TO READ: Depression's Devastating Self-Criticism Explained
When serious depression kicks in, one often-heard complaint is, "I do everything wrong." Now researchers have brain-wave evidence about where this perception may come from. Results from one study show that depressed people make no more mistakes than healthy controls -- but that they truly are better at detecting their errors.

Scientists measured two types of brain waves as subjects did a simple signal-detection task, and found that depressed people were just as quick and accurate as the non-depressed. No slowness or concentration problems were noticed. However, both types of brain waves -- one called error-related negativity, which measures brain resources used in early detection of errors, and the other called error positivity, which indicates error detection -- are exaggerated in depressed people.

Those responses indicate that the depressed group used more of their brain resources to detect errors. Researchers suggest that when they make a mistake, depressed people are more likely to notice it than a healthy person would be. While this extra acuity might be a good thing in certain situations, it also may be responsible for the hyper-criticism often felt during the illness. Something to bear in mind when that I-can't-do-anything-right feeling kicks in!

For more info: American Journal of Psychiatry 2007 164:58.

TO WRITE: A Sound from Childhood
Memories, especially those from childhood, can often evoke strong emotions, as well as triggering even more memories. Instead of replaying the same old childhood stories in your mind (we all have some that we rely on to piece together the story of our life), try with this exercise about specific sounds to see what other details or experiences you may not have thought about for a while. "New" material can supply all sorts of creative undertakings. In addition, focusing on specific sensory experiences makes for strong writing.

Play with this...
First, brainstorm a list of five to ten specific sounds you recall from childhood. My list includes the zip when my father cast his fishing line from a canoe on a lake, and the blaring honk of the tornado alarm in elementary school. Next, choose one of these sounds -- preferably one you haven't thought about for a long time -- and write for 20 minutes about your experiences relating to it. Then consider how it felt to write this memory -- was it sad, funny, a relief, an "aha" experience? If a particularly difficult memory came up, give yourself a few more minutes to write an imaginary ending to the story that wraps things up in a way you'd prefer.

TO READ: Why Did I Have To Gain 80 Pounds on Antipsychotics?
Researchers may have solved the mystery of why so many people with bipolar, depression, schizophrenia and other illnesses who take certain antipsychotic medications tend to gain weight -- sometimes lots of it.

While these medications may effectively treat symptoms such as hallucinations and delusions, that's a high price to pay. (I know -- I gained 80 pounds in a few months on one of these meds. Fortunately it's almost all come off now that I'm on a newer one instead.) Many people gain to the point that they become at risk for life-threatening conditions such as heart disease and diabetes.

Scientists knew that the link between brain cells and appetite seems to be an enzyme known as AMPK. Now, in a recent study at Johns Hopkins University, when researchers gave the antipsychotic medication clozapine to mice, their AMPK activity quadrupled. When the scientists chemically suppressed the mice's appetites, the AMPK levels lowered. But what mediates such a connection?

It turns out that histamine -- the substance responsible much allergic misery, as well as a protein which aids communication between cells -- plays a key role in the interaction between AMPK and appetite. By blocking histamine's effects, clozapine no longer led to AMPK spikes.

The results are exciting: This discovery may allow scientists to develop both a new generation of antipsychotic drugs that doesn't cause weight gain, and safe weight-loss drugs.

For more info: Proceedings of the National Academy of Sciences, online edition, February, 2007.

TO WRITE: A Cold Got You Down? Write About It!
I see low, deep gray clouds and the spattering of raindrops outside my window here in Northern California today. And the weather report says a big part of the country is getting snow on this day before tax day. Have the recent shifts in weather contributed to a spring cold for you, as it has many people I know? (So far, so good for me ... for this month.)

After you wake from your weekend nap and pop some more Benadryl, don't turn on the TV to numb your mind. Instead, consider curling up with a cup of hot tea and a blanket in your favorite chair and writing out just how miserable you are. You might just feel better. Your mind will engage and you may forget your sore throat for a while. And remember that writing has been demonstrated to improve immune functioning. I'm not claiming that writing will cure your cold -- but research does show that writing even 20 minutes a day for four days in a row about a difficult or traumatic experience leads to fewer doctor visits for months later. Now that's something to think about!

