Mindfulness treatment as effective as CBT for depression, anxiety

Group mindfulness treatment is as effective as individual cognitive behavioral therapy (CBT) in patients with depression and anxiety, according to a new study from Lund University in Sweden and Region Skåne. This is the first randomized study to compare group mindfulness treatment and individual cognitive behavioral therapy in patients with depression and anxiety in primary health care.

The researchers, led by Professor Jan Sundquist, ran the study at 16 primary health care centres in Skåne, a county in southern Sweden. They trained two mindfulness instructors, from different occupational groups, at each primary health care centre during a 6-day training course.
In spring 2012, patients with depression, anxiety or reactions to severe stress were randomized to either structured group mindfulness treatment with approximately 10 patients per group, or regular treatment (mainly individual CBT). Patients also received a private training programme and were asked to record their exercises in a diary. The treatment lasted 8 weeks. General practitioner and mindfulness instructor Ola Schenström designed the mindfulness training programme and model for training instructors.
A total of 215 patients were included in the study. Before and after treatment, the patients in the mindfulness and regular treatment groups answered questionnaires that estimated the severity of their depression and anxiety. Self-reported symptoms of depression and anxiety decreased in both groups during the 8-week treatment period. There was no statistical difference between the two treatments.
"The study's results indicate that group mindfulness treatment, conducted by certified instructors in primary health care, is as effective a treatment method as individual CBT for treating depression and anxiety," says Jan Sundquist. "This means that group mindfulness treatment should be considered as an alternative to individual psychotherapy, especially at primary health care centres that can't offer everyone individual therapy."
Source: http://www.sciencedaily.com/releases/2014/11/141127112755.htm

Mindfulness + Cognitive Therapy = Less Prenatal Depression Risk

Mindfulness techniques combined with cognitive therapy have been shown to reduce the risk of depression relapse among pregnant women.
Mindfulness approaches include meditation, breathing exercises, and yoga while cognitive therapy challenges and alters maladaptive thoughts and feelings.
University of Colorado, Boulder researchers found pregnant women with histories of major depression were less likely to relapse into depression if they used the non-drug interventions.
About 30 percent of pregnant women who have struggled with depression in the past will again become depressed in the months before and after birth, according to past research.
In the new study, researchers found that participation in a Mindfulness Based Cognitive Therapy program reduced the relapse rate to 18 percent.
“It’s important for pregnant women who are at high risk of depression to have options for treatment and prevention,” said Dr. Sona Dimidjian, an associate professor in University of Colorado, Boulder’s Department of Psychology and Neuroscience and lead author of the study.
“For some women, antidepressant medication is truly a lifesaver, but for others, concerns about side effects and possible impacts to fetal development may cause them to prefer a non-pharmacological intervention.”
Mindfulness Based Cognitive Therapy, which combines mindfulness practice with more traditional cognitive therapy, has been shown to be effective at preventing recurrent episodes of depression in the general population.
But few studies of any kind have looked at the effect of non-drug therapies and interventions among pregnant women. A major reason for the research shortfall is the difficulty to recruit participants for a study within the relatively short time period of pregnancy.
For the current research, published in the journal Archives of Women’s Mental Health, 42 women in Colorado and Georgia with at least one prior episode of major depression took an eight-session class during their pregnancies. During class and in homework assignments, the women worked to develop mindfulness skills.
“Mindfulness is about how to pay attention to your own moment-to-moment experience in a way that is suffused with an openness, curiosity, gentleness, and kindness towards oneself,” Dimidjian said.
The standard mindfulness practices used in class were tweaked to be more valuable to pregnant women. Lessons included prenatal yoga, walking meditation exercises that could be done later while soothing a baby, and shorter practices that could be easily integrated into the busy lives of new moms.
The lessons also specifically addressed worry, which can be an overwhelming emotion during pregnancy, and put particular focus on love and kindness for oneself and one’s baby.
The research team surveyed the women for symptoms of depression during their pregnancy and through six months postpartum.
“A high percentage of the women who began the courses, 86 percent, completed the study, a sign that the women found the sessions valuable,” Dimidjian said.
The researchers also were struck by the number of pregnant women who expressed interest in participating in a mindfulness program, even though they didn’t meet the criteria to participate in this study.
“I was surprised by the level of interest, even among women who didn’t have a history of depression,” Dimidjian said. “Pregnant women know they are going to have this upcoming event that’s going to change their lives, and they want to be ready.”
Dimidjian has worked to create an online program of Mindfulness Based Cognitive Therapy that could be used as a tool to address the demand by pregnant women and others to develop these skills.
To test the effectiveness of the online program, Dimidjian is now recruiting adult women with a prior history of depression to participate in a new study. The women do not need to be pregnant.
Source: http://psychcentral.com/news/2014/11/20/mindfulness-cognitive-therapy-less-prenatal-depression-risk/77549.html

Can hip-hop beat depression?

