Anxiety and depression caused by stress linked to gut bacteria living in intestines, scientists find

Anxiety and depression could be linked to the presence of bacteria in the intestines, scientists have found.

A study on laboratory mice has shown that anxious and depressive behaviour brought on by exposure to stress in early life appears only to be triggered if microbes are present in the gut.
The study, published in Nature Communications, demonstrates a clear link between gut microbiota – the microbes living naturally in the intestines – and the triggering of the behavioural signs of stress.
“We have shown for the first time in an established mouse model of anxiety and depression that bacteria play a crucial role in inducing this abnormal behaviour,” said Premysl Bercik of McMaster University in Hamilton, Canada, the lead author of the study.
The scientists called for further research to see if the conclusions applied to humans, and whether therapies that that target intestinal microbes can benefit patients with psychiatric disorders.
 Previous research on mice has indicated that gut microbes play an important role in behaviour. For instance, mice with no gut bacteria – called “germ-free” mice – are less likely to show anxiety-like behaviour than normal mice.
The latest study looked at mice that had been exposed to a stressful experience in early life, such as being separated from their mothers. When these mice grow up they display anxiety and depression-like behaviour and have abnormal levels of the stress hormone corticosterone in their blood, as well as suffering from gut dysfunction based on the release of the neurotransmitter acetylcholine.
But when “germ-free” mice with no gut bacteria are exposed to a similar stressful experience as newborns, they do not show any signs of anxiety or depression in later life even though they have similar levels of stress hormones in their blood and markers of dysfunction in their gut.
The scientists then transferred gut bacteria from the normal mice that had also been separated from their mothers to the “germ-free” . Within a few weeks, the germ-free mice that had previously shown no signs of anxiety or depression started to display the same depressive, anxious behaviour as the ordinary mice
“However, if we transfer the bacteria from stressed mice into non-stressed, germ-free mice, no abnormalities are observed,” Dr Bercik added. “This suggests that...both host and microbial factors are required for the development of anxiety and depression-like behaviour.”
Source:  http://www.independent.co.uk/life-style/health-and-families/anxiety-and-depression-caused-by-stress-linked-to-gut-bacteria-living-in-intestines-scientists-find-10422303.html

What is depression?

What is depression?

Depression is a mental health condition where a person has a long lasting low mood, and/or may lose pleasure or interest in activities.

Other symptoms of depression include:

• A depressed mood during most of the day, particularly in the morning
• Fatigue or loss of energy almost every day
• Feelings of worthlessness or guilt almost every day
• Impaired concentration, indecisiveness
• Insomnia or hypersomnia (excessive sleeping) almost every day
• Markedly diminished interest or pleasure in almost all activities nearly every day, a condition called anhedonia that can be indicated by a subjective account or by observations of significant others
• Recurring thoughts of death or suicide (not just fearing death)
• A sense of restlessness known as psychomotor agitation, or being slowed down, retardation
• Significant weight loss or gain

How long do these signs have to be present before they are diagnosed as depression?

With major or clinical depression, one of the key signs is either depressed mood or loss of interest. For a diagnosis of depression, at least one of these signs should be present most of the day either daily or nearly daily for at least two weeks. In addition, the depressive symptoms need to cause clinically significant distress or impairment. They cannot be due to the direct effects of a substance, for example, a drug or medication. Nor can they be the result of a medical condition such as hypothyroidism.

What are some common feelings associated with depression?

People with depressive illnesses do not all experience the same symptoms. How severe they are, how frequent, and how long they last will vary. It depends on the individual and their particular illness. Here are common symptoms people with depression experience:

• Difficulty concentrating, remembering details, and making decisions
• Fatigue and decreased energy
• Feelings of guilt, worthlessness, and/or helplessness
• Feelings of hopelessness and/or pessimism
• Insomnia, early morning wakefulness or excessive sleeping
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• No pleasure left in life any more
• Overeating or appetite loss
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
• Persistent sad, anxious, or "empty" feelings
• Thoughts of suicide, suicide attempts

While these are common symptoms of depression, they may also occur in patterns. For example, a person may experience depression with mania or hypomania, a condition known as bipolar disorder. Or the symptoms may be seasonal as in the case of seasonal affective disorder (SAD).

Is childhood depression common?

Childhood depression is different from the normal "blues" and everyday emotions that occur as a child develops. If your child is sad, this does not necessarily mean they have significant depression. It's when the sadness becomes persistent, day after day, that depression may be an issue. Or, if your child has disruptive behaviour that interferes with normal social activities, interests, schoolwork, or family life, it may indicate that they have a depressive illness. The NHS estimates that 4% of children aged between 5 and 16 years old has depression. Bear in mind that while depression is a serious illness, it is also a treatable one.

What about depression in teenagers?

It is common for teenagers to occasionally feel unhappy. However, when the unhappiness lasts for more than two weeks and the teenager experiences other symptoms of depression, then they may be suffering from adolescent depression. Seek medical advice to find out if your teenager may be depressed. There is effective treatment available to help teenagers move beyond depression as they grow older.

Is depression difficult to diagnose?

It is estimated that, by the year 2020, major depression will be second only to ischaemic heart disease in terms of the leading causes of illness in the world. Patients with depression sometimes fail to realise (or accept) that there is a physical cause to their depressed moods. As a result, they may search endlessly for external causes.
In the UK, about 15% of people will suffer from at least one episode of major depression, according to the NHS. The suicide risk in people with this type of depression is the highest rate for any psychiatric state. Unfortunately, most people with clinical depression never seek treatment. Left undiagnosed and untreated, depression can worsen, lasting for years and causing untold suffering, and possibly suicide.

What are the warning signs of suicide?

Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call a helpline, such as the Samaritans (on 08457 90 90 90, open 24 hours a day, 365 days a year) or the mental health charity, SANE (on 0845 767 8000, open from 1pm to 11pm every day). Or contact your GP or a mental health professional immediately.
Warning signs of suicide include:

• Thoughts or talk of death or suicide
• Thoughts or talk of self-harm or harm to others
• Aggressive behaviour or impulsiveness

Previous suicide attempts increase the risk of future suicide attempts and completed suicide. All mention of suicide or violence must be taken seriously. If you intend or have a plan to commit suicide, call 999 or go to hospital for immediate treatment.

Are there different types of depression?

There are a number of different types of depression including:

• Major depression
• Chronic depression (dysthymia)
• Bipolar depression
• Seasonal depression (SAD or seasonal affective disorder)
• Psychotic depression
• Postnatal depression

Are there other types of depression?

Other types of depression that can occur include:

• Double depression, a condition that happens when a person with chronic depression (dysthymia) experiences an episode of major depression
• Secondary depression, a depression that develops after the development of a medical condition such as hypothyroidism, stroke, Parkinson's disease, or AIDS, or after a psychiatric problem such as schizophrenia, panic disorder, or bulimia
• Chronic treatment-resistant depression, a condition that lasts over a year and is extremely difficult to treat with antidepressants and other psychopharmacologic drugs and psychotherapies
• Masked depression, a depression that is hidden behind physical complaints for which no organic cause can be found.

For chronic treatment-resistant depression, electroconvulsive therapy (ECT) is usually the treatment of choice.

Can depression occur with other mental illnesses?

Depression commonly occurs with other illnesses such as anxiety, obsessive compulsive disorder, panic disorder, phobias and eating disorders. If you or a loved one has symptoms of depression and/or these other mental illnesses, seek medical advice. Treatment is available to lift the depression so you or a loved one can regain your meaningful life.

Can depression have physical symptoms?

Because certain brain chemicals or neurotransmitters, specifically serotonin and norepinephrine, influence both mood and pain, it's not uncommon for depressed individuals to have physical symptoms. These symptoms may include joint pain, back pain, gastrointestinal problems, sleep disturbances, and appetite changes. The symptoms may also be accompanied by slowed speech and physical retardation. Many patients go from doctor to doctor seeking treatment for their physical symptoms when, in fact, they are clinically depressed.

Where can I get help for depression?

If you or someone you know is experiencing symptoms of depression, seek medical advice for treatment or referral to a mental health professional.
Source:  http://www.webmd.boots.com/depression/guide/what-is-depression

Toward a New Definition of Stress

We live in stressful times. We are holding down two or more jobs. We are putting up with heavy job loads and unreasonable demands. We are swallowing outrage and frustration with unfair situations and irrational superiors because we cannot afford to be laid off or fired. Or we have already been laid off and we are struggling to find another job. Or we have given up and are coping with unemployment.
Outside strains like these are called stressors. Stressors are the barely-tolerable external pressures or challenges that bring us tension, unhappiness, and, eventually, problems such as anxiety, depression, and even stress-related diseases.
We all know people who hardly seem to be affected by stressors. They maintain a sense of perspective and a sense of humor. They remain calm in the midst of adversity and catastrophe.
But most people are overwhelmed even by a lesser number and intensity of stressors and tend to experience fears and anxiety, lose mental balance, and can evenually slide downhill, losing relationships, jobs, and even their mental and physical health. What makes the difference between these two kinds of people?

Inner Strength

While it may seem that our problems are entirely the result of the enormous stressors in our lives, the degree of functioning of our nervous system actually almost completely determines how we feel and respond. Which is better: to be exposed to few stressors but still be overwhelmed by them, or to be exposed to many stessors and respond with grace and humor? Mental balance, normal functioning of the nervous system, grace, and good humor are all aspects of natural inner strength. The important question is why so many of us don't have the degree of inner strength that would protect us from stressors and would allow us to express our inner creativity and intelligence fully, resulting in a happy, productive, successful, and fulfilled life. That is, if inner strength is natural and normal for some people, what limits it for others? What causes inner weakness?

Stress: The Stored Effects of Overloads

Stressors can cause overloads of the nervous system. Examples include the physical and mental trauma of living through a car crash, enduring the pressure of working at multiple, or difficult jobs, or even receiving a sudden pleasant shock, such as of unexpectedly winning a lottery, inheriting a fortune, or catching sight of a beautiful sunset. The fact that we can relive these experiences in dreams (when our body is relesing stress accumulated during the day) and that they can stimulate our fight-or-flight hormones shows that they have a negative long-term effect on our health and happiness. In this new approach we define stress as the response of the nervous system to stressors that are too large for it to handle. It is the internal result of external overloads. It consists of changes, or abnormalities stored in the nervous system that serve to protect us from repeated exposure to the same overloads by limiting our functioning or perception.
An analogy may help make this clear.
Consider modern buildings. Every modern building is protected from electrical fire by a system of separate electrical circuits, each protected by its own circuit breaker. A circuit breaker interrupts the current in the circuit whenever there is an electrical overload, whether caused by using too many appliances or by a short-circuit. In the absence of circuit breakers, the intense heat caused by a high current could result in a serious fire. If one or two breakers are tripped, the building still functions. One could run an extension cord from an outlet that is still working to where one needs electricity. It's not convenient when a circuit breaker snaps open, but it's much preferable to having a fire.
Like a modern building, we hypothesize that the human nervous system has a distributed "graceful degradation" mechanism that protects it from serious damage when it is overloaded. While we haven't as yet identified this mechanism in terms of anatomy or neurology, researchers can observe the very real negative physiological and mental effects of stressors on people over time, using measurable effects or markers such as reaction time, anxiety, trust, anger, memory, creativity, problem solving, skin resistance, EEG, blood pressure, and blood chemistry, among many others.

