Is there a Link Between Adkins Diet and Clinical Depression?

Twice when I have done Atkins I see a huge change in my mental being. I get depressed. This usually starts around a month of doing Akins and basically lasted until I quit.

I talked to someone at The Akins Center and it was suggested I take vitamins especially B complex. I took the advice but saw no improvement. When I tried Atkins the 2nd time and added exercise to my plan the results were still the same, depression hit me like a ton on bricks. I do not take an antidepressant and will not take one. (which Dr. Atkins didn't like either).

P.S. I do want to mention I do not suffer from depression on a regular basis, it is when I low-carb that I get this way.




In one of our previous publications we provided an insight on the direct link between nutrition and depression. Here we will review the possible connection between Atkins Diet and Depression.



What is Atkins Diet?

Atkins style lower carbohydrate diet is one of the very popular diets that have helped people to lose weight. The most appealing aspect of the Atkins style lower carbohydrate diet, among other similar low carb diets, is that the foods you can eat are essentially the opposite of most other diets. With low carb diets, you eat a lot of protein and fats and very restricted carbohydrates.



The Atkins diet is a high protein and fat and very low-carbohydrate routine. It put emphasis on meat, cheese, and eggs, while recommending reduction in consumption of foods such as bread, pasta, fruit, and sugar. The key advantage of the diet is rapid and substantial weight loss.



By limiting carbohydrate intake, the body will burn more fat, stored in the body. Because there are no restrictions on the amount of calories or quantities of foods allowed on the diet, there is little hunger between meals. Uncontrollable hunger and food craving is the main cause of many dieting failures. It is in fact noted those who follow the Atkins style lower carbohydrate plan eventually find their effective individual range of carbohydrate intake, which is then considered as the tool that helps the dieters to maintain a healthy weight for the rest of their lives.



The primary reason that both men and women follow the Atkins style lower carbohydrate plan is to lose weight. With this principle, it is noted that many people who have followed the Atkins style lower carbohydrate procedure to weight loss readily take off inches and pounds.



The Atkins style lower carbohydrate plan has also worked for those people with strong metabolic resistance to weight loss. This diet provides many ways to surpass the barriers that obstruct a successful diet result. Those who have failed to lose weight with other diets, successfully do so with Atkins.



The Atkins style lower carbohydrate plan helps people to not only lose the weight, but to also keep it off. This fact makes the Atkins style lower carbohydrate nutritional approach more superior than other weight control programs.



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Does Atkins cause depression?

In spite of the certain effectiveness in losing weight, the low-carb Atkins diet has prompted criticism from many doctors who fear it could increase the risk of long-term health problems such as kidney damage, high cholesterol and diabetes. For example, the group of prominent nutritionists, supported by The Physicians Committee for Responsible Medicine, has urged the hospitals to ban the Atkins diet completely. 



Latest researches have now suggested Atkins Diet could also affect mental health, leaving dieters feeling grumpy, tired, irritable, apathetic and restless.



A study of 100 men and women found that dieters on a protein-rich regime are far more prone to mood swings and depression than those on high- carbohydrate, low-protein diets.



The reason? Carbohydrates produce higher levels of serotonin, the body's "happy hormone" which is released by the brain to stabilize mood swings. Carbohydrates raise serotonin levels naturally, acting as a natural tranquillizer and antidepressant.



The team from the Massachusetts Institute of Technology in the U.S. found that eating sweet and starchy carbohydrates, such as potatoes, pasta and bread, increases the brain's production of serotonin when eaten with very small amounts of protein.



Serotonin is also the chemical which makes us feel full after eating.



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'Emotional zombies'

Dr Judith Wurtmen, who led the study, concludes that dieters, who eat a lot of protein and fat, as recommended on the Atkins diet, are therefore in danger of becoming "emotional zombies".



Certain people, she says, are actually "carbohydrate cravers". They rely on carbohydrates to keep their moods steady, so cutting out this food group altogether is "like taking water away from someone hiking in the desert".



Dr Stuart Trager, chairman of The Atkins Physician Council, naturally disputes the claim that a low-carbohydrate diet can cause depression.



He says: "Mood and energy levels are related to many factors. Additionally, it is important to remember that serotonin is made within the body from ingested protein, rather than carbohydrates. Controlling carbohydrates helps people manage their weight, improve body image, and stabilizes blood sugar."



Protein lowers serotonin

But nutritionist Fiona Hunter says: "Although serotonin is made from the amino acid tryptophan which is found in protein-rich foods such as meat and cheese, eating a protein-rich meal actually lowers serotonin in the brain.



"This is because when you eat a protein-rich meal you flood the blood with other competing amino acids, as well as tryptophan, which all fight for entry into the brain. Only a small amount of tryptophan is able to get through, so serotonin levels do not rise greatly.



"In contrast, a carbohydrate-rich meal triggers the release of the hormone insulin which causes all amino acids, except tryptophan, to be absorbed into the cells. With the competition removed, tryptophan can freely enter the brain, causing serotonin levels to rise."



