that dreadful knot in your stomach and wonder if you will ever feel better.

Some people enjoy a straight path to remission. They get diagnosed. They get a prescription. They feel better. Others’ road to recovery isn’t so linear. It’s full of winding bends and dead-ends. Sometimes it’s entirely blocked. By what? Here are a few impediments to treatment to consider if your symptoms aren’t improving.

1. The Wrong Care

Take it from the Goldilocks of mental health. I worked with six physicians and tried 23 medication combinations before I found the right psychiatrist who has kept me (relatively) well for the last 13 years. If you have a complex disorder like I do, you can’t afford to work with the wrong doctor. I would highly recommend that you schedule a consultation with a mood disorders center at a teaching hospital near you. The National Network of Depression Centers lists 22 Centers of Excellence located across the country. Start there.

2. The Wrong Diagnosis

According to the Johns Hopkins Depression & Anxiety Bulletin, the average patient with bipolar disorder takes approximately 10 years to receive the proper diagnosis. About 56 percent are first diagnosed incorrectly with major depressive disorder, leading to treatment with antidepressantsalone, which can sometimes trigger mania.

In a study published in the Archives of General Psychiatry, only 40 percent of participants were receiving appropriate medication. It’s pretty simple: if you’re not diagnosed correctly, you won’t get the proper treatment.

3. Non-adherence to Medication

According to Kay Redfield Jamison, Ph.D., Professor of Psychiatry at Johns Hopkins University and author of An Unquiet Mind, “The major clinical problem in treating bipolar illness is not that we lack effective medications. It is that bipolar patients do not take these medications.” Approximately 40 to 45 percent of bipolar patients do not take their medications as prescribed. I’m guessing the numbers for other mood disorders are about that high. The primary reasons for non-adherence are living alone and substance abuse.

Before you make any major changes in your treatment plan, ask yourself if you are taking your meds as prescribed.

4. Underlying Medical Conditions

The physical and emotional toll of chronic illness can muddy the progress of treatment from a mood disorder. Some conditions like Parkinson’s disease or a stroke alter brain chemistry. Others like arthritis or diabetes impact sleep, appetite, and functionality. Certain conditions like hypothyroidism, low blood sugar, vitamin D deficiency, and dehydration feel like depression. To further complicate matters, some medications to treat chronic conditions interfere with psych meds.

Sometimes you need to work with an internist or primary care physician to address the underlying condition in tandem with a mental health professional.

5. Substance Abuse and Addiction

According to the National Institute on Drug Abuse (NIDA), people who are addicted to drugs are approximately twice as likely to have mood and anxiety disorders and vice versa. About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder.

The depression-addiction link is both strong and detrimental because one condition often complicates and worsens the other. Some drugs and substances interfere with the absorption of psych meds, preventing proper treatment.

6. Lack of Sleep

In a Johns Hopkins survey, 80 percent of people experiencing symptoms of depression also suffered from sleeplessness. The more severe the depression, the more likely the person will have sleep problems. The reverse is also true. Chronic insomnia creates a risk for developing depression and other mood disorders, including anxiety, and interferes with treatment. In persons with bipolar disorder, inadequate sleep can trigger a manic episode and mood cycling.

Sleep is critical to healing. When we rest, the brain forms new pathways that promote emotional resilience.

7. Unresolved Trauma

One theory of depression suggests that any major disruption early in life, like trauma, abuse, or neglect, may contribute to permanent changes in the brain. According to psychiatric geneticist James Potash, M.D., stress can trigger a cascade of steroid hormones that likely alters the hippocampus and leads to depression.

Trauma partly explains why one-third of people with depression don’t respond to antidepressants. In a study recently published in Scientific Reports, researchers uncovered three subtypes of depression. Patients with increased functional connectivity between different brain regions who had also experienced childhood trauma were categorized with a subtype of depression that was unresponsive to selective serotonin reuptake inhibitors like Zoloft and Prozac. Sometimes, then, intensive psychotherapy needs to happen alongside medical treatment in order to reach remission.

8. Lack of Support

review of studies published in General Hospital Psychiatry assessed the link between peer support and depression and found that peer support helped reduce symptoms of depression. In another study published by Preventive Medicine, teens who had social support were significantly less likely to become depressed after experiencing work or financial stress in early adulthood than those without support. Depression was identified among conditions affected by loneliness in a paper published in the American Journal of Public Health. Persons without a support network may not heal as quickly or as completely as those with one.

 

6 Ways Depression Changes As You Get Older, According To Science

Bustle Article
By JR Thorpe

It was my birthday yesterday (thank you, thank you), and this year marks a decade since my diagnosis with Major Depressive Disorder, or MDD. A lot has changed in the intervening ten years, but realistically, it’s likely that I’ll have MDD for the remainder of my life — and that’s an interesting situation, because research reveals that depression itself doesn’t remain static. As we get older, depressive symptoms can change, both in relation to life events (grief, upheaval, breakups) and natural physiological shifts. However, a lot of the time depression is still depicted as a monolith: a diagnosis with the same symptoms and treatments throughout your life. The truth is a lot more dynamic.

There are various types of depression, and it’s important to note that my diagnosis is distinct from situational depression, which is depression that develops in response to trauma and sad events. MDD sticks around even when there’s nothing apparently triggering it. It’s not more or less serious than other kinds of depression. However, it’s important that anybody with a depression diagnosis — and anyone who may have noted it in their family — knows how age can cause flare-ups and change symptoms. Here are six ways depression can change as you age.

