If you - or someone you know - are having thoughts about suicide, call 1-800-273-TALK (8255). Calls are connected to a certified crisis center nearest the caller's location. Services are available 24 hours a day, seven days a week. If you - or someone you know - are having thoughts about suicide, call 1-800-273-TALK (8255). Calls are connected to a certified crisis center nearest the caller's location. Services are available 24 hours a day, seven days a week.
Our mission is to create an atmosphere that is both supportive and informative in a caring, safe environment for our members to talk to their peers about depression, anxiety, mood disorders, medications, therapy and recovery.
Our vision is to advance the public awareness of mental health issues so as to eliminate the stigma that surrounds depression and mood disorders through education and advocacy, as well as striving to obtain quality medical care for mental health patients, as it is no different from any other medical illness.
Disconnect in informational priorities between those seeking treatment for depression, clinicians
More than 15 million American adults seek treatment for depression each year. However, a first-of-its-kind study reveals an eye-opening disconnect between the priorities of patients and clinicians when it comes to the information needed to make decisions about treatment options.
More than 15 million American adults seek treatment for depression each year. However, a first-of-its-kind study by researchers at The Dartmouth Institute for Health Policy & Clinical Practice reveals an eye-opening disconnect between the priorities of patients and clinicians when it comes to the information needed to make decisions about treatment options.
"The good news is that both patients and clinicians who treat depression consider whether a treatment will work to be the most important priority," said Paul Barr, an assistant professor at The Dartmouth Institute and the study's lead author. "However, while consumers place a high priority on cost and insurance information, clinicians do not always prioritize this as highly."
The study, published online by BMJ Open, surveyed close to 1,000 Americans who were currently undergoing or have previously sought treatment for depression and 250 clinicians who had recently treated patients for depression in the United States. Patients were recruited to reflect the age, gender and education level of the population of U.S. adults suffering from depression. Clinicians surveyed had an average of 15 years of professional experience and included therapists, psychiatrists and primary care physicians.
Let’s say you’ve been down in the dumps for months, but are leery of taking psychiatric drugs. Your doctor may recommend cognitive behavioural therapy (CBT), a form of “talk therapy” that focuses on changing the underlying thought patterns and distorted perceptions that perpetuate the “stinkin’ thinkin’” brought on by mood disorders. Several trials have shown that CBT is just as effective as medication, and highly successful in treating mild to moderate depression and anxiety. But what if you don’t have the time or money to see a therapist?
You could go online. In the past 10 years, dozens of Internet-delivered CBT programs have cropped up, many of them free of charge. In countries such as Australia and Britain, computerized CBT is being touted as a cost-effective way to treat greater numbers of patients suffering from the most common mental illnesses – mild to moderate anxiety and depression.
But is online CBT as effective as face-to-face sessions with a compassionate therapist? Advocates note that some patients prefer the anonymity of Internet-delivered CBT, even as they acknowledge that the treatment model still needs tweaking. Critics insist that mentally ill patients need the human touch. Both agree that more research is needed, but as things stand, here are the promises and pitfalls of psychotherapy at your fingertips.
How does it work?
Using a computer, tablet or smartphone, patients log on to an online program such as Beating the Blues or MoodGYM (which has at least 600,000 registered users worldwide). At their own pace, patients complete interactive modules on how to identify symptoms, set goals and find new ways of thinking about everyday events. For example, a module might teach the “three Cs”: Catch the unhelpful thought (“I am an idiot for forgetting my friend’s birthday”). Check it to identify the distorted thinking pattern (over-generalizing, focusing on the negative). Change it to a more accurate or helpful thought (“Everyone makes mistakes,” and “I am a good friend most of the time”). Online CBT programs may include quizzes, homework exercises and self-assessments to monitor progress.
Learning that your teen has depression can be terrifying for a parent – concerns range from getting the right treatment to general safety. It was estimated in 2013 that 8 percent of high school students attempted suicide one or more times in the previous 12 months, according to the Centers for Disease Control and Prevention.
And now, a reanalysis of data in The BMJ last week found that Paxil, one of the most prescribed antidepressants on the market, is ineffective and even harmful for treating major depression in adolescents.
The new findings are in contrast to the original study from 2001. Researchers of the original industry-funded study found Paxil, just one of a group of serotonin re-uptake inhibitors, was safe and effective. The reanalysis showed that a number of adolescents from the original study did experience increased thoughts of suicide. But the suicidal thoughts were simply counted as generic adverse events and not clearly presented in the results.