Dr Cecilia Tregear, who specializes in the effects that diet has on hormone levels, agrees: "In my experience people on the Atkins diet are prone to mood swings, anxiety and erratic behavior. Sugar is the main food for the brain and without it, the brain struggles.

"The thyroid gland needs to be activated by carbohydrates and without them it slows down, and a slow thyroid has been linked to depression.



"Overall, the Atkins diet is not a balanced diet, which will result in unbalanced hormones and therefore unbalanced moods."



Four years ago I went on the Atkins diet. It worked great; I lost over 60 pounds in about four months. I felt great and was on my way to being the best shape of my life.

However, as mentioned in the possible diet dangers it can affect the brain activity relying on carbohydrates, serotonin. In my case, I had a history of depression and with the Atkins diet after a couple months of the weight loss I went back into depression. So as mentioned be careful when thinking of going on this diet.



Summary

Based on the multiple sources, I have reviewed, there is hard to say, if the negative impact of Adkins Diet overweighs its positive results for the body weight loss.



However, the research materials and users feedback is sufficient to be extremely careful with using this diet in your nutrition program. The Atkins diet isn't for everyone. Some people need more carbohydrates than others. And many people don't need to go to the extreme of eating nothing but protein in order to lose weight.



If you notice any signs of depression, while on Atkins Diet, consult with your physician and therapist.



Sources and Additional Information:

When Hospitalization for Depression is Needed?

In cases of severe depression or treatment-resistant depression, some people need to stay in the hospital for a short time. You might check into the hospital yourself. Or you could be hospitalized under a doctor's order.



There is a powerful stigma associated with being hospitalized. Many people feel ashamed, as if it's a sign that they are "crazy." Some people fear that being hospitalized is the same thing as being institutionalized or sent to an asylum.



But that's not the case. Usually, a stay in the hospital is just a way for you to recover in a safe and stable environment. This allows you to take a break from some of the daily stresses that contributed to your depression. Your doctors can work with you to try different treatments and figure out which one is best.



Most people don't like being in the hospital. You may not like the routine, the food, or the other patients. It might be frightening. But look at it this way: Depression is an illness, as real and as serious as heart disease or cancer. And sometimes depression -- just like other serious diseases -- requires treatments that can only be provided in a hospital.



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Who Needs to Be Hospitalized for Depression?

Hospital admission can allow an extremely depressed individual to receive higher and more detailed care than if they were treated on an out-patient basis. It allows for doctors and other hospital staff to better assess a depressive condition and make important treatment recommendations.



There are many people with depression who might benefit from a hospital stay. Here are some examples.

  • People who are at risk of hurting themselves or others. Preventing suicide and violence is the most common reason for hospitalization. A stay in the hospital allows you to get back in control.

  • People who are unable to function. Hospitalization makes sense if you are so depressed that you can't take care of yourself.

  • People who need observation when trying a new medication. Sometimes, your doctor may be fine-tuning your depression medicine and may want you to check into the hospital. Since you will be under constant observation there, your doctor will be able to see more easily how well a treatment is working.

  • People who need treatments that are given only in a hospital. Some treatments, like electroconvulsive therapy (ECT) are usually given in the hospital. A stay in the hospital allows you to recover from anesthesia and gives your doctors a chance to see how you're doing after treatment.



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Relief From a Hospital Stay: Is It Possible?

Some people actually experience great relief from their time in a hospital and don't find it difficult to cope. Everyday challenges and worries involved in providing for home or career may be temporarily alleviated and a person might find they can better focus on getting well. For others, however, hospital treatment can be frightening and intimidating and the time away from regular support sources can be difficult.



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What Are Your Rights Regarding Hospitalization for Depression?

Many people with depression check themselves into the hospital because they feel unstable or suicidal. But others are hospitalized against their will. The laws concerning hospitalization for depression vary from state to state. Generally, you can only be hospitalized against your wishes if you are considered to be a risk to yourself or others.



During an emergency, a health care professional or police officer may require you to be evaluated by a hospital. Once there, a hospital doctor will talk to you and decide whether you actually need to be hospitalized.



Note that hospitalization of an individual suffering from the severe depression is deemed absolutely necessary when that person has attempted suicide or has serious suicidal ideation or plan for doing so. However, such suicidal intentions must be carefully and fully assessed during an initial meeting. The individual must be imminent danger of harming themselves (or another). Daily, routine daily functioning will likely be negatively affected by the presence of a clear and severe major depression. Most individuals who suffer from major depression, however, are usually only mildly suicidal and most also often lack the energy or will (at least initially) to carry out any suicidal plan.



Care must be taken with regards to any hospitalization procedure. When possible, the patient’s consent and full understanding would first be obtained and you as a client would be encouraged to check yourself in. Hospitalization is usually relatively short, until you state becomes fully stabilized and the therapeutic effects of an appropriate antidepressant medication can be realized (3 to 4 weeks). A partial hospitalization program might also be considered.



Suicidal ideation will be assessed during regular intervals throughout therapy (every week during the therapy session is not uncommon). Often, as the individual who suffers from a depressive disorder is beginning to feel the energizing effects of a medication, they will be at higher risk for acting on their suicidal thoughts. Care should be used at this time and hospitalization may need to be again considered.