1. Depression Can Change The Way Your Body Ages

Giphy

In 2018, scientists discovered that depression ages both our bodies and our brains. One study found that having depression prematurely ages your DNA, making it appear older by an average of around eight months, which has a series of knock-on effects on cells and chromosomes. Depression not only changes as we age; we physically change in response to it.

2. It Can Change Your Brain, Too

Another 2018 study of 71,000 people found that if you have depression, your brain ages faster, experiencing cognitive decline, memory loss, and slowdowns in processing information at an earlier age. “Cognitive function may need to be monitored closely in individuals with affective disorders, as these individuals may be at particular risk of greater cognitive decline,” the scientists wrote. Unfortunately he more cognitive decline experienced, the worse depressive symptoms can get.

3. Depressive Symptoms Can Appear For The First Time As You Age

RK Studio/Shutterstock

While depression can crop up when we’re young, it can also turn up for the first time past the age of 50. A 2015 study found that depression diagnoses increase from the ages of 65 to 85. Part of this is likely due to the issues of aging in general; the Cleveland Clinic has noted that an increase in health issues, loneliness, and grief as we age can be the trigger for depression and depressive feelings.

It’s not just about old age, though. A study in 2014 found that middle-aged women, between 40 and 59, had the highest proportion of depression diagnoses in the United States. There was a slight dip in diagnoses after the age of 60 before an increase again.

4. Age At Menopause Can Affect Depression, Too

Menopause may feel like a long way off, but studies show it seems to affect depressive symptoms too. A study in 2016 published in JAMA Psychiatry found a link between the age at which people hit menopause and their level of depression symptoms. The later they experienced menopause after the age of 40, the less likely they were to have depression.

The scientists said in a press release that “a potentially protective effect of increasing duration of exposure to endogenous estrogens […] as well as by the duration of the reproductive period” might be responsible for lowering depression risk; in other words, the longer we menstruate throughout our lives, the more we’re protected against hormonal-induced depression when menstruation ends.

5. Your Response To Anti-Depressants Can Change Over Time

Lightfield Studios/Shutterstock

Many people with depression will take anti-depressants for a long time, but it’s possible that as we age, our reactions to those medications changes. “It may be that over time certain medications lose their effectiveness or there could be biochemical changes that occur with age,” Dr. Kristina Randle wrote for Psych Central in 2018. “It is important to report your symptoms to your prescribing physician so that he or she may make the necessary adjustments.”

The Mayo Clinic identifies age as a potential reason for antidepressants losing their effectiveness, noting, “As you get older, you may have changes in your brain and thinking (neurological changes) that affect your mood. In addition, the manner in which your body processes medications may be less efficient. You’re also likely to be taking more medications.” Those factors combined can make antidepressants less useful as you age, requiring dosage changes.

6. Your Levels Of This Vitamin May Lead To Greater Depression Risk

For women, a particular consequence of aging can change our depression: folate. “Recent studies suggest that lower concentrations of folate in the blood and nervous system may contribute to depression, mental impairment and dementia,” notes the American Psychological Association. Folate is a B vitamin, and pregnant women are often told to take more folic acid to reduce the risk of miscarriage, but it also has a role in mental health more generally.

Some of us may naturally have lower folate levels, which can lead to problems with antidepressants, depression and anxiety expert Christine Borchard wrote for Everyday Health: up to 40 percent of the U.S. population has a genetic modification that makes folate conversion difficult. However, folate deficiency also increases with age. Studies have repeatedly found that the older you are, the more likely you are to have low folate levels, across numerous populations around the world. As we age, our dipping folate levels may contribute to more depressive symptoms over time.

Depression and age make for a powerful and difficult combination. One thing’s clear: there’s no such thing as a fixed, unchanging depression diagnosis. As we change and age, so does depression.

If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.

 

Some People Can Thrive After Depression, Study Finds

Author Article
We may think of depression as a recurring condition with a gloomy prognosis, but findings from one study indicate that nearly 10% of adults in the United States with major depression were thriving ten years later. The findings, which appear in Clinical Psychological Science, suggest that some people with depression experience more than a reduction in depressive symptoms over time – they can achieve optimal psychological well-being.

Writing for The Conversation, lead investigator Jonathan Rottenberg, a researcher at the University of South Florida, discusses how clinical scientists often neglect the potential for positive outcomes among individuals with depression.

“Depression can be a lifelong problem. Yet as we dug deeper into the epidemiological findings, we also saw signs of better outcomes – an aspect that we found is rarely investigated,” he says.

Although current clinical practice emphasizes symptom reduction and achieving an absence of stress, evidence indicates that patients prioritize other measures of well-being.

“They want to love and be loved, be engaged in the present moment, extract joy and meaning, and do something that matters – something that makes the pain and setbacks of daily life worthwhile,” says Rottenberg.

Rottenberg and his colleagues found that a substantial percentage of those with depression can achieve just that.

Using data from the Midlife Development in the United Stated (MIDUS) study, the researchers examined outcomes in a nationally representative sample of middle-aged adults. The participants completed phone interviews and questionnaires, including a measure of depression and a battery of nine facets of well-being including autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, self-acceptance, life satisfaction, and negative and positive affect.

A total of 239 participants in the sample met the criteria for depression, meaning that they experienced depressed mood most of the day or every day, as well as additional symptoms, for at least 2 weeks out of the previous 12 months. The researchers reviewed data from the initial screening and a follow-up survey completed 10 years later.

At the 10-year follow-up, half of the participants reported experiencing no major symptoms of depression in the past 12 months, and almost 10% of the participants with a history of depression were thriving. To count as thriving, a participant had to show no evidence of depression and score higher than 75% of nondepressed MIDUS participants on the nine factors of psychological well-being.