Play with this...
Describe how your body feels right now as if you're writing for someone who's never had a cold -- the aches, the fever, the lethargy, the stuffiness. OR describe a time you were sick as a child -- what were your symptoms? Who took care of you? How did the illness resolve? Write continuously for 20 minutes. When you look back at the pages you've filled, you'll see you have accomplished something today after all.

TO READ: Religion Shown to Help Depression for Many of Us
The data is overwhelming: Study after study shows that people who consider themselves religious or spiritual, especially those who attend weekly religious services, tend to be generally healthier and longer-lived than those who don't. And -- this rule of thumb holds true for depression in particular too. Interestingly, it's reported that 95% of Americans believe in God or a Universal Spirit. Along the same lines, a study of psychiatric inpatients found that 80% consider themselves religious or spiritual.

In terms of overall health, for example, one study which tracked more than 5,000 people from right here in Alameda County, CA, found that those who attended religious services at least weekly were 25 % less likely to die during the study than others. A huge 1999 study of 21,000 American adults found that by attending religious services more than once a week, people tended to extend their lifespan by up to seven years in general, and up to 14 years in African-Americans.

In terms of depression, the results are remarkable too. For example, in one study of 177 people (age 55-89) over one year, self-reported religiousity was correlated with less depression, and with recovery from depression in those who were initially depressed. Another study looked at depressed and medically ill men over age 60 for one year and found that, even after accounting for 27 other variables, religiousity was associated with both a greater likelihood of remission and a quicker remission from depression. In one review of 29 studies examining the relationship between depression and religious involvement, 24 found that religiously involved people had less depression and fewer depressive symptoms; five found no association.

Treatment of depressed religious people has been shown to be more effective in terms of post-treatment depression when religious content is added to standard cognitive-behavioral therapy and, in another study, when religious content is added to standard psychotherapy.

And what if you don't consider yourself a "religious" person? Good news: benefits of a spiritual but non-religious practice can still provide benefits that complement your medical treatment. Consider a regular yoga or meditation practice, for example. Also, giving to others through works and services can often provide a strong inner response. In addition, pay attention to your personal support network, and health habits such as drinking and smoking -- all of these have been shown to be improved by religious involvement, but don't rely on believing.

Remember -- spiritual beliefs should not be used to replace your medical care! Instead, appreciate how they can complement and augment one another in your efforts to feel better.

For more info see: www.mayoclinicproceedings.com/inside.asp?AID=1338&UID and www.mcmanweb.com/article-102.htm

TO WRITE: Could a "Laughter Club" Beat Out Prozac?
Is it hard to laugh when you're depressed? Well, consider doing it in a group. That old saw about laughter being the best medicine is being enthusiastically applied in Shanghai. China Daily reported that this month faculty members at Fudan University began inviting students to "laugh away their cares and concerns" by joining the Heartfelt Laughing Club.

Members, inspired by observations that laughter is powerful - and contagious - typically meet in parks early in the morning. They raise their arms high and begin laughing loudly, then silently with mouth closed, then open, in an effort to ease everyday stresses. Sometimes the laughter is combined with yoga and meditation. Chinese psychologists leading the Fudan group discovered that others follow the humor-filled practice too: There are more than 80 laughter clubs in India, and several thousand around the world!

Do you think they could be on to something?

Play with this ...
Even if it's been a while since you've giggled much, recall some times you have. Did you laugh yourself silly at Bugs Bunny as a kid? Or was it that time you and friends played a prank on a teacher? For me, watching Monty Python or Saturday Night Live with my gang of pals in high school comes to mind.

Write the story of a funny - no, hilarious - thing you once laughed at. How did it start, how did you react, did you feel different afterward? Are similar events still amusing to you now, or have your tastes changed? And what might make you laugh today - could you rent a video, play with the dog, rehash a family mishap with your sister? As usual, give yourself 20 minutes to write continuously about the laughter in your life. And leave a comment to let us know what works for you!

TO READ: Approaching a Genetic Understanding of Depression
Scientists continue to chip away - and sometimes blast away - at the mystery of depression. And they're making progress. In a major step forward, a consortium of psychiatric researchers announced last month the identification of a region on chromosome 15 that has "a very good chance" of ultimately explaining why some people develop depression.