The length of your stay is set by the staff. If the doctors no longer think that you are in danger, you will be released within two to seven days -- depending on the laws in your state. Keep in mind, if you disagree with the hospital's assessment, you can take legal action. Talk to your state's Protection and Advocacy agency.



When you're in the hospital, you may face some tough restrictions. Even if you check yourself in, you may not be able to leave as soon as you want. The hospital may strictly control visits from family and friends, and limit the items you can take in with you. You may be on a locked ward for at least some of your stay. You may also be expected to follow a certain schedule. While the restrictions can be hard to accept, keep in mind that they are in place for the safety of you and the other patients.



Some health insurance policies will cover hospitalization for a limited amount of time. Others won't cover it at all. Before a person can be hospitalized, some insurers require that he or she be evaluated by an expert under contract with their company. Very few insurers will cover a hospital stay for depression that isn't an emergency.



Keep in mind that most hospital stays for depression are brief and voluntary. The goal is for you to stay until your doctors are confident that you are safe and stable.



Sources and Additional Information:

Hamilton Rating Scale for Depression HDRS-17

Definition

The Hamilton Depression Scale (HDS or HAMD) is a test measuring the severity of depressive symptoms in individuals, often those who have already been diagnosed as having a depressive disorder. It is sometimes known as the Hamilton Rating Scale for Depression (HRSD) or the Hamilton Depression Rating Scale (HDRS).



Purpose

The HDS is used to assess the severity of depressive symptoms present in both children and adults. It is often used as an outcome measure of depression in evaluations of antidepressant psychotropic medications and is a standard measure of depression used in research of the effectiveness of depression therapies and treatments. It can be administered prior to the start of medication and then again during follow-up visits, so that medication dosage can be changed in part based on the patient's test score. The HDS often used as the standard against which other measures of depression are validated.





The HDS was developed by Max Hamilton in 1960 as a measure of depressive symptoms that could be used in conjunction with clinical interviews with depressed patients. It was later revised in 1967. Hamilton also designed the Hamilton Depression Inventory (HDI), a self-report measure consistent with his theoretical formulation of depression in the HDS, and the Hamilton Anxiety Scale (HAS), an interviewer-rated test measuring the severity of anxiety symptoms.



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Precautions

Some symptoms related to depression, such as self-esteem and self-deprecation, are not explicitly included in the HDS items. Also, because anxiety is specifically asked about on the HDS, it is not always possible to separate symptoms related to anxiety from symptoms related to depression.



Because the HDS is an interviewer-administered and rated measure, there is some subjectivity when it comes to interpretation and scoring. Interviewer bias can impact the results. For this reason, some people prefer self-report measures where scores are completely based on the interviewee's responses.



Description

Depending on the version used, there are either 17 or 21 items for which an interviewer provides ratings. Besides the interview with the depressed patient, other information can be utilized in formulating ratings, such as information gathered from family, friends, and patient records. Hamilton stressed that the interview process be easygoing and informal and that there are no specific questions that must be asked.



The 17-item version of the HDS is more commonly used than the 21-item version, which contains four additional items measuring symptoms related to depression, such as paranoia and obsession, rather than the severity of depressive symptoms themselves.





Examples of items for which interviewers must give ratings include overall depression, guilt, suicide, insomnia, problems related to work, psychomotor retardation, agitation, anxiety, gastrointestinal and other physical symptoms, loss of libido (sex drive), hypochondriasis, loss of insight, and loss of weight. For the overall rating of depression, for example, Hamilton believed one should look for feelings of hopelessness and gloominess, pessimism regarding the future, and a tendency to cry. For the rating of suicide, an interviewer should look for suicidal ideas and thoughts, as well as information regarding suicide attempts.



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Questionnaire HDRS-17 (17 Questions)

Answer the questions below as truly as you can. Record and summarize the obtained results for proper interpretation.

           

  1. Depressed mood

    Sad, hopeless, helpless, worthless

0 = Absent

1 = Gloomy attitude, pessimism, hopelessness

2 = Occasional weeping

3 = Frequent weeping

4 = Patient reports highlight these feelings states in his/her spontaneous verbal and

non-verbal communication.                                                                      



  1. Feelings of guilt

0 = Absent

1 = Self-reproach, feels he/she has let people down

2 = Ideas of guilt or rumination over past errors or sinful deeds

3 = Present illness is punishment

4 = Hears accusatory or denunciatory voices and/or experiences threatening visual

hallucinations. Delusions of guilt.                                                            



  1. Suicide

0 = Absent

1 = Feels life is not worth living

2 = Wishes he/she were dead, or any thoughts of possible death to self

3 = Suicide, ideas or half-hearted attempt

4 = Attempts at suicide (any serious attempt rates 4)                              



  1. Insomnia, early in the night

0 = No difficulty falling asleep

1 = Complaints of occasional difficulty in falling asleep i.e. more than half-hour

