Avoiding post-graduation depression amid pomp and circumstance

Today my son graduates from high school. His senior year has been a whirlwind of unfamiliar events: college applications, placement testing, campus visits, followed by more testing. This year he also attended as many school activities as he could manage, got fitted for a tuxedo, rode in a limo to prom, and attended lots of graduation parties. Now comes the big day when my oldest will be recognized, along with his peers, for his 13 years-worth of academic effort.

This flurry of activity has been wonderful and joyous, but his graduation will be a little sad. It will be sad for me because my little boy is all grown up and soon will be out on his own. But it turns out, that it is also incredibly sad for him.

After today everything changes. He no longer will follow a predictable schedule set by his school; he will be setting his own schedules. He won’t see the friends he loves on a regular basis; he will have to coordinate gatherings on weekends or during breaks from college. He must venture off and make brand new connections, learn a whole new set of social skills and rules, and recreate a brand new life at university. It is a huge life change for him. So it does not surprise me at all that he’s been acting a little depressed.

Being sad or blue should not be confused with actual, medical depression. Clinical depression has biological causes and is an area of intense scientific research. Scientists still don’t know everything about depression. They do know that dysfunction in the brain in which the neurons do not properly communicate with one another, hormonal imbalances, and disorders of the endocrine system play a role in the biological reasons for depression. There also seem to be genetic links predicating who will or will not develop depression. Clinical depression is a debilitating medical condition that must be treated with drugs, therapy and counseling.

Major life changes, however, also can bring on bouts of depression that may become, if not recognized and treated, equally as debilitating as the biological variety. More serious than just brief periods of melancholy, this type of depression can last for weeks. Typical triggers for depression include a divorce, loss of a job, or loss of a loved one to death. To a young person, a high school or college graduation can certainly be a major life change and trigger for depression.

Thankfully, I think that my son soon will become so involved in his summer activities and preparations for college that he will not become consumed by his feelings of loss about leaving high school and all his friends. But anyone with a recent graduate in their lives should watch out for signs of medical depression which, according to the National Institute of Mental Health include the following:

• A persistently sad, anxious or empty mood
• Loss of interest in activities previously enjoyed
• Excessive crying
• Decreased ability to concentrate and make decisions
• Decreased energy
• Thoughts of suicide or suicide attempts
• Weight gain or loss
• Social withdrawal
• Changes in sleep patterns
• Increased restlessness and irritability
• Feelings of helplessness, guilt and/or hopelessness
• Physical ailments that don't respond to standard treatment (i.e., chronic headaches)

The American Psychiatric Association says a person must exhibit at least five of the above symptomsto be diagnosed with clinical depression.

To ease the transition from high school into whatever comes next, teens are encouraged to try a few simple steps. Mike Hardcastle at About.com suggests various ways for teens to retain precious relationships after graduation, while still moving boldly into the future. Hardcastle’s article offers concrete advice to teens (and their parents) that may be feeling a little blue and asking themselves “what now?” after commencement. Although rather long, the web article is worth the read.

For families facing something more serious than teens with “the blues,” the web site Families for Depression Awareness provides many resources so concerned families can recognize when someone is truly depressed. There is even a mood test to gauge if you or a loved one is becoming depressed and should seek professional help. Depression is not something that ought to be endured, but sufferers do need medical care.

So, congratulations to every member of the Class of 2009, whether you are graduating from kindergarten or earning your doctorate. I hope you each find joy, peace and fulfillment in the years to come and can avoid post-graduation depression amid all the pomp and circumstance that surrounds you.

Depression affects 16.5 million American adults

Drawing on data from a survey in 2007, SAMHSA reports that over 16.5 million Americans over age 18 experienced at least one bout of major depression last year. That equates to 1 in 13 adults. Fewer than 64.5 % received treatment for their depression.

The Substance Abuse and Mental Health Services Administration (SAMHSA) conducted a study in 2007 of approximately 45,000 non-institutionalized adult. They defined a major depressive episode as being two or more weeks with a depressed mood, loss of interest or pleasure, and at least four other symptoms such as poor self-image, lack of appetite or loss of sleep.  

More than 43% of those not receiving treatment for their depression listed cost as the primary factor. Twenty-nine percent said they could deal with the depression on their own. Eighteen percent said they did not know where to get help, and 17% said they didn’t have the time to seek out help. The lack of health insurance coverage was sited by 11.3%, and fears about confidentiality kept another 11.1% from getting help.

The rates of major depression were found to be highest among the 18 to 25 year olds in the study with 8.9% reporting a major depressive episode. In the 26 to 49 year old group, 8.5 % reported at least one episode. This compared to 5.8 percent in the 50 and older age group. Of those reporting depressive episodes, 14.2% who described their health status as “fair” to “poor” reported depressive episodes and 4.3% who described their health status as ‘good” reported a major depressive episode. 