You probably know that both genetic and environmental factors are believed to be responsible for depression. A better understanding of specifically which genes (there are thought to be several) in our DNA place us at risk for depression would constitute a major research breakthrough: If scientists can locate the key genes, they can determine how they affect the brain and, as a result, can develop more effective therapies for the illness.

Two studies reported in the February American Journal of Psychiatry were conducted by groups at six universities, led by Stanford professor Douglas Levinson, M.D. First these researchers studied 650 families in which two or more members had experienced multiple bouts of severe depression that began in childhood or early adult life. They scanned the entire genome and found areas of "linkage" between depression and DNA markers in several areas. Then they homed in on the most suspicious region, which lies on chromosome 15.

What they found, after studying more than 88 DNA markers in that area, was what Levinson called "one of the strongest genetic linkage findings for depression so far."

The consortium is now studying more than 2,000 people to identify specific genes in the regions, including on chromosome 15, that look most likely to carry variations that increase depression risk.

TO WRITE: What We See and What We Don't
Many writers claim that observation is what their work is really all about. Author and writing teacher Natalie Goldberg says, "Writing is 90% listening."

But it's not just the writer surreptitiously monitoring the lovers at the next restaurant table for plot ideas and dialog. In fact, every human needs to observe his life and the world around him and try to fit the two together. Observing and reflecting are key, whether it's deciding when it's safe to step off a curb, or determining when to change careers. For people living with depression, observing the situations that make us feel worse or better, and the reactions we have to those stimuli, can be a powerful tool. We can use this technique both in the present and in retrospect.

Play with this...
Write continuously for 20 minutes, starting with the following prompt, and see what you discover.
Looking back, it was obvious...

TO READ: Changing the Structure of Your Brain
Wow, am I reading a great book right now! Train Your Mind, Change Your Brain by the wonderful science writer Sharon Begley, is billed on the cover as, "How a new science reveals our extraordinary potential to transform ourselves," and, "A groundbreaking collaboration between neuroscience and Buddhism."

Sound confusing? Well, I suppose anytime you get the Dalai Lama to write a foreword for a book on nerve cells in the brain, it's unusual, that's true. And neuroscience is typically thought of as a daunting field. Despite those things -- or maybe because of them -- I'm telling everyone I know to read this book! It's absolutely fascinating and it's very accessible.

Here are some of the things I've learned so far, boiled down and boiled down again. When I was a college student, and even when I was a graduate student in biology, it was taken as a given that whatever brain cells you were born with were what you got for good -- no exceptions. This was simply a basic rule of neuroscience. But... Begley describes a whole host of recent experiments that show how that belief is hooey. Instead, the incredible changes our brains can make -- the "neuroplasticity" of the brain -- will amaze you. For instance, in people blind from birth, you might imagine that the enormous visual cortex part of the brain would sit silent, since no visual input can get in through the eyes. No! In fact, instead of lying dormant, the visual cortex actually switches jobs to help the person hear certain tones and rhythms more acutely than sighted people can. In other words, it helps them compensate. Similarly, the brain region believed to only be able to process auditory stimuli can, in deaf people, be recruited to help the visual cortex to gain even more information from peripheral vision than usual, thus helping a deaf person to notice and react to changes in the environment more quickly.

What these kinds of experiments mean is that we can change our brains. By attending to particular things in our environment, we can cause regions of nerve cells in the brain to grow, to shrink, to adjust their function, even to change jobs completely. So, if you take up the violin, even as an older adult, your brain's motor cortex in the region controlling your left (fingering) hand, will grow. It takes attention and practice, but our minds really can change the structure and the electrical and chemical activity in our brains! That's consciousness changing matter.

I'm only half-way through the book, but I'm hooked. So stay tuned for an upcoming discussion of what happens when neuroscientists study the brains of Buddhist monks who have meditated for years, and learn what these discoveries mean for the treatment of OCD and depression.

TO WRITE: How Do You Care for Yourself?
Last time I circulated a notepad asking for writing topic suggestions in our class meeting at Stanford, I got an amazing mix of responses. We've already written using several of them as our jumping-off point -- from "joy" to "patriarchy" to "I'm afraid of" to imagining being "rich beyond dreams."