The Elimination of Stress

The only way to correct dead circuits in the electrical system of a building is to remove any problems like short circuits and too many appliances plugged into a power outlet, then go to the breaker panel and reset all the tripped circuit breakers. The natural way (actually, the only way) to eliminate limitations caused by stresses stored in the human nervous system is to remove the worst of the stressors (for example, by getting treatment for a medical condition), then expose the nervous system to deep rest.
This parallel between how an electrical system works in a building and how the nervous system works in the human body is fairly close. In both cases, dysfunctions caused by overload can be eliminated or reversed.
We know that the deep rest we gain through sleep is refreshing; there can be no doubt that it helps eliminate stress. But it is clearly not enough to prevent the loss of creativity, intelligence, and joy that seems to plague many of us as we grow older. And it is frequently not enough to reduce stress-related disease, or ameliorate psychological problems. As an extreme but apt example, if we have a traumatic experience, we may have nightmares for years before sleep finally dissolves the resulting stress.
What we need is a natural method of gaining deep rest that is much more efficient than sleep or dreaming, because the rest is deeper. Does such a method exist? The answer is yes, and it's called transcending.

The Recent History of Transcending

About 58 years ago, Maharishi Mahesh Yogi, at the time a secretary and disciple of a great spiritual leader in India (Brahmananda Saraswati), was asked to travel throughout the world, sharing the ancient Vedic knowledge of effortless transcending with everyone who would come and listen. Maharishi was the first to cast this basic bit of Vedic technique into terms easily understandable by any modern citizen of the world. What emerged from his unexpectedly successful journey out of India was the formulation of Transcendental Meditation®, a seven-step course of personal instruction taught in TM® centers throughout the world. Scientific researchers were immediately attracted to this "new" technique as a result of their personal experiences and observations, and their hundreds of high- quality research projects generated remarkable results that have been published in many peer-reviewed scientific journals ever since.
We have learned from these studies that TM®generates a broadly beneficial and unique state of physiology that has been prosaically called "restful alertness", a state of rest that is much deeper than sleep.
More accurately, TM® teaches a simple, effortless, and natural technique called transcending, which quickly reduces the metabolic activity of the body, while very gently keeping the mind alert.
But Transcendental Meditation®, fortunately, holds no monopoly on this natural technique. Even though NSR© is taught in a very different way by a different organization, the actual effortless and natural mental technique that both teach is generic and identical (see description below).
The published NSR© research studies produced some of the same results as the Transcendental Meditation® studies, and our unsolicited testimonials describe much the same sorts of remarkably beneficial results, all of these results based on gradually eliminating stored stresses. We believe that this evidence suggest that NSR© provides a viable alternative to Transcendental Meditation® for learning transcending.

Transcending in Natural Stress Relief©

In only 15 minutes of practice twice a day, stresses that were incurred many years ago and that have prevented our full functioning are automatically released. Not only that, but the unhappiness, frustration, or tiredness resulting from our activities yesterday and today are washed away, leaving us relaxed and energized. With the regular practice of NSR over a period of months and years, ever deeper stresses are released, continuously providing the possibility of releasing yet deeper stresses. It's like peeling off layers from an onion. Eventually, stresses of which we were not even aware (because we were so used to them) finally dissolve, giving us the flexibility and virtual immunity to stressors that is natural and spontaneous in a fully functioning nervous system.
Source: http://www.nsrusa.org/about-stress.php?gclid=COXe5trA6cYCFYvHtAodIhcLSA

Depression in employment

Work can be a good thing for people with depression but it can also be a source of stress.

Work can help your depression depending on the severity of your symptoms and the nature of your working environment. However, work can also be a source of stress for people and bad working environments can be a cause of depression.  

 

 The benefits of working with depression

While most people work because they need the money, there are other benefits to working when you have depression:

• It gives your day structure and something to focus on. Basically, it gets you out of bed in the morning. 
  
• It is social and creates opportunities for talking with other people. 
  
• It gives you a sense of achievement. 
  

But full-time paid work might not be the best option for you, especially if you’re going back to work. Think about different ways of working – part-time, job-sharing, voluntary work, temping, working from home for some of the time or being self-employed.

 

 Five reasons why having experience of depression can make you a better employee

1. You’ll be more aware of your strengths and weaknesses.
2. You’ve learned coping strategies for dealing with stress.
3. You’ll be more empathetic towards your colleagues when they are stressed and feeling pressured.
4. You’ll know why a good work / life balance is so important.
5. You’ve learned not to let things get out of hand before you take action.

 

 What can cause depression or stress at work?

Your depression might not be caused by your job. There is usually more than one thing that causes depression. But work can be a contributing factor for some people. The following problems in the workplace are often a cause of stress and worry.

• Excessive workload and too much pressure with deadlines and overtime
• Unsociable hours
• Unsupportive working environment
• Bullying and harassment
• Problems with colleagues
• Having too much responsibility beyond your job level. Or not having enough responsibility!
• Lack of job security, redundancies, cut backs in pay or hours
• Lack of job satisfaction, either from repetitive work or not getting positive feedback
• Personal crisis or problems, such as bereavement, financial problems, relationship difficulties, health concerns or illness, or problems with housing

 

 Should I tell my employer I've got depression?

