6 MUST KNOW SIGNS of DEPRESSION!

Can staying awake all night help combat depression?

Staying awake for more than 24 hours may be the fastest treatment for moderate to major depression. 

Early research has shown six out of ten patients can get symptom relief within a day of this treatment, compared with the six to eight weeks it can take antidepressants to work. 

Sleep deprivation is thought to work by boosting brain messengers such as serotonin - the same one that antidepressants act on.

Several studies have found 40 to 60 per cent of patients are helped by staying awake for a long time. One researcher described it as 'a remarkable transformation of often deeply depressed, psychotic, suicidal patients in a few hours into their pre-illness selves'.

However, the improvement is short-lived, disappearing after the patient slept.

Now researchers at the Medical University of South Carolina and Rhode Island Hospital are looking at providing longer relief by combining sleep deprivation with two other therapies. Pilot studies have shown that the effects of this treatment, known as triple chronotherapy, are rapid and are long-lasting - nine weeks in one trial.

The U.S. researchers will test the treatment in a larger study involving 80 patients with moderate to severe depression, postnatal depression or bipolar disorder.

Current treatments range from exercise and self-help groups to antidepressants. But medication doesn't work for everyone and some reports suggest it is no better than a placebo. It can also take two months for its effects to kick in.

The triple chronotherapy treatment, which is conducted over three days, combines sleep deprivation with 'bright light therapy' - where patients  are exposed to a special lamp for up to an hour - and 'sleep-phase advancement' - when waking and sleeping times are changed.

The theory is that sleep deprivation has an anti-depressive effect; the bright light and sleep time changes then help reset the body clock, in turn helping the anti-depressive effect of sleep deprivation last longer.  On day one, patients stay awake from 10.30pm, through the night and the whole of the next day. They then sleep from 6pm to 1am the following morning when the process is repeated, but sleeping and waking at different times. 

Bright light therapy is given in the early morning of each of the three days - light is thought to stimulate the brain's hypothalamus, which controls mood, sleep and appetite, and to boost brain chemicals such as melatonin and serotonin. 

On the second day, the patient sleeps from 8pm to 3am; on the last day, sleep starts at 10pm and finishes at 5am. From then on, patients continue with this 10pm to 5am sleep pattern.

Bright light and sleep time changes help reset the body clock, in turn helping anti-depressive effect last

A previous study at the University of California found significant improvements remained in 63 per cent of depressed patients seven weeks later.

New research at Tufts University has shed some light on what might be happening. It identified a protein called adenosine which is released when you're awake. Sleep deprivation increases levels of adenosine, which alters electrical signals in the brain, causing immediate improvement in mood.

'Triple chronotherapy typically reduces depressive symptoms within one to two days,' says psychiatrist Dr John Gottlieb, of Northwestern University Feinberg School of Medicine in Chicago and a leading expert in chronotherapy. 'It's as biologically active as antidepressants, inexpensive and has minimal side-effects.'

Carmine Pariante, professor of biological psychiatry at the Institute of Psychiatry, King's College London, adds: 'By putting sleep deprivation with other sleep-related therapies that have shown some effectiveness in depression, there is a reasonable expectation the antidepressant action will be stronger and more sustained. 

'If this proves true, it will be an important step forward, both to understand mechanisms that cause depression and to find a new treatment for the one in four patients who don't improve with available treatments.'

http://www.dailymail.co.uk/health/article-2683791/Can-staying-awake-night-help-combat-depression.html

Isolation - A short documentary on Depression & Anxiety

Depression affects mothers most when child is four years old

Doctors urged to be aware postnatal depression can occur much later than thought, prompting calls for change in care for women.

Four in ten of those suffering depression when their child was older had not previously had any problems Photo: Alamy

Mothers are more likely to suffer depression when their child is four years old than when they are babies, according to a study that has led to calls for a change in the way women are cared for.

Four in ten of those suffering depression when their child was older had not previously had any problems, the study found.

Researchers have now urged doctors to be aware that postnatal depression can first occur much later than thought.

Women who only had one baby were twice as likely to suffer postnatal depression when their child was four years old, than those who had subsequent children, it was found.

The study, which was conducted by Australian researchers, found more than 14 per cent of women suffered depression when their child was four years old.

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Fewer than one in ten at 12 months and eight per cent of women three months after giving birth.

Almost one in three first-time mothers reported suffering depressive symptoms at least once between pregnancy and four years after birth, the study found.

Postnatal depression is thought to affect up to 15 per cent of women in the UK in the first year after having a child and experts said this may now need to be revised.

Dr Hannah Woolhouse, psychologist and senior research officer, from the Murdoch Children's Research Institute, in Victoria, Australia and co-author of the report, said: "It is likely that current systems of maternal mental health surveillance in Australia and the UK will miss more than half the women experiencing depression in the early years of parenting.

"In particular, women who do not have subsequent children may be especially vulnerable to falling through the gaps as they will not be reconnected back into primary care services.

"There also needs to be a focus on social health and relationships as we have found a strong link between depressive symptoms and intimate partner violence."

Dr Carmine Pariante, of the Institute of Psychiatry at King's College London, said nurses and doctors should ask mothers how they are coping whenever they bring their child in for routine vaccinations and other appointments and be aware that depression can hit women at any point.

He said: "Mothers should be encouraged to seek help if they need help.

"This paper is not saying depression in the first few months after the baby is born is not important, it is. But it is also the case that women are vulnerable to depression as their children get older.