For a long time, there have been some indications that these medicines may raise the rates of thoughts of self-harm in adolescents. This led the U.S. Food and Drug Administration in 2007 to issue a “black box” warning about increases in suicidal thoughts. In December 2014, the warning was revised to state that attempts at self-harm decreased in patients ages 24 and older with anti-depressant use, but there was no change on the warning for adolescents.
During this nearly decade long discussion, most psychiatrists and many other mental health professionals felt that the warnings were too strict. As a result, they thought many teens were not getting the help that they needed – while others worried that these medicines were possibly harmful.
What has followed in the wake of this latest reanalysis are stories in the press which have raised the issue of the safety and effectiveness of some antidepressant medications for adolescents.
One in five New Yorkers have a mental health disorder, and at least 8% suffer from symptoms of depression, a new report by the city Department of Health says.
“Major depressive disorder is the single greatest source of disability in NYC,” the report says. "At any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40% report receiving care for it.”
Despite lots of advancements in the psychology world, many aspects of depression remain mysterious, to mental health professionals and their patients alike. The video below, one of the latest from TEDEd, suggests that this is due to the condition's intangibility — depression isn't a cold or some other illness with physical symptoms that are clear and consistent. However, the video, created by Helen M. Farrell, MD, provides some insight into what depression is, and what signs to look for (in yourself and your loved ones).
It's vital to understand the difference between feeling depressed and having depression. Just about all people deal with feelings of sadness, but they pass or are eventually (at times, even easily) resolved. Depression, on the other hand, lasts much longer, following those who suffer from it to the point that they may lose hope of finding a solution. Clinical depression, as explained in this video, can cause sufferers to avoid activities or people that used to excite and engage them, exacerbating the sense of guilt and worthlessness that also accompanies the condition. A lack of energy, appetite, and concentration commonly occurs as well. Most alarmingly, people with depression may deal with recurring thoughts of suicide.
If you are unfortunate enough to develop acute chest pain this winter you will probably be assessed by a clinician who will order a battery of tests to determine if your symptoms result from pneumonia, bronchitis, heart disease, or something else. These tests not only can yield a precise diagnosis, they ensure you will receive the appropriate treatment for your specific illness.
If you are unfortunate enough to have a psychotic episode this winter, the process of arriving at a diagnosis will be quite different. In fact, there are not many choices. Most people with a psychotic disorder are labeled as having either schizophrenia or bipolar disorder. The distinction has been in textbooks for a century: schizophrenia (originally dementia praecox) is associated with delusions, hallucinations, an absence of affect, and a chronic course; bipolar (originally manic depressive disorder) can also involve delusions and hallucinations, and ,typically, dramatic swings in mood and a fluctuating course. But outside of textbooks, in the real world of the emergency room or clinic, these distinctions are less clear as many patients do not neatly fit the formal descriptions. Sadly, there are no blood tests or scans to distinguish schizophrenia from bipolar disorder.
While clinicians have become very skilled at assessing symptoms and signs, the absence of diagnostic laboratory tools or biomarkers poses a serious problem in psychiatry. Do all people with a label of schizophrenia have the same disorder? What about the large number of people who appear to have aspects of both schizophrenia and bipolar? Are these disorders, diagnosed exclusively by signs and symptoms, identifying distinct biological entities or could there be many different illnesses with a continuum of psychotic signs and symptoms? These questions are not merely academic. As with chest pain, getting a precise diagnosis is important for selecting the best treatment.
I have learned that anxiety and depression go hand-in-hand, and there is no shame in having either — although it’s tough for many people to get their arms around that concept. When I struggled with both in my last couple years as the Texas Rangers’ baseball play-by-play announcer, the few people in whom I confided expressed genuine shock. “Depressed? About what? You’ve got a great job! Legions of adoring fans! A wonderful family! Dude, what’s your problem?”
Growing up, I had always been, quite naturally, the life of any party. But over a period of several years, I began to stay away from such parties. When I did go and fake my way through, I would usually leave upset, gripped by the weight of having been such a fraud.
Scared, Lonely, Exhausted
At my lowest moments, everything and everyone in the world was a threat. Not just people I knew, but people I knew I’d never meet. Brad Pitt’s looks? A threat. Same for Peyton Manning’s arm, Josh Groban’s voice, Justin Timberlake’s talent, the neighbor’s house...all things to threaten me, instead of for me to simply enjoy.
In an anxious state, all I could see were the things I couldn’t do or didn’t have, and people I couldn’t be. I had no appreciation whatsoever of anything I already was. No matter what I did, the foreboding sense was that it would never be enough. And if the people in my life who mattered had the “gall” to appreciate or acknowledge the talents of others, I took it as a punch in the face. It was a scary, lonely, exhausting way to go through life.
