The picture above is apparently what RNF123 looks like!

According to today’s Guardian

“The use of antidepressants has risen by more than a quarter in England in just three years, amid fears that more people are suffering from depression due to the economic crisis. The number of prescriptions for antidepressants increased by 28% from 34m in 2007-08 to 43.4m in 2010-11, according to the NHS information centre”.

But elsewhere of course there are doubts regarding the usefulness of such treatments, for example according to a “meta-analysis carried out by evolutionary psychologist Paul Andrews, an assistant professor in the Department of Psychology, Neuroscience & Behaviour. His findings suggest that people who have not taken medication for depression are at a 25 per cent risk of relapse, compared to 42 per cent or higher for those who have taken and gone off an anti-depressant”.

Furthermore “Paul believes that anti-depressants interfere with the brain’s natural self-regulation of serotonin and other neurotransmitters, and that the brain can overcorrect once medication is suspended, triggering new episodes.”

(See links here and here for full details)

In fact Shedler suggests that non-psychodynamic therapies may be effective in part because therapists use techniques that have long been central to psychodynamic theory and practice, such as gaining awareness of previously implicit feelings.

Shedler describes psychodynamic therapies as ‘a range of treatments based on psychoanalytic concepts and methods that involve less frequent meetings and may be considerably briefer than psychoanalysis proper. Session frequency is typically once or twice per week, and the treatment may be either time limited or open ended. The essence of psychodynamic therapy is exploring those aspects of self that are not fully known, especially as they are manifested and potentially influenced in the therapy relationship’. In his article he provides a useful description of the techniques used in the therapy.

*A randomised control trial is the gold standard of medical research where patients are randomly assigned to treatment or no treatment groups.

“Misery Has More Company Than People Think,” a paper in the January issue of Personality and Social Psychology Bulletin, draws on a series of studies examining how college students evaluate moods, both their own and those of their peers. Led by Alex Jordan, who at the time was a Ph.D. student in Stanford’s psychology department, the researchers found that their subjects consistently underestimated how dejected others were–and likely wound up feeling more dejected as a result. Jordan got the idea for the inquiry after observing his friends’ reactions to Facebook: He noticed that they seemed to feel particularly crummy about themselves after logging onto the site and scrolling through others’ attractive photos, accomplished bios, and chipper status updates. “They were convinced that everyone else was leading a perfect life”.

(source)

On the other hand a recent review by Bentall and Read (2010, see here) concluded that any benefits of ECT, when they arise, are minimal, short-lived and come with a significant risk of memory impairment and a slight risk of death. This conclusion was based on a review of studies over the last 60 years where the use of ECT for depression or schizophrenia was compared to a placebo control procedure. Bentall and Read’s final word is that the evidence is so poor that it’s use cannot be scientifically-justified.

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However, a word of caution is now being given about such therapy as a meta-analysis of over 12 years’ Canadian data suggests that the costs of such treatment might outweigh the benefits. The issue is that these treatments seem to be associated with a significant increase in mortality rate from 10.5% to 15.7%.  This is still a low risk of dying, but it does represent an increase if using the medication of about 36% compared to not using medication when other variables are factored in.  The data came from more than 14.000 adults between the ages of 18 and 102, and extraneous or confounding variables such as smoking, alcohol use, general health and physical activity were controlled for.

Why is there such an increased risk of dying when using these drug therapies? It is known that sleeping pills and anti-anxiety drugs all slow reaction times, alertness and coordination, so increased falls may be a partial factor. These drugs could also depress the respiratory system enough to cause or trigger breathing problems during sleep. And as these medications also inhibit some CNS function,  judgement may be affected, which could increase suicidal behaviours. CBT has been shown to have good results in treating people with insomnia and anxiety disorders, and this psychotherapy does not carry an increased risk of dying, so the research suggests that perhaps this could be combined with cautious use of drugs after discussion between doctor and patient.

Belleville, G. Mortality Hazard Associated With Anxiolytic and Hypnotic Drug Use in the National Population Health Survey. Canadian Journal of Psychiatry, 2010; 55 (9)

Now research suggests that many depressed people really do eat more chocolate. These findings came from both men and women who scored high on a psychometric depression scale but who were not receiving medication. There were no reported increases in other antioxident-rich foods, or other sources of caffeine, fat or sugar, between these depressed adults and non-depressed adults, just the increased chocolate consumption. What is not known is why the chocolate intake increased.

The evolutionary hypothesis explains our liking of chocolate as a combination of pleasures – the sweetness, the creamy texture in the mouth perhaps in some way reminiscent of breast milk – with the high energy-denseness of this food. But there is a complete lack of evidence that breast milk, even in mothers who do eat a lot of chocolate, has any chocolate flavour! So this does not explain why consumption of chocolate rather than any other sweet and creamy food increased in depressed people. Is it the pleasure which is the key factor? Or is it the cultural perception of chocolate as a reward food? Or is there another reason?