SAMHSA’s Acting Administrator, Dr. Eric Broderick was quoted in an agency news release as saying, “ Depression is a medical condition that should be treated with the same urgency as any other medical condition.”

Anyone experiencing depression should at least consult their primary care practitioner for evaluation. Depression, like any other mental illness, is a biological brain disorder that is treatable with medication as well as other modalities. Without treatment, depression can worsen and severely affect general health status as well as quality of life issues. 

Ask Dan: The depths of depression

For those who have never experienced clinical depression, it can be hard to understand. To most people, it is just a depressed mood, something that can be gotten over in a brief period. With a bad mood, most people can function with a pretty clear mind. It can be painful, but no big deal.

But for about 20 percent of us who have or will experience clinical depression, it's a very big deal. Clinical depression affects the way we think and the way we experience ourselves in the world. It affects relationships and our ability to accurately interpret information.

A young woman I treated years ago said she felt like a diamond inside a malignant tumor and didn't know whether she would live or die.

A recent colleague said he felt as if his brain were oatmeal and couldn't think properly.

When I suffered clinical depression, I felt like a frightened, confused child pretending to be a psychologist. And feeling like a sham made the anxiety, depression, and shame so much worse.

Steve Newman had his first episode of depression when he was in seventh grade. A good student, he experienced a precipitous drop in grades and felt lost for much of his youth. Although his IQ was measured in the top 10 percent nationally, he graduated from high school in the bottom 5 percent of his class.

When I spoke with him, he said his poor transcripts reflected the efforts of someone who didn't expect to live more than a few more years. Somehow, his father got him into a local college, which is where he first heard the worddepression.

He said his depression felt like climbing a mountain when a storm hit. Any thoughts of going upward were beaten down by cold rain and wind. Going down also was impossible because of the same elements. He said his goal in life was just hanging on.

A colleague once told me that depression is experienced from the outside in, that people on the outside can see it before the depressed person knows it.

Such was the case with Steve. That was true for me, too.

My depression began several years after I had become a quadriplegic as I felt my wife pulling away. My mind began to race and I worried all the time. I felt increasingly insecure and said almost nothing in meetings, fearful that what was occurring inside would become visible on the outside.

I didn't realize I was depressed until one of my nurses told me that I looked as if I had the weight of the world on my shoulders. Once I realized that what was going on inside my head was visible on the outside, I knew I was depressed and sought treatment.

Depression can affect a litany of things, from sleeping and eating patterns to concentration and memory. It can induce guilt and a feeling of worthlessness.

And although only a small minority of those with depression attempt suicide, it's not unusual to think about wanting to die. I recall thinking that life was just too difficult and painful to go on. I didn't want to die, but my suffering was unbearable.

There are many types of depression. The causes, too, are varied, but most have a genetic link. I had a mild predisposition, as there was dysthymia, a low-grade form of depression, in my family. Steve had bipolar disorder in his family.

Most people with depression get better with treatment. Gold-standard care for depression is a combination of medication and psychotherapy.

Prognosis is tied directly to the duration and frequency of episodes. That's because depression has a powerful negative effect on the brain; the longer it lasts, the more likely one is to have a second episode. And once that happens, patients are at far higher risk for even more episodes.

My depression diminished significantly with medication and psychotherapy. Now, when I see the first sign of depression, I'm on the telephone with my psychopharmacologist.

Steve has not been so lucky. He has what is called a drug-resistant depression. Although he has tried almost all medication and several kinds of psychotherapy, he still suffers.

In 2005 he heard about the Transcranial-Magnetic Stimulation program run by psychiatrist John O'Reardon at the University of Pennsylvania. This program has been approved by the Food and Drug Administration and uses magnets strategically placed near one's scalp to diminish depressive symptoms.

It's another promising treatment for an illness we're all still struggling to understand.

Antenatal depression: expecting a not-so-happy event?

The Times ’s investigation into the Eddie Gilfoyle case — he was convicted of murdering his pregnant wife in 1993 — has helped to highlight a medical condition that rarely gets the attention it deserves. While we are all familiar with postnatal depression and the risk to mother and baby, few people know that antenatal depression can be just as serious and is just as common. Indeed, more pregnant women and new mothers commit suicide than die from better-recognised complications of pregnancy, such as infection, high blood pressure and haemorrhage, combined.

Gilfoyle was convicted of hanging his wife in their garage after forcing her to write a suicide note. He protested his innocence but, after considering expert evidence suggesting that suicide was unusual during pregnancy, the police didn’t believe him. Sixteen years later we now know that suicide is one of the biggest threats to the life of a pregnant woman. So why do we pay it so little attention compared with other antenatal complications such as pre-eclampsia?