You may worry about what your boss and colleagues will think if you admit to having depression especially if there is a lot of job insecurity in your workplace. It is up to you whether you decide to tell them about your depression.  There are reasons why it may be helpful to disclose your depression and reasons why not to. It is a matter of choice and a few of the pros and cons are listed below: 

Pros:

• Employment is covered under the Equalities Act.  Your employer has to make adjustments for your depression if it is a long term condition.
• It may be less stressful for you if you have to take time off sick, if your employer already knows about your depression.  They can then support you to come back to work.  
• You can tell them about your depression positively.  It may seem like there's nothing positive about depression but look at the five reasons why depression can make you a better employee above.

Cons:

• You may worry that your employer or colleagues will see you in a different light due to stigma around depression
• You may feel your depression has no effect on how you do your job.

 

 Dealing with depression at work

• Don't be afraid to take time off sick if you need it. Sometimes it can be better to take time off when you first get sick and allow yourself time to improve, rather than make yourself feel worse by struggling on when you really are too ill to go to work. Ask yourself would you feel bad taking time off for the flu? Depression is an illness too.
• If any issues at work are causing you stress or making you feel ill at work, try to talk to your line manager about them. If the problems concern your line manager, can their line manager help resolve them?

Source: http://www.actionondepression.org/information/depression/living-with-depression/work-and-depression/depression-in-employment

A Point of View: Four types of anxiety, and how to cure them

Anxious by nature, Adam Gopnik has spent years looking for cures for his constant worrying.

I returned home to New York this week, after reporting trips to London and Paris, to find the city in a mild panic about Ebola. Now, Ebola is one of those things that really are worth having a panic about - a horrible and highly infectious fatal disease. On the list of things to worry about, this is real - unlike whether Chelsea's Diego Costa was fit enough to play Man-U, another item on my worry list.
But how to worry - and how not to, that's the question. I am a professional worrier, anxious by vocation - one thumb always hovering above the panic button, which is at least helpful when there's a real problem. I am so quick searching for comfort on the iPhone keyboard that, in London, riding the rising midnight tide of a toothache, it took me no more than 30 seconds to find an all-night dental clinic on Baker Street - not far I noted, still a tourist at heart, from Sherlock Holmes' lodgings.
Undue anxiety is the New York affliction, as unearned melancholia is the Parisian one, and over the long years I have discovered various cures, or at least treatments, for galloping anxiety, which I shall now share. Four overlapping but largely distinct types of anxiety afflict modern people, each with its own pathology and palliative. They are - catastrophic anxiety, free-floating anxiety, implanted anxiety, and existential anxiety. Let us take them one by one.
Catastrophic anxiety is the fear of something really horrible happening, right out of the blue. The plane goes down, the virus was left lingering on your plane seat, the terrorist bomb goes off in your bus. By far the best treatment for this kind of anxiety I've ever found came from a professional guide to cheating at cards.
There was a period in my life when I was spending time among great sleight-of-hand men - card magicians - in Las Vegas, and one of them slipped me a guide to card cheating that had been privately printed by a professional card cheat.
It was a sour piece of work, but it taught me something vital. Since a card cheat can only cheat effectively on his own deal, unless he has the cards marked, which is hard to do, the rest of the time he just has to play smart, and this means fully internalising, as instant reflexes, all the statistical probabilities of card playing. I recall the cheater's insistent formula about these odds, almost his precise words, with indecent clarity. If the odds on whatever it might be are 10 to one, you'll see it this week, if it's a 100 to one, you won't see it this week, but you will see it this year. If it's a 1,000 to one, you won't see it this year, but you will probably see it, once. Anything more than that - 10,000 to one, a 100,000 to one, you're never going to see at the card table. It's just never going to happen.

The great virtue was to think of the odds in terms of things you want to have happen rather than things you fear are going to happen. Turn the worries into wants, and you see how remote they really are. People draw five cards for a Royal Flush. You'd be an idiot to think you ever will. Planes go down. Yours won't. Those are 100,000 to one odds, too, probabilities so remote that you can live your life in the conviction that it will never happen, and you won't be wrong.
Now, free-floating anxiety is the worst kind of worry, because each worry can always be replaced with another - there will be no work tomorrow, the rent or mortgage can't be paid, the school fees, the work overdue, the... I have known it to get so bad, even with seemingly serene people, that it can only be treated with medicine, which works, fortunately.
But it can also be accepted, as inseparable from an aspect of human ambition - you can learn to use it. Self-renewing worry is a legacy of our predatory nature. Herbivores just walk across the lawn of life, munching. Lions and tigers, for all their glory, are anxiety driven beasts - watch their eyes and you see worry, floating free. "Does the impala see me now? Has it seen me yet? Am I close enough? When to pounce? And will there be another impala to feed the cubs tomorrow?" It does make for a driven life. But it is better to be a little bit driven than forever drugged.

Implanted anxiety is like the catastrophic kind but rises less from the fear of big personal disasters than from the ever-changing tides of long-term public worry - from the headlines. Yesterday, it was Isis in Iraq, today it's Ebola in West Africa, always the next thing coming to get us all. It is a natural consequence of living in a news culture - headlines are scary and the larger proportion of good news is not news. All over New York, in the early morning light, infections that would have killed in a minute are being cured; women who a mere century ago would have died in childbirth are cuddling their ingeniously delivered babies, and one man is isolated for an Ebola infection. But he is all we see.
This asymmetry of implanted anxiety is built, blessedly, into an open society. Only totalitarian ones insist on reporting only the good news. But the daily dose is still unhealthy. The only remedy is to absent yourself from it, however briefly. Our family learned to do this, at first by accident, by going away for three weeks each summer to a house with no Internet, no television, no cell phone reception and variable electricity. We emerge and find out all the anxiety causing events we have missed, and are puzzled by them. Hair raising as they were, our hair was not raised, and by now most everyone else's scalp has flattened out too.

