DSM-V Subcategory Facebook Depression?

If you believe news reports today, you may be bracing yourself for a new subcategory of mood disorder 'Facebook Depression' in the upcoming DSM-V (diagnostic manual for psychiatric disorders). Researchers claim that this is a possible outcome among adolescents who obsess over Facebook. Dr Gwenn O'Keeffe, the lead author of new American Academy of Pediatrics social media guidelines points out that social comparison may play an important part in making adolescents feel they don't measure up. Comparing number of friends, reading about how others seem to be having non-stop fun, Facebook can provide a skewed version of reality.

Of course, 'Facebook Depression' is not really slated for entry in DSM-V and the validity of this study is highly questionable. It's a catchy term, it draws a lot of media attention...Google 'Facebook Depression' and you'll come up with many references. Maybe, and I don't want to be out there with this idea, people with depression just happen to use Facebook? If you want to read a really good analysis of this research, look no further than Dr. John Grohol over at PsychCentral.

I'd write one myself but according to this study, I should be severely depressed, judging from the limited number of friends (and the good times that they're having - you know who you are!) on my Facebook page.

Self-help resources

Stumbled across the Centre for Clinical Interventions this morning while looking for something else.

There's a whole series of information packs downloadable that may be of interest to both consumers and practitioners. Topics include assertiveness, low self-esteem, depression, bipolar, disordered eating, perfectionism, shyness and worry.

Direct current stimulation study

Title:
Direct Current Stimulation as a non-medication treatment for depression

Researchers:
Associate Professor Colleen Loo (UNSW / Black Dog Institute)

Organisation:
School of Psychiatry, UNSW; Black Dog Institute, Randwick NSW

Details:
Researchers are investigating direct current stimulation (DCS) as a treatment for depression and potential alternative to medication and electroconvulsive therapy. Very weak currents are used to stimulate the brain. The stimulation is painless with no known serious side effects, and the person is fully awake and alert during the 20 minute treatment sessions. Participants will be required to attend the Black Dog Institute from Monday to Friday for 3 to 6 weeks usually for 30 minutes per visit.

Participants required:
Participants must be at least 18 years old and experiencing feelings of depression for at least 4 weeks prior to study entry.

Contact:
If you would like more information or are interested in participating, please call Angelo Alonzo on (02) 9382 3720 or Donel Martin on (02) 9382 9261 or email TMSandDCS@unsw.edu.au

Site of the week: Australian Psychological Society

Useful resources for community members can be found here. Topics include:

Addictions

ADHD

Coping with traumatic events

Depression

Psychology and climate change

Workplace issues

Also, a series of tip sheets are available here.

Seasonal woes

A recycled post but then this is a valid message year in, year out.

Christmas is almost on us again. A happy time for many of us, a time that invokes significant distress for others, as is reflected in the increased number of calls to the office.

Christmas is a time that heightens any vulnerabilities. Whether it triggers grief for those lost or for something we maybe never had, whether it highlights a sense of isolation or perhaps sets off traumatic memories, whether the stress of preparing and the management of family relationships hits home, the flipside of Christmas is less than positive.

Important then, as Christmas nears, that we keep an eye out for those who might not be doing so well at this time of year. Please find some helpful hints in this earlier post.

DepED

It's over a year since I first highlighted DepEd, an online resource for understanding and managing depression from the Black Dog Institute. As several people have since mentioned to me how useful they found DepEd to be, I thought it worth mentioning again.

There are seven modules in total, from depression in general through to specific types of depression through to getting help and keeping well.

This part of the Black Dog site also include a link to a set of modules for bipolar disorder education, personal stories from people who have experienced various types of depression, links to an extensive set of fact and hint sheets, and to various books available for purchase.

A great set of resources. Let me know what you like (or even don't like)?

My favourite Black Dog again.

Online learning resources for depression and bipolar disorder can be found here.

DepEd

Another fabulous initiative from The Black Dog Institute. Straight from their newsdesk:

The Black Dog Institute today launched DepEd, an online education program to help people better understand and manage depression. The Black Dog Institute believes there is a distinct need at the present time to make the assessment and management of mood disorders more sophisticated to ensure people are not over-treated or under-treated for their condition.