But one topic that comes up very regularly on such lists is how to manage your moods. And on this page, the topic of "self-care" came up specifically. Everyone who has coped with a mood disorder, even for a short time, has probably gravitated toward some activities that feel self-soothing or calming or activating or encouraging, depending on what you need at that time. When I'm depressed, reading a novel or writing about the situation over a big cup of coffee at Starbucks helps considerably. It doesn't remove the depression, but it reminds me that there are still things I can enjoy - even if only a little bit - and that I have the ability to seek out those things. And, in my case, the jolt of caffeine doesn't hurt either.

Play with this...
What self-care techniques can you recommend to others? Does walking the dog help you bond with her and get some exercise? Does herbal tea help you get a much-needed good night's sleep? And what about writing -- you may not feel up to crafting a poem, but does a good freewrite in your journal ease your burden a bit? Write continuously for 20 minutes on self-care and see what you discover -- then share your findings with a friend who could use them, and perhaps pick up a few tips from her too.

TO READ: Gamma knife surgery - could it help depression someday?
A former writing student recently made me aware of a "knife-less" brain surgery technique which is becoming widely used around the world. Called gamma knife surgery, it destroys tiny bits of brain tissue by focusing beams of cobalt radiation on, for example, a brain tumor. The gamma knife can be used even for deep brain sites and, unlike conventional radiation treatments or surgery, can be focused with one-tenth of a millimeter precision, so healthy tissue is largely unaffected.

Sounds very impressive to me. Now vascular malformations, both cancerous and benign brain tumors, epilepsy and other conditions are being treated with the gamma knife on over 60,000 patients each year, according to one web site.

But what about depression? I surfed and web-surfed some more, but haven't come across any studies on using gamma knife surgery in this realm. Yet. One site discusses using it for obsessive-compulsive disorder and even vaguely suggests using it for depression in the future....

But where in the brain would it be used? As this blog has described several times, more and more evidence is stacking up that says brain structures - not just the flow of neurotransmitters - are changed in depression. Perhaps one of these sites could be treated. Often the confusing point in these cases is that we don't know whether those structural changes cause, or are caused by, depression. The other approach would be to simply focus on brain regions now understood to regulate emotions and mood. But identifying the precise areas to target is still too difficult. Still, it sounds as though researchers are starting to consider the possibilities of gamma knife surgery for psychiatric illnesses. One more potential future treatment to keep an eye on.

For more info: www.sciencedaily.com, www.sd-neurosurgeon.com

TO WRITE: Are You Friendly with Your Little Pink Tablets?
If you take antidepressants - or mood stabilizers, antipsychotics, anti-anxiety drugs, sedatives, stimulants or any other of the panoply of psych meds - how do you feel about them? For many people with depression, that handful of tablets and capsules that it sometimes seems we gobble like candies can be hard to get down. That is, while we know intellectually that these drugs are helping us, or at least could help us, many of us still have mixed emotions about taking them.

Have you ever wondered what exactly those pink or white or turquoise or yellow pills are doing once you swallow them? Scientists still can't fully explain how they operate to change our thoughts and our entire mood. How does that mystery leave you feeling? At different times I've felt dumbfounded, nervous, grateful, embarrassed, angry, resentful and relieved to reach for my regular doses from those amber bottles.

Play with this...
Write continuously for 20 minutes describing your feelings about taking medicines for psychiatric reasons. What emotions did you feel initially? Have they changed at all? How do you feel when you take your prescribed dose today? And would you feel any differently if these were drugs you were taking for some non-psychiatric ailment? Untangling such thoughts and feelings may provide some insight into our attitudes toward our depression and our life situations as well as our treatments.

TO READ: Drug Combo for Resistant Depression
Has your depression - or you - been dubbed "hard to treat"? Been through drug after drug without success? A new study looking at treatment with the combination of antidepressants Effexor (venlafaxine) and Remeron (mirtazapine) looks encouraging.

Irish psychiatrists just reported a study of 32 patients (44% men) who had been through an average of 2.5 drug trials without depression relief. Impressively, after 4 weeks on this combination of meds, 44% had responded; after 8 weeks, 50% responded; and at a 6-month follow-up, 75% of those still taking the meds had significantly responded.

