Almost as soon as coronavirus lockdowns went into effect in March, discussion turned to mental health. It’s well-documented that natural disasters, wars and other mass traumas can lead to significant increases in population-wide psychological distress. Weeks or months of anxiety, fear, sadness and social isolation can take their toll, leading many experts to fear the U.S. would face a mental health epidemic at the same time it fought a viral pandemic.
Now, a study published in JAMA Network Open offers one of the first nationally representative estimates of how severe that epidemic may be: Three times as many Americans met criteria for a depression diagnosis during the pandemic than before it, according to the paper.
A pre-pandemic survey of about 5,000 American adults found that 8.5% of them showed strong enough signs of depression (including feeling down or hopeless; loss of interest in things that normally bring joy; low energy; trouble concentrating; or thinking about self-harm) to warrant a probable diagnosis. When researchers surveyed almost 1,500 American adults about their mental health from March to April of this year, that number rose to almost 28%. Even more people—almost an additional 25%—showed milder signs of depression.
Logically, people were more likely to suffer symptoms of depression during the pandemic if they experienced “COVID-19 stressors,” including losing a job, the death of a loved one or financial distress. People who said they had less than $5,000 in savings were also about 50% more likely to suffer from depression than wealthier people, the researchers found. In keeping with usual demographic trends, women were more likely to experience depression than men, and single people were more likely to experience depression than married couples.
But trends only go so far. Anyone—regardless of race, gender, relationship status or income—can experience mental health issues during something as traumatic as a pandemic. Small lifestyle tweaks can help. Getting enough sleep and exercise go a long way, and studies have shown that meditation and yoga can have a positive effect on psychological well-being. Social support is also crucial, even if it happens virtually.
It’s also easier than ever to seek mental health care if you need it. Teletherapy is surging in popularity during the pandemic, making it easier to see a clinician from home. If you need more immediate help, there are also hotlines that can provide support. If you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to 741741 to reach the Crisis Text Line. In emergencies, call 911, or seek care from a local hospital.
For the latest COVID-19 news and updates from Cleveland Clinic, please visit https://clevelandclinic.org/coronavirus From confusion and loneliness to worry and frustration, people are dealing with large and intense emotions while trying to navigate a new sense of normal. Psychologist Amy Sullivan, PsyD, ABPP, discusses how the coronavirus pandemic is starting to mentally wear on us and why it’s so important to protect our mental health.
In a new study, researchers have found a set of factors that could help prevent depression in adults. They named social connection as the strongest protective factor for depression and suggested that reducing sedentary activities such as TV watching and daytime napping could also help lower the risk of depression.
The research was conducted by a team from Massachusetts General Hospital (MGH). Depression is the leading cause of disability worldwide, but until now researchers have focused on only a handful of risk and protective factors, often in just one or two domains.
This study provides the most comprehensive picture to date of modifiable factors that could impact depression risk. To that end, researchers took a two-stage approach.
The first stage drew on a database of over 100,000 participants in the UK Biobank to systematically scan a wide range of modifiable factors that might be linked to the risk of depression, including social interaction, media use, sleep patterns, diet, physical activity, and environmental exposures.
The second stage took the strongest modifiable candidates to examine which factors may have a causal relationship to depression risk.
This two-stage approach allowed the researchers to narrow the field to a smaller set of promising and potentially causal targets for depression.
The team found an important protective effect of social connection and social cohesion.
These factors are more relevant now than ever at a time of social distancing and separation from friends and family.
The protective effects of social connection were present even for individuals who were at higher risk for depression as a result of genetic vulnerability or early life trauma.
On the other hand, factors linked to depression risk included time spent watching TV, though the authors note that additional research is needed to determine if that risk was due to media exposure per se or whether time in front of the TV was a proxy for being sedentary.
Perhaps more surprising, the tendency for daytime napping and regular use of multivitamins appeared to be linked to depression risk, though more research is needed to determine how these might contribute.
The study demonstrates an important new approach for evaluating a wide range of modifiable factors and using this evidence to prioritize targets for preventive interventions for depression.
One author of the study is Karmel Choi, Ph.D., an investigator in the Department of Psychiatry and the Harvard T.H. Chan School of Public Health.