2 = Complaints of nightly difficulty falling asleep                                  



  1. Insomnia, middle of the night

0 = No difficulty

1 = Patient complains of being restless and disturbed during the night

2 = Walking during the night – any getting out of bed rates 2 (except voiding bladder)     



  1. Insomnia, early morning hours

0 = No difficulty

1 = Waking in the early hours of the morning but goes back to sleep

2 = Unable to fall asleep again if he/she gets out of bed                         



  1. Work and activities

0 = No difficulty

1 = Thoughts and feelings of incapacity related to activities: work or hobbies

2 = Loss of interest in activity – hobbies or work – either directly reported by patient or

indirectly seen in listlessness, in decisions and vacillation (feels he/she has to push

self to work or activities)

3 = Decrease in actual time spent in activities or decrease in productivity. In hospital,

rate 3 if patient does not spend at leas three hours a day in activities

4 = Stopped working because of present illness. In hospital rate 4 if patient engages

in no activities except supervised ward chores                                        



  1. Retardation 

    Slowness of thought and speech; impaired ability to concentrate; decreased motor activity

0 = Normal speech and thought

1 = Slight retardation at interview

2 = Obvious retardation at interview

3 = Interview difficult

4 = Interview impossible                                                                          



  1. Agitation

0 = None

1 = Fidgetiness

2 = Playing with hands, hair, obvious restlessness

3 = Moving about; can’t sit still

4 = Hand wringing, nail biting, hair pulling, biting of lips, patient is on the run       



  1. Anxiety, psychic

    Demonstrated by:

  • subjective tension and irritability, loss of concentration

  • worrying about minor matters

  • apprehension

  • fears expressed without questioning

  • feelings of panic

  • feeling jumpy

0 = Absent

1 = Mild

2 = Moderate

3 = Severe

4 = Incapacitating                                                                                     



  1. Anxiety, somatic

    Physiological concomitants of anxiety such as:

  • gastrointestinal: dry mouth, wind, indigestion, diarrhea, cramps, belching

  • cardiovascular: palpations, headaches

  • respiratory: hyperventilation, sighing

  • urinary frequency

  • sweating

  • giddiness, blurred vision

  • tinnitus

0 = Absent

1 = Mild

2 = Moderate

3 = Severe

4 = Incapacitating



  1. Somatic symptoms: gastro-intestinal

0 = None

1 = Loss of appetite but eating without staff encouragement. Heavy feelings in abdomen.

2 = Difficulty eating without staff urging. Requests or requires laxatives or medication for bowels or medication for gastro-intestinal symptoms.



  1. Somatic symptoms: general

0 = None

1 = Heaviness in limbs, back or head; backaches, headaches, muscle aches, loss of energy, fatigability

2 = Any clear-cut symptom rates 2                                                          



  1. General Symptoms

    Symptoms such as: loss of libido, menstrual disturbances

0 = Absent

1 = Mild

2 = Severe                                                                                                 



  1. Hypochondriasis

0 = Not present

1 = Self-absorption (bodily)

2 = Preoccupation with health

3 = Strong conviction of some bodily illness

4 = Hypochondrial delusions                                                                   



  1. Loss of Weight

    Rate either ‘A’ or ‘B’:

A When rating by history:

0 = No weight loss

1 = Probable weight loss associated with present illness

2 = Definite (according to patient) weight loss

B Actual weight changes (weekly):

0 = Less than 1 lb (0.5 kg) weigh loss in one week

1 = 1-2 lb (0.5 kg-1.0 kg) weight loss in week

2 = Greater than 2 lb (1 kg) weight loss in week

3 = Not assessed                                                                                       



  1. Insight

0 = Acknowledges being depressed and ill

1 = Acknowledges illness but attributes cause to bad food, overwork, virus, need for rest, etc.

2 = Denies being ill at all                                                                          



Scoring and Results

In the 17-item version, nine of the items are scored on a five-point scale, ranging from zero to four. A score of zero represents an absence of the depressive symptom being measured, a score of one indicates doubt concerning the presence of the symptom, a score of two indicates mild symptoms, a score of three indicates moderate symptoms, and a score of four represents the presence of severe symptoms. The remaining eight items are scored on a three-point scale, from zero to two, with zero representing absence of symptom, one indicating doubt that the symptom is present, and two representing clear presence of symptoms.



For the 17-item version, scores can range from 0 to 54. One formulation suggests that scores between 0 and 6 indicate a normal person with regard to depression, scores between 7 and 17 indicate mild depression, scores between 18 and 24 indicate moderate depression, and scores over 24 indicate severe depression.



There has been evidence to support the reliability and validity of the HDS. The scale correlates highly with other clinician-rated and self-report measures of depression.



Sources and Additional Information:

Miller Self-Evaluation Depression Test

Larry R. Miller is neither researcher, nor clinical therapist. He is a freelance writer, photographer and webmaster. I would like to offer your attention the self-evaluation depression test, developed by him. While it does not have world-wide recognition of the psychotherapists’ community, it might still be useful to you for the enemy identification purposes.



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As you understand, the following is a self screening test only and should not be used in place of professional help.