Feeling fed up? Perhaps a blast of The Notorious BIG or Grandmaster Flash & The Furious Five could help, Cambridge researchers say.

They say that listening to hip hop can actually be beneficial to those suffering with depression.

'There is often a message of hope in amongst the lyrics, describing the place where they want to be – the cars they want to own, the models they want to date,' the researchers wrote. 

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Researchers recommend The Message by Grandmaster Flash (pictured) & The Furious Five, released in 1982, which includes the lyrics: 'I can't take the smell, can't take the noise Got no money to move out, I guess I got no choice'

WHAT TO LISTEN TO

Researchers recommend The Message by Grandmaster Flash & The Furious Five, released in 1982, which includes the lyrics: 'I can't take the smell, can't take the noise Got no money to move out, I guess I got no choice'

They also cite Juicy by The Notorious BIG, which is 'dedicated to all the teachers that told me I'd never amount to nothin'' but details how he became successful. 

In an article in The Lancet Psychiatry, the team claims that lyrics which speak of overcoming hardships and struggles can offer refuge.

'Much of hip-hop comes from areas of great socioeconomic deprivation, so it's inevitable that its lyrics will reflect the issues faced by people brought up in these areas, including poverty, marginalisation, crime and drugs,' said Dr Akeem Sule, of the University of Cambridge.

'In fact, we can see in the lyrics many of the key risk factors for mental illness, from which it can be difficult to escape. 

'Hip-hop artists use their skills and talents not only to describe the world they see, but also as a means of breaking free.

'We believe that hip-hop, with its rich, visual narrative style, can be used to make therapies that are more effective for specific populations and can help patients with depression to create more positive images of themselves, their situations and their future,' says Sule. 

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'It's been about forty years since hip-hop first began in the ghettos of New York City and it has come a long way since then, influencing areas as diverse as politics and technology,' said co-author Dr Becky Inkster Clinical Neuroscientist in the Department of Psychiatry, University of Cambridge.

'Now we hope to add medicine to the list.'

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Notorious B.I.G., whose real name was Christopher Wallace, left, gestures as he and producer Sean "Puffy" Combs leave a party at the Petersen Automotive Museum in Los Angeles in 1997. Researchers now say his music could be the key to beating depression.

The team, hope to take their 'Hip Hop Psych' project into prisons, schools, and hostels to promote positive self-esteem through engagement with hip-hop artists. 

'We've had an enormous response from the global community, from patients, prisoners, and parents to artists and fans alike,' says Inkster.

 'We are overwhelmed and excited by requests from people around the world reaching out to us who want to help. 

'It has been moving to see how honest and open people have been with us. 

Source: http://www.dailymail.co.uk/sciencetech/article-2830877/Can-hip-hop-beat-depression-Researchers-say-positive-lyrics-help-boost-people-s-mood.html

Depression May Interfere with Intuition

People who suffer from depression appear to be disconnected from their intuition, or gut instincts, according to a new study published in the British Journal of Clinical Psychology.
The findings may help explain why depressed people often have a hard time making decisions.
For the study, Carina Remmers, a researcher from the University of Hildesheim in Germany, and her team asked 29 patients with major depression and 27 healthy controls to complete the Judgment of Semantic Coherence Task, a well-established scientific measure of intuition.
The researchers presented participants with groups of three words (e.g. salt, deep, foam). In less than three and a half seconds, the participants had to decide whether the three words were linked in meaning by a fourth word (in this case the answer was “yes” and the word was sea).
If the participants answered that the words were linked, they were given eight more seconds to provide the linking word. They were also allowed to say that they felt the words were linked, but that they didn’t know how. When this was the case, it was taken by the researchers as an instance of intuition (knowing without knowing why).
No differences were found between the depressed patients and controls in how often they answered correctly for the fourth linking word, nor in the number times they gave no response at all. This suggests both groups were similarly motivated and attentive to the task.
However, the depressed patients gave fewer correct intuitive answers (i.e. when they answered correctly that the words were linked but didn’t consciously know how).
Having poorer intuition on the task was associated with a higher measure of brooding (indicated by agreement with statements like “When I am sad, I think ‘Why do I have problems others don’t have?’”). This connection, in turn, appeared to be explained by the fact that the brooding patients felt more miserable.
The researchers note that their study is the first to investigate intuition in people with major depression. The findings are consistent with previous research on healthy people showing that low mood encourages an analytical style of thinking and inhibits a creative, more intuitive style of thinking.
According to National Institute of Mental Health, major depression causes severe symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy life. It is one of the most common mental disorders in the United States with about 6.7 percent of adults affected each year.
Source: http://psychcentral.com/news/2014/11/09/depression-may-interfere-with-intuition/77119.html