Of existential anxiety, well, this is the inescapable kind. Our mortality is not a long shot, it is, so to speak, a dead cert. And even if we can hold that anxiety at the arm's length that we mostly manage, the existential agony we feel for those we love is still too great. The best that we can do is to take control of the other three kinds of anxiety, so that then there is a possibility that in the time we have left we will have the mental space to seek out pleasures rather than focus on unfixable problems.
I mentioned my London toothache and its Baker Street at two am cure. As I sat in this strange single examination chair on the third floor - with, to be sure, the themes, and many scenes, from Sweeney Todd playing in my anxiety-prone head, I thought of how lucky we actually are to be alive now. The fix was pricey - about the cost of a meal for two in a good London restaurant. But it was worth it. At two am, I had my tiny preoccupying tooth fixed, and felt exuberant, the weekend to look forward to.

If humanism has a message it is not the fatuous one of progressivism that says everything will always get better. But the real one of the all-night dentist at his lonely, well-lit chair, many pains can be relieved, for more and more people. And the good feeling after is not an illusion but a weekend's worth of wonder. For millennia, the world has had a toothache - and thanks to use of critical reason applied to the problems of human pain, we do better. We have Novocain and electric drills and all night dentists with well-washed hands.
That thrill of the ameliorative is built into our mythology of the modern, right there on Baker Street, by Arthur Conan Doyle. Sherlock Holmes is not a miracle worker, he is a problem solver. The people in the Holmes stories don't become immortal or blessed when the Red-Headed League is exposed, or the Hound of the Baskervilles shown to be no more than a big dog covered with luminescent paint. They just get to carry on living. Sometimes, Dr Watson even gets a wife out of it.

The job of modern humanists is to do consciously what Conan Doyle did instinctively - to make the thrill of the ameliorative, the joy of small reliefs, of the case solved and mystery dissipated and the worry ended, for now. To make those things as sufficient to live by as they are good to experience. We cannot cure existential anxiety, but we can show that there is no necessity to have big ideas worth dying for in order to find small pleasures worth living for. Some days, or late nights, I think we do this a bit better than we once did. Other days I think that the endless cycle of anxiety, of needless panic and false promises, will win. It is, perhaps, my chief remaining worry.

Source: http://www.bbc.co.uk/news/magazine-29835995

Coming off antidepressants

Introduction

The aim of this leaflet is to help you decide about when and how to come off antidepressants.

Some people find coming off antidepressants is quite easy. But others may get withdrawal or a return of the depression.

We asked people to tell us what it was like for them to come off antidepressants. This leaflet brings together the views of the 817 people who completed our survey and shared their experiences.

 

Survey findings

In our survey, the most common drug stopped was Citalopram. This was taken by 235 people. Fluoxetine was next, taken by 173 people, followed by Venlafaxine (109), Sertraline (89), Escitalopram (51), Mirtazapine (38), Paroxetine (29) and Duloxetine (26).

36% stopped their antidepressant suddenly. Males were more likely to do this (m=44%, f=34%). Younger people were also more likely to stop suddenly (59% of 18-24 yr olds compared with just 20% of the over 65s).

512 (63%) people in our survey experienced withdrawal when stopping their antidepressants.

Some drugs were more likely to cause withdrawal than others. In the table below we have split the drugs into 3 groups (high, medium and low withdrawal).

High		Medium		Low
	% with withdrawal		% with withdrawal		% with withdrawal
Venlafaxine	82%	Sertraline	62%	Fluoxetine	44%
Escitalopram	75%	Citalopram	60%	Mirtazepine	21%
Paroxetine	69%
Duloxetine	69%

A further 43 people were on Tricyclic antidepressants. 53% of them had withdrawal. 23 people were on other types of antidepressant, but the individual numbers on these drugs were too small to be able to draw conclusions.

Common withdrawal symptoms

Overall, the most common symptoms were:

• anxiety (70%)
• dizziness (61%)
• vivid dreams (51%)
• electric shocks / head zaps (48%)
• stomach upsets (33%)
• flu like symptoms (32%)
• depression (7%)
• headaches (3%)
• suicidal thoughts (2%)
• insomnia (2%).

Anxiety was the most common symptom for every antidepressant except Duloxetine, for which 'dizziness' was the most common. The least common symptoms across all types were stomach upsets and flu-like symptoms. These patterns were the same for men and women.

Why do people stop?

The people in our survey decided to stop for a number of reasons:

Reason for stopping	Number of people
Felt better	219
Side-effects	213
Didn’t help	175
Wanted to try without	45
Pregnant	39
On advice of doctor	21

When to stop?

Deciding when to stop is really important.

If you have had one episode of depression, you are usually advised to stay on antidepressants for 6 months to 1 year after you feel better. If you stop too soon, your depression may come back.

If your problems have been going on for some time, your doctor may advise you to stay on antidepressants much longer.

It is important to be aware of two things if you do stop:

• you may get withdrawal
• the condition for which you were taking your antidepressants may come back.

Seeking advice

We strongly advise that your decision to stop is made with your doctor.

In our survey:

• 372 people got advice from a professional
• 95 from the internet
• 75 from the information leaflet  provided with their pills
• 35 from someone who had stopped antidepressants
• 289 did not seek advice.

A quarter of people in our survey were not aware that there could be problems linked with stopping.

 

What is withdrawal like?

People in our survey reported that the symptoms generally lasted for up to 6 weeks. A small percentage of symptoms lasted longer than this.  A quarter of our group reported anxiety lasting more than 12 weeks.

