Understanding Mental and Emotional health

When one feels down and this may happen from time to time in today’s fast paced world where family and friends rarely have time for each other. Emptiness and despair take hold of you and simply won’t be driven away then it is a sure case of depression. ‘Feeling blue’ is a term most commonly used in everyday parlance functioning even in daily activities seem a herculean task and one cannot enjoy life as one normally did. Exhaustion at all times, friends and hobbies don’t give you joy, everything seems hopeless and just the thought of getting through the day seems daunting. But there is help at hand and one must make use of support groups and individuals who can help you cope and overcome this terrible feeling. You must extend your hand and take help but before that you need to understand what depression is.

Life’s struggles are a feature in everyone’s life. Setbacks don’t choose to happen only with you and disappointments are a part of normal cycle of human existence. But these things alone which some people label as depression is not true, sadness and disappointments don’t constitute as depression. Some people who are depressed describe it as a feeling of being in a ‘black hole’. Some others feel lifeless, empty and devoid of feelings for what is happening around them. Men sometimes get aggressive, angry and violent when depressed.

Depression is different from being sad as when you are depressed it puts a halt to normal behavior- one cannot work, eat, study, sleep or have fun as one would in a normal course of a work day. The intensity and unrelenting hopelessness and worthlessness drown one’s life into a pit from where there seems to be no way out- a maze of helplessness with no door to the outside. There are a number of questions you can ask yourself for singling out symptoms of depression. One either sleeps too little or too much, previously done easy tasks are difficult now, you feel hopeless and helpless, even after trying you cannot seem to control negative thoughts, you are more than normally aggressive, irritable and short tempered, you have thoughts of life not worth living- any or most of these symptoms should immediately make you ask for help.

These symptoms may vary in degree from person to person. But the stronger and longer they have lasted means that you are heading towards a severe form of this malaise and you need to seek help as soon as possible. Depression has been seen to be a major cause of suicides. When a person even talks of suicide it may be a major cry for help. These thoughts and behavior need to be addressed immediately by those in the know of such people. Though one treatment does not fit all types of depression the most common and effective forms have been a combination of social support, lifestyle changes, emotional skill building and professional help. Managing stress, cultivating supportive relationships, practicing relaxing techniques, eating healthy, etc are all ways of combating this terrible feeling.


Chronicity and recurrence of depression

Consistent gender differences in the duration, chronicity, or acute recurrence of MD have not been found. Longitudinal studies have reported that women recover more slowly than men from a depressive episode and the average duration of an episode is longer in women.[28,29] Therefore, women were significantly more likely to suffer a chronic and recurrent course of illness, with women over age 30 years having the highest rate of recurrent depression.


A retrospective study found a difference in the course of 12-month major depressive episodes, with older women having more recurrent episodes than older men[13]; this difference was most pronounced in women between the ages of 45 and 54 years. A prior history of depression substantially increased the risks of chronicity and 12-month recurrence, and women were more likely than men to have a prior history.


In contrast, cross-sectional studies have not reported any gender differences with respect to chronicity or recurrence of illness.[10,11,25] In the longest naturalistic, prospective, follow-up study to date, 96 men and 101 women with a first episode of MD were followed for an average of 8.4 years.[26] No significant evidence was found for a more chronic course of depression in women than men.


Women also did not significantly differ from men with regard to time to recovery and the overall time to first recurrence. However, a post hoc analysis restricted to the first 6 months after intake revealed one significant difference in that women tended to experience recurrences earlier than men. Milder depressive syndromes were more recurrent in women,[28] but when DSM-IV criteria for major depression were used, the gender difference was not significant, in agreement with previous findings.

Behavioral analysis of depression patients

Cognitive behavioral analysis has a good track record of treating chronic depression in several small studies–the reason why it was chosen for the Chronic Depression study, Dr. Keller says. The treatment draws on several forms of therapy: Behavioral therapy, which helps people analyze the impact of their behavior, Cognitive therapy, which challenges people’s belief systems, and Interpersonal therapy, which emphasizes problem-solving and personal relationships, (including the doctor-patient bond).


Susan C. Vaughn, MD, assistant professor of psychiatry at Columbia University and author of The Talking Cure: The Science Behind Psychotherapy, says she believes that psychotherapy and medicine work “synergistically.” Many of the patients she sees in private practice need antidepressants to “get to the emotional place to do therapeutic work,” she says. “The drugs change the chemical context–the neurotransmitters spritzed and sprinkled in the brain–while psychotherapy challenges belief patterns and how people act upon these beliefs.”