Fish intake associated with boost to antidepressant response

Up to half of patients who suffer from depression (Major Depressive Disorder, or MDD) do not respond to treatment with SSRIs (Selective Serotonin Reuptake Inhibitors). Now a group of Dutch researchers have carried out a study which shows that increasing fatty fish intake appears to increase the response rate in patients who do not respond to antidepressants. This work is being presented at the European College of Neuropsychopharmacology congress in Berlin.

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According to lead researcher, Roel Mocking (Amsterdam): "We were looking for biological alterations that could explain depression and antidepressant non-response, so we combined two apparently unrelated measures: metabolism of fatty acids and stress hormone regulation. Interestingly, we saw that depressed patients had an altered metabolism of fatty acids, and that this changed metabolism was regulated in a different way by stress hormones."
The researchers were looking at the relationship between depression and fatty acids, and various hormones, including the stress hormone cortisol. They took 70 patients with depression and compared them to 51 healthy controls, by measuring their fatty acid levels and cortisol levels. They then gave the depressed patients 20mg of an SSRI daily for 6 weeks, and in those who did not respond to the SSRIs the dose was gradually increased up to 50mg/day. Fatty acid and cortisol levels were measured during the trial.
They found that the MDD patients who didn't respond to the SSRI also tended to have abnormal fatty acid metabolism, so they checked the dietary habits of all those taking part in the trial. Fatty fish is rich in fatty acids, such as the well-known Omega-3 DHA. So the researchers looked at the amount of fatty fish in the diet of all involved in the trial. They categorised the patients into 4 groups, according to their fatty fish intake, and they found that those who took the least fish tended to respond badly to anti-depressants, whereas those who had most fish in the diet responded best to anti-depressants. Those who ate fatty fish at least once a week had a 75% chance of responding to antidepressants, whereas those who never ate fatty fish had only a 23% chance of responding to antidepressants.
Roel Mocking continued: "This means that the alterations in fatty acid metabolism (and their relationship with stress hormone regulation) were associated with future antidepressant response. Importantly, this association was associated with eating fatty fish, which is an important dietary source of omega-3 fatty acids. These findings suggest that measures of fatty acid metabolism, and their association with stress hormone regulation, might be of use in the clinic as an early indicator of future antidepressant response. Moreover, fatty acid metabolism could be influenced by eating fish, which may be a way to improve antidepressant response rates."
"So far this is an association between fatty acids in blood and anti-depressant response; so it's not necessarily a causal effect. Our next step is to look at whether these alterations in fatty acid metabolism and hormonal activity are specific for depression, so we are currently repeating these measurements in patients with post-traumatic stress disorder and schizophrenia."
ECNP President, Professor Guy Goodwin (Oxford) said: 'Understanding non-response to treatment with SSRIs remains an important known unknown. There is already an intriguing association between eating fish and general health. The present study, while preliminary, takes the story into the realm of depression. Larger scale definitive studies will be of considerable interest."
Source: http://www.sciencedaily.com/releases/2014/10/141020090142.htm

Depression Medicines

Not only does it take time to get an accurate depression diagnosis, finding the right medication to treat depression can be a complicated, delicate process. Someone may have a serious medical problem, such as heart disease or liver or kidney disease, that could make some antidepressants unsafe. The antidepressant could be ineffective for you or the dose inadequate; there may not have been enough time to see an effect, or the side effects could be too bothersome -- leading to a failure of treatment.

As you approach taking antidepressants to treat depression, it is important to keep these points in mind:

1. Only about 30% of people with depression go into full remission after taking their first course of antidepressants. That’s according to a 2006 study funded by the National Institutes of Health. Those who got better were more likely to be taking slightly higher doses for longer periods.
2. Some antidepressants work better for certain individuals than others. It's not uncommon to try different depression medicines during treatment.
3. Some people need more than one medicine for depression treatment.
4. Antidepressants carry a boxed warning about increased risk compared to placebo for suicidal thinking and behavior in children, adolescents, and young adults 18-24 years old.