Check it out here! Bookmark it for future reference.

Tis the season to be blue

'Tis the season to be jolly Fa-la-la-la-la, la-la-la-la...or maybe not.

While many of us look forward to celebrating the holiday, for many others this time of year can magnify ongoing problems and bring additional worries.

For those facing an ongoing struggle with depression, the relentless cheeriness of the season can be very confronting. For individuals who feel isolated or who have suffered bereavement over the past year, the coming together of friends and family can emphasise the sense of loneliness or loss. For some, it’s the opposite, as coming together with family at the holiday reignites conflict or struggles. Add to the additional financial pressure as we cave in to the commercialism of Christmas and it's no wonder that the number of calls to crisis lines such as Lifelife increase dramatically and that the suicide rate climbs in December.

For those of us fortunate to be looking forward to the holiday, we can at least be mindful and look out for those around us who may be struggling. It may not always be obvious, people can often be skilled at masking their feelings. Important signs to look out for can include: a loss of pleasure, withdrawal, changes in eating and sleeping patterns, fatigue, irritability, sad mood, expression of suicidal thoughts.

Helping can be as simple as taking the time to ask people what’s happening for them and listening. Be supportive, avoid offering platitudes. If you think suicide may be an issue, don’t be afraid to ask about it – it’s one of the biggest myths of suicide that talking about it prompts action. If you know someone who is alone, invite them over.

If you know it’s yourself that is vulnerable at this time of year, think carefully about what might help your situation and follow through. Professor’s House has some useful advice about boundary setting. Things getting out of hand? Scale Christmas back to a more acceptable level. At Christmas, when we might feel the weight of our own and others expectations upon us, accept that is okay to ask for help and be prepared to accept it when offered.

Here's wishing a happy holiday to all!

Resources

Watch out for signs of depression at Christmas from beyondblue

Mental Health Week

Picture from http://www.mentalhealth.asn.au

It's Mental Health Week (7-13th October). There are many interesting activities and initiatives undertaken this week to promote awareness and understanding of mental health issues. I've attached a list of some of starter resources at the bottom of this post if you'd like to read more or get involved.

This week I've been thinking about mental health in the setting of chronic illness and the issues involved. Some of the prevalence figures for depression and anxiety in the presence of chronic illnesses can be quite high but also quite variable. It can be hard to get a real picture of the extent of the problem because psychological disorders such as depression and anxiety can often be overlooked. Some of the symptoms of such disorders may be simply attributed to the disease process, particularly symptoms such as fatigue and lethargy.

Conversely, the potential is also for these conditions to be falsely diagnosed, with symptoms of a medical condition closely matching the diagnostic criteria for a psychological disorder. I experienced this myself when my thyroid disease (Graves) was misdiagnosed as anxiety. It is always important to make sure that medical conditions commonly known to cause symptoms similar to psychological disorders are ruled out.

The presence of psychological disorders in chronic illness can also change. For example, following a heart attack, you often see initial levels of anxiety rise and fall dependent on where the individual is in the recovery process. Depression will often set in much later, usually post-discharge from hospital.

People are also often reluctant to consider psychological conditions in the context of illness and this can be understandable, particularly for those in the process of getting diagnosed. Many people fear that being treated for depression or anxiety will mean that the diagnosis process will come to an end or that continuing symptoms will simply be written off to the psychological diagnosis and so continue to suffer needlessly.

Sadly, this can be true. I've seen patients under investigation for medical illness for concurrent psychological evaluation. In many cases, there is a genuine concern by the referring doctor to ensure all bases are covered for the good of their patient. Unfortunately, sometimes this isn't communicated well to the patient. In some cases, you can tell that the patient has simply been handed over. Regardless of the particular illness circumstances, people usually aren't very happy to end up in the hands of a psychologist, which is a shame because, beyond the treatment of psychological disorders, psychologists can also help with many aspects of coping with chronic illness.

While I've referred to depression and anxiety, it is important to be aware that other psychological conditions can be seen concurrent with physical illness.

In Mental Health Week, I wonder what can be done to improve the psychological burden of chronic illness. If you have an experience you'd like to share or a suggestion to make, please do so.