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If you asked 100 people about psychedelics, you’d most likely get 100 opinions based on their firsthand experience, strong condemnation or stories from their adventures at Woodstock in the ’60s. No matter what people might know or think they know about psychedelics, the 40-year moratorium that closed down related research in the ’70s is now coming to an end. Psychiatrists are beginning to realize that strategic, supervised use of these psychopharmacological drugs is helping people with mental disorders including obsessive-compulsive disorder, post-traumatic stress disorder, alcoholism, depression and cluster headaches. Still, are there enough scientific studies to warrant the use of these drugs in mainstream society?
I’ll admit that talk of psychedelic therapy to treat depression makes me nervous. In researching my book, Unstoppable, I looked at other key triggers that can mimic psychological disorders like depression and anxiety, such as inflammation, nutritional deficiencies, hormonal changes, side effects from medications, gut imbalances and food sensitivities. The reality is, depression is complex. What works for one may not work for another. Any successful treatment must first identify the root cause of one’s depression successfully, which can be a complex process if not done under the right medical care. A psychedelic treatment isn’t suddenly going to fix a nutritional deficiency, for example, but it may help target other symptoms and behaviors that correspond with depression. This is why it was critical to set my own biases aside and speak to an expert.
I was fortunate enough to interview Dr. Domenick J. Sportelli, who is board-certified by the American Board of Neurology and Psychiatry for General Psychiatry and fellowship-trained and Board Certified in Child and Adolescent Psychiatry. He also specializes in human behavior and psychopharmacology. I wanted to get the most current information on the use of psychedelics in treatment for depression, anxiety and PTSD, so I first asked him first to clarify what psychedelics were.
“The term ‘psychedelic substance’ refers to an exogenous substance [derived outside the body] that, when taken into the body in various ways, physiologically, neurologically and psychologically manifest an internal personal experience of altered states of consciousness,” he explains. “This includes perceptual distortions, hallucinations, synesthesia [a mixing of the senses], altered sense of time and space, as well as potentially inducing what researchers call a ‘mystical experience’ — a sense of oneness, of noetic experience and an undefinable but profoundly spiritual quality.”
Is there enough evidence to support psychedelic therapy?
Sportelli wants to make clear that the most researched psychedelics — LSD, psilocybin (mushrooms), peyote, MDMA, DMT and ketamine — have different mechanisms of action and even induce subtle, subjective experiential differences. Although each is grouped under the term “psychedelics,” they are quite disparate.
Dr. Sportelli is cautiously optimistic about the multitudes of large-scale, university-based testing and prior research compiled decades ago, but worries about the abiliity to circumvent bureaucracy and conduct safe, credible and substantial testing today. He does add that recent testing of psilocybin, LSD, ketamine and MDMA in particular has generated cause for optimism, and that they will likely have a place not only in continued, diverse research design and protocol, but eventually in therapeutic use.
What types of depression can psychedelics treat?
If we were to look at the onset of most mental illnesses, the majority start to become evident between the ages of 11 and 24, according to the National Institute of Health. With only 42 percent of people getting treatment, most typically do not seek out assistance until a secondary mental illness occurs several years later.
When asked how broadly psychedelics might be able to help treat people with depression, Sportelli concedes that, “Unfortunately, research hasn’t determined the level of scientific data to specify the type of depression or mood disorder that psychedelic therapy will benefit.” But he does add that research and data are beginning to show statistically significant improvements in mood, reduced anxiety, change in positive personality traits over time, the possibility of reducing addictive behaviors, reduction in suicidal tendencies and increased personal insight.
Do psychedelics treat the symptoms or the cause?
According to Dr. Sportelli, depression stems from a mix of genetic, biological, neurological, psychological and sociological factors. Recent research has demonstrated how the chemical breakdown of psilocybins closely resembles that of serotonin, and indicated the promising interplay of select hormone transmission. Dr. Sportelli stresses the critical role that these drugs might offer in mood disorders is at the forefront of the pharmaceutical quest for treatment.
“We have never seen substances like these that can potentially change the way that we look at our life and change perspective with lasting results,” he says, noting that they might be able to help “supercharge psychotherapy.”
Is this ultimately a recommend treatment, and where does one turn for it?
