TO READ: Could Depression Relief be "All in Your Mind"?
We've all heard it, or even thought it ourselves: You're not "really sick," your depression is just "all in your mind." Before you grind your teeth too hard, read about how neurofeedback, aka EEG biofeedback, has helped a few people ease their depression by training their brains.

It seems that in depressed people a particular type of brain wave, the alpha wave, is not equally strong in the left and right brain hemispheres, but is more active on the right. This distribution of alpha waves can be related to mood. Though the technique is highly experimental, and no controlled studies have been conducted yet, researchers at Northwestern University and the NeuroQuest Neurofeedback Center in Evanston, Illinois have seen some positive results when depressed subjects learned to balance the alpha waves in their brains.

After electrodes were stuck to spots on their face and scalp, depressed research subjects were trained in 15-30 minutes sessions to play a sort of game. In this rudimentary computer game, played simply by thinking, not using the hands, success was measured in changes in brain waves. When their alpha waves in the left frontal cortex grew stronger than in the right, they heard a note played on a clarinet. Their goal was to keep this tone playing as long as possible. The training worked -- at least for some people. One woman had outstanding results: After 12 years of recurrent depressions that were not responsive to treatments, she learned in just 35 hours of training to control the waves so that her symptoms decreased dramatically. Amazingly, she remained depression-free during the next six years as the scientists followed her case.

Brain training, as it's called, is being studied for many other uses as well: predictions of seizures in patients with epilepsy, treatment of ADHD, communication for those who cannot speak or move and, yes, even improving healthy people's cognitive skills such as memory, concentration and musical abilities.

For more info, see: Scientific American Mind, February 2006.

TO WRITE: What Are You Grateful For?
As the long weekend of family, food and crazed shopping ends, I'm reflecting on what it all means. What am I really thankful for, and do I ever truly stop and think about those things? Some recent psychological research suggests that the trait of being grateful is a particularly powerful one. The psychologists involved suggest the following practice for greater contentment: Keep a special notebook, and at the end of each day, write down three specific things for which you are grateful. These can be large or small things -- I was able to sleep six solid hours last night; I called my sister for support today when I felt really low; I felt engaged when reading the front page of the newspaper. Ocassionally look back at your notebook and see what things jump out at you or form a trend. Are these things you could strive to increase in your life?

Play with this...
Try the exercise described above for a week. Then reread your notebook entries and write consistently for 20 minutes on your findings. If you feel a sense of satisfaction, lightness or joy, continue the practice and see how your feelings evolve over time and how you might apply your discoveries day-to-day.
Beth

TO READ: The Creativity-Depression Link: Rumination
Science, as well as centuries of popular observation, has shown that there is a strong relationship between mood disorders and creativity. Artists, writers, musicians and scientists all have higher than usual rates of depression, for example. But why? Does depression lead somehow to creativity? Or are creative pursuits somehow depressing? Research now shows that there may be no direct link between the two. Rather, their connection may be the tendency to ruminate.

In the 1990s, one overview of research studies on creativity and depression concluded that major depression in writers and artists is 8-10 times higher than in the general population. Another study found that people working in the creative arts had a lifetime prevalence of depression of 50%, while scientists came in at 24%, and the general public had a rate of 9%. In particular, poets had a depression rate of 77%; fiction writers, 59%; and visual artists, 50%.

More recently, researchers at Syracuse University and Stanford University found evidence that the strong relationship between mood disorder and creative behavior is rumination -- having conscious thoughts about a particular topic that recur whenever the person is not facing immediate outside demands. This tendency to self-reflection increases the risk for depression, and it also triggers interest in and ability for creative activities.

The results suggest that depressed people, who tend to be ruminators, may turn to creative pursuits when they are feeling better in order to express their feelings and the content of that self-reflective thought. Also, rumination may allow the depressed individual to later generate more ideas, some of which are original and can be pursued -- though of course, the possibility of having repetitive negative thoughts about oneself is higher too.

From: Verhaeghen, et al. (2005). Why we sing the blues: The relation between self-reflective rumination, mood, and creativity. Emotion, 5, 226-232.

TO WRITE: Tell me what helps!
A recent comment left on this blog -- a request for help, really -- got me thinking about how easy it can become to focus on what makes our depression and other symptoms worse, not what makes us feel better. One of the many uses of support groups for those living with mental illness is that through sharing with others, we can often identify healing techniques, be they large or small. Writing can also trigger us to pinpoint what works for us, both as we put our finger on these approaches ourselves, and as we share them with others.

Play with this...
Imagine a person who has just been diagnosed with your illness coming to you for advice on how to ease the pain. What would you suggest? I'd include both broad approaches -- educating oneself through the links listed in this blog, seeing a highly-recommended physician -- and small, specific tricks -- holding my cat, coffee with a trusted friend, writing down my feelings of confusion. Writing continuously for 20 minutes, describe what you'd say to this new acquaintance who needs your help. And let me know what you come up with!
Beth

TO READ: Depression gene enlarges "negative" brain region
If you're clinically depressed, your brain's structure is probably different than that of your healthy friends. That's right -- while the use of biochemicals such as serotonin is undoubtedly different in depression, as we've heard for years, there are gross physical differences in the brain tissue as well. Several research studies have demonstrated that numerous regions of the brains of people with depression differ from that of non-depressed people -- usually certain areas are smaller in depressed people. Now, there's evidence that the "negative emotions" part of the brain is bigger in those with depression.