Higher well-being at beginning of the study predicted thriving 10 years later, but severity of depression did not. Specifically, depressed adults who reported higher well-being at the beginning of the study had a 30% chance of thriving, compared with a 1% chance for participants who had low well-being when they began the study. Depressed participants with higher well-being at the beginning of the study and who were thriving at the end of the study had larger increases in well-being over time than did other depressed participants.

These findings could influence how mental health professionals think about the prognosis associated with depression, as well as how they communicate this prognosis to patients. The study suggests that treatment could focus on strategies for optimizing well-being optimization that go beyond just managing symptoms.

“The task now for researchers is to follow these encouraging signs with systematic data collection on how people thrive after depression,” says Rottenberg.

Reference

Rottenberg, J., Devendorf, A. R., Panaite, V., Disabato, D. J., & Kashdan, T. B. (2019). Optimal well-being after major depression. Clinical Psychological Science. https://doi.org/10.1177%2F2167702618812708

Sometimes Depression Means Not Feeling Anything At All

Author Article

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This article originally appeared on Tonic in the US.

I never realized how little I knew about depression until I became depressed. I didn’t know, for instance, how depression can snatch away your sex drive, leaving you feeling newly—and involuntarily—asexual. I didn’t know that depression attacks your attention span, your energy, and your ability to finish things. During a recent bout, I had trouble finishing magazine articles and movies. The number of emails I sent plummeted. Everyday errands felt like Herculean tasks.

But perhaps most surprising was the emotional numbness. Nothing about hearing the word “depression” prepares you for having a moment of eye contact with your two-year-old niece that you know ought to melt my heart—but it doesn’t. Or for sitting at a funeral for a friend, surrounded by sobs and sniffles, and wondering, with a mix of guilt and alarm, why you’re not feeling more. 

During my recent depression spell, I experienced this kind of numbness for weeks. Political news that would have previously enraged me left me cold. Music had little effect beyond stirring memories of how it used to make me feel. Jokes were unfunny. Books were uninteresting. Food was unappetizing. I felt, as Phillip Lopate wrote in his uncannily accurate poem “Numbness,” “precisely nothing.”

And this was new to me. Because while I had been in and out of depression before, I still, like many people, didn’t fully grasp an illness that affected 16 million Americans in 2015. (That’s more than the combined populations of New York City, LA, and Chicago.) “It’s ubiquitous,” the author of The Noonday Demon: An Atlas of Depression, Andrew Solomon, tells me. “[And yet] I think the public doesn’t really understand it well at all.”

The Diagnostic and Statistical Manual of Mental Disorders says, for a person to be diagnosed with Major Depressive Disorder, they need to experience “Depressed mood most of the day, nearly every day” or “markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day” for a period of two weeks. But this is just the baseline. For a diagnosis to be made, the person must also report at least four additional symptoms from a list that includes significant weight loss or weight gain, an inability to sleep or excessive sleepiness, physical restlessness or slowness (“psychomotor agitation or retardation,” in clinical terms), frequent fatigue or energy loss, feelings of worthlessness or excessive guilt, indecision or a diminished ability to concentrate, and recurring thoughts of death or suicide.

“It’s truly amazing to me, the longer I’ve been in the field, how many manifestations of depression there can be in the body,” says Jennifer Payne, a professor of psychiatry and director of the Women’s Mood Disorders Center at Johns Hopkins School of Medicine. These can range from headaches to GI issues to various pain syndromes, and depression can also exacerbate existing conditions, like diabetes or high blood pressure. “If you take two women with the same breast cancer, one’s depressed [and] one’s not, the woman who’s depressed has twice the chance of dying from her breast cancer,” Payne says.


During my conversations with Payne and other medical experts, I began to understand just how vast and multifaceted this illness can be. Depression can be visible or invisible to a person’s loved ones. It can last for weeks, years, or even decades. It can affect sleep, concentration, appetite, energy, memory, movement, and—as I know well from trying to write while depressed —a person’s facility with language.

A particularly scary aspect is the fact that hopelessness and helplessness are actually symptoms of the illness. Stanford University’s David Spiegel, a professor of psychiatry and behavioral sciences and director of the school’s Center on Stress and Health, tells me that depression is a common, treatable mental disorder, but people it afflicts can blame themselves for things that aren’t their fault. “And so depressed people often feel guilty about being depressed and not performing the way they should,” he says. “And that’s part of the disease…[that] keeps them from digging their way out, or getting help from people to dig their way out.”

And the causes of the illness can be as varied as the symptoms. Emory University’s Nadine Kaslow, a professor of psychiatry and behavioral sciences, tells me that, with some people, depression is more genetically driven, while others experience it as reaction to external stress. She runs off a long list of the circumstances that can trigger depression: loss of a loved one, job, or key identity; things that cause feelings of failure, shame, or humiliation; a natural disaster that overturns your life, like the recent hurricanes in Texas, Florida, and Puerto Rico; financial woes and anxiety; child abuse; domestic violence.

We also know that depression can be devilishly impervious to happy events. Readers of William Styron’s Darkness Visible: A Memoir of Madness, may remember how he describes receiving a prestigious literary prize in Paris, a check for $25,000, and royal treatment from his hosts, all while feeling what he describes as “panic…dislocation, and a sense that my thought processes were being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world.”

