Tag Archive for depression

Can Cbt Help ‘Biological’ Depression?

We can all feel low and poorly motivated from time to time.  But for as many as 30% during our lives, our low mood and lack of motivation just won’t shift.  Often, despite our best efforts, and the efforts of those who care for us, our low moods exhaust our ability to cope.  We have become depressed.
mental health
The question for mental health practitioners is how best to help someone who has become depressed?  One treatment strategy, the medical approach, involves prescribing an antidepressant.  These work on the neurotransmitters in the brain cells to improve our mood.  The other strategy is to use a proven psychological approach like counselling or cognitive behavioural therapy (CBT).

On the face of it looks confusing for the patient.  Is my depression a biological illness, or a psychological problem?  The reality is that depression is best seen as both biological and psychological.  Just two sides of the same coin.

It is certainly true that for some patients, their depression falls more towards the biological, and for others their depression falls more toward the psychological.  One theory suggests that the more a person excretes catecholamines in their urine, the more the depression has a biological component.

For talking therapists like myself, the interesting question is, are the interventions I use effective for people with these biological markers of depression?  In a recent study by Oei in the journal Behavioural and Cognitive Psychotherapy, patients with high levels of catecholamine’s and low levels of catecholamine’s  were each given a course of CBT.  Although the high catecholamine’s group had a higher score of depression severity at the start of therapy, both groups showed the same rate of improvement overall.

What does this mean?  Well in short it suggests that CBT is an effective treatment for depression, even for people showing evidence of a high ‘biological’ component.  This will bring some comfort for those people who are depressed and don’t want to take medication.  CBT also holds the advantage that you learn the skills to stay well which, if practiced, will help keep you well for the long term.  Unfortunately with medical approaches, the depression can sometimes return once the medication is stopped.

My own view is that antidepressants and talking therapies like CBT both have a role to play in the treatment of depression and often work extremely well together.  But if you really don’t want to take tablets, CBT or counselling really is an effective option for many people.

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Are You One Of The 6 In 10?

As a blogger on men’s mental health, I’m often struck by the difficulty some men find admitting they have a problem they can’t resolve themselves.  I think some of this is cultural.  As a society we don’t treat mental health as seriously as we should.  The NHS services for mental health are often seen as the Cinderella services, receiving the least funding and overwhelming demand.    I think it’s also something about men.  Our instinct when faced with an emotional crisis is to retire to the ‘garden shed’ and try and work it out for ourselves.  But we can’t always do it on our own.
mental health
Mental health problems affect the majority of us at some point in our lives.  A recent survey by the mental health charity Together found that 6 out of 10 Britain’s have had a period of their life when  they have found it difficult to cope mentally.  70% had suffered from stress, 59% had suffered from anxiety, and 55% from depression.

As a professional I know that it is much easier to treat disorders like stress, anxiety and depression if men present early.  All too often men present after years of suffering, which makes treatment longer, more complicated and more expensive.

Men who present early make the quickest recovery.  What’s more, the mental health skills they learn mean they are better able to cope with future problems much more effectively.  Modern treatments for things like stress, anxiety and depression are not just about helping with the current problem, but teach the skills and knowledge you need to prevent it from happening again.  I’m struck by the number of men that say to me ‘why wasn’t I taught this before’, or ‘everybody should know about this’.

My advice if you are finding it difficult to cope right now is get the right advice early.  What you learn may mean the next time you go to the garden shed to reflect on a problem, you have the right tools to know what to do with it.

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Exercise Helps You Beat Depression

exerciseDepressed mood is one of the most common problems I see in my practice with men. Feeling low is not the only symptoms guys complain of. Often low mood is coupled with a lack of energy, sleep disruption, reduction of libido, anxiety and appetite changes. Sometimes men feel so bad they think life is not worth living and feel suicidal. Depression is a serious health problem that can lead to death and should never be ignored. The question is how should it be treated?

I recommend a three pronged attack to get your life back on track. Antidepressants, cbt (cognitive behavioural therapy), and exercise.

Antidepressant medication is helpful for many men particularly if your low mood is starting to interfere severely with your life, for example by taking a lot of time off work. Antidepressants, however, should never be the only answer. It is really important that you get to understand ‘the depressed mind’, and how to combat it.

Depression is notorious for ‘rekindling’, that is, coming back again and again and becoming a chronic health concern. If depression is only treated with antidepressants, and you don’t learn the strategy’s you need to stay well, then you risk chronicity becoming a problem.

In fact there is a lot of research around that shows that antidepressants and a talking therapy like cbt, have a cumulative effect upon each other. That is to say having cbt while being on an antidepressant produces a positive effect greater than either antidepressants or cbt on their own.

