Tuesday, 12 April 2016

Laughter and Depression Can Mix

When we think of depression it’s often in terms of everything appearing black, of great sorrow, self-recrimination, loss of confidence and guilt. These symptoms are certainly classic features of depression but we also have to remember that symptoms vary in terms of their nature and intensity and whether the person is slipping into or starting to recover from a depressive episode.

Holding back the tears during depression doesn’t really help. In fact a good bawl can be immensely therapeutic. There may also be a difference in crying alone or crying in the company of a trusted friend or relative. Crying in isolation isn’t harmful, but it does serve to amplify a sense of isolation and loneliness. In the company of someone trusted, crying is likely to be within the context of conversation. Being able to talk about one’s feelings provides an outlet for processing and understanding internal conflicts. Such conflicts often run deep and are complex and confusing. Talking helps the process of recovery and sharing this with someone who perhaps has a personal background of depression or crisis can help. For their part, the listener can respond with compassionate talk to aid depression recovery, and they will fully understand the need for tears during this difficult time.

Depression and humor may appear at odds. During bleak periods it’s true that the ability to find humor in anything is in pretty short supply. However, returning to comments in my opening paragraph, it’s important to remember that depression isn’t a fixed unit of mood. It is actually quite a dynamic process that can vary considerably, even over the time of day. Some people function for years in a state of despondency yet are perfectly capable of laughing out loud. Such moments may be short-lived, but they do exist, sometimes at the cost of masking the dominant mood.

I remember once speaking to a lady who was recovering from depression. She was in hospital and had several previous admissions for depression. One of the things that struck me was her declared fear of laughing in case relatives felt her depression was something of an act. Despite a suicide attempt that very nearly succeeded, her view was that people with depression weren’t meant to see the funny side of anything. We spoke at length about the people I’d met in similar situations, about the nature of depression, and the fact that, like her, some needed to be given permission to laugh. Even depression comes with its stereotypes that can affect behavior.

There are other ways of working through depression that can supplement talking. Keeping a log or diary can become a highly personal and reflective tool to help articulate and make sense of conflicting emotions. Some people craft letters to an imaginary friend, sometimes to a loved one who has passed away, and sometimes to a real person.

Emotions associated with depression often seem to strip away self-worth and our sense of mastery. Writing or talking about the things lost provides a vehicle for reminding ourselves of the important issues and can provide a way of gaining 

Sunday, 10 April 2016

Your Memory Lapses May Be Stress Related

You’re running late. You get to the car only to find you’ve forgotten the keys. Worse still, you've left your child, your own child in a taxi, on a train, or in some café. It's more common that you might imagine. Forgetfulness is a fact of life. The causes and extent of memory lapses may vary from fatigue to problems in the way we encode, store and retrieve information, competition for our attention, through to organic reasons such as trauma, or diseases like dementia. We generally accept our forgetfulness as a human flaw but there are times when people begin to notice they’ve become more forgetful than usual and this gives rise to concerns.

Chronic stress is a well-known cause of forgetfulness and researchers believe they understand at least part of the mechanism behind this. An area of the brain called the prefrontal cortex is responsible, amongst other things, for working memory, attention, judgment and decision-making. It takes just a few days of exposure to stress hormones like cortisol before the negative effects of stress on these processes begin to show.

Professor of psychiatry and psychology, John W. Newcomer, M.D., asked volunteers to take a substance that mimicked the effects of cortisol over a four day period. Volunteers were asked to recall certain parts of a paragraph in order that a component of memory (known as verbal declarative memory) involving particular regions of the brain could be tested. The results were then compared with volunteers who took a lower dose and those who took none. Only those who were exposed to higher levels of the cortisol substitute showed forgetfulness.

Exactly what does this experiment tell us? According to Newcomer the amount of stress required to produce such an effect far exceeds a typical bad week at work, for example. He likened the experimental effect to that of a major trauma such as abdominal surgery. Even so, he says, the cumulative effect of stress over a period of time could well explain why many chronic stress sufferers appear to have problems with their memory.

And what about everyday activities? Well professor Newcomer concedes that some people may well experience high levels of cortisol in response to other forms of psychological stress. The pressure of upcoming final exams could be an example. He says, “Mom and Dad may have been right when they told us cramming for exams is not a good idea.”

The good news is that it after a week on the cortisol-memory experiment the memory impairments shown by volunteers were reversed.