A British woman has a one-in-four chance of developing at least one episode of clinical depression in her life, and this is most likely to occur during her reproductive years. It has long been recognised that women are particularly vulnerable after they have given birth, and that one woman in ten goes on to develop postnatal depression, which, in its most severe form, can require compulsory hospital admission under the Mental Health Act to protect mother and baby. But since Gilfoyle’s conviction it has become widely accepted that depression is probably just as common before baby is born — it is just more likely to be missed, or attributed to the trials and tribulations of pregnancy, which is partly why The Times has argued that Gilfoyle’s conviction is unsafe.

Tell-tale emotional clues such as tearfulness, irritability and anxiety are put down to “hormones”, while associated somatic symptoms such as poor sleep, loss of appetite and unexplained fatigue are generally attributed to the physical demands of pregnancy — a misattribution that is unlikely to happen in the postnatal period when midwives, health visitors and GPs are extra vigilant about changes in mood or behaviour.

No pregnant woman is immune but depression is more common in those who have had previous mental health issues. Young single mothers with little social support are more susceptible, too, as are women in unhappy relationships, particularly those in which domestic violence is involved.

The Edinburgh Postnatal Depression Score is a way of screening for depression in women who have given birth and it can be a useful tool in the antenatal period, too. It is a simple questionnaire asking how a woman has felt in a variety of situations over the previous seven days. Each answer is scored and added to give a final tally which gives a good idea of whether the woman is likely to have significant depression. There are ten questions looking at various aspects of mood — for example, the first asks “Have you been able to laugh and see the funny side of things in the past week? Score 0 for answering ‘As much as I always could’, 1 for ‘Not quite as much now’, 2 for ‘Definitely not so much now’ and 3 for ‘Not at all’.”

Another asks about heightened anxiety — a common symptom in depression. “In the past seven days, have you been anxious or worried for no good reason? Score 0 for ‘Not at all’, 1 for ‘ Hardly ever’, 2 for ‘Yes, sometimes’ and 3 for ‘Yes, very often’.”

You can complete the full questionnaire at www. patient.co.uk/showdoc/40002172 and it will tot up your scores. Anything up to ten is normal but a score of 13 or more suggests that you are depressed and should seek advice from your GP or midwife. They can assess you more carefully and decide what, if anything, needs to be done.

In the mildest of cases, counselling and support, along with advice to start taking more exercise (not a priority for most pregnant women although a sensible, graded exercise programme can give a significant boost to mood) may be all that is required. Others may be offered cognitive behavioural therapy and some will need to take antidepressants. The threshold at which a doctor would consider prescribing antidepressants during pregnancy is higher than normal because of the additional risk to the developing baby.

Antidepressants, particularly the newer types, have been linked to congenital malformation and withdrawal effects once the baby has been born. Older-generation drugs such as amitriptyline and dosulepin, and the more recent fluoxetine (Prozac) are generally regarded as the safest, but the theoretical risks still have to be carefully balanced against the benefits.

Untreated depression can lead to a host of problems, ranging from an increased likelihood of miscarriage or going into premature labour to self-neglect and suicide.

Fortunately, if dealt with properly, antenatal depression should respond well to treatment, though therapy may well need to be continued up to and beyond the child’s first birthday. The tricky bit is spotting it early.

For more information on depression and the treatments available, visit www.depressionalliance.org

Patients in Trials of Depression Drugs Called Unrepresentative

Most patients diagnosed with depression and treated with antidepressants would be excluded from the pivotal clinical trials used to justify approval of these drugs, researchers found.

Moreover, they were significantly less likely to achieve clinical responses or remissions compared with the 22.2% who did meet such criteria, even after adjusting for baseline differences in such factors as duration of illness, presence of anxiety symptoms, history of suicide attempts, and demographic and socioeconomic variables.

"Phase III trials do not recruit representative treatment-seeking depressed patients," the researchers concluded.

They recommended that pivotal drug trials use broader inclusion criteria, which would increase their generalizability to real-world practice.

The strategy would reduce the number of failed trials, they argued, by cutting down responses and remissions with placebo.

But the researchers also acknowledged that such a strategy would probably increase rates of adverse events, insofar as safety profiles of investigational drugs are inherently not fully known.

The National Institute of Mental Health funded STAR*D -- Sequenced Treatment Alternatives to Relieve Depression -- precisely to examine the efficacy of various antidepressants in patients most likely to receive them in clinical practice.

Its inclusion criteria were relatively loose: a DSM-IV diagnosis of single or recurrent nonpsychotic major depressive disorder and a minimum depressive symptom score for moderate severity (>14) on the 17-item Hamilton Rating Scale for Depression.

In contrast, said Dr. Wisniewski and colleagues, most company-sponsored phase III trials typically bar patients with Hamilton scores lower than 19, more than one concurrent general medical condition or axis I psychiatric disorder in addition to depression, or current episodes lasting more than two years. Those with obsessive-compulsive disorder are also usually excluded.