Working with your doctor, you can weigh the risks and benefits of treatment and optimize the use of medication that best relieves your symptoms.

What is an antidepressant?

Antidepressants, sometimes in combination with psychotherapy, are often the first treatment people get for depression. If one antidepressant doesn't work well, you might try another drug of the same class or a different class of depression medicines altogether. Your doctor might also try changing the dose. In some cases, your doctor might recommend taking more than one medication for your depression.

What are the different types of antidepressants?

Here are the main types of antidepressants along with brand names:

• Selective serotonin reuptake inhibitors (SSRIs) were launched in the mid to late 1980s. This generation of antidepressants is now the most common class used for depression. Examples include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), vortioxetine (Brintellix), and sertraline (Zoloft). Another SSRI, Viibryd, was approved in early 2011. Side effects are generally mild, but can be bothersome in some people. They include stomach upset, sexual problems, fatigue, dizziness, insomnia, weight change, and headaches.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer type of antidepressant. This class includes venlafaxine (Effexor),  desvenlafaxine (Pristiq and Khedezla), duloxetine (Cymbalta), and, levomilnacipran (Fetzima). Side effects include upset stomach, insomnia, sexual problems, anxiety, dizziness, and fatigue.
• Tricyclic antidepressants (TCAs) were some of the first medications used to treat depression. Examples are amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Side effects include stomach upset, dizziness, dry mouth, changes in blood pressure, changes in blood sugar levels, and nausea.
• Monoamine oxidase inhibitors (MAOIs) were among the earliest treatments for depression. The MAOIs block an enzyme, monoamine oxidase. Examples are phenelzine (Nardil), tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline (the EMSAM skin patch). Although MAOIs work well, they're not prescribed very often because of the risk of dangerous reactions. They can cause serious interactions with other medications and certain foods. Foods that can negatively react with the MAOIs include aged cheese and aged meats.
• Other medications:
  • Bupropion (Wellbutrin, Aplenzin) is different than other antidepressants is thought to affect the brain chemicals norepinephrine and dopamine. Side effects are usually mild, including upset stomach, headache, insomnia, and anxiety. Bupropion may be less likely to cause sexual side effects than other antidepressants.
  • Mirtazapine (Remeron) is usually taken at bedtime. Side effects are usually mild and include sleepiness, weight gain, elevated triglycerides, and dizziness.
  • Trazodone (Desyrel) is usually taken with food to reduce chance for stomach upset. Other side effects include drowsiness, dizziness, constipation, dry mouth, and blurry vision.
  
   Are other medicines used with the antidepressants?
  
  Other medicines may be prescribed in addition to antidepressants, particularly in treatment resistant depression. Here are examples of medicines that may be used to augment as an add-on to antidepressant treatment.
• Antipsychotic medications like Abilify and Seroquel can be used as an add-on to antidepressant treatment. Symbyax, a combination of the antipsychotic drug Zyprexa and an SSRI (fluoxetine), is approved for treatment-resistant depression.
• Your doctor may recommend or prescribe other medications or supplements not FDA approved for use in depression   

Are there suggestions for how to get the most from depression treatment?