The down-side? No "serious" side-effects were reported, but 19% of patients felt sedated and 19% experienced weight gain. Five of the 32 quit the trial because of these effects. Remember to keep trying if your depressive symptoms haven't been helped by meds yet - just because one drug or combination doesn't work for you doesn't mean others won't!

For more info: Journal of Psychopharmacology, Vol. 21, No. 2, 161-164 (2007).

TO WRITE: Are You "Religious"?
Many, many people, I've found, bristle at this question. OK, those who practice the rituals of a particular religion, who attend temple or church or mosque regularly -- or even just once a year on a holiday -- have little problem with it. But what about the others? I've often heard the response, "Well, I was raised (insert religion here), but I never really practice it...."

Either of these responses can be fruitful to explore. Our relationship -- or lack thereof -- with a religious life sheds light on many aspects of our world view, our moral and ethical beliefs, our sense of spirituality outside a formal religion, and what we draw on in times of crisis, such as depression.

Play with this...
What religious beliefs did you grow up with -- Were Mom and Dad strict atheists? Did Grandma take you to mass every week? Did you learn to bow and pray several times a day? Meditate? Did you develop your own ideas about the mysteries of life?

How do those childhood beliefs and experiences affect you as an adult -- Do you practice any formal religion now? Where did you get married? What are you teaching your children? And how do your past and current beliefs affect you as you cope with depression?

Write for 10 minutes on each of these two main questions and see what you discover.

TO READ: Men and Depression
Conventional psychiatric wisdom has it that depression is twice as common in women as in men. But that rule of thumb may not be correct.

Newsweek's cover story last week (Feb. 26, 2007 issue) was on men and depression, and it reports that more and more medical providers are discovering that men just don't admit or even face up to their depressive symptoms at the rate women do. Six million men will be diagnosed with depression this year, and more and more men are seeking treatment as stigma gradually lessens. Still, many men feel they must maintain a certain image -- for themselves as well as for others -- of being "in control." As a result, the article claims, men's moods may manifest as irritability, anger, alcoholism and other substance abuse, even violence.

In addition to the untold suffering of these men and their families due to such effects, depression leads men to commit suicide at rates at least four times greater than women. At a societal level, depression's effects are enormous as well: studies estimate that adult depression leads to $83 billion (with a "b") worth of lost productivity.

I certainly know many men who have had the "manliness" to step up, realize they have a problem, and seek treatment for their depression. They, like women in our society, still face tremendous stigma. But they do it. "Coming out" with depression is often the wisest, and healthiest, thing they can do -- for themselves, their families and their careers.

TO WRITE: Is There a Book In You?
This weekend I attended the San Francisco Writers Conference for three long intensive days. I came away with new information, contacts, publishing leads and ideas. But one comment I recall, made by a presenter, really made me smile: Everyone has a book in them.

I think it's true. How often have you heard someone discuss an experience or a passion and say, "I could write a book." Maybe you've thought it too -- "My life could be a book!" Those of us who've struggled with depression or other mental illnesses may be especially prone to this, wishing we could accurately communicate to others what bizarre and painful journeys we've been through. Whether it's a manual on collecting toy trains, a steamy romance novel, a family history, or a memoir of your illness, most people I've asked about this do feel they have a book "in them."

Play with this ...
Imagine you were to sit down at the kitchen table and start writing or typing your first book. What would it be about? What would you really like to say to the world and leave behind in perpetuity? It doesn't need to be brilliant or perfect, it just needs to be from your unique perspective, as it will be. Now write continuously for 20 minutes on what you'd like to say to people about something you know well or can imagine well. You may feel lighter after pinpointing what you'd like to get out. And, who knows, maybe this will trigger you to pick up your pen again and begin Chapter 1!

TO READ: Human Brain Cells That Continuously Regenerate Discovered
A site in the human brain in which new nerve cells are constantly being regenerated has just been identified for the first time. Researchers are excited that the results open wide the possibility of repairing the brains of people with neurodegenerative diseases such as Alzheimer's, and even treating brains damaged from injury or other diseases.

