Depressive chicken, meet chocolate egg

According to this BBC report, chocolate lovers 'are more depressive', say experts. The BBC story is a digest of an article in the Archives of Internal Medicine, Mood Food: Chocolate and Depressive Symptoms in a Cross-sectional Analysis. (You have to be a subscriber to read the full report.)
The abstract of the article tells us:

Conclusion  Higher CES-D depression scores were associated with greater chocolate consumption. Whether there is a causal connection, and if so in which direction, is a matter for future prospective study.

It's fun, kinda, to see how the headlines from various media outlets try to parse this correlation, but not necessarily causation result. IMO, the best summary comes from Medscape (free registration required): Mood Food? Depressed People Eat More Chocolate.

• An article in the Daily Mail (UK) promises to explain How the blues make you crave chocolate, when the study clearly doesn't. 
• The headline in Chocolate may cause depression | Psych Central News leads us to a conclusion that isn't quite there.
  And there's this:
  
  
  
• Chocolate a Sweet Pick-Me-Up for the Depressed - BusinessWeek isn't. The study  says that it's drawing no conclusion about whether chocolate relieves the symptoms of depression in any significant way.
  As reported in the Medscape article, "The study," one of the researchers emphasized, "does not address the issue of whether chocolate is beneficial or harmful in terms of mood, as this is an observational and cross-sectional study."
• Depressed? You must like chocolate | Reuters - No, it doesn't say that. The study doesn't conclude that all depressed people eat more chocolate.
  The people in the study, folks who'd not been diagnosed with depression but who scores on a depression screening test indicated that they met the criteria for depression, ate more chocolate. Th study was not a review of chocolate-eating among people with depression.
• Study: Chocolate Can Relieve Depression - cbs4denver.com - This is seriously wrong.  The study makes no such claim and, in fact, suggests the opposite, that chocolate may trigger symptoms of depression.
• And, we mustn't overlook the PG-13 pictures of women eating chocolate in Is chocolate linked to depression? | The Money Times
  The researchers deliberately included more men than women in the study because previous inquiries typically focused on women and their alleged love of chocolate.

There's a lot of bad journalism out there, people who have access to scientific and medical research who then write articles that are cute, clever, and dangerously wrong. 

Depression and everthing else

This reminds me of the time that Bruce Spingsteen was on the cover of both Time and Newsweek in 1976. This week, though, it's depression, featured in  two major New York magazines.
Head Case — Can psychiatry be a science? by Louis Menard joins New York Times Magazine's piece on Depression’s Upside. In Head Case, Menard reviews two books on the topic of depression —  Gary Greenberg’s "Manufacturing Depression" and Irving Kirsch’s "The Emperor’s New Drugs."
The discussion is in even greater depth than in the NYT article and reaching violently similar conclusions. Antidepressants don't work except in the cases that they do and talk-therapy works best unless it's an evil kind that's just getting you to accept the way things are.
It should be noted that none of the books or articles mentions other therapies that are in use today - ECT or TMS  (See the WebMD article, FDA OKs TMS Depression Device, for a summary of the two approaches.) or Vagus Nerve Stimulation (VNS).
In addition, depression is usually self-limiting, remitting spontaneously in about 50% of the cases. The trouble is that we don't understand well enough which 50% and the stakes for untreated and undertreated depression are very, very high.

via Current Worldwide Suicide Rate

Thinking and depression

One of the latest efforts to make sense of depression is in this week's New York Times Magazine - Depression’s Upside.
The article profiles research by Andy Thomson and Paul Andrews on the vexing question - why does depression exist? Given that the illness/condition affects such a large percentage of the population (about seven percent of the population in a year and, apparently, across cultures), why is this response so common and what is the irritant that's causing it?
Their research shows that depressed patients commonly have a hyperactive left ventrolateral prefrontal cortex (VLPFC). Activity in the VLPFC is also associated with a particular type of deeply analytical thinking.
The depressed mood, then, is not so much a response to thinking sad thoughts, but our response to extended periods of that type of analytical thinking. The article notes, "this deliberate thought process is slow, tiresome and prone to distraction; the prefrontal cortex soon grows exhausted and gives out."
There are plenty of critics of this view, that people with depression are in a deep state of rumination. This is, in part, due to the problems we have in defining and diagnosing depression. The illness/condition is an amalgamation of symptoms present over time (typically two or more weeks). Doctors build a circumstantial case for the diagnosis. They're sometimes able to identify a cause (family crisis, work troubles, long-standing relationship issues) and sometimes they can't identify a triggering event.
"To say that depression can be useful doesn’t mean it’s always going to be useful,” Thomson says. “Sometimes, the symptoms can spiral out of control."
Thomson goes on to ask, "Do these ideas help me treat my patients better?" Based on this research, he's less inclined to prescribe antidepressants, instead setting up frameworks to help patients discover what's triggering this ruminative response.
The idea that many people with depression will respond better to cognitive therapy and less to antidepressants is borne out in other research. A meta-analysis of research into the effectiveness of antidepressants, published in the Journal of the American Medical Association,  (Antidepressant Drug Effects and Depression Severity) showed that effectiveness of antidepressants increased with the severity of depression. Antidepressants for patients with mild-to-moderate depression weren't much better than treatments with placebo. For patients with severe depression, antidepressants were beneficial.
What we're finding, then, is that the easiest, cheapest, and least-effective ways of treating mild-to-moderate depression are found in the prescription of antidepressants.
As we're often reminded - fast, cheap, good: pick two.