• Monitor your mood. Monitoring your moods and behavior from time to time can help your doctor treat your depression before it becomes hard to control. Try to observe any patterns of mood swings each week and call your doctor if you aren’t feeling at the top of your game.
• Strengthen your social support. Although you cannot control your depression diagnosis, there are some things you can control. You can seek or create a positive support system for yourself. Whether your social network stems from your spouse, family members, close friends, co-workers, religious organizations, or community groups, support is available.
• Stick with the prescribed treatment. Antidepressants can take up to eight weeks before they take full effect. Don't skip doses or quit treatment early. If you don't take your depression medicine exactly as prescribed, you’re not giving it a fair chance to work.
• See a depression expert. It's important to talk with a trained professional during your treatment. Although psychologists cannot prescribe medication, they are well-trained in psychiatric assessment and psychotherapy. You can work with a psychologist while taking antidepressants prescribed by your regular doctor, or you can see a psychiatrist for both your depression medication and talk therapy. Try to find someone who has a lot of experience helping people with treatment-resistant depression.
• Develop good habits. Take your depression medicine at the same time every day. It's easier to remember if you do it along with another activity such as eating breakfast or getting into bed. Get a weekly pillbox, which will make it easy to see if you've missed a dose. Since people sometimes forget a dose now and then, make sure you know what to do if that happens.
• Don't ignore side effects. Side effects are one of the main reasons that people give up on medication. If you have side effects, talk to your doctor. See if there's any way to minimize or eliminate them. However, keep in mind that side effects might be worse when you first start a medicine. Side effects often ease up over time.
• Let your doctor know if you are prescribed other medicines by another health care professional.  Some medicines can have important interactions with antidepressant medicines.  Tell your doctor if you are already taking, or begin taking, any other medicines so he or she can safely monitor your treatment.
• Never stop taking your depression medicine without your doctor's permission. If you need to stop taking your medicine for some reason, your doctor may want to reduce your dose gradually. If you stop suddenly, you could have side effects and your depression could get worse.
• Don't assume that you can stop taking your depression medicine when you feel better. If you feel that you’d like to come off your medication, talk to your doctor. Don’t stop on your own; quitting abruptly can lead to symptoms associated with discontinuing a drug as well as risk for relapse.

Source: http://www.webmd.com/depression/guide/optimizing-depression-medicines?page=1

New Treatments For Anxiety and Depression - The Alternative Way

Most clinicians and therapists will prescribe you with medicine to treat mood disorders. Others will recommend scientific methods of treatment for anxiety and depression, such as transcranial magnetic stimulation, vagus nerve stimulation or electroconvulsive therapy. However, these new treatments for anxiety and depression may have serious side effects and their effects on your body in the long term aren't recognized yet.
If you are looking for ways to treat your mood disorder less the side effects, you may consider the alternative treatments for anxiety and depression. They may work for you if you have the strength, courage and patience to try these treatment approaches.
Acupuncture
It is amazing what needles can do for you. In recent studies, it has been shown that acupuncture can help reduce depression. The study conducted by the National Institute of Health revealed that forty three percent of patients who were treated with acupuncture have showed favorable response.
A well-trained acupuncture specialist will insert thin needles in key points to normalize the body's equilibrium and allow a surge of positive energy into the body.
Cardiovascular Exercises
As many athletes say, run and you shall be happy. This is true. Many people have attested to the theory that cardiovascular exercises such as running, jogging, brisk walking and swimming are one of the best new treatments for anxiety and depression.
These testimonials are backed up by researches done by psychiatrists and scientists. It has been found that people who regularly exercise become less anxious and depressed. The reason is that exercise neutralizes fight-or-flight hormones in people with anxiety.
During an intensive body activity, all organs in the body are working well and efficiently. Thus, deficiency or excess of hormones in the body is controlled and normalized.
For depressed people exercise stimulates the brain to release "happy" hormones. The amount of serotonin is likewise increased, thus removing depressing thoughts out of a patient's mind.
Meditation and Breathing Exercises
Buddhists and Hindus have practiced meditation for centuries. Those who practice meditation and breathing exercises are calmer, happier and live longer.
The reason is that meditation promotes body and mind relaxation. When the mind is calm so are the organs in it. And when this happens, the organs will release just the right amounts of hormones.
Breathing exercises helps the heart to function well. If you know how to breathe well, you can prevent anxiety from ever attacking you. If you notice that a stressor makes you anxious, all you have to do is breathe correctly and quiet your mind. And when you do this, you will have prevented anxiety from disrupting your normal life.
Light Therapy
There is a disorder known as seasonal effective disorder, meaning anxiety and depression only occur during rainy or winter days.
During rainy and winter days, when the sun is hiding behind the thick clouds, some people feel melancholic, sad and depressed. They attributed the dark environment to gloominess and sadness.
With bright light therapy (sunlight and artificial light) people with anxiety and depression are "conditioned" to be sunny and happy. This alternative treatment for anxiety and depression has worked for many.
Dietary Supplements
People with anxiety and depression are found to be lacking in these vitamins, minerals and hormones: vitamin B12, magnesium, zinc, and serotonin.
To increase the levels of these substances, you need to increase your intake of foods rich in these vitamins and minerals that promote the production of serotonin.
However, diet is not enough for an effective new treatment for depression and anxiety. You need supplements of these vitamins and minerals in tablet or capsule forms. You can ask your doctor to prescribe you with these supplements although you can buy them directly over the counter. This way, he can regulate your intake of these supplements and avoid overdose.

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