Depression: A revolution in treatment?

It's not very often we get to talk about a revolution in understanding and treating depression and yet now doctors are talking about "one of the strongest discoveries in psychiatry for the last 20 years".

It is based around the idea that some people are being betrayed by their fiercest protector. That their immune system is altering their brain.
The illness exacts a heavy toll on 350 million people around the world, among them Hayley Mason, from Cambridgeshire:
"My depression gets so bad that I can't leave the bed, I can't leave the bedroom, I can't go downstairs and be with my partner and his kids.
The 30-year-old added: "I can't have the TV on, I can't have noise and light, I have suicidal thoughts, I have self-harmed, I can't leave the house, I can't drive.
"And just generally I am completely confined to my own home and everything else just feels too much."
Anti-depressant drugs and psychological treatments, like cognitive behavioural therapy, help the majority of people.
But many don't respond to existing therapies and so some scientists are now exploring a new frontier - whether the immune system could be causing depression.
"I think we have to be quite radical," says Prof Ed Bullmore, the head of psychiatry at the University of Cambridge.

 He's at the forefront of this new approach: "Recent history is telling us if we want to make therapeutic breakthroughs in an area which remains incredibly important in terms of disability and suffering then we've got to think differently."
The focus is on an errant immune system causing inflammation in the body and altering mood.
And Prof Bullmore argues that's something we can all relate to, if we just think back to the last time we had a cold or flu.
He said: "Depression and inflammation often go hand in hand, if you have flu, the immune system reacts to that, you become inflamed and very often people find that their mood changes too.
"Their behaviour changes, they may become less sociable, more sleepy, more withdrawn.
"They may begin to have some of the negative ways of thinking that are characteristic of depression and all of that follows an infection."
It is a subtle and yet significant shift in thinking. The argument is we don't just feel sorry for ourselves when we are sick, but that the chemicals involved in inflammation are directly affecting our mood.


Inflammation is part of the immune system's response to danger. It is a hugely complicated process to prepare our body to fight off hostile forces.
If inflammation is too low then an infection can get out of hand. If it is too high, it causes damage.
And for some reason, about one-third of depressed patients have consistently high levels of inflammation. Hayley is one of them: "I do have raised inflammation markers, I think normal is under 0.7 and mine is 40, it's coming up regularly in blood tests."
There is now a patchwork quilt of evidence suggesting inflammation is more than something you simply find in some depressed patients, but is actually the cause of their disease. That the immune system can alter the workings of the brain.

Joint pain

To explore this revolutionary new idea in depression, we visited an arthritis clinic at Glasgow Royal Infirmary.
It is perhaps an unexpected location, but it was in clinics like this that doctors noticed something unusual.

Rheumatoid arthritis is caused by the immune system attacking the joints. And when patients were given precise anti-inflammatory drugs that calmed down specific parts of the immune response, their mood improved.
Prof Iain McInnes, a consultant rheumatologist, said: "When we give these therapies we see a fairly rapid increase in a sense of well-being, mood state improving quite remarkably often disproportionately given the amount of inflammation we can see in their joints and their skin."
It suggests the patients were not simply feeling happier as they were in less pain, but that something more profound was going on.
Prof McInnes added: "We scanned the brains of people with rheumatoid arthritis, we then gave them a very specific immune targeted therapy and then we imaged them again afterwards.
"What we are starting to see when we give anti-inflammatory medicines is quite remarkable changes in the neuro-chemical circuitry in the brain.
"The brain pathways involved in mediating depression were favourably changed in people who were given immune interventions."
One possible explanation is that inflammatory chemicals enter the brain. There they interrupt the production of serotonin - a key neurotransmitter that's linked to mood.
 
To hear more we visited Carmine Pariante's laboratory at King's College London. The professor of biological psychiatry has been piecing together the evidence on inflammation and depression for 20 years.
He told the BBC: "Nearly 30% to 40% of depressed patients have high levels of inflammation and in these people we think it is part of the causal process.
"The evidence supporting this idea is that high levels of inflammation are present even if someone is not depressed, but is at risk of becoming depressed.
"We know from studies that if you have high levels of inflammation today you're at higher risk of becoming depressed over the next weeks or months even if you are perfectly well."
He's shown that not only are depressed patients more likely to have high levels of inflammation, but those with an overactive immune system are also less likely to respond to anti-depressants.
This is a big deal because a third of patients don't get any benefit from drug treatments.