Mental Health Week Resources

beyondblue

International Medical Corps

Mental Health Association

Mental Health Foundation of Victoria

Anxiety & depression awareness

Picture from http://www.oxford.anglican.org

One of the reasons there continues to be stigma associated with mental illness is a lack of knowledge and openness about what are relatively common conditions.

In conjunction to the forthcoming Mental Health Week (7 to 13th October) and World Mental Health Day, beyondblue are launching Anxiety and Depression Awareness Month during October.

beyondblue are asking for your support during this time to engage individuals, community, government and corporate organisations in activities specifically targeted at increasing awareness of anxiety and depression. Suggested activities may include hosting community forums, disseminating beyondblue materials or wearing something blue to work.

See here for initial details of how you can become involved.

beyondblue can also provide you with an information pack which includes materials, posters and fact sheets for you to distribute in your local community, to friends and to family detailing the signs and symptoms of anxiety and depression, where to get help, appropriate treatments and how to stay well.

When promoting anxiety and depression, it is important to provide access to information. Promote the beyondblue website and the beyondblue info line 1300 22 4636 on intranets, notice boards or other information areas.

To receive your free beyondblue Anxiety and Depression Awareness Month Kit, visit the beyondblue website materials order form or call the beyondblue Distribution Centre on 03 9810 6143.

Depression in the elderly

I wrote briefly before about how my mother viewed depression, that it was simply a matter of getting on with things. In her generation, admitting to being depressed or experiencing any other kind of psychological problem is all too often equated with being weak. Yet depression, in particular, is a common problem in old age, although it is often missed because people don't recognise the symptoms or the symptoms get misattributed to health problem frequently experienced in old age.

So it's good news to hear of a new national peer-education program by the Australian national depression initiative beyondblue in conjunction with the Council on the Ageing (COTA). Over the next 18 months COTA will run a series of information sessions across Australia to increase awareness of depression and where to go for help.

The scheme is based on a pilot program undertaken in South Australia in 2006 which examined the effectiveness of using existing peer support networks to deliver specific depression-awareness education to older people.

“Feedback from participants was extremely

positive with many people stating how

they had struggled with the stigma of

depression for many years."

Ian Yates, COTA SA Chief Executive

beyondblue report that following the sessions, the number of people who could correctly identify the symptoms of depression rose from 28% to 70%. Now that can only be a good thing, right?

Resource

beyondblue press release

Walking the Black Dog

The benefits of exercise on our physical health are a given. Now, a recent study conducted by the Black Dog Institute and published in the Australian and New Zealand Journal of Psychiatry confirms that Australians diagnosed with clinical depression rate exercise as the most successful self-help strategy for managing their symptoms.

The study interviewed 2692 people who had received treatment for clinical depression, asking about their use of medication and professional psychotherapy as well as self-help and alternative methods. Self-help strategies were rated as good as or better than antidepressant drugs, with exercise the most effective tool, followed by yoga/meditation, massage and relaxation.

However, the author of the study, Professor Gordon Parker, highlights the danger inherent in a comparison of drug therapies to self-help strategies such as exercise. Professor Parker stresses people generally tend to prefer non-drug approaches and would therefore be more likely to emphasise their usefulness. Thus, while the study suggests the usefulness of exercise as an adjunctive therapy, it is important to remember that a range of treatments, including drug therapy, are appropriate in clinical depression.

Mental Health Ambassadors

I wrote earlier about increasing levels of depression, anxiety and suicide among farmers in the rural regions of Australia as a consequence of the worsening drought. Usually resilient by nature, they're often less likely to seek help, particularly for mental illness.

It's great news therefore that The Black Dog Institute has launched an important new initiative to help reduce the stigma of mental illness in the rural regions of Australia. The Institute has appointed ten ambassadors, people who have experienced depression and bipolar disorder either personally or as a carer, to talk publicly about their experiences and act as local contacts.

Read more about this great program and the program ambassadors.

Personality and depression

In reviewing my selected website of the week, I found an interesting questionnaire hosted byThe Black Dog Institute, the Temperament and Personality Questionnaire. This questionnaire provides feedback on ten dimensions of personality that may be important in predisposition to non-melancholic depression. The questionnaire formed part of an earlier study on personality and response to treatment type by the Institute.