The researchers stratified the 2,855 STAR*D patients according to these more restrictive criteria. The 635 who met the typical criteria for entry into phase III clinical trials were called the "efficacy sample," the remaining 2,220 were the "nonefficacy sample."

Dr. Wisniewski and colleagues found important differences in responses to initial treatment with citalopram (Celexa) in the trial:

• Response rates (defined as at least 50% reduction in Hamilton score): 51.6% in the efficacy sample, 39.1% in the nonefficacy sample (P<0.0001)
• Remission rate (Hamilton score of 5 or less): 34.4% in the efficacy sample, 24.7% in the nonefficacy sample (P<0.0001)

After adjusting for baseline factors, the differences were changed only slightly.

The adjusted odds ratio for clinical responses in the efficacy versus nonefficacy samples was 1.37 (95% CI 1.12 to 1.68).

For remission, it was 1.33 (95% CI 1.07 to 1.65).

Psychiatric hospitalization was required in 2.5% of the nonefficacy group versus 0.3% of the efficacy sample (P<0.001).

Severely or intolerably intense side effects were also significantly less common in the efficacy group, despite similar levels of drug exposure.

"Given these between-group differences, the smaller efficacy sample is clearly not representative of the more inclusive, treatment-seeking population," the researchers said.

Dr. Wisniewski and colleagues noted that previous studies had also found that a majority of depressed patients would be excluded from registration trials of antidepressants.

However, the researchers said, those trials examined only baseline characteristics. They said theirs was "the first to examine the differences in treatment outcome."

Their findings that outcomes are generally better with tight inclusion criteria mean that registration trials likely paint a rosier picture than should be expected in ordinary practice.

"The duration of adequate treatment suggested by data from efficacy trials may be too short," they added.

Dr. Wisniewski and colleagues acknowledged several limitations to their analysis: STAR*D relied on participants' self-reports of comorbid somatic and psychiatric conditions. Also, the current analysis used STAR*D data from a single drug that was given open-label.

Moreover, they said, although the investigators have previously helped design antidepressant registration trials, the inclusion-exclusion criteria they identified as typical for such trials may differ from those of actual individual studies.

Bad mood drinking may lead to depression

"Although the frequent co-occurrence of AD and MD is widely recognized, the association between the disorders works differently for different people. There are likely multiple mechanisms that result in the disorders co-occurring, for example, having MD increases the risk to develop AD, having AD increases the risk to develop MD; and causal factors - such as genetic risk or social circumstances - also contribute to developing both disorders," said Kelly Young-Wolff, whose master's thesis provided the stimulus for the study. 

Victor Hesselbrock, professor of psychiatry at the University of Connecticut School of Medicine, said that the link could also differ by gender. 

"Studies of both clinical and community samples have found that primary depression - depression occurs first, followed by alcoholism - is more typical in females while primary alcoholism - alcoholism followed by depression - is more common among males. Furthermore, while most persons affected with alcoholism do report a lifetime history of significant depressive symptoms, the reverse is not true. Most people with depression do not report long periods of heavy drinking nor do they report significant numbers of lifetime AD symptoms," Hesselbrock said. 

Young-Wolff added: "Previous research had shown that individuals with higher than average scores on mood-related drinking scales are at increased risk to develop heavy drinking and AD. There is also evidence for familial risk factors, such as shared social and environmental or genetic factors, that contribute to overlapping risk for MD and AD, and for AD and mood-related drinking motives. Yet no study had examined whether mood-related drinking motives explain the overlapping familial risk for MD and AD." 

The new findings are based on an examination of 5,181 individuals aged 30 and older (2,928 males and 2253 females), drawn from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders, a longitudinal study of psychopathology in two samples of adult twins. 

The researchers have revealed that the subjects completed a clinical interview which assessed lifetime MD, AD, and mood-related drinking motives. 

"Our study suggests that the familial factors that underlie mood-related drinking motives are the same factors that contribute to the overlapping familial risk for MD and AD. The results are consistent with an indirect role for mood-related drinking motives in risk for depression and AD, and suggest that individuals with strong mood-related drinking motives may be vulnerable to developing both MD and AD," said Young-Wolff. 

Hesselbrock added: "In short, the findings indicate that the drinking motives for both males and females who are well into the period of risk for both AD and for major depressive disorder are similar. However, it should be noted that the findings do not address motives regarding the initiation of drinking behaviour in adolescence; the findings apply only to the subjects'' current drinking behaviour. Since this was not a longitudinal study that began in adolescence, it cannot be assumed that these subjects'' motives for beginning to drink when they were teenagers were to cope with feelings of depression." 