 But there's something confusing here. The immune system responds to infection and that doesn't seem to fit the usual story of depression.
Take Jennifer Streeting, a trainee midwife in London, who traces her mental health problems back to when she was 14.
"My nana passed away and my mum had breast cancer and if you ask my therapist now she puts it down to grief and not really dealing with that at the time, I think there was just a lot going on."
Prof Pariante argues it is actually these awful moments in our lives that change our immune system, priming it to increase the risk of depression years later.
He said: "We think the immune system is the key mechanism by which early life events produce this long-term effect.
"We have some data showing adult individuals who have a history of early life trauma, even if they have never been depressed, have an activated immune system so they are in a state of risk."
The hope is that drugs targeting the immune system will provide much needed treatments for patients, particularly for those like Jennifer who seem to have tried them all.
"I had sertraline, I had Prozac, there was another one, I got started on citalopram, I was put on duloxetine, mirtazapine as well. I was on three at one point."
She is now on a combination of drugs that seem to be working for her, but it has been a long journey.
"It is totally trial and error," said Prof Pariante.

He added: "We are not able to predict right from the beginning whether someone will respond.
"We think by measuring inflammation in the blood we'll actually be able to identify individuals that do require more complex, intensive antidepressant treatment, maybe a combination of an antidepressant and and anti-inflammatory."
Most of us have common anti-inflammatories like ibuprofen at home, but doctors warn against experimenting at home, while clinical trials are taking place to prove whether this will work in patients.
The world's largest medical research charity, the Wellcome Trust, has brought together universities and the pharmaceutical industry.
The aim is to consolidate the evidence to accelerate the field; ultimately they want to find a new treatment for depression and develop a test to identify those who will benefit.
Cambridge University's Prof Bullmore is leading the consortium. But we interviewed him at his other employer, GlaxoSmithKline.
The company's immuno-inflammation laboratory is where scientists are developing new molecules which they hope will become effective medicines for inflammatory disorders.
That process will take more than a decade, but Prof Bullmore says there may already be a drug out there.
"One of the exciting things about immunopsychiatry is that because of the success of immunology in other areas of medicine there are already many drugs that are far beyond this stage of development.
"They may already be licensed or in late-stage clinical trials so the timeline from start of work on that project to delivering a medicine that might make a difference to patients could be much shorter."

Progress

Raiding the cupboards is already showing signs of success. Those early clues in arthritis mean the anti-inflammatory drug sirukumab is now being trialled in depressed patients.
So are drugs targeting the immune system about to transform the treatment of depression?
Prof Bullmore argues: "I don't think they are going to be a panacea, I don't think we're talking about a scenario in future where every patient with symptoms of depression is going to be offered an anti-inflammatory drug.
"I don't think that makes sense and frankly that sort of blockbuster one-size-fits-all approach to development of drugs for psychiatry has not been helpful to us in the past.
"We have to take a more personalised or stratified approach, not everyone that is depressed is depressed for the same reason."
That will require a blood test to identify which patients will benefit from immune-based therapies.

Depression is a disease that affects hundreds of millions of people. Even if anti-inflammatories help just a small proportion of them - that would still be a huge number of patients. But if immunotherapy becomes a success, its biggest impact may be on the way we think about the disease, making people less likely to believe sufferers should just "pull themselves together".
"I hate that phrase, if I could I would," says Jennifer.
She adds: "Just as if someone had diabetes and their insulin levels weren't working correctly, you wouldn't say, 'Oh snap out of it, stop having a hypo.'"
Hayley feels the same: "If there was a way to say depression was a physical problem I think it would make a massive difference, I think people would treat depression as something that is not made up and going on in the head.
"It would be seen as a genuine condition, it would validate a lot of people's feelings."
Prof Pariante concludes: "It is groundbreaking because, for the first time, we are demonstrating that depression is not only a disorder of the mind, in fact it is not even only a disorder of the brain, it is a disorder of the whole body."

Source: http://www.bbc.co.uk/news/health-37166293

How Should Psychology Define Happiness?