Psychotherapy has been a “scary item” for health insurers, according to Robert Field, PhD, JD, MPH, director of the graduate program in health policy at the University of the Sciences in Philadelphia. He says a great deal of the problem is that talk therapy is perceived as open-ended by insurers, and that the gains patients make in treatment are difficult to measure. But Field says he believes that pressures from managed care organizations are forcing the mental health community to figure out what works and what doesn’t.


“If researchers can document that certain therapies–whether drug-psychotherapy combo or short-term behavioral therapy–can relieve depression and other psychiatric disorders and keep them from recurring, it makes sense for insurers to pay for these treatments,” he says. “It is this kind of research that will help us find answers and save money in the long run.”

Depression and gender

Yet despite the obvious relevance of these states to particular women, using hormonal changes to explain broad differences between the sexes has not stood up well. Premenstrual mood changes are generally mild, and when severe, are often related to preexisting depressive and other disorders. (The menstrual cycle seems to act as a channeler or lightening-rod rather than as a cause.)


Depressions around childbirth are occasionally related to hypothyroidism. Mostly, they are associated with preexisting vulnerabilities to depression and life stresses, including, of course, the stress of becoming a mother. As for menopause, there is no evidence that particularly large numbers of women become depressed at that time. Those women who do are often faced with life issues, such as changing roles and socioeconomic problems, that were long in the making, before hormone levels declined.


For all the obvious attractiveness of biological-hormonal theories, other theories related to differences in culture, experience, psychological makeup, and socioeconomic status keep poking up their heads. What if factors that are known to predispose a person to depression are more common in women? These factors include low socioeconomic status, low education, being widowed, being abused, traditional feminine role, house-bound labor and social isolation, and adverse life events. Other explanations combine biological and cultural factors and look to childhood events or patterns, such as sexual abuse, which may have led to subtle nervous system damage, predisposing the person to later depression.


Again, these events might be supposed to be more common in females. Understanding sex differences turns out to be a very difficult and complicated business. In the absence of solid answers, it is tempting to indulge in some pet theory or ideologically-inspired notion. But keep in mind, when you hear someone speaking with great confidence on the subject, his or her opinions are not based on the current state of knowledge.

Depression is a disorder of multifactorial etiology

It is a heterogeneous symptom complex characterized by an overwhelming sense of fatigue, neuropsychiatric symptoms (anxiety, depression), neuroimmunological disturbances (2), neuroendocrine abnormalities and various somatic complaints (1). Fatigue is the pivotal feature of the syndrome. Both the organic and psychiatric factors contribute to fatigue to an uncertain extent.


CFS patients are also more prone to psychiatric disorders like anxiety and depression, which occur in about two-third of some groups of patients. Also, the subjects with pre-existing psychiatric problems are more likely to develop chronic fatigue after recurrent infections (3). The conundrum of CFS is further compounded by the fact that its natural history and ultimate prognosis are unknown and that there is neither a diagnostic test nor an immediate effective treatment.


Thus, the exact treatment still remains elusive. Although various classes of drugs have been studied for their effectiveness in CFS, no specific therapeutic agent is available. Yet among these, antidepressants appear to be promising agents and they already have been reported to be beneficial in providing symptomatic relief in such patients. Besides improving the depressive symptoms, these agents ameliorate sleep disturbances and emotional symptoms (4,5). With the above point of view, the present study was designed to investigate the comparative effectiveness of antidepressants and herbal psychotropic drugs in a mouse model of chronic exposure to forced swimming.


The anxiety level of the animals was also tested before and after subjecting them to the chronic forced swimming test. This study examined the effects and comparative efficacy of various antidepressants and herbal psychotropic drugs in a mouse model of chronic fatigue. Animals were subjected daily to forced swimming (Porsolt’s forced swimming test) and the duration of the immobility period was recorded in 6-minute sessions on each day for 7 days. Chronic forced swimming resulted in significant increases in immobility time on day 7 as compared to day 1 in control mice. Pretreatment with imipramine (10 mg/kg, i.p.), desipramine (10 mg/kg, i.p.), tranylcypromine (10 mg/kg, i.p.), alprazolam (0.5 mg/kg, i.p.), fluoxetine (10 mg/kg, i.p.) and melatonin (10 mg/kg, i.p.) produced significant decreases in immobility time as compared to control on each day.