Is there anything else a man can do? Well I’ve long held the hunch that exercise is a key factor in men’s emotional health. I’m sure it plays a role in women’s emotional health too; I just think it’s even more important for men. In fact a 2007 study in Psychosomatic Medicine found it the equal of antidepressants in curing depression. For this reason I also recommend exercise for the men I se e who are depressed.

There is a problem with exercise in depressed people, in that they often feel too tired and lethargic to get going with an exercise program. I advocate starting with a small but regular exercise regimen: one that is easily achieved. Say a five minute walk to the shops and back, three times a week. Once the routine has bedded down, start increasing the duration and intensity of the exercise. Your ultimate target is three half hour sessions of vigorous, pulse raising, exercise a week. Like antidepressants, it can take several weeks before the benefits of exercise take hold, so stick with it.

I see the best results with men who adopt all three strategies: antidepressants, cbt and exercise. However not everybody’s depression is severe enough to warrant an antidepressant, and some men simply don’t want to take a drug. I can understand and respect this. For these men, knowing that exercise is as effective as an antidepressant in shifting mood is really helpful information. I suspect exercise coupled with cbt is the way to go for these men.

The worst thing you can do if depression has got a hold of your life, is ignore it. If you are feeling depressed at the moment, the time to do something about it is now.

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Dying From a Broken Heart

Link Between Heart Disease and Depression

Can a man die of a broken heart? “Yes” says Dr Martin Cowie, consultant cardiologist at the National Heart and Lung Institute in London.

Most folk would have seen among their own friends, families and acquaintances (if not themselves!) how emotional stress can exacerbate heart disease and angina.

A 1969 study of 4500 widowers, all over 55 years, published in the British Medical Journal, revealed that for these men, the risk of dying in the first six months after they lost their spouse was 40% higher than expected. The single most common cause of these deaths was a heart attack.

A similar study in 1996 analysed statistics from a population of 1.5 million people between the ages of 35 and 84 – and found that the risk of dying from a heart attack in the first six months after losing a spouse was increased by 20 to 35%.

Depression linked to heart disease

Research studies have consistently shown that depression and heart disease are interlinked, with each being able to lead to the other. Just as depression can precipitate heart disease, so too can the development of heart disease result in depression, with all the psychological morbidity that this implies. Today, Depression is recognised as being an important risk factor for developing heart disease – just as serious a risk as having high blood pressure and elevated blood cholesterol.

A 1996 study conducted over a period of 14 years in Baltimore followed a group of 1551 people who were free of heart disease at the beginning of the study. It was found that those in this group who had a previous history of depression were four times more likely, compared to those who had no history of depression, to suffer a heart attack!

Another research study from Montreal found that heart patients who were depressed were four times as likely as those who were not depressed to die within the following six months.

Many similar research studies have shown that heart disease can follow the development of depression. Psychological distress can result in the blood pressure rising, the heart rate increasing, and blood clots forming more easily. People with depression may feel slowed down while paradoxically having high levels of stress hormones like adrenaline and steroids in their circulation – which can thus increase the workload of the heart.

Heart disease leading to depression

The original studies linking heart disease and depression found that people diagnosed with heart disease were more likely to suffer depression compared to otherwise healthy people. An interesting 1996 study by the same Montreal group mentioned above showed that, while in North America about 5% of the population at the time experienced major depression in a given year, this proportion increased to about 30% of people who had suffered a heart attack. And suffering from depression can make it harder for patients to take their heart medications properly and comply with their doctors’ advice.

Unfortunately, many patients being treated for their heart disease do not receive appropriate treatment for their concomitant depression. Heart specialists and general practitioners, unless they have a special interest or training in this field, often miss the diagnosis of depression – and even when they do recognize the symptoms, they often do not treat their heart patients’ depression adequately. Today we have new medications that can be used to treat depression quite effectively in many patients without causing the unpleasant side effects associated with the older anti-depressant drugs.

Interpersonal Therapy and Cognitive Behavioral Therapy

While modern anti-depressant medication is helpful in some patients for improving the symptoms and signs of depression, they are not the whole answer. Intervention in the form of Interpersonal Therapy (IT) and Cognitive Behaviour Therapy (CBT) has proved helpful in heart patients. Such therapy can also help to motivate patients to comply with taking their medication as well as changing their unhealthy lifestyles.

Physical exercise

Regular physical exercise provides another pathway that can help in reducing both depression and the risk of heart disease. A 1999 research study found, in a group of older patients diagnosed with major depression, that taking part in an exercise training programme was as good as antidepressant medication in improving their symptoms of depression. Since regular exercise is a major protective factor against heart disease, this form of exercise therapy has a doubly beneficial effect.

So just as much as emotional heartbreak can precipitate an actual heart attack, having a real heart attack can bring on psychological depression.

Observations like “It broke his heart when his life partner died” or “He seems so depressed after his heart attack”, are not without foundation.

They could well be providing the very medical diagnosis which is the crux of the problem.

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