There’s no doubt that happiness research is at the top of the charts in psychology-related studies of well-being. From measures of a population’s psychological health to indications of moment-to-moment variations in people’s daily moods, research tries to pinpoint the factors that will give us joy.
However, this focus may be taking us away from a true understanding of psychological well-being. Happiness research has a definite down side in its emphasis on those feelings of joy and elation. In a New York Times op-ed piece fittingly called Happiness and its Discontents, St. Louis Philosophy professor Daniel Haybron challenged what he saw as an over-reliance on simple happiness scales to index people’s psychological health.
Psychological researchers have, for years, distinguished between “life satisfaction,” or the overall assessment of your feelings and attitudes about your life at a particular point in time, from “subjective well-being,” which captures the actual feelings of happiness you have at the moment.  The aptly-labeled phrase paradox of well-being describes a puzzling finding, long known about in the field of psychology and aging, that older people express higher levels of subjective well-being despite the fact that, objectively, their life circumstances are less positive than are those of younger but often, unhappier, people.
According to a 2009 Pew Research Center report, “Growing Old in America: Expectations vs. Reality,” older adults are much happier than they ought to be. The survey results reported here compared the expectations of growing older by people 64 years and younger with the reality of aging as expressed by those 65 and older. Rather than being bogged down by such problems as memory loss, not being able to drive, having a serious illness, not being sexually active, and feeling sad or depressed, older adults felt pretty good about their lives. They felt they had more time for hobbies and interests, family, and volunteer work, and regarded themselves as well-respected, financially secure, and less stressed. Across all age groups, about one-third rate themselves as “very happy,” which is pretty steady from ages 18 and up. The age groups who rate themselves as happiest are the people in their 20s, but there isn’t a tremendous fall-off after that even until ages 75 and older.
Again, though, we have to ask about the difference between “happiness” and other forms of well-being. To be happy means that you feel positive emotions but, as we know, emotions are fleeting states. If I ask you right this second to say how happy you are, would this be a fair estimate of how much well-being you have? For example, maybe at the moment, you’re a little tired, worried about whether one of your family members or loved ones is okay, or just a bit frazzled after a long commute in heavy traffic or bad weather. Being truly honest, you might say “3” out of a 10-point scale. However, if I asked you to rate your satisfaction with your overall state in life, you’d stand back and from this big-picture point of view, and may very well give yourself a far higher 9 out of 10.
It’s also possible that you would rate yourself as both unhappy (at the moment) and not all that satisfied. Perhaps you’re undergoing some pretty negative experiences at the moment, lowering your felt happiness right now, and you’re also feeling dissatisfied because your life isn’t going where you’d like it to go. You’re not getting that job you wanted, you’re not in a close relationship, or you’ve lost touch with your favorite relatives and friends. However, perhaps your mood and dissatisfaction are at their worst right now because you’ve decided to give up the comforts of home to find work in a new location, to serve a charitable cause, or to join the military. You’ve made this decision because you’re seeking to give your life a higher purpose.  At the moment, you’re not happy or even satisfied, but you feel that you’re working toward fulfilling important life goals.
Happiness doesn’t equal life satisfaction, or even feelings of fulfillment.  What’s more, much of the happiness research reporting on, for example, the relationship between income and “happiness” asks people how happy they are, but not how unhappy they are as well. This bias in the question wording can result in failure to detect true sources of pain and discontent in people’s lives. Just as a physician needs to ask “where it feels ok” in addition to where it doesn’t, psychologists need to give people a chance to provide a description of their complete emotional state, even if it is only their feelings at the moment.