Saturday, 9 April 2016

Gut Bacteria and Anxiety

The average adult carries around five pounds of bacteria in the gut and the effects of correcting bacterial imbalance can be dramatic according to a study published in Nutritional Neuroscience. In an interview with ABC news, Dr. James Greenblatt, a Boston-area psychiatrist, described how a simple urine test revealed elevated levels of HPHPA (a chemical byproduct of clostridia bacteria) in a teenager with obsessive-compulsive disorder and attention deficit hyperactivity disorder. He put the patient on an intensive dose of probiotics and after six months the symptoms began to disappear. Greenblatt says he now checks everyone in the same way and while “eight out of ten are fine, in the two patients where it’s elevated, it can have profound effects on the nervous system.”

There has been mounting evidence that bacteria in the gut can play a huge role in our overall mental health. Harmful bacteria is known to ramp up anxiety and several studies have shown that probiotics can have the opposite effect. It’s a two-way street, says Dr. Siri Carpenter, writing for the American Psychological Association, just as bacteria in the gut seem able to influence the brain, so the brain can exert influence on the gut. Stress, for example, manages to suppress beneficial bacteria and opens the way for harmful bacteria to flourish causing inflammation and increased risk of infection. Some experts are now suggesting that people suffering from anxiety may benefit from eating more healthy bacteria in order to correct the imbalance that has accumulated in the gut. 

Such findings appear to offer a tantalizing treatment but research into the gut-brain connection is still in its infancy. Certainly for a subset of people with anxiety or possibly even depression there may be relatively quick and useful outcomes by changing diet, but it’s by no means a magic bullet. Everyone has their own unique system determined in part by genetics and in part by the bacteria that live in on and around us. Gut bacteria actually produce hundreds of neurochemicals that the brain then uses to regulate psychological processes like learning, memory and mood. Did you know, for example, that gut bacteria manufacture about 95 percent of the body’s supply of serotonin?

Much of the research to date has been with animal studies and it looks like we’re many years away from a time when doctors may routinely check our gut bacteria when we report symptoms of anxiety or depression. Even so there are increasing indications that healthy bacteria can reduce stress-induced hormones while increasing the expression of receptors for the neurotransmitter GABA, which helps to calm us.


Bravo, J.A. et al (2011) Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proceedings of the National Academy of Sciences.

Carpenter, S (2012) That Gut Feeling. APA, vol 43, No 8, page 50.

Friday, 1 April 2016

Depression Jargon

People unfamiliar with the world of medicine often find the terminology used quite baffling and frustrating. Unfortunately things don’t get much better in the world of psychology or psychiatry. To the insider, the jargon used often has a very precise meaning, but to the person who just wants some help for their troubles it can seem like another set of hurdles to jump at a time when they could really do without it. Although I can’t do anything about that, one thing I can do is spend a little time unpicking some of the more common words and phrases you might be confronted with when listening to health professionals or conducting your own research.

The term mood disorder refers to a variety of conditions where some disturbance in mood is central. Imagine a horizontal line on a piece of paper. At one end sits depression, at the other mania. These extremes of mood are what we think of as mood disorders. The rest of the line, the bits between these extremes, comprises the various highs and lows we experience. Extreme moods have a habit of lasting a long time, feel very uncomfortable and disrupt work and social activities.

I’ve just used the term depression as though it exists as a well defined thing in its own right. When most people use the term depression or depressed, they are generally referring to a feeling of low mood or of being a bit downbeat about things. Clinical use of the term is different. For example the symptoms of bipolar depression (depression that sometimes alternates or corresponds with mania) may be different to those of unipolar depression (depression only).

The term affect is commonly used as in, for example, an affective disorder. Basically affect means emotion, but slightly more accurately it refers to our personal experience of emotion. So a term like affective disorder is basically the same as mood disorder.

Some other terms associated with mood disorders:

Anhedonia: low mood most of the time.
Chronic depression: depression (mild, moderate or severe) that lasts at least two years.
Cyclothymia: persistent instability of mood, moving between mild depression and elation.
Delusions: delusions are false beliefs. A significant minority of people with depression experience them (I am unworthy, guilty, being persecuted) but they frequently occur in mania and mostly as delusions of grandeur (I have special powers, I am the son of God) which may explain why the diagnosis of schizophrenia is sometimes wrongly applied.
Diurnal variation: mood worse in the morning.
Hypomania: symptoms of mood elation not quite as severe or extreme as mania.
Melancholia: is actually a severe form of depression with quite prominent symptoms such as marked weight loss and psychomotor retardation (see below).
Psychomotor retardation: refers to the slowing down of mental (psycho) and physical (motor) activities, often seen in depression.

The golden rule with all jargon is to ask the person to explain what they mean and to tone it down. A consultation shouldn’t be a test of your intelligence or a stressful experience. A medical consultation is for you and you must set the agenda, even if it feels an effort to do so. Don’t be afraid to say you don’t understand as it’s the job of health professionals to be understood. Ultimately this benefits them as much as it does you.