Test Instructions



Read and evaluate each question carefully before scoring. Each of the 20 questions has 4 answering options. Think about the option that fits the best. Be honest with yourselves. Use the numbers to score each question, guided by the following criteria:



0: You very rarely or never feel as described
1: You occasionally feel as described

2: You have the feeling twice a month or more

3: You feel as described most of the time or constantly.




Self-Evaluation Questions
           
A: I have problems making decisions (0 1 2 3).

B: I’m always tired (0 1 2 3).

C: Nothing, including my favorite pastimes, really excites me anymore (0 1 2 3).

D: If something goes wrong I feel it’s my fault (0 1 2 3).

E: Sex doesn’t interest me (0 1 2 3).

F: I’m unhappy with the way I look (0 1 2 3).

G: I’m not happy with where life is taking me ands I see no change in my future (0 1 2 3).

H: I have trouble going to sleep (0 1 2 3).
I: I think about committing suicide (0 1 2 3).
J: I worry about everything, including things out of my control (0 1 2 3).

K: I only stay at my present job because I have bills and no other income (0 1 2 3).

L: I cry for no apparent reason (0 1 2 3).

M: My day to day life gives me no satisfaction (0 1 2 3).

N: Compared to others, I feel I’m a failure (0 1 2 3).

O: I know my physical appearance is getting worse (0 1 2 3).

P: I always feel mentally exhausted (0 1 2 3).

Q: I never feel really happy (0 1 2 3).

R: I’m sensitive to criticism and have a hard time letting it go (0 1 2 3).

S: I’m irritable with others, including family and friends, for no reason (0 1 2 3).

T: I prefer not to be around other people (0 1 2 3).



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Test Scoring
Add up your score and refer to the following chart.
20-29 – No signs of depression, or possible mild depression.

30-40 - Suggests moderate depression. A consultation with your health care provider would be in order to discuss possible causes.

40 and over - Indicates definite need for professional help and guidance.

Zung Self-Rating Depression Scale

Background
Zung’s model for depression, the Zung Self-Rating Depression scale, measures psychological and somatic symptoms linked to depression.  In addition, the scale can be used as a screening tool, monitor for changes, and clinical research purposes.

   
The questionnaire includes 20-items testing four common characteristic of depression – the pervasive effect, the physiological equivalents, other disturbances, and psychomotor activities. Respondents are given a 4-point scale to react to positive or negative statements. Approximately 10 minutes is required to complete the test.



Author
: Dr. William W.K. Zung




Structure
  1. Twenty question survey completed by patient

  2. Likert Scale Format

  3. Asks half of questions positively and half negatively


    1. Negative Example: "I notice that I am losing weight"

    2. Positive Example: "I eat as much as I used to"


  4. Answers scored on 1 to 4 scale


    1. Minimal: None or a little of the time

    2. Severe: Most or all of the time

Please read each statement and decide how much of the time the statement describes how you’ve been feeling during the past 2 weeks. Respond to all statements.
  1. I fell down-hearted and blue.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. Morning is when I feel the best.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. I have crying spells or feel like it.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. I have trouble sleeping at night.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. I eat as much as I used to.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. I still enjoy sex.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. I notice that I am losing weight.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. I have trouble with constipation.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. My heart beats faster than usual.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. I get tired for no reason.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. My mind is as clear as it used to be.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. I find it easy to do the things I used to.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. I am restless and can't keep still.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. I feel hopeful about the future.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. I am more irritable than usual.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. I find it easy to make decisions.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. I feel that I am useful and needed.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. My life is pretty full.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

  1. I feel that others would be better off if I were dead.


    • A little of the time (1)

    • Some of the time (2)

    • Good part of the time (3)

    • Most of the time (4)

  1. I still enjoy the things I used to do.


    • A little of the time (4)

    • Some of the time (3)

    • Good part of the time (2)

    • Most of the time (1)

Scores Interpretation
Scores on the test range from 25 through 100. The scores fall into four ranges:
  • Score <50: Normal

  • Score <60: Mild depression

  • Score <70: Moderate or Marked Major Depression

  • Score >70: Severe or Extreme Major Depression









Sources and Additional Information:

Geriatric Depression Scale - Self-report Assessment for Elderly

The Geriatric Depression Scale (GDS) is a 30-item self-report assessment designed specifically to identify depression in the elderly. The items may be answered yes or no, which is thought to be simpler than scales that use a five-category response set. It is generally recommended as a routine part of a comprehensive geriatric assessment. One point is assigned to each answer and corresponds to a scoring grid. A score of 10 or 11 or lower is the usual threshold to separate depressed from non-depressed patients. However, a diagnosis of clinical depression should not be made on the GDS results alone. Although the test has well-established reliability and validity, responses should be considered in conjunction with other results from a comprehensive diagnostic work-up. A short version of the GDS containing 15 questions has been developed. The GDS is also available in a number of languages other than English.