The more I dug into my reporting, it also became clear how many things depression is not. It is not the fault of the person afflicted, nor is it necessarily in their control to “snap out of it” or “pull themselves up by their bootstraps.” (These two points really can’t be stressed enough.) And it certainly is not merely feeling sad. “People who have never experienced depression think, ‘Well, I pulled myself together after a rough time,’ and they don’t understand the intense physicality, the immediacy, and the incontrovertibility of the condition,” Solomon says. It’s tempting to envision depression as an extreme point on a mood spectrum, he adds, but it’s really the mood spectrum shutting down altogether. The word he used frequently in our conversation was a feeling of “nullity.” And in his TED talkon depression, he repeats the sentence, “The opposite of depression is not happiness, but vitality.”

The British author Matt Haig recently tweeted, “Everyone is comfortable so long as you talk about mental illness in the past tense.” And I admit, it’s easier for me to write this piece after my recent bout of depression passed. When I share it with people I know, I can truthfully say, “I feel much better now,” and spare us both a less comfortable conversation. But being outside of a depressive spell (at least for now; I have little doubt I’ll return at some point) also allows me an interesting journalistic perspective.

One point worth making—and I say this as a mostly non-religious person—is that emotions are a sacred, miraculous thing. You realize this when you lose them. I don’t think I’ve ever felt so happy to feel angry as the recent day when, after reading about some recent political horror, I felt my first stirrings of moral outrage in months. I was offended again—and it was beautiful. Other revelatory moments followed, like household appliances flickering back on after a power outage: the return of that almost-crying lump in my throat during emotional movies, or the burst of spontaneous laughter when I heard a joke. A few weeks ago, I drove home after an errand and stayed in my car for a minute just to soak in the old-but-new joy I from a song I had recently discovered.

But even as I exit my latest depressive spell, I remain mindful of the people who are still there. I know what it means to smile for a photo and feel like you’re lying. I know what it means to feel a vague sense of sadness over not feeling sadness. I know what it means to comb the Internet for a video, an article, a book, that explains what’s going on inside your seemingly broken brain. To know depression is to become familiar with one of its paradoxes: the feeling that you’re missing out on the full human experience is, in fact, a large part of the human experience.

This is where friends and family can help. Odds are that you know someone who has been, or will be, depressed at some point. And so being a vigilant friend and family member means keeping an eye out for the person who’s less and less socially active. Stay aware of the co-worker for whom it appears, as one expert told me, “like the light in their eyes is gone.” Check in with them. Call them. Visit with them.

The brain is a complex and crucial organ that represents humans’ major evolutionary advantage over other animals, Spiegel tells me. And sometimes it has problems working. When this happens, it’s not a judgment on the person affected, he says. “It’s a problem that sometimes comes up when you’re dealing with using a complex organ to deal with complex problems in life.”

It’s easy to fix a bike or a car when they break, he continues, but your brain is complicated. “So get help with it if it’s not working right.”

 

Child Abuse May Change Brain Structure And Make Depression Worse

Author Article

A study of over a hundred people’s brains suggests that abuse during childhood is linked to changes in brain structure that may make depression more severe in later life.

Nils Opel at the University of Münster, Germany, and his colleagues scanned the brains of 110 adults hospitalised for major depressive disorder and asked them about the severity of their depression and whether they had experienced neglect or emotional, sexual or physical abuse during childhood.

Statistical analysis revealed that those who experienced childhood abuse were more likely to have a smaller insular cortex – a brain region involved in emotional awareness.

Over the following two years, 75 of the adults experienced another bout of depression. The team found that those who had both a history of childhood abuse and a smaller insular cortex were more likely to have a relapse.

“This is pointing to a mechanism: that childhood trauma leads to brain structure alterations, and these lead to recurrence of depression and worse outcomes,” says Opel.

The findings suggest that people with depression who experienced abuse as children could need specialised treatment, he says.

Brain changes can be reversible, says Opel, and the team is planning to test which types of therapies might work best for this group.

Journal reference: Lancet Psychiatry, DOI: 10.1016/S2215-0366(19)30044-6

Why Do Antidepressants Fail For Some?

Author Article

Serotonin is the chemical messenger that has a major impact on feelings of happiness and wellbeing.

Scientists have long suspected that disruption in serotonin brain circuits is a key factor in major depressive disorder. Selective serotonin reuptake inhibitors (SSRIs) are a significant class of drug that seeks to remedy this disruption by increasing serotonin levels at nerve junctions.

However, for reasons that have been unclear, SSRIs do not work for around 30 percent of people with major depression. Now, researchers from the Salk Institute for Biological Studies in La Jolla, CA, and the Mayo Clinic in Rochester, MN, may have solved the mystery.

A Molecular Psychiatry paper describes how, by studying cells from hundreds of people with major depression, the team uncovered differences that could explain resistance to SSRIs.

“These results,” says senior study author Fred H. Gage, who is president of the Salk Institute and also a professor in their Laboratory of Genetics, “contribute to a new way of examining, understanding, and addressing depression.”

He and his colleagues believe that their findings also offer insights into other psychiatric illnesses that involve disruption of the brain’s serotonin system, such as schizophrenia and bipolar disorder.

Depression and nerve cell response to SSRIs
Depression is a leading cause of disability that affects all ages and contributes in a major way to the “global burden of disease,” according to the World Health Organization (WHO). The United Nations agency estimate that there are around 300 million people worldwide living with this widespread psychiatric condition.

In the United States, the National Institutes of Health (NIH) suggest that in 2017 around 17.3 million adults, or 7.1 percent of all adults, reported having “at least one major depressive episode” in the previous 12 months.

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For the recent study, the scientists took skin cells from more than 800 people with major depression and turned the cells into stem cells.