Depression is not only dependant to your genetics

As the FAME 2000 International Fibromyalgia Conference was nearing a close last month in Los Angeles, one of the presenters said: “Given the amount of research that shows physical abnormalities in fibromyalgia, anyone who still believes this illness is ‘all in your head’ should have their head examined!” Indeed, despite increasing research distinguishing Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) from psychiatric disorders, the role of psychological factors is still being hotly debated.


Dr. Muhammed B. Yunus, M.D., one of the presenters at FAME 2000, has been researching the clinical characteristics of FMS for over a decade. Many of his published studies have challenged the notion that this syndrome is nothing more than a problem of stress, anxiety, or depression. He argues that while psychological factors may aggravate symptoms, they also camouflage the real cause of FMS, which he believes involves aberrant neurotransmitter mechanisms. Yet some doctors still cling to the belief that FMS/CFS is psychological in nature.


Dr. Yunus calls this “Disturbed Physician Syndrome” (DPS). Says Yunus, “DPS people are trouble because of their preoccupation that FMS patients are psychologically disturbed. It is not the FMS patients who are disturbed, it is the physicians who are psychologically disturbed because they ignore the data, and whatever data there is, they manipulate it to say what they want it to say.” In fact, psychologist Phyllis Chesler, who suffers from CFS herself, points out that the process of struggling for acknowledgment and understanding is, in itself, highly stressful.


She writes, “I believe people with poorly understood illnesses are subjected to a level of stress that’s more than a healthy person can take.” She notes that rheumatoid arthritis and multiple sclerosis were initially seen as manifestations of psychological stress, but are now recognized as bona fide physical diseases. Research is increasingly showing that CFS and FMS are real, not psychosomatic. Findings such as abnormal levels of brain chemicals have been discovered in people with these illnesses. While many unanswered questions remain, this research may eventually lead to the discovery of an underlying cause (or causes), as well as promising treatments.

Image analysis on depression patients

Subjects rested comfortably on the imaging table with eyes closed and covered and environmental noise kept to a minimum, while the tracer injection was administered over a 30 s period. The subject’s head was then positioned in a moulded head-holder and aligned with the help of two crossed positioning lights. During the scan, the head was fixed with pressure pads over the zygomatic arches. Slices were acquired parallel to the orbito-meatal plane, starting at a level approximately 2 cm above the orbito-meatal line and at 1 cm intervals above this level; further details of the method have been described previously (Ebmeier et al, 1995).


Images were reconstructed using software supplied by Strichmann Medical Equipment (SME) for the Apple Macintosh. The SME reconstruction algorithm selects an enveloping ellipse, derived from an oversmoothed image of the brain. This, together with the absorption length parameter (95 mm), determines the Chang-like attention correction which was done with one iteration. Count distributions were deconvoluted into the radio-isotope concentrations responsible, using a Wiener filter with a correlation length of 6 mm.


Image analysis Two transverse slices were chosen for the ROI analysis, approximately 4 and 6 cm above the orbito-meatal line. A standard template was prepared by drawing regions of interest over corresponding brain atlas slices (Talairach et al, 1988). Although this atlas is oriented to an internal anatomical reference (the line between anterior and posterior commissures), the orbito-meatal line is almost parallel with it (Szikla et al, 1977). The ROIs included, in the lower slice, frontal, anterior and posterior cingulate, anterior temporal, posterior temporal, calcarine and occipital cortex, as well as caudate, putamen and thalamus.


The corresponding template for the higher slice contained frontal, anterior and posterior cingulate, parietal and occipital cortex. The templates are linearly and symmetrically deformed to fit different brain sizes and shapes, using the 20% isocontour line to define the cortical edge. ROI were thus preserved in their relative position to each other, and no additional adjustments were made for single regions that appeared to be out of position (Ebmeier et al, 1991). Regional count densities were normalised by proportional scaling to whole brain blood flow (derived from the two slices examined).

Cerebral perfusion in CFS + Depression

These researchers measured regional cerebral perfusion at rest using high resolution single-photon emission tomography (SPET). The subjects were in 30 patients with CFS (CDC criteria ‘94) 20 with major depressive disorder (MDD) and 15 healthy controls. Other measures included Hospital Anxiety and Depression Scale (HAD), the Hamilton Depression Rating Scale (HAM-D), and the Chalder Fatigue Scale. Fourteen of the patients were taking some sort of medication, mostly antidepressants.


Both the CFS and depression patients had increased blood flow in the right thalamus. The CFS patients also showed increased perfusion in the left thalamus but there was no reduction in prefrontal perfusion as seen in the depressed group. The researchers conclude that abnormal cerebral perfusion patterns in CFS subjects who are not depressed are similar but not identical to those in patients with depressive illness.


