Melancholia

Via Neuroskeptic, from the British Journal of Psychiatry:

Melancholia - in 100 words

Max Fink and Michael A. Taylor

Melancholia is a classical episodic depressive disorder that combines mood, psychomotor, cognitive and vegetative components with high suicide risk. In the present psychiatric classification it is buried as a modifier in both bipolar and unipolar depressions. It is hardly used to characterise patients in the clinic or research. The syndrome is frequently recognised in delusional and agitated depression, and in the elderly. Cortisol or sleepEEG abnormalities are prognostically helpful. Melancholia is particularly responsive to tricyclic antidepressants and electroconvulsive therapy but not to selective serotonin reuptake inhibitors or psychotherapy. Recognising melancholia as a distinct disorder improves clinical care and research.

Men and Depression

I was very pleased to see this article in the Observer a couple of weeks back: Depressed men missing out on treatment. The problem is that the descriptions of depression and the diagnostic criteria are heavily skewed towards women's experience of depression. Men often do not experience depression in the same way. In particular while women tend to turn in on them selves, men by contrast "can become animated, aggressive and angry". This sums up my own experience of depression. The negativity gets played out! And no one seems to understand, least of all me.

The article came from a press release by Paul Farmer of the charity Mind, who have a campaign to try to improve access to mental health help for men.

Most depressing day of the year?

The Guardian have dusted off a story about 'blue monday' - no, not the New Order song, but the idea that the post-christmas slump reaches a peak on the 3rd monday in January. That's actually today - I am a bit depressed and have been since Christmas, so there you go.

Meanwhile The Times suggests that "toxic society" is to blame for depression, well they would, wouldn't they. But apparently it's not genetic, and certain demographics, and those who had traumatic childhood's are much more likely to develop depression. Then at the end you find it's all an advert for some guy's book, which is a bit depressing - he's scathing of drugs and flogging CBT which isn't the ultimate answer I can tell you!

I really don't think that medical journalists have understood depression, let alone the medical profession. But it's a hot topic cos every other person has it, a lot of money is thrown at it and not much of it is any help! So it's 'a story' now.

Antidepressants may change your personality

paxil aka paroxetine aka aropax aka seroxat

Tweeted by CognitiveTherap

Same story in the LA Times; in the Guardian.

No one talks about the way that depression changes your personality. No one asks how relevant personality tests are, nor what they measure, nor how seriously we should take them. This is a one off study of just 240 people which has not, as far as I can tell, been repeated. No one seems to measure personality before as well as after the onset of depression and treatment with drugs. This story should not be in the news at all. Medical journalism is a crock of shit. The Guardian article is slightly better written, the LA Times article is reprehensible and irresponsible.

Did you know that the information on Anti-depressant medications all say something like: "the action of this drug is presumed to be due to its effect on the levels of serotonin." [my italics] Actually they don't know, they certainly don't know why the side-effects come on within 30 minutes, and the mood effects take 2-4 weeks. They just don't know.

Panacea

Sometimes all the cognitive therapy techniques and affirmations in the world don't help. Mindfulness is the next big thing in 'treating' depression and anxiety - and people I know are heavily involved in this new industry. It does help, but it's not a panacea. (Beyond Blue)

There's that old saying: when the only tool you have is a hammer, then everything starts to look like a nail. The mindfulness brigade are a bit like this at times.