Purpose
Depression is widespread among elderly persons, affecting one in six patients treated in general medical practice and an even higher percentage of those in hospitals and nursing homes. Older people have the highest suicide rate of any group, and many medical problems common to older people may be related to, or intensified by, a depressive disorder. Recognition of the prevalence of depression among older people prompted the development of the geriatric depression scale in 1982-83. Yes/no responses are thought to be more easily used than the graduated responses found on other standard assessment scales such as the Beck Depression Inventory, the Hamilton rating scale for depression, or the Zung self-rating depression scale.
While it is not found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR ) produced by the American Psychiatric Association, the GDS is widely recommended for clinical use and is included as a routine part of a comprehensive geriatric assessment. It is also increasingly being used in research on depression in the elderly.



Precautions
Depression scales are either interviewer-administered or by self-report means. The GDS is a self-report assessment developed in 1982 by J. A. Yesavitch and colleagues. A self-report assessment is easier and quicker to administer, though an interviewer-administered test is generally more sensitive and specific—another reason for using more than one tool to obtain an accurate diagnosis.



There is some controversy over whether the GDS is reliable for depression screening in individuals with mild or moderate dementia. Several studies have shown good agreement with observer ratings of depression, whether or not the patient had dementia. However, persons with dementia may deny symptoms of depression. It also appears that less educated people are more likely to score in the depressed range on the GDS 15-item short form. These caveats notwithstanding, the GDS can be usefully applied in general medical settings in combination with other clinical assessments, observation, and interviews with elder patient and their families.



Both symptom pattern and symptom severity must be considered when trying to identify depression. These dimensions are taken into account in the development of symptom scales and, while clinical judgment takes priority, a scale such as the GDS can help in identifying persons with depression, whether they are making satisfactory progress with treatment, or when they may need further assessment or referral.



Description
Yesavitch and his coworkers chose 100 statements that they determined were related to seven common characteristics of depression in later life. These included:
  • somatic concern

  • lowered affect (affect is the outward expression of emotion)

  • cognitive impairment

  • feelings of discrimination

  • impaired motivation

  • lack of future orientation

  • lack of self-esteem

The best 30 items were selected after administration of the 100 items to 46 depressed and normal elders. Those items were then administered to 20 elders without depression and 51 who were in treatment for depression. The test was 84% sensitive and 95% specific for a depression diagnosis. Repeated studies have demonstrated the value of GDS.



Long Mood Assessment Scale
1. Are you basically satisfied with your life?
2. Have you dropped many of your activities and interests?
3. Do you feel that your life is empty?
4. Do you often get bored?
5. Are you hopeful about the future?
6. Are you bothered by thoughts you can t get out of your head?
7. Are you in good spirits most of the time?
8. Are you afraid that something bad is going to happen to you?
9. Do you feel happy most of the time?
10. Do you often feel helpless?
11. Do you often get restless and fidgety?
12. Do you prefer to stay at home, rather than going out and doing new things?
13. Do you frequently worry about the future?
14. Do you feel you have more problems with memory than most?
15 Do you think it is wonderful to be alive now?
16 Do you often feel downhearted and blue?
17 Do you feel pretty worthless the way you are now?
18 Do you worry a lot about the past?
19 Do you find life very exciting?
20 Is it hard for you to get started on new projects?
21 Do you feel full of energy?
22 Do you feel that your situation is hopeless?
23 Do you think that most people are better off than you are?
24 Do you frequently get upset over little things?
25 Do you frequently feel like crying?
26 Do you have trouble concentrating?
27 Do you enjoy getting up in the morning?
28 Do you prefer to avoid social gatherings?
29 Is it easy for you to make decisions?
30 Is your mind as clear as it used to be?



Scoring
A scoring grid accompanies the GDS. One point is given for each respondent's answer that matches those on the grid. For example, the grid response to "Are you basically satisfied with your life?" is "no." If the elderly person responds in the negative one point is scored; if the response is "yes," then no point is scored.



1. no 6. yes 11. yes 16. yes 21. no 26. yes
2. yes 7. no 12. yes 17. yes 22. yes 27. no
3. yes 8. yes 13. yes 18. yes 23. yes 28. yes
4. yes 9. no 14. yes 19. no 24. yes 29. no
5. no 10. yes 15. no 20. yes 25. yes 30. no







Results
For the 30-item assessment, a score of 0–9 is considered normal; 10–19 indicates mild depression, and a score over 20 is suggestive of severe depression. The maximum number of points that can be scored is 30.



Short Mood Assessment Scale
1. Are you basically satisfied with your life?
2. Have you dropped many of your activities and interests?
3. Do you feel that your life is empty?
4. Do you often get bored?
5. Are you in good spirits most of the time?
6. Are you afraid that something bad is going to happen to you?
7. Do you feel happy most of the time?
8. Do you often feel helpless?
9. Do you prefer to stay at home, rather than going out and doing new things?
10. Do you feel you have more problems with memory than most?
11 Do you think it is wonderful to be alive now?
12 Do you feel pretty worthless the way you are now?
13 Do you feel full of energy?
14 Do you feel that your situation is hopeless?
15 Do you think that most people are better off than you are?