Carol A. Prescott, professor of psychology at the University of Southern California, as well as corresponding author for the study, said: "We might remember that there are many people with high mood-related drinking motives who do not have a history of MD or AD. We would argue that the occasional use of alcohol to relax or unwind is not necessarily a bad idea. What should be avoided is heavy drinking as a regular coping strategy, since this can lead to other problems and is often a means of avoiding dealing with the issues that are contributing to the negative emotions." 

The researchers are of the opinion that their findings may help doctors identify individuals at risk for both MD and AD, with a focus on examining motives for drinking, as well as finding alternative strategies for coping with negative mood states. 

Hesselbrock said: "I think it is important that family members understand that there is a real link between drinking and depression. While the family member who is drinking may believe that they are doing so to cope with and relieve their symptoms of depression -and there is some pharmacological basis for this - they probably do not realize that their drinking will only prolong and exacerbate the negative feelings. For the person without AD, reducing/stopping drinking will help reduce the negative effect/depression. For the person with MD, stopping drinking will help reduce depression symptoms but not totally relieve the depression. It is a complex picture." 

The study, to be published in the August issue of Alcoholism: Clinical and Experimental Research, is currently available at Early View.

Men More Prone to Depression During Recession, Says Study

he U.K.'s BBC online reported Monday that men are more likely to suffer mental health problems than women during an economic slump. According to a survey of 2,000 adults by British mental health charity Mind, "almost 40 percent of men feel low at the moment with job security, work and money playing on their minds." 

The charity said that some 2.7 million men in England suffer mental health problems such as depression, anxiety, or stress but they were more reluctant to talk about them than women. Only 29 percent of the men surveyed responded that they talk about their problems with friends and family while 53 percent of women do so. 

The recession could worsen the situation, with study finding one in seven men suffer depression within six months of losing their jobs. Paul Farmer, chief executive at Mind, said, "Being a breadwinner is something that is still crucial to the male psyche, so if a man loses his job he loses a large part of his identity, putting his mental well-being in jeopardy."

Great Depression survivor fears current recession

But the economy has Breeding fearing for her independence. While she is able to manage her expenses by clipping coupons and hunting for bargains, Breeding worries that a new prescription for her spinal arthritis or any other expense might prohibit her from living on her own.

"Food is my big concern," says Breeding, who lives on Social Security and a small pension. "It's gotten so expensive. And if I have to go on medication, I don't know what I would do. I'd probably have to sell and move in with someone."

Breeding is lucky. She knows any of her six children would be happy for her to move in.

But she doesn't want to leave the mobile home where she has lived since she retired in 1999 at age 75.

"I eat what I want to, I watch what I want to," says the retired home health care nurse. "I want to remain independent as long as possible. My family needs privacy, and so do I."

She worries about how the economy is hurting her older friends who have no one to turn to.

In recent years, Breeding, a Tucson resident since 1947, has received help with unexpected expenses from Pima Council on Aging.

After a knee replacement in 2003, the agency installed a ramp, so she would not have to walk the eight steps up to her mobile home.

Pima Council on Aging built a new roof four years ago after a storm ripped off a portion. "My insurance wouldn't cover the roof, and it's so expensive to fix these old mobile homes," she said.

The agency helped her get a bracelet that she can use to alert authorities if she falls and needs assistance. The spinal arthritis causes Breeding to easily lose her balance.

Each time, her family has made a donation to the agency, she said.

Breeding relies on Van Tran or her children for rides to the doctor, church or shopping. She shops at four grocery stores, looking for the best value.

Breeding, who was born in 1922, was one of nine children, seven who survived past childhood.

Her father developed typhoid fever in Missouri, and the family moved to Phoenix in 1926 when Goldie was 4. She has vivid memories of the Depression.

"We were fortunate to live on a dairy farm, so we had milk and vegetables," she said.

She recalls a time when her family had no butter, having sold all the cream from the farm.

"Daddy was selling everything he could. Mama said we had to go downtown and sign up to get margarine. I didn't know what that was."

Her parents always managed.

"We were young and we didn't realize how tough times were," Breeding said. "Mama always had a pot of stew. She made good bread and we always had a pot of beans."

Goldie married in 1939 at age 17. She and husband James had two children. But James died, leaving her a widow at age 22.

She remarried, and she and husband Herschell had four children. At age 50, Goldie was again widowed when Herschell died from a heart attack in 1971.

It was then she went to work for the first time, and loved the years she spent caring for others.

Breeding has six children, 14 grandchildren, 12 great-grandchildren and six great-great-grandchildren.

"I'm so rich," she said.

She predicts the economy will get worse before it gets better.

"I call it a depression," she said. "I lived through one and that's what it feels like to me."

She turns to her faith in hard times, and hopes her prayers will be answered.

"I'm praying that this new president can turn things around, but he has a lot on his shoulders," she said.

"Every night I pray for the United States to be back to where it was when I was raising children. I want Tucson to be back to the way it was."