Thalamic overactivity may be a correlate of increased attention to activity in CFS and depression; reduced prefrontal perfusion in depression may be associated with the greater neuropsychological deficits in that disorder. They did not measure blood flow in the brainstem, so there was no opportunity to replicate the findings of Costa et al 1995 (SPET) and Tirelli. et al 1998 (PET) . The hypoperfusion which these papers documented has not been found in any other patient group. What baffles me is that the abstract of this report notes that their CFS patients “were not depressed” (according to the HAD and SADS) but the discussion on limitations refers to this group as having “high levels of depression”.


Given the earlier comments plus the HAM-D scores, this is a surprising statement. Can anyone enlighten me? Another oddity is the suggestion that the thalamic overactivity in CFS and depression “reflect” increased attention to motor and cognitive tasks. This may well be true but the abstract notes that the scans were completed at rest, not while performing cognitive tasks. Why should increased blood flow to the thalamus reflect an activity which the patients were not engaged in? And if they had performed tests just prior to the scans, why did the researchers not analyse the data for correlations

What did she mean by depression?

That there is exactly ONE person in this group that would notice someone unjustifiably picking on you, shows that you have zero credibility no matter what you say. And as long as you continue to act like a bastard, people are going to treat you like one. I realize that no matter what you say or claim, you really don’t want people to accept what you have to say. You want them to dislike you and ignore you.


You like receiving negative attention or you might have done something to change it over the last eight years. I understand now that you are sick, and I pity your illness, sir. Perhaps someday you will get treatment, and maybe people will be able to forgive you. And maybe some day you’ll be able to forgive yourself. I know because while I was never as bad as you display yourself now, I used to suffer terribly from manic depression.


I had some treatment and came OUT of it and knew what the difference was. And at the time I didn’t think there was anything wrong with me until I discovered the difference. Perhaps someday you will be willing to accept that you cannot accept the way things are and want to change them for the better in order to make yourself happier and your life more fun. Until then, wherever you post, they will ignore you as irrelevant, virtually no one will listen to anything you have to say, and you will have no one to blame but yourself.


You can make the (obviously false) claim that you don’t care what other people think of what you say, but do you really want to post to a place where 99% or more of those around you will not listen to you? If all you want to do is post in a vacuum where nobody is willing to listen to you, why not use alt.test instead? At least you’d get feedback from the bots that monitor it for messages. And they won’t argue with you, either!

Attempted Suicide, Drugs and Adultery and Depression

Just in case you were interested, Brian has in fact considered suicide many times. Brian was so strung-out on drugs during our marriage that his mind was miserably disturbed to the point of wanting to end it all. Only his addiction to cocaine, booze, marijuana and crack was making his life bearable, or so he thought. Those illicit drugs were in fact causing him to contemplate committing suicide. Brian’s violent mood swings, while under the influence, were a serious problem in our marriage.


Brian’s depression is very serious and he chose of course to self-medicate. As I have stated before, it is Brian who brought all the drugs into our home. His depression is self-induced and I seriously think that Brian needs some more psychiatric help, more than what he has already received. The reason why Brian won’t go to a drug rehab center like Mountain Vista Farm is because he is too proud to admit that he has a serious drug problem. Also, he doesn’t want anyone to know that he brought the drugs into our home so that he could get me hooked on them and then use that as a pre-text for our divorce. If Brian were to commit suicide, he would not be the first at KGO. I remember how mentally disturbed Brian became when KGO’s Duane Garret jumped to his death off the Golden Gate bridge. Brian fell into another bout of depression right after the suicide and even told me that “jumping off the Golden Gate isn’t a bad way to go”. I haven’t heard of anyone committing suicide after having suffered the torurously long “comedy” act of Brian’s, but one thing is for sure and that is that his “comedy” act is horribly boring and especially dis-jointed during the 2nd act: If Brian finally commits suicide or not is not really my concern anymore. Brian has destroyed our marriage, maligned me personally, has stolen my children and refused to let me see them, and daily slanders and lies about me to many people.


Brian has tried to kill me with drugs, drowning me like the infamous Scott Peterson, in his attempt to get rid of me so that he could marry his adulterous home-wrecking nympho slut, that adulterer named Susie. Go ahead Brian with it Brian. The Golden Gate is open today. Go and join Duane Garret your friend. At this stage in our marriage and relationship, and Brian having stolen my children, I could care less if he killed himself. All I know is that Brian tried to kill me with drugs and an over-dose.