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Because of this inherent bias in “happiness” ratings, psychologists David Watson, Lee Clark, and Auke Tellegen designed the “PANAS,” or Positive and Negative Affect Schedule” (1988), which has since been expanded and translated into many languages. It’s much more complex than the usual happiness indexes, which in their simplest form, consist of a single item, or perhaps as many as three or five. In addition to the PANAS, Bradburn’s Affect Balance Scale (ABS; Bradburn, 1969) includes 10 questions with 5 assessing positive and 5 assessing negative emotional states.  What matters is not only how happy you are, but what the ratio is of pleasure to displeasure in your life.
Returning to the question of how it is that older adults manage to feel pretty good about themselves and their lives, it’s possible that the paradox of well-being reflects some sort of survival effect. The older adults who are alive now are the ones who, obviously, are not dead. Perhaps these are the ones who are in better health, both physical and psychological, and are of a different breed than their deceased counterparts. Perhaps these individuals were always inclined to view the world in a positive way, and the fact that they are the ones left standing at the end of life reflects their particular optimistic bias.
To understand the possible contributors to subjective well-being means that you need to drill pretty far down into the data, more so than often is evident from the reports we read in the news about which country makes it to the top of the happiness charts. It’s also important to realize that, all other things being equal, claims that money can’t buy you happiness fail to recognize that there are real benefits to having, if not higher income, then higher levels of education and freedom from discrimination on the basis of race, gender, and class. Although money and status cannot guarantee happiness,  they can help to resolve many of the real-life challenges that people at the lower end of the income spectrum experience (Deacon, 2008).
At the end of the day, what’s going to matter more for your long-term feelings of well-being will not be how happy you were on a given Monday or Friday, but whether you see yourself as making a difference in improving the well-being of others. Focus on what you’re doing with your life, and your feelings of well-being will eventually fall into place.

Source:  https://www.psychologytoday.com/blog/fulfillment-any-age/201405/how-should-psychology-define-happiness