Scoring
1. no   6. yes   11. no
2. yes  7. no    12. yes
3. yes  8. yes   13. no
4. yes  9. yes   14. yes
5. no   10. yes  15. yes



Results
For the 15-item assessment, a score of 0–4 is considered normal; 5-8 indicates mild depression, 8-11 indicates moderate depression, and a score over 12 is suggestive of severe depression. The maximum number of points that can be scored is 15.



Sources and Additional Information:

Screening for Depression through Beck Depression Inventory

The Beck Depression Inventory (BDI) is a series of questions developed to measure the intensity, severity, and depth of depression in patients with psychiatric diagnoses. Its long form is composed of 21 questions, each designed to assess a specific symptom common among people with depression. A shorter form is composed of seven questions and is designed for administration by primary care providers. Aaron T. Beck, a pioneer in cognitive therapy, first designed the BDI.

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Development and history
Historically, depression was described in psychodynamic terms as "inverted hostility against the self". By contrast, the BDI was developed in a novel way for its time; by collating patients' verbatim descriptions of their symptoms and using these to structure a scale which could reflect the intensity or severity of a given symptom.



Throughout his work, Beck drew attention to the importance of "negative cognitions": sustained, inaccurate, and often intrusive negative thoughts about the self. In his view, it was the case that these cognitions caused depression, rather than being generated by depression.



Beck developed a triad of negative cognitions about the world, the future, and the self, which play a major role in depression. An example of the triad in action taken from Brown (1995) is the case of a student obtaining poor exam results:
  • The student has negative thoughts about the world, so he may come to believe he does not enjoy the class.

  • The student has negative thoughts about his future, because he thinks he may not pass the class.

  • The student has negative thoughts about his self, as he may feel he does not deserve to be in college.

The development of the BDI reflects that in its structure, with items such as "I have lost all of my interest in other people" to reflect the world, "I feel discouraged about the future" to reflect the future, and "I blame myself for everything bad that happens" to reflect the self. The view of depression as sustained by intrusive negative cognitions has had particular application incognitive behavioral therapy (CBT), which aims to challenge and neutralize them through techniques such as cognitive restructuring.
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BDI Purpose: Designed to determine presence and severity of symptoms of depression.



Population: Adolescents and adults.



Score: Produces single score indicating intensity of the depressive symptoms.



Time:  5-10 minutes, longer for patients with severe depression or obsession disorders.



Author: Aaron T. Beck, Robert A. Steer, and Gregory K. Brown.



Description: The Beck Depression Inventory Second Edition (BDI-II) is a 21-item self-report instrument intended to assess the existence and severity of symptoms of depression as listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV; 1994).  This new revised edition replaces the BDI and the BDI-1A, and includes items intending to index symptoms of severe depression, which would require hospitalization. Items have been changed to indicate increases or decreases in sleep and appetite, items labeled body image, work difficulty, weight loss, and somatic preoccupation were replaced with items labeled agitation, concentration difficulty and loss of energy, and many statements were reworded resulting in a substantial revision of the original BDI and BDI-1A. When presented with the BDI-II, a patient is asked to consider each statement as it relates to the way they have felt for the past two weeks, to more accurately correspond to the DSM-IV criteria.
    Suggested use:  The BDI-II is intended to assess the severity of depression in psychiatrically diagnosed adults and adolescents 13 years of age and older.  It is not meant to serve as an instrument of diagnosis, but rather to identify the presence and severity of symptoms consistent with the criteria of the DSM-IV.  The authors warn against the use of this instrument as a sole diagnostic measure, as depressive symptoms may be part of other primary diagnostic disorders.



    Sources and Additional Information:
    http://www.minddisorders.com/A-Br/Beck-Depression-Inventory.html

    Repetitive Transcranial Magnetic Stimulation for Depression Treatment

    What is Transcranial Magnetic Stimulation?

    Transcranial Magnetic Stimulation (TMS) is a non-invasive technique that uses a powerful electro-magnet placed on the scalp of a person to alter brain activity. Originally developed as a diagnostic tool for mapping brain function, TMS appears promising as a treatment for a variety of complex neuropsychiatric conditions, particularly major depression.



    TMS induces an electromagnetic current in the underlying cortical neurons, which may explain its therapeutic effects. Repetitive TMS, using varying frequencies and intensities, can increase or decrease excitability in the cortical area directly targeted by the stimulation. Recent studies combining TMS and neuroimaging techniques, such as magnetic resonance imaging, demonstrate that the effects of TMS are not limited to the cortex but spread to functionally related subcortical structures. This finding provides a basis for using TMS to treat the pathologic neural activity that may underlie neuropsychiatric illness.



    Repetitive transcranial magnetic stimulation, known as rTMS, can produce longer lasting changes for treatment of various neurological conditions (e.g. migraine, stroke, Parkinson's disease, dystonia, tinnitus) and psychiatric conditions (e.g. major depression, auditory hallucinations).












    Clinicians and physicians are excited about the therapeutic applications of repetitive transcranial magnetic stimulation (r TMS) because it is non-invasive, unlike other implanted devices such as the Vagus Nerve Stimulation (VNS) System, and does not have the pain and potentially devastating side effects of Electroconvulsive Therapy (ECT or "shock therapy").