The crux of an anxiety disorder is the complete inability to be at peace with the present moment. Always expecting the other shoe to drop. Waiting for something to go wrong. I’d be racked with guilt about things I’d done poorly and trembling with worry that I’d soon screw something else up too. Professionally, that would all come crashing down within an hour of air time. Quite routinely, I’d seek refuge in the press box bathroom, head in my hands, trying to remind myself “it’s okay. I’m okay.” Sometimes I was…most times I wasn’t.
The woman described the sensation as a delicate flicker, like a moth
trapped in a small gauze bag. She ran her slender fingers repeatedly
over the spot in her slightly distended abdomen and said, “Doctor, right here.”
Sometimes, she told me, the flicker gave way to a more forceful kick
that rippled beneath her hand and then spread like a warm tide over her
body. She felt contented and soothed as she imagined the baby growing
I was tempted to smile, but I kept still. An actual pregnancy would have been international news: the woman was 83 years old, recovering from a hip fracture and pneumonia. But her delusion was not unique. Indeed, our nursing home was having something of a baby boom.
Just the day before, another woman who had recently suffered a stroke
insisted that she had given birth to twin boys, who were now crying in
the adjacent nursery. I reminded her that she was 90, but my words were
no match for the force of her belief. She looked at me blankly and
called again for her babies.
Her husband, distraught, begged me to consider some pharmacologic
remedy. But I was struck not by any mental suffering on the woman’s
part, but by the opposite.
In the face of terrible losses and confusion, her mind had found refuge
in imaginary children. Their coos and cries brought comfort and hope.
as delusional pregnancy is called, is neither common late in life nor
a normal response to aging or illness. It is a form of psychosis, and it can lead to severe anxiety or disruptive behavior that must be treated.
But it is too easy to see pathology in what may actually be a protective
mechanism in the aging brain. What a psychiatrist might call a symptom
held deep meaning for each woman, and prompted them to focus on
recovering from severe illness.
In each case, I had to act in the opposite direction of my instinct as a
doctor. Medication might have only sedated them and even taken away a
protective cocoon. Instead I let time do its work: the delusions faded,
and physical and mental recovery took hold.
Such examples are relatively rare and, one might argue, easily
romanticized. But they hold a larger lesson about the aging brain.
What we perceive as a brain in flight or decline, disengaging from the
world or tumbling into a netherworld of oldness, might actually be a
more selective, creative and wiser brain.
The paradox is that even as the normal aging brain loses capacity across
numerous discrete skills — memory-processing speed, verbal reasoning
and visuospatial ability, to name a few — it is simultaneously growing
in knowledge, emotional maturity, adaptability to change and even levels
of well-being and happiness.
I witnessed this common phenomenon in a couple I know well. The woman is
a sharp and active 82-year-old who only recently retired as a social
worker. Her new husband, now 92, was a World War II bomber pilot and
retired marketing genius who always prided himself on his mental
discipline and physical stamina.
Recently he began to complain bitterly of creeping short-term memory
impairment and a general slowing of his motor functions. Both factors
can bring him great unhappiness. During a recent meeting, however, I
pressed him on his complaints, asking, “Is that all there is to growing
old — decline, slowing and loss?”
His bride interrupted and told how their relationship was unique because
of old age, in many ways deeper and more intimate than either had
experienced as younger people.
Even as his memory declined, she said, his emotional maturity and wisdom
had increased, opening perspectives and relationships he had never had
before. Here was old age — and an aging brain — acting as a force that
added even as it took away.
In telling this tale as a relatively young doctor who works primarily
with older individuals, I could easily be accused of painting an overly
rosy picture of what I want growing old to be.
If so, I plead guilty. But I do so in the spirit of the gerontologist
Thomas Cole, who suggests that the ways in which we look at old age
begin to constitute its reality.
We will all grow old, and despite the inevitable changes we do have
choices. Indeed, growing evidence suggests that the aging brain retains
and even increases the potential for resilience, growth and well-being.
I have seen this lesson lived in my friends, loved ones and older
patients, whether free of illness or fettered by it. I saw it in the two
older women whose imagined pregnancies brought needed hope at a time of
threatened despair. Their fervent wishes, though unattainable, allowed
them to achieve something better.
Similarly, we can all hope for a vital and meaningful old age — for our
elders, ourselves and our children. In the end, we may actually get what
we wish for.
Dr. Marc E. Agronin, a geriatric psychiatrist at the Miami
Jewish Health Systems in Florida, is the author of the new book “How We
Dr. Marc E. Agronin, a geriatric psychiatrist at the Miami
Jewish Health Systems in Florida, is the author of the new book “How We