“At this time, in the U.S., I would only recommend this treatment be a part of, and under the close supervision of, a university-based IRB [Institutional Review Board]-monitored clinical trial,” Sportelli emphasizes. Before any psychiatric treatment, Dr. Sportelli also recommends a full medical and neurological evaluation to rule out any of the multitudes of medical circumstances that can manifest as a primary mood disorder, and reiterates that significant and often profoundly adverse outcomes associated with such powerful, mind-altering chemicals need to be weighed further as well. That’s why, as part of any regulated trial, all the necessary medical workups would be completed before participation.
Is the stigma around psychedelic therapy warranted?
Sportelli acknowledges that there is a safety concern associated with psychedelics, and does not condone their recreational or illict use. But he does believe that regulated clinical trials, judicious and ethical research methodology and the progression for therapeutic intervention should not be overlook based on previous stigma and possible misclassification.
I’ve never been one to throw the baby out with the bathwater. After interviewing Dr. Sportelli, I hold hope for the future, but also a concern for those who may seek out this kind of treatment without an accurate medical diagnosis. My number-one hesitation remains — that is we simply do not have the studies to show which types of depression psychedelic therapy successfully treats, which may result in people attempting to use a hammer when in fact they need a nail.
Either way, if you are to venture into this arena, find someone who specializes in it. The risk of going it alone could come at too a high price.
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Margaret collapsed onto a couch after sending her kids to school. She could hardly make sense of her jumbled thoughts. “I’m exhausted.” “My husband is too busy to notice.” “The kids don’t help.” “I never get time for myself.” “I’m so lonely…but there’s no one to talk to.” After several minutes she looked at the clock and willed herself off the couch to head to her retail job, reminding herself that she had a pretty good life. “Then why am I so unhappy? Why does everything feel like such a chore?”
But here is the worst part. People who are depressed too often conclude that there is something wrong with them. They feel shame, like they are broken and unworthy which not only aggravates the depression but makes it hard to talk about or seek help.
However, the truth is that depression is not a sign of personal weakness but an illness (like kidney failure, high blood pressure, or cardiovascular disease) in which the brain lacks chemicals like serotonin and norepinephrine that regulate happiness, motivation and self-esteem. Although the causes vary, there is something real going on in the mind and brain that needs to be treated.
And here is the good news. Depression is very treatable. Most people who take steps to overcome their depression will experience a full remission—whether on their own or with the help of a professional.
In this article, I want to help you understand depression, it’s symptoms and causes. In my next article, I’m going to teach you the actions you can take to both prevent and overcome this malady that wears you down and strangles your enjoyment of life.
Symptoms of Depression
Depression revolves around a constellation of symptoms that have to do with how we think, feel and act. Brain physiology is altered and hormones surge, disrupting normal rhythms of mind and body and leading to disturbances in sleep, concentration, appetite, energy, self-esteem, emotional regulation and interest in life.
Although the symptoms will vary in severity, below is a checklist of the most common. Be aware that reading a list of symptoms does not really capture the totality of the anguish that a severely depressed person may feel.
Fatigue, low energy and motivation
Numb or dulled feelings and loss of pleasure or interest in anything
Sadness, feeling down in the dumps for long periods of time
Poor appetite or overeating
Difficulty concentrating or making decisions
Low self-esteem and confidence; sense of failure and worthlessness
Isolation and withdrawal
Hopeless about future
Self-injuring, suicidal thoughts and sometimes actions
Male Pattern Depression
For years mental health professionals believed that women were more likely to be depressed than men. Perhaps this is because women are more likely to talk about their feelings and seek treatment. However, research from studies of thousands of men and reported in the Journal of the American Medical Association concludes that men are just as likely to experience depression although their symptoms often demonstrate:
Agitation and irritability
Reactivity and blame
So, don’t be fooled. Such aggressive forms of behavior often mask deeper feelings of hopelessness, isolation and loss of interest in life and may mean that men experience depression as much as women.
What Causes Depression?
It is natural for people to be curious about the causes of their depression. Some causes relate clearly to one’s situation and life events—loss or chronic stress. At other times depression seems to come out of the blue for unexplainable reasons. For most people, depression is caused by multiple factors, like those listed below:
Genetics. Science tells us that as much as 40% of depression is linked to genetics. If a parent or close family member has been depressed, it increases the likelihood that you’ll be depressed.
Hormones. The likelihood of a woman becoming depressed increases during the reproductive years and is associated with menstruation, child-birth or perimenopause. This risk declines following menopause.