They then coaxed the stem cells to mature into “serotonergic neurons,” which are the nerve cells that make up the brain circuitry for producing and using serotonin.

The team compared serotonergic neurons of “SSRI non-responders” with those of “SSRI responders.” The non-responders were those individuals with depression whose symptoms showed no improvement, while the responders were those whose symptoms showed the most dramatic improvement to treatment with SSRIs.

In previous work, the researchers had demonstrated that cells from SSRI non-responders had more serotonin receptors, causing them to overreact to the chemical messenger.

Structural differences in nerve cells
The new study explored a different facet of SSRI non-response at the cell level. It found no differences between SSRI responder and non-responder cells in terms of the biochemistry of serotonin. However, it did reveal some fundamental structural differences in the cells.

These differences were in the shape and growth of neurites — or projections — that carry signals to and from nerve cells.

The development of the nervous system relies on tight control of neurite growth. Disruption of this process, according to a 2018 study, can lead to “developmental and neurological disorders.”

The team found that the nerve cells of SSRI non-responders had much longer neurites than those of SSRI responders. Genetic analysis also uncovered much weaker expression of the genes PCDHA6 and PCDHA8 in the non-responder cells.

These two genes belong to the protocadherin family and play a key role in the growth and formation of nerve cells and brain circuits.

When they silenced PCDHA6 and PCDHA8 in healthy serotonergic neurons, the researchers found that these also grew unusually long neurites, just like the nerve cells of SSRI non-responders.

Having neurites of the wrong length can disrupt communication in serotonin brain circuits with some regions having too much traffic and others not enough. This could explain, says the team, why SSRIs sometimes fail to treat major depression.

“This paper,” Prof. Gage concludes, “along with another we recently published, not only provides insights into this common treatment but also suggests that other drugs, such as serotonergic antagonists, could be additional options for some patients.”

The team now intends to take a closer look at the role of the two protocadherin genes in SSRI non-responders.

“With each new study, we move closer to a fuller understanding of the complex, neural circuitry underlying neuropsychiatric diseases, including major depression.”

Prof. Fred H. Gage

What You Need to Know if You’re Dating Someone With Depression

Author Article

DEAR DR. JENN,

When my boyfriend and I first started dating, he told me that he struggled with depression. In retrospect, I think I was naive. I didn’t realize how much it would impact me and our relationship. What can I do to help him? What can I do do help our relationship when he’s struggling? —Down (Not Out)

DEAR DOWN,

You are not alone and neither is your boyfriend: According to the American Psychological Association, as many as 17 million adults in this country suffer from depression. Depression does not discriminate based on age, socioeconomics, fame or success. In fact, many celebrities have spoken openly about their own difficulties with depression, including Lady GagaKristen Bell. Most recently, reports have come out that the newly married Justin Bieber, while thrilled with his marriage to Hailey Baldwin, has been struggling with depression and has undergone treatment for it. This really speaks to depression being an underlying issue and not a reflection of someone’s relationship. That said, it impacts a relationship enormously. Studies have shown that relationships where at least one partner suffers from depression have a divorce rate that’s nine times higher than the average. Understanding the signs and difficulties that depression can bring, and exactly how to get help, are crucial to keeping yourself — and your partnership — on an even keel when tides get rough.

The symptoms of depression can vary from upsetting and concerning to debilitating, and it’s obvious how this would impact a relationship. It is common to see sufferers struggle with apathy, hopelessness, loss of joy or interest in things that once brought pleasure, mood swings, exhaustion, obsessive thinking, sadness and anxiety. And in terms of lifestyle or behavior, depression can impact sleep (insomnia or sleeping too much), eating (loss of appetite or overeating), energy (low energy or restlessness), and cognitive ability.

Often, depression in men shows up up differently, in the form of agitation, irritability or anger. While anyone can experience depression related to a life event — a death of a loved one, loss of a job, traumadivorce, e.g. — certain people are more prone to general depression. People who have one or both parents who struggle with depression, have experienced abuse, suffered from neglect growing up, and people who have drug or alcohol issues are among those who can be predisposed to depression. Whether your partner is dealing with a-once-in-a-while down mood, or has been diagnosed with a mental illness that will be part of your lives for good, here’s what you need to know.

It’s Not About You

Depression greatly impacts the way a person thinks. It creates a lot of negative filters when it comes to how a person views the world. Someone who is depressed tends to see the glass as half-empty and anticipate the worst a situation or person can offer. They typically do not feel worthy of love, kindness and care. They may appear lethargic or lazy when in fact they are just too physically exhausted from the depression to do much of anything. Many people who are depressed feel emotionally numb or sad much of the time.

RELATED: I Thought I Needed Klonopin — Turns Out I Needed a Divorce

Keep in mind that his depression is not a reflection of you or your relationship. (Think of Justin Bieber and how over the moon he is for Hailey, even while he says he’s “struggling a lot” and asking for prayers and healing.) While it impacts you, this is your partner’s own struggle and it is important not to take it personally. Separating yourself from the “cause” or reason your partner is depressed can help you better support him. Understand that even if it’s hard for him to take action against depression, he does not want to be depressed. Depression is not a choice. Do not feel blamed or attacked for it “happening to” you or your relationship; and speak about it with empathy. Getting mad at someone for suffering from depression is like getting angry at someone for having cancer.

View Getting Help as a Sign of Strength

The single most important thing you can do to help your boyfriend is to encourage him to get treatment. In a more general sense, creating a judgment-free zone where he can be vulnerable and talk about his struggle can be very healing. Anything you can do to help reduce his stress and lighten the load while he is struggling can be helpful.