Brain Stimulation Therapy Eases Tough-to-Treat Depression

technique called cortical brain stimulation improved symptoms and, in some cases, launched a full remission for people with major depression who had suffered for decades and who had failed multiple other treatments, researchers report.
"On average, these individuals had had depression for 27 years and had failed about 10 medication trials," said Dr. Emad Eskandar, lead author of a study presented this week at the annual meeting of the American Association of Neurological Surgeons (AANS), in San Diego. "Their current depressive episode had lasted an average of six years or longer. These were very, very sick people who were out of options."
Cortical stimulation, which involves placing electrodes near the surface of the brain (i.e., outside the lining of the brain but not actually in the brain), is potentially much less invasive than other therapies currently available.
Placement of the electrodes, which emit tiny, adjustable, electrical pulses that block dysfunctional activity in the brain, is done with minimally invasive surgery.
Brain stimulation tools may be emerging as the next wave of treatments for depression and other brain-related disorders, experts say.
In April, other researchers reported that deep brain stimulation -- where electrodes are inserted into specific brain areas -- cut symptoms of otherwise intractable depression by 50 percent for about half of those treated. The technique has also been successful in treating some cases of obsessive-compulsive disorder.
"Deep brain stimulation has been known to us. The first treatment for Parkinson's was done in 1987, and now it's gaining acceptance and more widespread use in psychiatry," said Dr. Vladan Novakovic, a psychiatrist with Maimonides Medical Center in New York City. "This is an emerging area of therapeutic neuromodulation. The brain is an electrical organ. There is a role for both chemical and electrical interventions in the treatment of brain-based disorders."
About one-fifth of people suffering from depression get no relief from psychotherapy and/or medication. About 70 percent of these "non-responders" can, however, benefit from electroconvulsive therapy. But many of these will later relapse, and there's still the group of individuals who fail all treatments.
For this trial, a dozen patients with refractory depression were randomly assigned to receive 8 weeks of cortical stimulation of the left dorsolateral prefrontal cortex (DLPFC) area of the brain, which appears to play a role in depression, or to get "sham" stimulation. Those receiving the sham treatment were then switched over to active therapy.
Stimulation was delivered via an investigational epidural cortical stimulation system, developed by Northstar Neuroscience, which funded the study. One of the authors is a consultant to the company.
On average, participants experienced an improvement of about 25 percent to 30 percent on different measures of both depression and quality of life.
Three people went into complete remission.
"That may not sound like a lot, but to get any response at all in an otherwise extremely refractory group is extremely promising. This is a potentially less invasive therapy," said Eskandar, who is an attending neurosurgeon at Massachusetts General Hospital and associate professor of neurosurgery at Harvard Medical School, both in Boston. "We also learned that improving the electrode position and giving more current got better effects, so, in the future, we have a pretty good idea of how to improve on this."
The group is now organizing a larger trial to study the potential of the method.
A second study also being presented at AANS found that a type of deep brain stimulation known as globus pallidus internus (GPi) deep brain stimulation was effective in relieving symptoms of primary dystonia in children.
People with this movement disorder suffer from disabling involuntary muscle contractions, explained researchers led by Dr. Jan Mehrkens of Ludwig-Maximilians University in Munich, Germany.
According to the authors, GPi deep brain stimulation has been shown to be effective in adults, but there is little research in children, even though the condition often begins at a young age.
For this study, researchers implanted electrodes in five patients aged 16 or younger who had not responded to other treatments for primary dystonia.
"Significant" improvements were seen for over a year, with all children being able to go back to school, said the authors, two of whom had received speaker's fees from medical device maker Medtronic.
"The advantage of deep brain stimulation over the earlier surgeries is you don't have to destroy any part of the brain. You're essentially turning off the overly active part of the brain and letting the healthy parts of the brain take over," said Dr. Alain de Lotbiniere, medical director of the Northern Westchester Hospital Cancer Treatment and Wellness Center in Mt. Kisco, N.Y., and a practicing neurosurgeon who has performed several deep brain stimulation procedures.
"It's a very exciting area because, up to now, everyone's heard of deep brain stimulation for Parkinson's and for essential tremor, but these are additional areas that border neurology and psychiatry where we're just beginning to understand what happens in terms of the brain chemistry and the brain electricity," he continued. "We're just at the beginning of understanding this. There's a lot of hope there for patients who otherwise may have felt that there was nothing they could do."

Maternal depression is associated with significant sleep disturbance in infants

Findings suggest that parents, especially ones with a history of depression, should pay close attention to the conditions they create for their infant’s sleep


Babies born to depressed moms are likely to suffer from chaotic sleep patterns, which could predispose them to depression later in life, according to a University of Michigan study published in the May issue of the journal SLEEP.
Findings of the study, conducted by U-M sleep expert Roseanne Armitage, Ph.D., are significant because they show that sleep and biological rhythms disturbances persist at least through the first eight months of life in the infants of depressed mothers.

