Tuesday, December 14, 2010

Social Support and Major Depression

Low social support has long been considered a risk factor for depression.
However, it is also possible that connections go in the other direction: episodes of depression may lead to an erosion of social support.
This is potentially an interesting question because problems in the area of social support may be a kind of psychological "scar" left behind after and episode, and which may in turn increase the risk of occurrence of another episode.

We recently sought to examine this issue using the National Population Health Survey in Canada. We confirmed that deficient social support was strongly associated with the risk of developing major depression. In the other direction, though, only one type of social support (the form that involves expression of emotion with a trusted person - affective social support) was adversely affected by depression. Other types of social support (people being around to give advice or offer help) are easier to address in clinical settings - but this change may be an important part of the challenges of bouncing back from depression.

A link to the full report can be found here.

Wednesday, October 20, 2010

Post from another blog

This is a posting from another blog.
Can't vouch for the accuracy of this information - but it is an interesting list to look at.

"I thought perhaps you would be interested in sharing the article with your readers? If so, you can find the article here: ( Or, you can just go straight to our homepage and find it there."

Saturday, September 4, 2010

Trends in Antidepressant Use in Canada

Depression is a common health issue, so it is not surprising that a fairly large proportion (between 5 and 6%) of the Canadian population are taking antidepressants. However, not all depressive episodes require antidepressant treatment. Some such episodes resolve on their own and some can be treated by psychotherapy, so it is not surprising that a sizable proportion of those with depression do not take antidepressants. The frequency of use of antidepressants increased a lot in the 1990s, but this increase has slowed (at least in adults) in recent years. In a recent study, we found an interesting trend: that most people taking antidepressants do not report past-year episodes and that this is the category in which the frequency of use is increasing the most. This probably means that those with severe episodes or highly recurrent episodes are taking these medications over the longer term in order to prevent relapse. If this is true, it is a positive indication of appropriate treatment. Of course, it is also possible that some people may be taking these medications for reasons other than for depression (e.g. to prevent migraines or for chronic pain), which could also explain this trend.

Monday, August 9, 2010

Occupation and Depression

I received this link from another blog site concerned with depression.
It has a top 10 list of professions/occupations purported to be associated with depression.
There are no sources listed, so I can't vouch for its accuracy - can't tell, either, whether is meant by "highest risk." Usually, "risk" means incidence (the possibility that someone who is not depressed will become depressed), but the term is often used informally to denote prevalence (the frequency of occurrence at a point in time in a specified group).

Wednesday, July 21, 2010

Incidence of Major Depression

Prevalence is the proportion of people in a population who have a condition, whereas incidence is the frequency or rate at which people "at risk" (non-depressed) become depressed over time. Recently, Jian Li Wang (a psychiatric epidemiologist at the University of Calgary) has examined the incidence of major depression in Canada. His analysis confirms that the condition is very common - over a six year period, nearly 6% of the population developed a new episode of major depression. The incidence was higher in women and in younger age groups, but the strongest risk factor was having a family history of major depression.

A link to the abstract is here.

Wednesday, May 19, 2010

Changes to DSM-5

The Diagnostic and Statistical Manual of Mental Disorders has probably been the most widely used classification in clinical practice since the publication of DSM-III in 1980. The manual is now in its fourth edition (DSM-IV-TR) and work is underway to create the next edition, DSM-V. A major change is proposed to the diagnosis of Major Depressive Disorder. According to the current criteria, the occurrence of one or more major depressive episodes (MDE) is the main feature of Major Depressive Disorder, and one of the exclusion criteria for MDE is bereavement. In other words, the diagnosis should not be made if the syndrome follows the death of a loved one - unless the symptoms are too extreme or too persistent to represent bereavement. The proposal for DSM-V involves removing this bereavement criterion. This proposal, if it is accepted, has the advantage of making the criteria more free from judgment - ie. more purely empirical, which may increase their utility for research. However, it also represents a broadening of the diagnostic criteria. This will mean that episodes previously regarded as grief-reactions will now qualify for a diagnosis of a mood disorder. Whether such episodes should be treated 'as if' they were the same as other mood disorders is a different question - one suspects that they should not be. An argument has been put forward that in some respects the exclusion for bereavement is arbitrary - other losses (employment, relationship, health-related) are not treated as exclusions in DSM. On the other hand, depressive symptoms following losses may represent an adaptive response of some type - and certainly it seems to be a 'natural' response to many people. A general principle seems to hold true: that as diagnostic categories widen they become more heterogeneous which probably means that the clinical response to them should be more flexible.

Thursday, March 18, 2010

Depression's "upside"

Occasionally, the comment is made that depression may have a "upside." Depression in its clinical forms is usually destructive, sometimes disabling and dangerous, but in other of its manifestations it may be adaptive (e.g. bereavement). An interesting article has emerged on this topic, here is the link. This is actually a follow-up comment on the NY Times article cited below.

Monday, March 1, 2010

Does Depression have an Upside?

A so called "teleological" problem concerning depression asks the question "why does it exist." Various authors have long postulated that depression, at least in its milder forms must serve some purpose. In DSM-IV there is diagnostic exclusion criterion for bereavement, recognizing that in circumstances of loss depression is not necessarily "abnormal." Darwin made some interesting observations on this point in relation to his own struggle with health. These are summarized in a recent NY Times article, available here.

Saturday, January 9, 2010

The Bipolar Spectrum

Over the past decade there has been an effort on the part of some psychiatric researchers to expand the boundaries of bipolar disorder. The most recent salvo is a paper published in the Archives of General Psychiatry in December. The title is: Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity. The study uses data from a longitudinal psychiatric epidemiological study conducted in Germany. About half of people diagnosed at a baseline interview with major depressive disorder had "subthreshold bipolarity" meaning that they had some symptoms of hypomania (a milder disturbance than the manic episodes seen in Bipolar disorders). This subset was found to more often have a family history of bipolar disorder (5.9% vs. 1.9%) and more often converted to bipolar disorder (7.2% vs. 1.7%), among other differences. Based on this, the authors imply that people with major depressive disorder should be more carefully screened for subthreshold bipolarity so that they can be receive more "adequate treatment." They do not emphasize the reality that more than 90% of this subthreshold group did not have a family history of bipolar disorder and did not convert to a bipolar disorder. These recommendations are, in my view, somewhat reckless. In the absence of evidence from randomized controlled trials that treating people with subthreshold bipolar symptoms as if they had a bipolar disorder leads to better outcomes that treating them as if they had a major depressive disorder. This is a strange deviation from accepted principles of evidence-based medicine and surprising to see in the world's most highly ranked psychiatry journal.