Identifying and confronting depression and oppression in our lives

Depression is the state where a person has persistent feelings of hopelessness or dejection, lack of energy, inability to sleep and sometimes suicidal tendencies. Clinical depression is a very serious problem which necessitates professional treatment. Through medication and therapy, most people suffering from clinical depression can resume a normal life.
Until recently, anyone diagnosed with depression was immediately classified as either a mental nut job or a “whiner” or “wimp”. Because of these stereotypes, people with depression tend to get even more depressed. Without help, a depressed person will withdraw from society and become a recluse or find a way to end his/her life.
There are many things in our society that are not only bad but downright hurtful. The tag attached to people suffering clinical depression is one of the worst things that society has ever come up with. To blame a person suffering clinical depression (a disease just like arthritis, heart disease or cancer) as either a hypochondriac or a weakling is the predominant reason for the spike in suicides.
When a person feels dejected, continually sad, like a social outcast or misfit; they descend the ugly ladder into one of the most tormenting versions of personal hell there is. Of all the feelings a person goes through in this life, the feelings of hopelessness and rejection are the most tormenting and disastrous.
I can think of nothing Christians do that is worse than condemning someone suffering depression because of a tragic event that took place or because they have a disease. When a preacher beats people over the head with the Bible and tells them there is no excuse for being depressed, it only serves to drive a person deeper into depression. When an individual believer sharply rebukes another believer because they are depressed, it only serves to drive that believer into a state that is dangerous and spiritually sick.
There are, of course, times when a person is just feeling sorry for himself and they need a swift kick in the rear to wake them up and get moving again. Clinical depression does not fit this description. There is a HUGE difference between a temporary pity party and a state of mind brought on by chemical imbalances within the body or something wrong with any number of different organs or bodily functions.
It seems that any Christian who admits to going to see a Psychologist or other mental health professional is immediately judged as insane and guilty of gross unbelief. Somehow it is fine for a Christian to see a medical doctor but not a doctor specializing in mental or emotional disorders. I think this is very wrong and has prevented many individuals from receiving the help they desperately need.
Having said all this, I believe most of us do NOT suffer from clinical depression but rather the reaction to bad things happening to our bodies, families, finances, relationships etc. When we are forced to endure a string of bad things we tend to get depressed. When we must become the most austere people on earth and live on snow and grass because of no money, we tend to get depressed. When relationships go sour, the car breaks down, a loved one passes away and we get diagnosed with cancer, all in one day, we tend to get depressed.
Simple depression can many times be helped by someone manifesting the love of God. Simple comfort and exhortation from the Word of God can lift a person out of a temporary down time. Many times a person just needs to spend some quality time with the Lord or go have fun to break the back of simple depression. Sometimes a person needs to sit with a qualified Christian counselor to isolate the problem and take steps to correct it.
Depression usually is the consequence of oppression. Oppression is a heaviness or downward pressure brought on by gloominess, negatives, lack of results, loneliness etc. The biggest cause of oppression is sickness. Long term sickness of any kind is oppressive and that oppression almost always leads to depression.
Satan is the author of oppression and he uses it constantly to hinder and beat down Christians. Oppression is the opposite of inspiration and enthusiasm. Oppression thwarts the ability of a believer to recognize God working in them to do and to will of His good pleasure. Oppression drags us down to the level of the enemy instead of raising us up to the exalted position we have in Christ Jesus.
The Word and power of God can and does break the back of oppression when spoken and manifested in love. Prayer can and does lift the suffocating blanket of oppression. Action many times knocks oppression flat on its back. If these things are not done, oppression slowly drags a person into the dark night of depression.
Oppression is on the outside and is caused by everything from the weather to the day’s headlines. The biggest source of oppression is legalistic religion. Whenever and wherever legalistic religion reigns, oppression will overspread the area as a heavy blanket. Oppression is like carrying a heavy burden on one’s back. Oppression hangs over a person like a giant anvil ready to drop on them whenever they sin. Religious oppression is ugly, wicked and lends itself to depressed people robbed of a reason for living and resigned to a life of woe.
Religious oppression inevitably leads to depression. This is why religiously oppressed people manifest hopelessness, dejection and gloom. Certainly the enemy succeeded in making a mockery of the joy we have in Christ by oppressing God’s people under a yoke of laws and regulations that are impossible to keep. In my travels, many of the most oppressed areas I have seen are filled with depressed people living in the so called “Bible Belt”.
God has called us to liberty and not the bondage associated with religious oppression. God has called us to walk in the freedom Christ won for us on the cross and not to spend our lives carrying that cross on our shoulders. God has called us to walk in His power, grace and joy. God wants us to enjoy all He has given to us while we share to GOOD NEWS of the gospel of Jesus Christ with others.
Breaking free from religious oppression is the single greatest thing that a believer can do to overcome depression. We have not been called to walk in fear of going to hell but rather to walk in the exuberance of those absolutely called to an eternal life with God in the heavenlies. We have not been given a tablet of stone to record all of our sins but rather a glorious Word of God filled with exceeding great and precious promises.
We, of all people on earth, have no right to ever feel hopeless or helpless. We have been given a bright and glorious hope and the promise that God is with us and fighting for us. We must renew our minds to believe what God has said in His Word and categorically reject the lies this world and religion attempt to place upon us.
If you suffer from clinical depression please seek professional help. If you suffer from depression brought on by oppression, FIGHT. That is right, FIGHT for yourself, your family, your future. Never give in to the relentless pressure of negativity but rather claim the promises God has given to us. God is able and willing to lift oppression and break apart depression. With God’s help, we can lay claim to the promise that “the joy of the Lord is our strength”!

Source:https://mercyman53.com/tag/religious-oppression/ 

Former British Army chief says that Irish soldiers are being given a drug that may cause depression

Irish soldiers are being given a drug that has potentially harmful side effects such as severe anxiety, depression and aggressive outbursts according to the former head of the British Army, Lord Richard Dannatt.

The drug in question is an anti-malarial drug called Lariam, which is still available to members of the Irish Defence Forces from international wholesalers, despite the fact that it was taken off the Irish market in July. The drug was first prescribed to Irish soldiers in 2001 during a peacekeeping mission in Eirtrea, where malaria is a common disease.

The drug has caused controversy over the past number of years, with many soldiers and former soldiers complaining about the after effects of using it. Lord Dannatt has outlined how his son Bertie took two dosages during the 90s, which left him extremely depressed.

"Because Bertie had that effect, whenever I’ve needed anti-malarial drugs, I’ve said, ‘I’ll take anything, but I’m not taking Lariam," said Lord Dannatt.

While Lariam is an extremely effective drug when it comes to preventing malaria, there have been questions raised over its use in recent years. The British and Irish armies have other drugs available to defend themselves against the disease, but Lariam remains the most effective. 

Source:  http://www.kildarenow.com/news/former-british-army-chief-says-that-irish-soldiers-are-being-given-a-drug-that-may-cause-depression/114940