Of the common symptoms reported, the one rated severe by most people was anxiety. The symptoms that were rated moderate by most people were stomach upsets, flu-like symptoms, dizziness, vivid dreams and electric shocks/brain zaps. The less common symptoms were reported as severe: returning depression, headache, suicidal thoughts, insomnia, fatigue and nausea.

I want to stop - how should I go about it?

We would suggest the following:

BEFORE

• Make an informed decision
  • discuss the options with your doctor
  • be aware of possible withdrawal or return of depression
• Make a plan
  • choose a good time
  • decide the speed of reduction
  • who will you contact if there are problems?                    
• Seek support
  • from friends and family
  • work - will you need some time off?                       

DURING

• Reduce slowly
• Research suggests:
• • if treatment has lasted less than 8 weeks, stopping over 1-2 weeks should be OK
  • after 6-8 months treatment, taper off over 6-8 weeks
  • if you have been on maintenance treatment, taper more gradually: e.g. reduce the dose by not more than ¼ every 4-6 weeks.
• Stay in touch with your doctor
• Be prepared to stop the reduction or increase your dose again if needed
• Keep a diary of your symptoms and drug doses.

AFTER

• Keep an eye on your mood
• It may take some time before you fully stabilise
• It is important you look after yourself and keep active
• Keep practising Cognitive Behavioural Therapy (CBT)/relaxation techniques if you have been taught these
• Go back to see your doctor is you are worried about how you feel.

Advice from other who have stopped

People who responded to our survey also made the following suggestions (we don’t necessarily endorse these suggestions – we leave them to you to consider):

Before deciding to stop

• Be prepared.
• Seek advice first.
• Research, but don’t let online stories scare you.
• Listen to doctors and your own body and mind.
• Don’t feel societal pressure to come off.  If you have a medical condition (diabetes/asthma etc) you shouldn’t be made to feel bad for taking medications.
• Stop for the right reason. Not to please others.
• Weigh up pro’s of taking drugs against the side-effects from continued use.
• If you don’t get on with the GP you’ve previously seen, ask to see one with an interest in mental health
• It takes time/patience/perseverance.
• Think/write down with someone why you want to stop.

Once you have decided to stop

• Be sure you’re ready, avoid stopping during any disruptive periods in your life - the timing needs to be right.
• Talk to someone else who’s been there.
• Let others know. Have support around you.
• Understand the possible withdrawal symptoms you might experience.
• Have plans in place to manage your mood. Have something else to focus on.
• Get details of who to contact if you have a problem.
• Advice for family/partners would be useful.
• View it like recovery from an operation. Be good, focussed and approach it in a lifestyle change sort of way.
• If possible plan time off in advance.

During withdrawal:

• Be prepared, sometimes withdrawal can take longer than expected.
• Rest, drink water, eat healthily, and be kind to yourself.
• Take time off work if you need to.

Dose adjustment

• Go slowly – reduce by small amounts.
• Ask if can reduce very slowly at end with liquid instead of pills.
• Keep some tablets in reserve so you can stop extra slowly.
• Increase your dose temporarily to control symptoms if needed.
• Be aware that your symptoms may come back, at any time, if the dose is reduced further .
• Don’t be ashamed to go back on antidepressants if needed.
• Don’t feel bad if you can’t come off at 1^st or 2^nd attempt.

Setting

• Avoid people/situations that may cause stress whilst coming off.

Activity and monitoring

• Keep a diary to reflect on your thoughts/feelings.
• Exercise.
• Avoid unnecessary responsibilities.
• Ask a friend or someone close to you to monitor your mood in case you go down again – they might notice this before you do.

Symptoms of withdrawal

• Just as side-effects are a sign that medications are getting into your body, withdrawal effects are a sign they are leaving.
• If you get side-effects, don’t allow other people minimise their importance.
• It’s tough, but persevere, it will get better eventually.
• Side-effects will pass – they are time-limited.
• Be alert to feelings. If your mood gets worse or your anxiety increases, it’s not failure, it just might not be the right time to stop.
• Withdrawal symptoms may feel like a return of depression.

After withdrawal

• Expect to feel a little lower or flat for a while afterwards.
• Seek talking therapy to get to the root of the problem/consider talking treatments as an alternative.
• Keeping busy is the key to staving off the depression coming back, as your focus is outside yourself.
• You are not a failure if you can’t come off them.
• Recognise why you don’t need them and be proud of other ways you’ve helped yourself.
• Try Cognitive Behavioural Therapy (CBT).
• Do some exercise.

Sources of information suggested by our responders

• http://antidepressantsteps.com/self-help/antidepressants/whenToStop.php
• http://www.mind.org.uk/help/medical_and_alternative_care/making_sense_of_coming_off_psychiatric_drugs
• http://antidepressantsteps.com/_uploads/booklet_full/2.pdf

https://www.blogger.com/blogger.g?blogID=4592506238738253894#editor/target=post;postID=6482979760033699690Final comments

63% of people in our survey said they had experienced withdrawal or a return of depression. This is a higher figure than other research suggests (about 30%). It is possible that the research has underestimated the problem, but it is also possible that people were more likely to respond to our survey if they had problems stopping.

Either way, we hope that you find the advice given in this leaflet useful.

We would also like to reassure readers that despite some people having symptoms of withdrawal when stopping antidepressants, antidepressants are not addictive.

Produced by the Royal Colllege of Psychiatrists' Public Education Editorial Board.

Series Editor: Dr Philip Timms.

Main authors and researchers: Dr Martin Briscoe and Dr Leanne Hayward
This leaflet reflects the best available evidence at the time of writing.