Sheila Marcus, M.D., clinical associate professor of psychiatry at the U-M Medical School, and Heather Flynn, Ph.D., a psychologist and member of the U-M Depression Center Women’s Mood Disorders Program, co-authored the study.

The findings suggest that parents – especially ones with a history of depression – should pay close attention to the conditions they create for their infant’s sleep, says Armitage, leader of the U-M Sleep & Chronophysiology Laboratory team at the U-M Depression Center.

Armitage and her team have shown that insomnia and interupted sleep are strongly linked to depression.

Their research in depressed adults, teenagers and pre-teens led them to expand their research to babies. Infants need a lot more sleep than grownups, but tend to get it in shorter chunks of time throughout the day and night, at least for the first months of life.

Armitage conducted her research with two groups of new mothers and their babies, funded by the Cohen Sleep Research Fund and the Drs. Jack and Barbara Berman Depression Research Fund at the U-M Depression Center.

One group was made up of mothers who sought help for depression during pregnancy from the U-M Depression Center’s Women’s Mood Disorders Program. The other group had no past or current depression. Each group wore devices that measured sleep time at night, light exposure and daytime activity/rest patterns.

The moms wore the devices during the last trimester of pregnancy, and after their babies were born, the team fitted each child with a tiny actigraph at two weeks of age. Information was collected monthly until babies were 8 months old.

Results indicate that infants born to mothers with depression had significant sleep disturbances compared to low-risk infants. The high-risk group took up to 2 hours more to settle for night time sleep, woke up more often and had more daytime sleep than infants who were born to mothers without depression at two weeks and 30 weeks post-partum.
“We think we may have identified a vulnerability in the initial entrainment of sleep and circadian rhythms that may elevate the risk for these children to develop later depression,” Armitage says. “Our task now is to determine if it is modifiable. Can we reverse the effects and reduce the risk of developing later depression by enriching sleep and circadian rhythms in infancy? ”

Infants and toddlers need to nap during the daytime to get all the sleep they need – 11 to 18 hours for newborns in the first two months, 11 to 15 hours for the next 10 months, and 12 to 14 hours from ages 1 to 3 years. And, newborns wake up in the night when they need food.

“But going to bed at the same time, getting up at the same time, establishing rituals around the bedtime helps infants begin to distinguish between night sleep and day sleep,” says Armitage, a professor of psychiatry at the U-M Medical School. “Put the baby in day clothes for naps, and in night clothes for night sleep – babies pick up these cues.”

Parents can also make sure that babies are regularly around bright light during the day, which helps the body develop circadian rhythms linked to light cycles. The bright light shouldn’t shine directly in babies’ eyes and they should be shielded from direct sunlight and wear sunscreen outside.

By four months of age, a baby’s sleep schedule should have become regular, more focused on nighttime sleep, and their blocks of sleep more “consolidated” or longer – especially at night.

The main thing, she says, is to make sure babies and small children get enough sleep on an increasingly regular schedule – and that their moms do too.

The period immediately after giving birth is a high-risk time for depression, even in women who have never had depression before. Those who have had depression, or have relatives who have suffered depression, are most at risk. This postpartum depression can be worsened by lack of sleep – or triggered by it.

“Chronic sleep deprivation is associated with an elevated risk for depression in everybody, at all stages of life, but in new moms, because of the hormonal changes and the need to recover from the pregnancy and birth, sleep deprivation can really be a problem,” Armitage concludes.

“It can interfere with the social rhythms that are important for keeping the circadian clock in the brain in sync, minimize the amount of energy moms have to care for their infants, and contribute to the development of depression.”

Five Great Depression Success Stories

The news about the economy continues to be glum, which makes you wonder if any industry or business could possibly be doing well in such a crummy financial climate. While it might not be easy, it's certainly possible to succeed in a slumping economy. Just take a look at these entities that faced serious challenges during a much bigger fiasco, the Great Depression, and lived to tell about it.

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Mental Floss Magazine Mental Floss Lists Mental Floss Quizzes 1. Floyd Bostwick Odlum
Many investors lost everything during the market crash of 1929 because they has mistakenly assumed Wall Street's good times were never going to end. Odlum, a former corporate attorney who had cannily turned $39,000 into a multimillion-dollar fortune by investing in utility companies, didn't like the way he thought the markets were moving, though. He cut bait on stocks in an effort to generate cash before the market crash he thought was coming.

When the crash came, Odlum had millions in cash on hand, an enviable position in a cash-starved market. He began swooping in to buy up failing companies at drastically reduced prices and then consolidating or spinning their assets for more cash. It sounds like a pretty simple model, but it was so effective it made Odlum one of the ten wealthiest men in the country and earned him the title of "possibly the only man in the United States who made a great fortune during the Depression."