What's eating you?

There have been several stories in the news regarding diet and one's risk for depression. This isn't surprising. Depression, at its most severe, is one of the most debilitating, intractable, and expensive conditions to treat. In its milder forms, it's often treated successfully with various therapies and/or medications.
Wouldn't it be great, then, if we could find ways to reduce its severity and duration or, even better, prevent depression before it starts. Adding or removing some foods from our diets, it would seem, might be an answer.
We've long heard that oils from fatty, typically cold-water fishes are rich in omega-3s which, it's believed, can relieve depressive symptoms. It turns out, though, that it's not quite that simple. There are, we learn (Nutrition and health: Food, glorious food | The Economist), two types of omega-3 oils - long-chain and short-chain. The long-chain, primarily from fish, are the ones that do us the most good and are also the more expensive. Short-chain omega-3 oils, derived from plant oils, aren't nearly as effective.
A study published in the British Journal of Psychiatry concludes

that people who ate a diet high in Mediterranean-style foods, such as pulses, fruits, nuts, cereals, fish and olive oil were 30% less likely to develop depression than those who ate less healthy foods.
via Mediterranean diet 'can help stave off depression' | Society | The Observer

(Pulses is another word for beans.)
It seems simple to conclude that a Mediterranean diet supplement with cold-water fish ought to be part of a depression prevention program.
Except that, olive oil includes omega-6 which can negate the beneficent effects of long-chain omega-3 oils. The Economist concludes " those who buy omega-3 supplements that also contain omega-6s are probably wasting their money."

Another study released this week shows how junk food diet 'can give you depression' | Mail Online. Well, it doesn't quite say that. The study says that people who eat more processed foods have a higher risk of depression. The researchers conclude that these dietary habits are predictive of depression and imply that the processed foods themselves are causing depression. I'm not sure. (The full text of the study is behind a subscription wall, so I can only rely on the news reports.)
For example, I'm having a heck of time parsing this item

Although the researchers cannot totally rule out the possibility that people with depression may eat a less healthy diet they believe it is unlikely to be the reason for the findings because there was no association with diet and previous diagnosis of depression.

via BBC NEWS | Health | Depression link to processed food

I suspect that the study's authors and certainly the reporters are confusing causation with correlation. It's not surprising that people with depression would have bad eating habits. When in the middle of depressive episodes, most folks are lucky to put on clean clothes, let alone make sure that they're getting enough veggies.
And, while we're at it, another study indicates that happiness is overrated anyway.

An Australian psychology expert who has been studying emotions has found being grumpy makes us think more clearly.

via BBC NEWS | Health | Feeling grumpy 'is good for you'

Same word with a new emphasis

I've been using Google's automated blog search to find out what people are writing about depression. Even a few weeks ago, most of the topics were about depression, the mental illness. It's since become almost exclusively about depression, the economic illness. People are more worried about the state of their pocketbooks than the state of their minds.

Google Reader (112) via kwout

Not only that, but, FWIW, Sarah Palin seems to be in the middle of all of the discussions.

When content aggregators get the blues

Apparently, this site, allaboutdepression.info, generates articles by locating topics related to keyword, collecting the topics, and publishing them. In this case, the keyword was depression. The aggregator didn't bother to notice that there are many different meanings and uses for the word depression and its derivatives.

Tropical Depression 3 could become a tropical storm (Carteret County News-Times) | allaboutdepression.info via kwout

Why I trust the Internet for all of my medical questions.

» Overtime Work Linked to Anxiety and Depression - Psych Central News

A recent study suggests employees who work overtime are at increased risk of anxiety and depression.