© October 2014. Due for review: October 2017. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit is gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked to directly.
Source: http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants/comingoffantidepressants.aspx

I may never have received the support I needed if I hadn’t relapsed

A few months back I wrote about my time in hospital and the fears I had around my discharge and reintegration back into the community. Aside from being concerned about what people would think when they found out about my diagnosis of bipolar, I was worried about what care I would have in the community. When I was discharged the first time, after a 2-month stint, my psychology sessions ceased as I was no longer a patient. I was to continue seeing a care coordinator in the community once a week to discuss the week’s events. Unfortunately I found this support inadequate and one month later I was back In the Wedgewood Psychiatric unit as a result of taking an overdose.
‘I was worried about what care I would have in the community..’
When I next returned to the community the care package was increased. I was to see my care coordinator twice a week and have phone calls on the days in between as well as see a clinical worker once a week. I found talking about the previous week’s events wasn’t resolving the underlying psychological issues I was having at the time and when I raised this with my care co I was told that it was hard find a Psychologist who worked in our local area of Suffolk on the NHS. Because of this I had to settle for my care co acting as a Psychologist by consulting with a psychologist before each session. Unfortunately this support wasn’t enough and I relapsed and returned to Wedgewood for another month.
Finally the psychiatrists at the hospital put their feelers out and found an NHS psychologist willing to carry out the work with me. This time when I was discharged, things started to improve and I felt there was little chance of a relapse as I felt properly supported and my issues were being explored and managed in a way that fitted my individual needs. I often wonder if I had not relapsed would I ever have received the support I needed. What do other people with mental health conditions do for support in the community? Is the only way we can get the support, through hospitalisation?
‘..I found this support inadequate and one month later I was back In the Wedgewood Psychiatric unit..’

Reading back over my article, I realise that, in the end, the system did not work. What I now see is that the process required me to play a pivotal role. Without my feedback how can true and lasting progress be possible? I could have remained a victim of my condition allowing others to present me alternatives while I choose to accept or reject their suggestions on a whim or, be proactive in my recovery, become self aware and test out what feels right for me and if I feel I need a different support or intervention, then to ask for it. Maybe we’ve been brainwashed into expecting things to be right first time and that those with the knowledge should be mind readers and get it right first time.
It’s all too easy to have expectation of others without putting the same criteria on ourselves. To fail, or in my case relapse, was perhaps a necessary part of my recovery. In the words of Thomas Edison when struggling with his electrical experiments,
‘I have not failed. I’ve just found 10,000 ways that won’t work’.

Afrika Green is a musican and blogger, she is a guest contributor for GBC and recently started a blog called http://www.my-bipolar.com which documents her feelings about her recent stay in Wedgewood Psychiatric hospital coming to terms with her diagnosis as Bipolar.

Disclaimer:The opinions expressed by the guest writer/blogger and those providing comments are theirs alone, and do not necessarily reflect the opinions of Link Up (UK) or any employee thereof. Link Up (UK) is not responsible for the accuracy of any of the information supplied by the Guest writer/bloggers. This work is the opinion of the blogger. It is not the intention of Link Up (UK) to “malign any religion, ethnic group, minority, club, organization, company, or individual.

Source:  http://greatbritishcommunity.org/i-may-never-have-received-the-support-i-needed-if-i-hadnt-relapsed/

Low testosterone linked to depression

Men who have low levels of testosterone have an increased risk of depression and depressive symptoms, according to a new study.
Depression can range from lasting feelings of sadness and hopelessness to losing interest in hobbies previously enjoyed. It can also incur physical symptoms, such as constantly feeling tired, sleeping badly and a loss of appetite or sex drive.
Researchers at the George Washington University set out to investigate the relationship between testosterone levels and depression.
Michael Irwig, lead researcher of the study, said: 'In an era where more and more men are being tested for "Low T" - or lower levels of testosterone - there is very little data about the men who have borderline low testosterone levels.
'We felt it important to explore the mental health of this population.'
For the study, they recruited 200 men aged between 20 and 77, with an average age of 48 years old. Each participant was referred for borderline total testosterone levels between 200 and 350 ng/dL.
The researchers collected information about the participants, including medical histories, signs and symptoms of hypogonadism (reduction or absence of hormone secretion), assessments of depressive symptoms and/or any known diagnosis of depression or use of an antidepressant.
It was found that 56 per cent of the men had depression and/or depressive symptoms. What's more, one-quarter of the participants were taking antidepressants and had high rates of obesity.
Common symptoms among these men included decreased libido, fewer morning erections, erectile dysfunction, sleep disturbances and low energy.
The researchers concluded that GPs and clinicians should check for depressive symptoms and depression in men who have been referred for low levels of testosterone
Source:  http://www.netdoctor.co.uk/interactive/news/low-testosterone-linked-to-depression-id801793200-t116.html

Genetic test may help customize antidepressant prescriptions for US vets with PTSD