2. Movies
Associated Press
Searchlights frame the "Tara" facade of Loew's Grand Theater on Peachtree St. for the movie premiere of "Gone With the Wind" in Atlanta, Ga., on Dec. 15, 1939.
The beginning of the Great Depression in late 1929 came at a particularly inopportune time for the film industry, which had recently evolved with the 1927 release of The Jazz Singer, a milestone talkie. Just as the industry seemed to be gaining momentum, unemployment shot up and the sort of disposable income one uses for little luxuries like going to the movies steeply declined. Early in the economic crisis, many moviehouses had to close their doors due to the decreased traffic, and most of the once-profitable studios started turning losses in the 1930s.

Faced with this glum market, the film industry got creative. To give customers maximum bang for their scant bucks, theaters cut ticket prices by 50% or more and started giving patrons two features for the price of one ticket. These double features propped up demand for cheaply made B movies, and smaller studios stayed afloat by banging out these quick products.

Theater owners resorted to even more desperate hucksterism, though. During the Depression it was fairly common for theaters to use giveaways to fill their seats. Promotions like "Dish Night" in which any woman who attended got a free dinner plate, cash door prizes, and silverware giveaways where each trip to see a flick got you closer to having a complete set of flatware helped buoy up attendance. Although box-office takes swooned to $480 million in 1933, they slowly climbed back up to $810 million by 1941, in part due to these disaster-management tricks.

3. Procter and Gamble

Associated Press

Tide detergent, a Proctor & Gamble product.
The Great Depression was trying for most consumer product companies, but Procter and Gamble came out of the whole ordeal smelling better than it had in 1929. How did the soap giant beat the Depression? Things were tough at first when mainstay grocery customers started cutting their orders and inventories piled up. P&G apparently realized that even in a depression people would need soap, though, so they might as well buy it from Procter and Gamble.

Thus, instead of throttling down its advertising efforts to cut costs, the company actively pursued new marketing avenues, including commercial radio broadcasts. One of these tactics involved sponsoring daily radio serials aimed at homemakers, the company's core market. In 1933 P&G debuted its first serial, Oxydol's Own Ma Perkins, and women around the country quickly fell in love with the tales of the kind widow. The program was so successful that P&G started cranking out similar programs to support its other brands, and by 1939, the company was producing 21 of these so-called "soap operas." In 1940 the company started its own production division for soap operas, and in 1950 it made the first ongoing television soap opera, The First Hundred Years.

P&G's share price is currently trading at about $20 below its 52-week high, so maybe it's time for the consumer goods behemoth to go back to what works. Might we suggest YouTube videos involving the antics of adorable babies?

4. Martin Guitars
Like movies, musical instruments would seem to be a vulnerable industry in a down economy, but venerable acoustic guitar maker Martin made it through the Depression using a number of strategies. The company stuck to its principle of not giving high-volume retailers discounts, which maintained its relationship with smaller dealers and cemented the company's image as a square dealer.

Martin also started offering new, less expensive models that went on to enjoy great popularity. The "dreadnought" body style was one of these triumphs; it included a larger, deeper body that provided more volume and bass resonance. Martin introduced its first archtop guitar in 1931, and the company also revolutionized its designs by using 14-fret necks on its guitars. These technical changes, coupled with Martin's dedication to giving its customers high-quality instruments at reasonable prices, helped keep its sales up throughout the Depression.

5. Brewers
The Depression was hard enough for most companies, but the nation's brewers had it especially bad. Sure, money was tight, but brewer's core product, beer, wasn't even legal. During national Prohibition from 1920 to 1933, about half of the country's breweries closed their doors for good, but the rest stuck it out hoping for a repeal. How did these brewers make ends meet during the Depression when they couldn't sell suds to the distressed 25% of workers who didn't have jobs?


Associated Press

Yuengling beer.
By diversifying. And then diversifying some more. Brewers started running dairies, selling meat, and venturing out into other agricultural enterprises. Brewers were also allowed to make "near beer" that had only trace amounts of alcohol, but the Depression killed off consumer demand from 300 million gallons in 1921 to just 86 million gallons in 1932. Breweries also started applying their expertise to non-alcoholic tipples like ginger beer; during the Depression there were upwards of 300 breweries making the spicy soft drink. Frank Yuengling, who headed the brewery of the same name outside of Philadelphia, remained confident that Prohibition was just a phase, and he personally diversified widely, including a foray as a bank president and opening a dance hall.

In the end, waiting out the storm by diversifying (and maybe brewing some illicit beer on the side) turned out to be a sound strategy. According to a 2005 survey of the American brewing industry, eight of the 10 largest brewers in the U.S. are pre-Prohibition brands that survived through the Depression.