In order for you to help your partner, it is very important that he be open to help. Too many people who struggle with depression mistakenly think that getting help is a weakness. A woman recently wrote to me on Instagram saying that she had been “so weak” that she started therapy. The opposite is true. Getting help shows enormous strength. It is brave to be willing to face your pain, work on making things better, and be honest about your emotional state. Many people are too afraid to do the work. It is important that your boyfriend knows that you view this as a strength.

And the “work” shouldn’t be seen as insurmountable. Depression is extremely treatable. It is the common cold of psychotherapy, and something every licensed therapist knows how to handle. Psychotherapy can be very helpful treatment. For those who are experiencing depression that is more resistant to psychotherapy, the combination of antidepressants along with talk therapy can be extremely effective. Helping your boyfriend to utilize whatever support system he has is important. People who are depressed tend to isolate from those who love them, which only feeds their depression. In addition, encouraging him to take good care of himself is an important component of treating depression and even preventing it. Encouraging him to get enough sleep, eat healthy, get sunlight, exercise, and utilize stress reduction techniques can help.

RELATED: How to Salvage Your Sexless Marriage

De-Stress Your Sex Life

Depression will impact your sex life together. It can kill a person’s libido, or simply challenge intimacy as it makes your boyfriend struggle to connect. If he is pulling away from you in bed, it does not mean he is not sexually attracted to you, it is the result of a chemical imbalance. And unfortunately, some antidepressant medications can lower libido, too. Do your best to work together to address these issues. You won’t want to put pressure on him to perform, as that could exacerbate the problem. Each person should have space to express their wants and needs, and the safety to know their boundaries will be respected. Proceed with care.

Look Out for You, Too

Men who suffer from depression often experience it as anger, meaning they have a short fuse and can be very moody. It is also not uncommon for them to self-medicate with drugs or alcohol which can have terrible results in terms of mood and temperament with their partner. It is important that you have good boundaries and self-care when it comes to how he treats you. If his illness manifests in poor treatment of you, or abuse of any kind, you may not be able to stay together. If someone is unwilling to get help and is consistently mistreating you — as hard as it can be to leave someone you love — sometimes you have to leave for your own well-being. You are allowed to do this, even if the other person is suffering from mental illness. You are not expected to endanger or harm yourself out of a sense of guilt for what the other is going through.

Call for Help

In some severe cases, people with depression may become suicidal. If your boyfriend expresses anything along those lines it should be taken very seriously. It is important to share with his therapist if he has one, family and support system, especially if it seems as if he isn’t addressing it how he needs to. Sometimes it is necessary to call authorities so they can determine if he’s a danger to himself, and needs to be checked into a hospital where they can monitor and treat him. (This is called “50150,” and can be a life-saving measure.) Another resource if you are concerned about suicidality is the Suicide Prevention Hotline (there’s a web chat, or you can call 1-800-273-8255). That can be a resource for you, for him, or for anyone else who is concerned.

How New Ketamine Drug Helps with Depression

Author Article

An illustration of a woman suffering from depression who might be helped by esketamine

The FDA approval of esketamine gives doctors another valuable tool in their arsenal against depression—and offers new hope for patients no one had been able to help before. “This is a game changer,” says John Krystal, MD, chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the country.

On March 5, the Food and Drug Administration (FDA) approved the first truly new medication for major depression in decades. The drug is a nasal spray called esketamine, derived from ketamine—an anesthetic that has made waves for its surprising antidepressant effect.

Because treatment with esketamine might be so helpful to patients with treatment-resistant depression (meaning standard treatments had not helped them), the FDA expedited the approval process to make it more quickly available. In one study, 70 percent of patients with treatment-resistant depression who were started on an oral antidepressant and intranasal esketamine improved, compared to just over half in the group that did not receive the medication (called the placebo group).

“This is a game changer,” says John Krystal, MD, chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the country. The drug works differently than those used previously, he notes, calling ketamine “the anti-medication” medication. “With most medications, like valium, the anti-anxiety effect you get only lasts when it is in your system. When the valium goes away, you can get rebound anxiety. When you take ketamine, it triggers reactions in your cortex that enable brain connections to regrow. It’s the reaction to ketamine, not the presence of ketamine in the body that constitutes its effects,” he says.

And this is exactly what makes ketamine unique as an antidepressant, says Dr. Krystal.

However, as the nasal spray becomes available via prescription, patients have questions: How does it work? Is it safe? And who should get it? Read on for answers.

How do antidepressants work?

Research into ketamine as an antidepressant began in the 1990s with Dr. Krystal and his colleagues Dennis Charney, MD, and Ronald Duman, PhD, at the Yale School of Medicine. At the time (as is still mostly true today) depression was considered a “black box” disease, meaning that little was known about its cause.

One popular theory was the serotonin hypothesis, which asserted that people with depression had low levels of a neurotransmitter called serotonin. This hypothesis came about by accident—certain drugs given to treat other diseases like high blood pressure and tuberculosis seemed to drastically affect people’s moods. Those that lowered serotonin levels caused depression-like symptoms; others that raised serotonin levels created euphoric-like feelings in depressed patients. This discovery ushered in a new class of drugs meant to treat depression, known as selective serotonin reuptake inhibitors (SSRIs). The first one developed for the mass market was Prozac.

But eventually it became clear that the serotonin hypothesis didn’t fully explain depression. Not only were SSRIs of limited help to more than one-third of people given them for depression, but growing research showed that the neurotransmitters these drugs target (like serotonin) account for less than 20 percent of the neurotransmitters in a person’s brain. The other 80 percent are neurotransmitters called GABA and glutamate.