Depression is the most common comorbidity in the United States— exacerbating conditions like diabetes, hypertension and post-traumatic stress disorder (PTSD)— but identifying the best medication has historically proved challenging for psychiatrists. Studies show that, on average, when a doctor prescribes an antidepressant, there’s a 50 percent chance it will work, and, if not, there’s only a 25 percent chance the next attempted drug will work.
“So now, you have 75 percent of patients failing the second medication, so you get this nocebo effect— you feel hopeless and that nothing is going to work on you, and you start giving up on the interventions. And half of how these interventions work is if you believe in these interventions,” Bryan Dechairo, PhD, senior vice president of medical affairs and clinical development for Assurex Health, a personalized medicine company specializing in pharmacogenomics, told FoxNews.com.
The need for effective, fast treatment is especially noticeable among U.S. military veterans with PTSD, of which 40 to 70 percent, depending on the branch, are also diagnosed with depression, said Kathleen Chard, associate chief of staff for research at the Cincinnati VA Medical Center.
To help identify the right type of antidepressant from the get-go, Chard’s team is collaborating with Assurex Health to deploy 100 kits of its patented cheek swab test to Cincinnati VA Medical Center patients.
The genetic test, called GeneSight, extracts a patient’s DNA from the cheek swab and runs it through an algorithm, analyzing eight different genes in the body to produce 20,736 possible patient genetic profiles. Unlike other tests, Dechairo said, GeneSight looks at genes all together rather than one at a time. Next, scientists use that information to determine which of the 38 medications approved by the Food and Drug Administration (FDA) are appropriate for a given patient, and, if so, at what dose. The test can produce a total of 787,968 total possible gene-medication combinations..
Psychiatrists are two months into the quality improvement pilot project, whose ultimate aim is to measure the effectiveness of psychotherapy and antidepressants against their previous average response rate in U.S. veterans with PTSD. Assurex Health and psychiatrists in Cincinnati aim to move onto a larger clinical trial next.
“The number-one treatment for PTSD is psychotherapy, but so many of our patients have gone past this where they have become depressed, so we need that antidepressant to get them along,” Chard told FoxNews.com. “Having this test kit for us is, in many ways, a wonderful opportunity, an awakening, and a way to raise hope when hope is fairly lost.”
Tailoring treatment for better outcomes 
Chard noted that one of the key parts of PTSD is avoidance. Because veterans diagnosed with the condition are fearful of triggers in various social settings, from Fourth of July parties to baseball games, they are at risk of depression.
“The second highest diagnosis behind PTSD is depression, and if left untreated, people turn to substance abuse— so we really want to intervene as early as we can,” she said.
After scientists produce results from the GeneSight test, they supply psychiatrists with a report containing three color-coded columns indicating which medications should be used as directed (green), which should be used with caution (yellow), and which should be used with extreme caution (red). The report also specifies how the listed medications are metabolized in the stomach and liver, and, thus, what dosing is appropriate for any given patient.
“The way the algorithm works for us is we’re looking at two different things the body does with medications: How does the body process medication [and] how does it remove that medication from your body?” said Dechairo, who received his PhD in common complex human genetics from the Institute of Child Health at University College London and a bachelor’s degree in integrative biology from the University of California, Berkeley.
Psychiatrists can use GeneSight to determine the proper prescription not only for PTSD and depression, but also for anxiety, bipolar disorder and schizophrenia. About 11,500 health care professionals have registered to administer the test, and 170,000 American patients— compared to about 30,000 in 2013— have used it.
In 2010, Assurex Health commercially launched the test, which combines previous technology from Cincinnati Children’s Hospital and the Mayo Clinic. It is covered under Medicare, and the U.S. Department of Veterans Affairs awarded a contract that allowed the test to be used at VA facilities nationwide beginning in June 2014.
To date, results from five clinical trials suggest that in the general population, the test can result in 70 percent greater improvement in depressive symptoms and an average annual savings of $2,500 per patient, compared to their current standard of care.
In Cincinnati, psychiatrists have administered about 40 of the 100 test kits in their study group, and researchers expect to have formal results by the end of the year.
Benefits of testing 
Casey Williams, 46, of Lake County, Ohio, received one of the 100 test kits being deployed at the Cincinnati VA Medical Center in late May.
Williams, who served in the U.S. Army from 1987 to 1993 as a combat engineer, was diagnosed with PTSD and depression in 2005. But he was struggling with hyper-vigilance, irritability, difficulty connecting with loved ones, and anxiety— all symptoms of PTSD— long before, he said.
“I played everything by ear,” Williams told FoxNews.com. “Get a job, lose a job. Get in a relationship, lose a relationship. Everything was negative. Everything.”
Since he was diagnosed with PTSD, Williams has tried at least 10 different kinds of antidepressants, going back and forth between those medications and antipsychotics. Many of them made him nauseous and drowsy, and one even made him hallucinate.
“It was a lot of trial and error,” he said. “It was very frustrating. None of them were effective.”
Now, after taking the GeneSight test, he is on a new combination of drugs recommended by the results— he takes three pills in the morning and one at night— and said he’s feeling less anxious already.
He’s nearing the end of an eight-week residential PTSD program at the Trauma Recovery Center Division of the Cincinnati VA Medical Center, and he said being on medication that feels effective has enabled him to concentrate on the program. For veterans enrolled in therapy for PTSD, maintaining that focus is crucial for success in therapy, said Dr. Jacob Forrester, MD, medical director of the trauma recovery center.
“It was very nice to have the information to help tailor [his prescription] because we’re kind of time limited here,” Forrester told FoxNews.com. “The benefit to this testing is really to make it less random and to have more info— that’s not to say side effects can’t occur even if genetic testing says it shouldn’t be occurring. But it lessens that risk and gives us little more guideposts for medicine.”
Chard said an upcoming separate pilot study with 10 GeneSight kits and 10 veterans will utilize functional magnetic resonance imaging (fMRI) scans to examine the efficacy of PTSD and depression therapy before, during and after treatment. Assurex, Cincinnati Children’s Hospital, the VA Air Force Research Lab and the Cincinnati VA Medical Center are collaborating for the study. Researchers expect to begin enrolling patients in two weeks.
“We really do not have a lot of understanding in terms of the biomarkers, and in terms of who gets PTSD and who responds better to which treatment,” Chard said. “We don’t want people to stay sick a long time. It’s a drain on them, their families and society to be sick with PTSD, so the sooner we can get them healthy, the better.”
Source:  http://www.foxnews.com/health/2015/07/02/genetic-test-may-help-customize-antidepressant-prescriptions-for-us-vets-with/