"That is due to the stressors to having a child and raising a child. The sooner we can help those women and put them on the right trajectory the better."

The study, published in BJOG: An International Journal of Obstetrics and Gynaecology, used data from 1,507 first time mothers registered to give birth at six hospitals in Melbourne, Australia, who completed questionnaires at three, six, 12, 18 months and four years after giving birth.

The strongest predictor of depressive symptoms at four years post birth were having previously reported depressive symptoms either in early pregnancy or in the first 12 months after childbirth.

Other factors associated with depressive symptoms were being young – 18 to 24 years old – stressful life events in the year before the four year follow-up, violence from a partner or a low income.

The authors of the report said the findings presented a "compelling" case for a rethink on approaches to monitoring maternal mental health where policies focus on pregnancy and the early months after birth.

Dr Woolhouse wrote in the paper: "The fact that one in three first-time mothers reported depressive symptoms on at least one occasion from early pregnancy to four years postpartum, coupled with the finding that the prevalence of depressive symptoms was highest at four years postpartum, provide a compelling case for rethinking current policy frameworks for maternal mental health surveillance.

John Thorp, BJOG editor in chief, said: "Much research has been conducted around maternal mental health during the perinatal period, however, we know very little about the prevalence of maternal depression after the first 12 months of giving birth.

"The findings of this study reinforce the need for an increased focus on maternal health, particularly in the long term, as current guidance for professionals focuses on pregnancy and the early months after birth, and the need to take into account factors linked to the mother's life."

Prof Ian Jones, Professor of Psychiatry at Cardiff University, said: "Clearly services must be aware that mothers remain at risk of depression and that risk does not go away after the postpartum period.

"For more severe episodes of mood disorder - severe postpartum depression and postpartum psychosis - there is no doubt at all that the period after having a baby is associated with very high risk. For example, women are 23 times more likely to be admitted to psychiatric hospital in the weeks following having a baby than at any other time in their life. This study does not change these facts. The more severe episode of depression or mood disorder the more clear it is that childbirth is an important trigger.

"The importance of postpartum depression is not due merely to it being more or less common than depression at any other time.

"Depression at this time has enormous implications for women, their babies and their wider families. Women are in contact with many health professionals through this period and its vital that depression is picked up and treated to prevent the negative outcomes we know are associated with depression at this time."

Why we should treat depression, anxiety and sexual dysfunction together

It may not seem likely because it's not widely discussed, but a majority of people will be affected by symptoms of depression, anxiety and sexual dysfunction at some point in their lives. This fact is at odds with the shame and discomfort surrounding these symptoms in our society.

Sexual dysfunction covers issues such as a lack of sexual desire, an inability to become aroused or achieve orgasm, premature ejaculation and erectile dysfunction. These problems are often not picked up by doctors, and people hesitate to raise the issues themselves, maybe because they feel embarrassed.

While depression, anxiety and sexual dysfunction can each have a profound effect on quality of life, their impact is much worse when the symptoms co-occur.

In these combined cases, symptoms tend to be more severe and last longer, and when not dealt with together, treatments tend to be less effective. Indeed, people using ineffective approaches end up having worse long-term outcomes, tend to drop out of treatment, and are less likely to return.

Fundamental connectedness

We know depression, anxiety and sexual problems are related, but there's very little research on how or why. Some studies show the disorders tend to appear at the same time, or that sexual dysfunction develops as a symptom of depression and anxiety.

Others suggest sexual dysfunction creates a vulnerability to anxiety and depression. But when we look at the body of research as a whole, the relationships appear to go deeper than this.

We know depression, anxiety and sexual problems co-occur at very high rates, and that they share multiple cognitive and emotional characteristics. We also know they can all be treated effectively using mindfulness and cognitive behavioural therapy.

These commonalities suggest they might all be part of a
family of disorders called "internalising disorders"; one isn't causing another but they all share an underlying vulnerability. Preliminary research has supported this idea.

Lack of awareness

Given this close relationships between the disorders, and the negative impact of not treating them together, it's concerning that they're consistently treated separately. And that the manuals used by mental health professionals and clinicians to diagnose disorders (the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases) don't recognise the relationships between them.

Indeed, the separation in the way we diagnose and treat these disorders is likely contributing to the low recognition rates of sexual problems in primary care.

Studies have shown that most people with sexual problems consider it appropriate to discuss their symptoms with their doctor, but very few actively seek out help. People tend to expect their doctor to ask, and will not bring it up themselves.

Only 6 per cent of participants in a study of Australian adults aged between 40 and 80 had been asked about their sexual function during a routine medical exam in the last three years. And those who were asked were more likely to seek help and enter treatment.

Clearly, doctors should be screening for sexual problems, as people aren't actively seeking the help they require.

Moving forward together

If assessment of sexual problems were part of the initial evaluation of depression and anxiety, and vice versa, the low recognition rates of sexual dysfunction could be improved, and all symptoms could be treated concurrently. This would improve effectiveness and be better for patients.

Effective new treatment programs that target the common elements of multiple disorders have already been developed for the shared aspects of depression and anxiety disorders. The same types of programs could be developed using mindfulness and cognitive behavioural therapy to treat sexual dysfunction, along with depression and anxiety.

Taken together, what research we have suggests this would improve the quality of life of people suffering from combinations of these disorders.

At the very least, doctors should be aware of the co-occurrence of the symptoms of these disorders, and the fact that if a person is experiencing depression or anxiety, that should act as a red flag to screen for sexual dysfunction.

http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11251656