The survey is anonymous and feedback is provided for each personality dimension, along with an explanation of how that dimension may influence the risk of non-melancholic depression.

It is important to note, however, that a significant score on any particular dimension does not mean that depression will necessarily develop. Additionallly, the scale operates as a self-report mechanism and, as such, is subject to certain limitations.

The Getting of Wisdom

This week, the Black Dog Institute, launched it's annual writing competition.

Last year, people were invited to submit writings around the use of the term "Black Dog" to describe depression. Contributions from the many entries subsequently were compiled into the basis of a book called "Tracking the Black Dog."

This year the subject is Bipolar Disorder, with an emphasis on how sufferers, family members and friends have learnt to manage the 'high' that is characteristic of this disorder.

Again, the underlying idea is to collate experiences into a 'Bipolar Survival Kit.'

Entries must be between 500-1500 words and be submitted by the 31st of January. The winner receives $2000, second prize $1000 and third prize $500.

Update: Entry is restricted to residents of Australia and New Zealand only.

For more information read here and apply here.

MoodGYM

MoodGYM is an initiative of the Centre for Mental Health Research at the Australian National University.

It's an interactive program designed to help people identify whether they are experiencing problems with emotions such as depression and anxiety, to help them learn skills to overcome these problems and develop good coping skills for the future.

The program is easy to use and is based on both cognitive and interpersonal therapy, both of which have been shown to be beneficial in the treatment of depression, anxiety and related mood disorders.

It shouldn't be used as a substitute for diagnosis and treatment by an appropriate health professional but is a good starting point if you want to learn more about these disorders.

Source: MBF

Ruminations on depression

"It's not what you think but the way you think it."

I have been spending a lot of my time thinking about rumination recently. Rumination can be likened to a mental chewing of the cud, a repetitive thinking about issues or problems without any real progression to action. It's apt then that this is the area underlying my thesis, because it's been a lot of thought and very little action so far.

It is widely accepted that the content of our thoughts can influence the way we feel. However, a growing body of research demonstrates that the way in which we think about things is important in determining the severity and duration of depression.

Work by Dr. Susan Nolen-Hoeksema has examined the role of ruminative thinking in depression: specifically, a repetitive focus by the individual on being depressed, on the symptoms of his or her depression and on the cause, meanings and consequences of those symptoms. (1) Typical contemplations might include questions such as, ‘Why did this happen to me?’ and statements like, ‘I’ll never feel good again.’

How does rumination impact on depression?

The inward-focus inherent in rumination can increase an existent bias towards negative thinking, including distorted interpretations of life events, more negative self-evaluations, a sense of loss of control and more pessimistic predictions about the future. (2) (3) In what could be termed a snowball effect, this can initiate further concerns which then accumulate.

Rumination can affect problem-solving ability. Ruminators often fail to generate solutions to problems. Even when they do, they often express low confidence in their solutions and fail to act on them. (2) While active cognitive coping can be adaptive initially, thinking about ways to improve a situation raises levels of anxiety and depression when it fails to be followed up by subsequent action. (4) As a result, an increasing sense of failure and a general sense of hopelessness can occur, resulting in a further escalation in the severity and duration of depression.

Rumination can also impair social support. Constant rumination can drive others away, which can start off a whole new cycle of rumination. "Why are people abandoning me?" A loss of social support can be critical because social support can act as a distraction and divert attention away from depressed mood and its consequences. (5)

Are you a ruminator?

Assess your own tendency to think about problems.

Are you an obsessive thinker? Would you generally spend more than five minutes thinking about a problem? Ask others what they think.

If so, you are probably likely to ruminate.

Breaking out of the rumination cycle

Distraction techniques can help break the rumination cycle by reducing the tendency to focus on problems. (2) Engaging in activity can help break the stranglehold of obsessive thinking. Go for a walk. Read a book. Watch a movie.

Learn to recognise and reappraise negative perceptions of events and high expectations of others.

Let go of unrealistic goals.

Break down problems into a series of more manageable tasks which can then be acted upon.

For further reading on rumination

It's the thought that counts

Dr. Susan Nolen-Hoeksema

Edited by Costas Papageorgiou and Adrian Wells