Anxiety and Depression
The bombs that exploded on Monday near the finish line of the Boston Marathon killed three people, physically injured nearly 200 others, and traumatized thousands more. Recovery and healing are beginning for the families of those who died, for the injured and their families, and for others touched by this tragedy. For some, healing will be swift. For others it will be measured in small steps over months, and possibly years. The Marathon explosions will leave a legacy of emotional scars along with the physical ones, even among those who weren’t anywhere near the blasts. Some people who were at the scene of the explosions will undoubtedly develop post-traumatic stress disorder (PTSD). But PTSD is not the only response to frightening events. In fact, most people exposed to a trauma do not develop this condition. They may develop an anxiety disorder, for example, or become depressed. Most people do have some emotional response, but the majority develop no illness at all.
Five seemingly different mental health disorders—major depression, bipolar disorder, schizophrenia, autism, and attention-deficit hyperactivity disorder—may be more alike than we think. A ground-breaking new study has identified four regions of the genetic code that carry same variations in people with these disorders. Two of the affected genes help control the movement of calcium in and out of brain cells. That might not sound like much, but this movement provides a key way that brain cells communicate. Subtle differences in calcium flow could cause problems that, depending on other genes or environmental factors, could eventually lead to a full-blown mental illness. But this work offers tantalizing hints that bipolar disorder, major depression, and schizophrenia—and possibly autism and attention-deficit hyperactivity disorder—may not be so distinct after all, but could be different manifestations of the same underlying disorder. This could change the way we view mental illness and open the door to more effective therapies.
People tend to think that the telltale sign of depression is sadness—a pervasive down, dragging feeling that won’t let up, day after day. But depression often manifests itself as something else entirely—like aches and pains or memory lapses. These “unusual” symptoms are actually quite common. They can mask depression—and delay an important diagnosis—especially in older people, who often display their depression in ways other than sadness. These include trouble sleeping, lack of energy, fatigue, trouble concentrating or remembering, loss of appetite, and aches and pains that don’t go away. If you have one or more of these symptoms that can’t be traced to an illness or ailment, a frank talk with a trusted doctor about the possibility of depression might be a good step forward.
December 21st marks the shortest daytime of the year in the northern hemisphere. Although the winter solstice marks a seasonal turning point, with daylight getting incrementally longer from here until June 21, for people with seasonal affective disorder it’s just another day of feeling lousy. People with this condition lose steam when the days get shorter and the nights longer. Symptoms of seasonal affective disorder include loss of pleasure and energy, feelings of worthlessness, inability to concentrate, and uncontrollable urges to eat sugar and high-carbohydrate foods. Although they fade with the arrival of spring, seasonal affective disorder can leave you overweight, out of shape, and with strained relationships and employment woes. A unique approach to this problem is the use of light therapy. It involves sitting near a special lamp that emits bright light for 30 minutes a day as soon after waking up as possible.
Therapy dogs provide comfort and support. They must be social, gentle, and enjoy getting and giving physical affection. My therapy dog, Maps, has those qualities in spades. They also must be well behaved and respond to their handlers, neither of which applied to Map when I got him as a puppy. After many therapy dog classes and a lot of practice, we learned. After two years of training, Map became a certified therapy dog. He shines when he is in his blue training coat visiting a preschool. He loves to see the kids and to work with me. How does Map help kids? His presence somehow lets children open up to learning. He offers kids a way to feel more whole in the face of physical illness or disability. He can also help children heal from emotional pain. Like any great therapist, Map knows how to listen and how to help children help themselves.
Depression can strike at any age. Children can develop it, as can octogenarians. No matter when it starts, depression can drain the joy and pleasure from life. The first appearance of depression later in life may also be a signal of memory loss or dementia down the road. According to a study in the Archives of General Psychiatry, dementia is more common among people who become depressed in middle age or later in life than among those who aren’t depressed. Depression is often overlooked in older adults, so it’s important to be on the lookout for warning signs, like feelings of hopelessness, loss of interest in activities, trouble sleeping, and more. It’s important to treat depression in individuals with the beginning of dementia, and older individuals who are depressed should be evaluated for dementia.
A close friend of one of my colleagues committed suicide last week. It happened as so many suicides do—out of the blue. A few days earlier, my colleague had spent the day hanging out with her friend, who was relaxed, upbeat, and normal. Sadly, that’s not uncommon. Many people who commit suicide don’t have an identifiable mental health problem, or give any hints that they are thinking about taking their lives. Every suicide, like every person, is different. Many are sparked by intense feelings of anger, despair, hopelessness, or panic. Suicide almost always raises anguished questions among family members and friends left behind: What did I miss? What could I have done? In my friend’s case, the answers are nothing and nothing. When individuals suddenly take their own lives with no warning, all we can do is look to each other for support. It may be natural to ask, “What did I miss?” But we should remind ourselves what experts say: This kind of death defies prediction.
A friend once asked me about his son, who was about to turn 20. As a teenager, the boy had a quick temper. But now, on the brink of adulthood, the young man seemed to be getting worse. When a teen gets angrier as time goes by, it is a cause for concern. A 19-year-old is no longer a child, but neither is he or she a fully-fledged adult. This in-between state can extend well into the twenties. Some human development researchers have begun to call it “emerging adulthood.” No matter this stage is called, it presents a tricky time for parents and their children. Emerging adults must decide how much help they want or are willing to accept from their parents or anyone else. At the same time, parents must decide how much help it is reasonable to give.
For some people with depression that isn’t alleviated by medication or talk therapy, a relatively new option that uses magnetic fields to stimulate part of the brain may help. Called repetitive transcranial magnetic stimulation (rTMS), it was approved by the FDA in 2008. Although more and more centers are beginning to use transcranial magnetic stimulation, it still isn’t widely available. Transcranial magnetic stimulation directs a series of strong magnetic pulses into the brain. These pulses create a weak electrical current that can increase or decrease activity in specific parts of the brain. In two large studies, rTMS improved depression in 14% of people who underwent it, compared to 5% who underwent sham, treatment. The cost can range from $6,000 to $10,000, depending on the clinic and how many sessions are needed. Insurance may not cover the cost of treatment.
We usually think of post-traumatic stress disorder (PTSD) as an aftermath of military combat or terrible trauma. It can also strike heart attack survivors. By the latest account, 1 in 8 people who live through a heart attack experiences a PTSD-like reaction that might be called post-traumatic stress disorder (PTSD). They experience the same key symptoms: flashbacks that occur as nightmares or intrusive thoughts. They try to avoid being reminded of the event and become hypervigilant worrying that it will happen again. As treatments for heart attack continue to improve, 1.4 million people a year are now surviving the event long enough to be discharged home. If the study is correct, 168,000 of them will be diagnosed with PTSD every year. It’s a grim reminder that as we get better at fixing the body, we must recognize the need to treat the mind.