    Effects on the Brain
    The exact details of how TMS functions are still being explored. The effects of TMS can be divided into two types depending on the mode of stimulation:
    • Single or paired pulse TMS. The pulse(s) causes neurons in the neocortex under the site of stimulation to depolarise and discharge an action potential. If used in the primary motor cortex, it produces muscle activity referred to as a motor-evoked potential (MEP) which can be recorded on electromyography (EMG). If used on the occipital cortex, 'phosphenes' (flashes of light) might be detected by the subject. In most other areas of the cortex, the participant does not consciously experience any effect, but his or her behavior may be slightly altered (e.g. slower reaction time on a cognitive task), or changes in brain activity may be detected using Positron Emission Tomography or fMRI. Effects resulting from single or paired pulses do not outlast the period of stimulation. A review of TMS can be found in the Handbook of Transcranial Magnetic Stimulation.

    • Repetitive TMS (rTMS) produces effects which last longer than the period of stimulation. rTMS can increase or decrease the excitability of corticospinal or corticocortical pathways depending on the intensity of stimulation, coil orientation and frequency of stimulation. The mechanism of these effects is not clear although it is widely believed to reflect changes in synaptic efficacy akin to long-term potentiation (LTP) and long-term depression (LTD).

    Risks
    Single pulse TMS is regarded as safe although seizures following single pulse TMS stimulation have been reported in some patients with stroke or other disorders involving the central nervous system. Seizures from single or paired pulse TMS are rare, especially in patients without pre-existing conditions that affect the central nervous system such as epilepsy. rTMS has been reported to cause seizures in normal individuals at certain combinations of stimulation frequency and intensity. Guidlines have since been instituted regarding the maximum safe frequency and intensity combinations of rTMS.



    Common adverse effects of TMS are:
    • Discomfort or pain from the stimulation of the scalp and associated nerves and muscles on the overlying skin. Discomfort is rarely a problem for single pulse TMS but some people may find rTMS quite uncomfortable.

    • Rapid deformation of the TMS coil produces a loud clicking sound which scales with stimulator intensity. The sound has been characterized as deceptively mild sounding and has the potential to affect hearing, given sufficient exposure (particularly relevant for rTMS). Hearing protection may be offered to prevent this.

    • rTMS in the presence of EEG electrodes can result in electrode heating and, in severe cases, skin burns.





    FDA approval
    In January 2007 FDA advisory panel said clinical trials failed to establish that the device was clinically effective. Although TMS-treated patients were twice as likely as sham-treated patients to show clinical benefit, some panel members said this effect was "small," "borderline," "marginal," and "of questionable clinical significance."



    However, two years later, in October 8, 2008, a TMS device, NeuroStar, manufactured by Neuronetics Inc. has been approved for use by the Food and Drug Administration (FDA) in the United States for use in adult patients with major depression who have previously tried medication and not improved satisfactorily.



    Most TMS use is currently done off label or under research protocols approved by hospital ethics boards and, in the US, often under Investigational Device Exemption from the U.S. Food and Drug Administration (FDA). The requirement for FDA approval for research use of TMS is determined by the degree of risk as assessed by the investigators, the FDA, and the local ethics authority.



    Main Differences between ECT and TMS
    • ECT, also known as electroshock therapy, uses an electric shock to induce seizure. TMS uses a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness.

    • ECT is extremely effective in treating severe depression. TMS is not so powerful. It is used to treat milder depression, and it works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments.

    • TMS is much safer than ECT. Unlike ECT, TMS does not require sedation and is administered on an outpatient basis.

    Treatment
    Patients undergoing TMS must be treated four or five times a week for four weeks.



    Because your psychiatrist needs to determine how to most effectively administer treatment, your first session could last up to an hour and a half. You will be provided and asked to wear protective earplugs, as the system emits a tapping sound during operation.



    Your psychiatrist will first perform a test to identify your motor threshold. The motor threshold is the amount of magnetic field strength that results in a movement of your right thumb. This test is important because it identifies the magnetic field strength that will be used in your treatment. This field strength is customized for each patient to deliver the correct treatment dose.



    After this initial procedure, the doctor will determine the place on the head where the TMS treatment will be applied and the treatment coil will be moved to that location. This will allow you to receive optimal treatment.



    The physician will then administer TMS Therapy over a 40-minute period. In 30-second intervals, the device will deliver rapid “pulses” of the magnetic fields. These will feel like tapping on your scalp. Some patients may find this tapping uncomfortable. Your physician may be able to make adjustments to reduce this discomfort.




    Conclusion
    The efficiency of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression has been assessed in a number of acute treatment trials during the last 10 years. Little is known about the long-term impact of the treatment on the disorder and its effectiveness when applied for repeated relapses of depression over time. The majority of patients achieved a significant improvement in each treatment course with significant improvements achieved in patients treated with both low-frequency right-sided rTMS and high-frequency left-sided rTMS. While some of the trials produce controversial results, the widely accepted approach suggests that rTMS may have value in the treatment of episodes of depressive relapse with little reduction in efficacy over time.





    Sources and Additional Information:
     
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