Last week in the journal Biological Psychiatry, scientists reported their studies of a particular gene, the serotonin transporter gene (SERT), which has two forms, known as short and long. If you have two short SERT genes (one from each parent), you're likely to have a bigger "pulvinar" in your brain. The pulvinar region handles negative emotions. People in the study who had depression had pulvinars 20% larger and with 20% more nerve cells than people with one or two long genes. Researchers believe about 17% of the population has two SERT genes.

The SERT gene also affects the nerve cells' use of the neurotransmitter serotonin. Prozac, Zoloft and several other antidepressants act by keeping serotonin more available for cells to communicate.

How does this new information help us? "The brain is wired differently in people who have depression, and probably from the point of view of treatment, we should try to identify these people as early as possible and intervene before the 'hard-wiring' gets altered," the lead researcher told Reuters.

TO WRITE: What makes you you?
When living with depression or any other mental illness, it's all too easy to lose sight of who we really are. We're busy taking meds or going through other treatments to help change the ways we think and feel, and underneath it all our sense of self can be seriously compromised. The following quote by William James has helped me on several occasions to connect to what I consider my core -- my unique abilities, character, desires, needs, goals.

"Seek out that particular mental attribute which makes you feel most deeply and vitally alive, along with which comes the inner voice which says, 'This is the real me,' and when you have found that attitude, follow it."

Play with this...
Write continuously for 20 minutes on "What makes you the real you?" Afterward, reread your piece and see if you can come up with ideas on how to "follow it."
Beth

TO READ: Migraines and depression -- What's the connection?
I want to report today on migraines, usually considered a neurological, not a psychiatric issue. However, I contend that for some of us there's a real connection. I say this because of personal experiences, and because of similar stories numerous others have told me about their illnesses. (See, for example, the comment from "Patricia" below the November 1 posting in this blog.) My ill health actually began, 20 years ago, as severe daily migraines that appeared suddenly for the first time, and made it very hard to work. After a year of trying various medicines, during which my depressive symptoms first appeared, an old tricyclic antidepressant took care of both ailments. At least it largely took care of the migraines; the depression has returned umpteen times. Of course, not everyone has even that much success, though medicines used have advanced a great deal.

Interestingly, however, there may soon be non-pharmacological treatments for migraine sufferers. The New York Times reports this week on two experimental treatments being studied in large trials for migraine -- ONS, or occipital nerve stimulation, and TMS, transcranial magnetic stimulation.

ONS uses electrodes implanted just under the skin on the back of the head to deliver electric current to a specific nerve. The electrodes are wired (under the skin) to a pacemaker-like device implanted in the upper buttock. The treatment sounds analogous to the VNS, or vagus nerve stimulation, therapy now used for treatment-resistant depression, where a device implanted in the upper chest is wired to electrodes in the side of the neck and delivers pulses of electricity. Very different nerves -- similar idea.

And TMS is already being studied for the treatment of both major depression and bipolar depression. I've previously described in this blog how fabulous TMS treatment has been for me. The idea in using TMS for migraine is similar. Instead of the side-of-the head stimulation I've gotten, here the back of the head is targeted. Again, a device pressed against the head provides brief magnetic pulses, which alter the electrical activity in a localized region of the brain. In neither case is it known exactly how the stimulation helps, and it doesn't help everyone. Also, the migraine studies so far are limited to those who experience an "aura," or a premonition period, before the migraine. Still, the idea of having more electrical -- as well as chemical -- treatment options for both depression and migraine is exciting. Stay tuned for more results.
Beth

TO WRITE: How do relationships affect your mental health?
All of our personal relationships are bound to affect us in myriad ways, and our mental health is definitely one of them. Think about the people in your romantic life, for example -- your spouse, partner, or a current or former relationship. Does that person know about your depression, bipolar disorder, or other mental health problem? Can you discuss it with him/her? Is that person supportive? Have you learned over time how to best handle conversations with her/him on this topic? What would you like to change in this area?

Writing about our relationships can be extremely fruitful -- and fascinating. For a great example of writing on changing romantic relationships, check out the essays on the blog of a writer friend of mine at: MovingInMovingOn.typepad.com.

Play with this...
Choose your current partner or a person with whom you had a former romantic relationship. Writing consistently for 20 minutes, describe how you relate(d) to that person on the topic of your mental health. Does reading what you wrote provide any insight into changes you might like to make in this realm, if any?
Beth

TO READ: Depressed? Keep trying new meds
The final portion of a large, six-year federal study of depression was published today in the American Journal of Psychiatry. The findings: While one-third of people were helped by starting on the antidepressant Celexa, one-third more got better if they were patient and added or switched to a second, third, or even fourth antidepressant, as needed. Thus, 67% of the 3,671 of the depressed patients studied reached remission by taking one or more medicines.

The downside of trying additional antidepressants, however, is that relapse becomes more likely the more drugs you try. Among those who achieved remission with the original Celexa prescription, 40% relapsed in the first year. For those who had to use a second, third or fourth drug, the relapse rates rose to 55, 65, and 70%, respectively.