Chronic stress. Depression and anxiety go hand-in-hand. Living with the ongoing stresses of modern life can wear us down and eventually lower serotonin and increase cortisol in the brain leading to depression.
Loss. Any type of loss may result in depression. Most obvious is loss of a loved one, but loss may also include job, health or status. More insidious is loss of one’s hopes and dreams—be it career, marriage, living situation, how kids turn out, etc. We either come to terms with such losses or slip, albeit imperceptibly, into the shadows of depression.
Social isolation. Feeling lonely is highly correlated with depression. When human connection is missing, even if around other people, we are far more likely to feel depressed. Unfortunately, our feelings of loneliness are increasing in our modern society with people withdrawing from active involvement in community organizations and turning inward. More Americans say they have no close friends in spite of our participation in social media.
Lack of meaningful work. According to a massive study by the Gallop Organization in 2012, only 13% of people feel like they do meaningful work. Most people report that their work is monotonous, repetitive and unfulfilling which often leads to a sense of boredom and even depression.
Personality predisposition. Perfectionists are more likely to be depressed. Likewise, those who are accommodating, conscientious, worry-prone, and hard-working. These people set high standards for themselves and, if not careful, feel like they can never do/be enough, tell-tale signs of depression.
Unresolved traumas from the past. Upsetting childhood or earlier life events make us more susceptible to depression, especially when deep and unresolved emotions are involved. Painful feelings are often suppressed until into adulthood when they begin to resurface. Our attempts to avoid or resist them often lead to depression.
Poor health care. Poor nutrition and self-care can contribute to depression. Some studies have found that diets high in sugar or low in omega 3 fatty acids are associated with depression. Likewise, lack of exercise and abuse of substances contribute.
Superficial Values and Social Comparing. We live in a competitive society in which it is easy to judge ourselves based on how others are doing—whether it be material success, beauty, status, athletic fetes, popularity or what not. Social media certainly contributes to this phenomenon. Comparing means we look outside ourselves for validation and feelings of success which often results in self-criticism and not feeling good enough.
Three Dynamics that Keep us Trapped in Depression
Irrespective of the specific causes, there are three dynamics that not only contribute to depression but make it difficult to escape. Understanding these three factors will help you know what it is like to be depressed and also frame the most important work to loosen its grip.
First, is negative and distorted thinking. Depression is not so much a disorder of mood but of perception. People who are depressed view the world through a negative filter that influences everything they see, feel and do. This filter originates in the limbic system of the brain, which evolved to protect us from the threats and dangers of life but also robs us of hope, optimism and confidence. Negative thinking colors everything and makes it difficult to enjoy life. Challenging this distorted thinking is perhaps the most important and effective treatment of depression.
Second, the emotions of depression are addictive. Our bodies literally memorize such hormonal or feeling states as sadness, emptiness, hopelessness, and self-distain. Although we hate these feelings, they become so powerful that it is difficult for the conscious mind to override them. They become default emotional states which crowd out more pleasant emotions. Overcoming depression has much to do with putting ourselves in new feeling states, incompatible with the feelings of depression.
Third, people who are depressed are trapped in a catch 22. They need to take action to overcome their state and yet they lack motivation. They feel fatigued, low energy and a loss of interest in life and so have a difficult time mustering up the motivation to do what they need to do to feel better. And yet, doing something different is exactly what the doctor ordered. They must act in new ways to feel better.
So, notice the pattern that I’m describing. Distorted thinking, negative, memorized feelings and inaction not only characterize depression but make it difficult to overcome. So many people like Margaret (opening paragraph) feel burdened by life and yet quite powerless to free themselves from the clutches of depression.
But there is so much hope. In my next article, I’ll teach you some powerful strategies to both avoid and overcome depression. The strategies get at the heart of these three patterns and are essential to feeling and doing better.
By: Roger K. Allen
Roger K. Allen, Ph.D. is an expert in personal transformation and family development. His tools and methods have helped tens of thousands of people live happier and more effective lives. To learn more, visit www.rogerkallen.com>.
Everyone feels worried or anxious at some time and it’s not always easy to tell if you are experiencing anxiety or depression. Dr. Michael Marcus, psychiatrist for Kaiser Permanente in Portland, Ore., explains the symptoms and how to identify the differences between anxiety and depression.