These newly discovered stem cells travel from just below fluid-filled chambers or "ventricles" of the brain, through a microscopic tube, to the area of the brain that deals with smell, morphing into new nerve cells along the way. The results, reported by scientists in New Zealand and Sweden, was published in the journal Science, according to BBC News. This cellular system had previously been identified in mice, rats and other species, but not in humans, and its detection encourages researchers that these animal models are applicable to humans.

For decades, scientists believed that the brain did not develop any new nerve cells after birth, but that theory has been disproven in recent years. Thus, as in this situation involving the brain's "olfactory bulb," the brain can grow new nerve cells to respond to different stimuli encountered throughout a person's life. Brain cells and the connections between them deteriorate or die in certain diseases. In mental illnesses such as depression, subtle changes in the brain's cellular structure have been identified in recent years too, but little is known yet about those alterations.

For more information: BBC News 2/16/2007.

TO WRITE: Life's "Grand Essentials" Amid Depression
A writing student recently sent me the following quote, and then I saw it elsewhere a couple of days later. I felt it was calling to me.

"Three grand essentials to happiness in this life are something to do, something to love, and something to hope for."
-- Joseph Addison (1672- 1719)

When depression is lurking or even feels smothering, consider this recipe for happiness. It won't replace your other healing techniques, but for me, it provides perspective, a sense that life isn't as complicated as it sometimes feels, and gratitude. Every time I use it to take stock of my situation I come up with different responses. They don't need to be big things either - coffee with a friend, a soft cat, and looking forward to a positive new volunteer job have been fulfilling for me.

Play with this...
Take 20 minutes to respond to the Addison quote. List several things in each of the three categories if you like, then reflect (in writing) on what they mean to you in terms of your emotions and mood. Does imagining these things in your life leave you a little more satisfied, or does it feel discouraging? If it's the latter, are there tiny things you could work on in these areas of your life that might bring more contentment?
Beth

TO READ: Peer Support Study Results Extremely Positive
I just read the results of several research studies that asked: What benefits do peer support programs offer to mental health consumers? The answers, on the website of the Depression and Bipolar Support Alliance (www.dbsalliance.org), were astounding.

In these programs, consumers act as trained service providers to others with mental health issues to: help them develop self-management skills, aid in restoring social roles such as work, and encourage them to find - and commit to - more effective care for their illness. Organizations including the National Alliance on Mental Illness (www.nami.org) offer such peer-to-peer training programs.

In Canada, research on a program known as the Consumer/Survivor Initiatives found very positive results in terms of mental health symptoms, recovery support, and reduced use of hospital and emergency services. The CSI report found:

-- The average number of hospital days for participants dropped from 48 to 4.
-- More than $12 million was saved in reduced hospital stays for three hospitals over one year.
-- Self-described "lonely" consumers who were partnered with a peer mentor used on average $20,300 less per person in hospital and emergency services in the one year post discharge.

I've known many people who've benefited from peer services, as well as informal friendships and support groups, but I still found the degree of these improvements amazing. It seems obvious that training peers to provide such support - which I believe benefits them as well - should be a priority in all mental health care systems.

TO WRITE: Finding Your Own Deep Wisdom
I taught a creative writing workshop at a spiritual retreat among the redwoods in Aptos, California this weekend. In one exercise, we used the following Native American quote, followed by a short guided meditation, to access our inner wisdom as presented by an animal. As you try this freewrite, remember not to think too much -- you're simply there to take dictation.

Play With This...
This quote is from J. Reuben Silverbird (Navajo/Apache):

We must listen

to the wisdom of

the Animals of the

Four Nations:

Forest, Land, Water & Sky.

With this in mind, close your eyes and visualize yourself walking alone. You might be in the forest, the desert, on a beach or a mountaintop. Ahead you see movement. As you approach, you see it's an animal. As you near it, the animal begins to speak to you. When you're ready, open your eyes and take at least five minutes to write down what the animal says to you.

Later, reread what you wrote and reflect on what meaning those words might have for you. You, like some others, may find that this sort of exercise, like a dream, provides insights into your life and current issues, particularly if you consider the possible symbolism in what is revealed. If it is useful for you, you may want to try it again in another setting or with another animal.