GABA and glutamate were known to play a role in seizure disorders and schizophrenia. Together, the two neurotransmitters form a complex push-and-pull response, sparking and stopping electrical activity in the brain. Researchers believe they may be responsible for regulating the majority of brain activity, including mood.

What’s more, intense stress can alter glutamate signaling in the brain and have effects on the neurons that make them less adaptable and less able to communicate with other neurons.

This means stress and depression themselves make it harder to deal with negative events, a cycle that can make matters even worse for people struggling with difficult life events.

Ketamine—from anesthetic to depression “miracle drug”

Interestingly, studies from Yale research labs showed that the drug ketamine, which was widely used as anesthesia during surgeries, triggers glutamate production, which, in a complex, cascading series of events, prompts the brain to form new neural connections. This makes the brain more adaptable and able to create new pathways, and gives patients the opportunity to develop more positive thoughts and behaviors. This was an effect that had not been seen before, even with traditional antidepressants.

“I think the interesting and exciting part of this discovery is that it came largely out of basic neuroscience research, instead of by chance,” says Gerard Sanacora, MD, PhD, a psychiatrist at Yale Medicine who was also involved in many of the ketamine studies. “It wasn’t just, ‘let’s try this drug and see what happens.’ There was increasing evidence suggesting that there was some abnormality within the glutamatergic system in the brains of people suffering from depression, and this prompted the idea of using a drug that targets this system.”

For the last two decades, researchers at Yale have led ketamine research by experimenting with using subanesthetic doses of ketamine delivered intravenously in controlled clinic settings for patients with severe depression who have not improved with standard antidepressant treatments. The results have been dramatic: In several studies, more than half of participants show a significant decrease in depression symptoms after just 24 hours. These are patients who felt no meaningful improvement on other antidepressant medications.

Most important for people to know, however, is that ketamine needs to be part of a more comprehensive treatment plan for depression. “Patients will call me up and say they don’t want any other medication or psychotherapy, they just want ketamine, and I have to explain to them that it is very unlikely that a single dose, or even several doses of ketamine alone, will cure their depression,” says Dr. Sanacora. Instead, he explains, “I tell them it may provide rapid benefits that can be sustained with comprehensive treatment plans that could include ongoing treatments with ketamine.  Additionally, it appears to help facilitate the creation new neural pathways that can help them develop resiliency and protect against the return of the depression.”

This is why Dr. Sanacora believes that ketamine may be most effective when combined with cognitive behavioral therapy (CBT). CBT is a type of psychotherapy that helps patients learn more productive attitudes and behaviors. Ongoing research, including clinical trials, addressing this idea are currently underway here at Yale.

A more patient-friendly version

The FDA-approved drug esketamine is one version of the ketamine molecule, and makes up half of what is found in the commonly used anesthetic form of the drug. It works similarly, but its chemical makeup allows it to bind more tightly to the NMDA glutamate receptors, making it two to five times more potent. This means that patients need a lower dose of esketamine than they do ketamine. The nasal spray allows the drug to be taken more easily in an outpatient treatment setting (under the supervision of a doctor), making it more accessible for patients than the IV treatments currently required to deliver ketamine.

But like any new drug, this one comes with its cautions. Side effects, including dizziness, a rise in blood pressure, and feelings of detachment or disconnection from reality may arise. In addition, the research is still relatively new. Studies have only followed patients for one year, which means doctors don’t yet know how it might affect patients over longer periods of time. Others worry that since ketamine is sometimes abused (as a club drug called Special K), there may be a downside to making it more readily available—it might increase the likelihood that it will end up in the wrong hands.

Also, esketamine is only part of the treatment for a person with depression. To date, it has only been shown to be effective when taken in combination with an oral antidepressant. For these reasons, esketamine is not considered a first-line treatment option for depression. It’s only prescribed for people with moderate to severe major depressive disorder who haven’t been helped by at least two other depression medications.

In the end, though, the FDA approval of esketamine gives doctors another valuable tool in their arsenal against depression—and offers new hope for patients no one had been able to help before.

To learn more, visit yalemedicine.org.

More American Millennials Are Experiencing Depression and Suicide

Author Article

 | THINKSTOCK

More young adults in the U.S. are experiencing mental health issues, and digital media usage might be partly to blame, said a new study.

Between 2005 and 2017, the rate of adolescents reporting symptoms consistent with major depression in the last 12 months jumped 52 percent, according to the study published Thursday in the peer-reviewed Journal of Abnormal Psychology, run by the American Psychological Association.

The study found a 63 percent increase in young adults between the ages of 18 and 25 reporting symptoms of depression between 2009 and 2017. It also showed significant increases in the rates of young adults who reported serious psychological distress and suicidal thoughts or suicide-related outcomes during similar time periods.

Researchers also note there is no similar increase among older adults during corresponding time periods.

Jean Twenge, lead author of the study and professor of psychology at San Diego State University, said digital media might play a role in the increase among young adults.

“Cultural trends in the last 10 years may have had a larger effect on mood disorders and suicide-related outcomes among younger generations compared with older generations,” Twenge said in a statement.

Ian Gotlib, a professor of psychology at Stanford University and director of the Stanford Neurodevelopment, Affect, and Psychopathology (SNAP) Laboratory, said genetics can be ruled out as a potential factor because the increase in reports of mental health issues happens too quickly.

“It’s correlational, but what’s increased with depression is the use of social media with kids,” said Gotlib, who was not affiliated with the study. “And I don’t think that should be underestimated.”