Unfortunately, we cannot use this type of evidence to promote eating chocolate as a safeguard against depression, a serious, common and sometimes debilitating mental health condition.
This is because this study looked at an association between diet and depression in the general population. It did not gauge causation. In other words, it was not designed to say whether eating dark chocolate caused a reduction in depressive symptoms.
People in the study reported what they had eaten in the previous 24 hours in two ways. First, they recalled in person, to a trained dietary interviewer using a standard questionnaire. The second time they recalled what they had eaten over the phone, several days after the first recall.
The researchers then calculated how much chocolate participants had eaten using the average of these two recalls.
Dark chocolate needed to contain at least 45% cocoa solids for it to count as “dark”.
The researchers excluded from their analysis people who ate an implausibly large amount of chocolate, people who were underweight and/or had diabetes.
The remaining data (from 13,626 people) was then divided in two ways. One was by categories of chocolate consumption (no chocolate, chocolate but no dark chocolate, and any dark chocolate). The other way was by the amount of chocolate (no chocolate, and then in groups, from the lowest to highest chocolate consumption).
The researchers assessed people’s depressive symptoms by having participants complete a short questionnaire asking about the frequency of these symptoms over the past two weeks.
The researchers controlled for other factors that might influence any relationship between chocolate and depression, such as weight, gender, socioeconomic factors, smoking, sugar intake and exercise.
What did the researchers find?
Of the entire sample, 1,332 (11%) of people said they had eaten chocolate in their two 24 hour dietary recalls, with only 148 (1.1%) reporting eating dark chocolate.
A total of 1,009 (7.4%) people reported depressive symptoms. But after adjusting for other factors, the researchers found no association between any chocolate consumption and depressive symptoms.
However, people who ate dark chocolate had a 70% lower chance of reporting clinically relevant depressive symptoms than those who did not report eating chocolate.
When investigating the amount of chocolate consumed, people who ate the most chocolate were more likely to have fewer depressive symptoms.
What are the study’s limitations?
While the size of the dataset is impressive, there are major limitations to the investigation and its conclusions.
First, assessing chocolate intake is challenging. People may eat different amounts (and types) depending on the day. And asking what people ate over the past 24 hours (twice) is not the most accurate way of telling what people usually eat.
Then there’s whether people report what they actually eat. For instance, if you ate a whole block of chocolate yesterday, would you tell an interviewer? What about if you were also depressed?
This could be why so few people reported eating chocolate in this study, compared with what retail figures tell us people eat.
Finally, the authors’ results are mathematically accurate, but misleading.
Only 1.1% of people in the analysis ate dark chocolate. And when they did, the amount was very small (about 12g a day). And only two people reported clinical symptoms of depression and ate any dark chocolate.
The authors conclude the small numbers and low consumption “attests to the strength of this finding”. I would suggest the opposite.
Finally, people who ate the most chocolate (104-454g a day) had an almost 60% lower chance of having depressive symptoms. But those who ate 100g a day had about a 30% chance. Who’d have thought four or so more grams of chocolate could be so important?
This study and the media coverage that followed are perfect examples of the pitfalls of translating population-based nutrition research to public recommendations for health.
My general advice is, if you enjoy chocolate, go for darker varieties, with fruit or nuts added, and eat it mindfully. — Ben Desbrow
Blind peer review
Chocolate manufacturers have been a good source of funding for much of the research into chocolate products.
While the authors of this new study declare no conflict of interest, any whisper of good news about chocolate attracts publicity. I agree with the author’s scepticism of the study.
Just 1.1% of people in the study ate dark chocolate (at least 45% cocoa solids) at an average 11.7g a day. There was a wide variation in reported clinically relevant depressive symptoms in this group. So, it is not valid to draw any real conclusion from the data collected.
For total chocolate consumption, the authors accurately report no statistically significant association with clinically relevant depressive symptoms.
However, they then claim eating more chocolate is of benefit, based on fewer symptoms among those who ate the most.
In fact, depressive symptoms were most common in the third-highest quartile (who ate 100g chocolate a day), followed by the first (4-35g a day), then the second (37-95g a day) and finally the lowest level (104-454g a day). Risks in sub-sets of data such as quartiles are only valid if they lie on the same slope.
The basic problems come from measurements and the many confounding factors. This study can’t validly be used to justify eating more chocolate of any kind. — Rosemary Stanton
Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.