Long Work Day Not Linked to Stress

A bad day at the office has little to do with the number of hours you put in working. Workplace stress, research has found, is not linked to clocking in more hours. Rather, the culprit for stress in the office is workplace environment.

You Know You Blog Too Much When…

As a footnote to this post on blog depression, there's also You Know You Blog Too Much When…| Zoli’s Blog

Nothing but blue skies is all I see

After the wild weather of the last couple of days, a calm dome of cold air has settled atop of us. The contrails are like dusty chalk lines against the deep blue sky. When the upper air is calm, contrails can last for hours. If the jet stream is chugging along normally, the markings of the jets' passage are gone in minutes or even seconds.

The National Weather Service forecast says that we can expect more heavy rain tomorrow night into Saturday. The meteorologist calls the storm "an inside runner," meaning that it will go up the eastern seaboard, but the center of the low will stay over land, perhaps as far inland as the Appalachian chain. An inside runner brings us rain, while the far north and west gets ice or snow. Yesterday's storm cleared away snow from half of our back yard, but the ground is still hard frozen.

As I've mentioned before, I use some of the automated search tools in Google to keep track of news on various topics. The searches that I have set up for depression, as you might expect, pick up info about the mental illness, but also about troubled economic times. It turns out that economic advisers to the president have maintained a Misery Index since the 1960s. The index is simply the unemployment rate added to the inflation rate. The worst rating was in the latter party of the Carter administrator, while Ike scored the best. The current administration is in the middle of the pack, better than his father's, but worse than Bill Clinton's.

So, what can we expect from the future?

Restarting winter or awaiting spring?

A snow squall came through overnight, leaving a half-inch of fresh powder, smoothing everything to a bright white. By mid-day, even though the temperatures are still in the teens, the sun has melted some of the snow. We're in that crossover time. The weather can still bring cold and snow, but the sun is getting high and strong. There is a lot of cold air banked up in Canada and more snow is in the forecast for a couple of days out.

Some readers have noted that I've not written much, that posts of late have been collections of links about depression or brief notes about music. Yup. The words are there and I'll get them going again. Thanks for your patience.

The FMLA Blog: Leave Due to "Depression" Insufficient Notice for FMLA Protections

The FMLA Blog: Leave Due to "Depression" Insufficient Notice for FMLA Protections: "the FMLA does not 'include depression in all of its forms.'"

What does a change change?

My application for Social Security disability benefits has been approved.

When I first read the letter, I was pleased, as though I'd achieved something of note. I guess that's true. With the help of family, doctors, friends, and others, I've been able to make a clear and truthful case that I'm unable to work. Clarity and truthfulness are important parts of the humility that supports a good life. So, there you have it. By way of federal paperwork (web- and paper-based), I've learned that, according to the rules of the SSA, I am disabled and unable to work because of treatment-refractory depression.

Knowing our limitations is a good thing, but that knowledge, by itself, is a death sentence.

Whether we're looking for a path out or just a path forward, we need to be able to see beyond our limitations. That ability to see beyond can come from many places. Some would call it a higher power. Others might call it reframing. Still others might find it on a long walk in a cold morning. The important thing to know is that any truth worth knowing is a truth that is in transition. A truth that doesn't change is a dead truth.

The disability benefits include a modest income, access to rehabilitation programs, and, in a couple of years, eligibility for Medicare. I'm permitted to work under some restrictions.

My life and my career(s) are filled with stuff that I didn't set out to do, most of which turned out to be better than I'd expected. Here's another one.

This just in.

It takes a big, fancy British medical journal to tell us that antidepressants don't help cancer patients who don't have depression.

Work, interrupted

Simply put, I've been too sick for too long. After conversations with Sandra, with one doctor, and with another, I went on disability leave on Tuesday. Depression, it is, although I didn't use the word often. I told my manager and the one co-worker who'd be most affected by my absence. I'm not sure how long it will take for me to be well enough to be able to return to work, but it's likely to be months rather than weeks.

Sandra and the rest of my family have been wonderfully supportive. My manager and the co-worker were very encouraging. I'm also sure that people are more than a bit afraid, in part of the work that I won't be able to do and in part because the d-word is scary.

The company's policies regarding the treatment of depression and related illness are quite good, but it's still a big company.

• The envelope that brought me the paperwork had a statement on the back that said "Extremely Urgent." The words UPS Express, however, were redacted and replaced with UPS Ground. Urgent, but don't hurry.
• When I called the agency that provides services for behavioral health matters, I had to provide my doctor's name to determine if he is included in the insurance plan. (He is.) To confirm the doctor's address, the very nice person on the other end of the phone said, "Wuh, Wuh, Worchester."

So, here we go on another adventure of healing.