A Pew Research survey released last month revealed 70 percent of teens believe anxiety and depression are critical issues among peers, even more than bullying or drug and alcohol use.

Several other studies have found a rise in depression among teens and young adults, leaving many experts to wonder how big a role social media might contribute.

“These results suggest a need for more research to understand how digital communication versus face-to-face social interaction influences mood disorders and suicide-related outcomes and to develop specialized interventions for younger age groups,” Twenge said.

Gotlib said having conversations with your kids is a good starting point, as well as paying attention to their digital media habits. “I would just watch for what looks to be an inability to not be with your phone,” he said. “It doesn’t necessarily mean depression but it has that potential.”

Read more at usatoday.com.

Here’s A Way To Protect Yourself When You Feel The Depression Coming

Author Article

As someone diagnosed with ADD who, without medication, has been able to accomplish some truly focus-dependent projects (like writing a 250-page book, for example), here are 10 ways I have found to increase productivity:

1. Prepare before you get started

Productivity doesn’t just happen “in the moment.”

It happens long before you even sit down and get to work. The more you prepare ahead of time, and get clear on exactly what it is you want, need, or should do, the easier and faster you will move once you start.

The reason why so many people struggle with “being productive” is because they skip this step, and when they sit down, they expect to start flying even though they haven’t even decided where it is they want to fly to.

2. Turn off all distractions

It doesn’t take a genius to realize that every time your phone buzzes, your e-mail pops up on your screen, your office door opens, your train of thought is ruined.

We like to believe we can both participate in a group chat via text and write our best-selling novel, but the truth is, we can’t — and to think we can is wishful and naive.

Your best work comes in silence.

It’s why people retreat and take vacations away from the busyness of life — to distance themselves from distraction.

3. Make your expectations flexible

The hardest part about “productivity” is that we want it to exist on a static playing field.

We want there to be one formal definition for “being productive” and we want that definition to mean we got from point A to point B. But, depending on what you’re working on, sometimes you have to take the scenic route.

Sometimes the most productive thing you could possibly do right now is to brainstorm a million random ideas, play with a few of them, watch them fail before your eyes, and then come to a more refined conclusion of what it is you’re actually trying to build or “get done.” In many cases, people would see this as an afternoon failure. But on the contrary, it is necessary in order to better understand whatever it is you’re doing.

Don’t fight yourself when that happens.

4. Measure, measure, measure

“If you can’t measure it, don’t do it.”

This is something my own mentors have gone to great lengths to teach me, and rightfully so. If you can’t measure it, you don’t know how to improve it — or worse, you spend too much time on the “scenic road” and you never actually reach a point of conclusion. Measurement doesn’t always have to do with time, or money, or something tangible.

Sometimes, the best way to measure is to simply look back at old pieces of work and see how and where you’ve improved stylistically. But be conscious of measurement, so that you can tweak as you go along and see where you can become more efficient.

5. Share what you’re working on — for feedback

For the longest time, I never wanted to share or talk about anything I was working on.

I thought it was “bad luck” or would take me out of my flow. And I’ll admit, there are those moments when your ideas are best left to ruminate in your own head, but you should not be hesitant to share what you’re working on. Feedback is extremely important, and a lot of time can be saved by a single conversation where someone points out, very clearly, something that isn’t “working.”

It might not be easy to hear in the moment, but you will be thankful for it later.

6. Practice In public

When we talk about productivity, we often think of ways to seclude ourselves in our bedroom or office, alone, in the dark, with only the light of our laptop to keep us illuminated.

But sometimes that approach actually ends up netting a poor return on your time investment because you aren’t getting outside feedback. Find ways to practice in public.

Use the digital tools we have access to, like social media, to release test versions of whatever it is you’re working on: Whether that’s a book, an album, a startup, a comedy sketch, anything.

Practicing in public gives you feedback, and feedback speeds up the learning and development process.

7. Caffeine

Need we really explain the productivity benefits of a black coffee with an extra shot of espresso?

8. Music

To some, this would be a distraction, but I have always found light instrumental music in the background (Beethoven and Mozart, especially)to be quite the productivity booster.

As long as it isn’t filled with catchy melodies that take you out of the task at hand, music can be like that whirring fan in the background that acts as a subtle cue to your subconscious to stay on the task at hand.

9. Take Breaks

Again, being “productive” does not necessarily mean sitting still for eight straight hours.

You might be able to swing that for a day or two, but you are not a robot. You will burn out. Productivity is all about flow. It’s about knowing your limits and being conscious of how to move within your own constraints.

Maybe you need to take 10-minute breaks after every 50 minutes of focus

Great. Do that.

Or maybe you can work for four hours no problem, but then you need to take the afternoon before diving into another four-hour work session at night.

Great. Do that.

Do what works for you, and you only.

This isn’t about being productive based on someone else’s habits or way of doing things.

This is about knowing yourself, and using your habits to your advantage.

10. Create a routine

It is said the best musicians, athletes, innovators, etc., follow a daily routine that trains their subconscious to know when it is time to work and when it is time to relax.

There is absolutely something to be said for always practicing at the same time, or always going to the gym at the same time, or always writing at the same time, every day. You train yourself to know, as soon as that hour strikes, to fall into that mode of focus required to do your best work.

Trying to be productive when one day you are working in the morning, the next day you’re working at night, the next day you’re working in the middle of the day, it gets exhausting. Routine is extremely helpful, and inherently removes the distraction of adjustment to something “new.”

Consistency is what you’re after.

This article originally appeared on Inc Magazine.

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