How to consult with your iPhone if you have depression?

This year, Ezvid Inc. has released the "Do I Have Depression?" application. This application is
a psychological questionnaire and basic analysis system for non-medical use
only. "Do I Have Depression?" addresses concerns many people may have
of themselves and their friends and loved ones. The app will help to
distinguish if the medical condition can be determined as clinical depression,
or it can be considered as normal mood fluctuations.

Please be sure not to perceive this application as
replacement for professional care. It is definitely NOT. If you feel that your
personal, or your loved one medical condition is somehow out of the ordinary,
please consult with professional therapist. And this app might just help you to
make up your mind and turn to the doctor for psychological assistance.

The application asks the user a set of 34 questions based on
a rubric developed by clinical professionals, on topics ranging from sleep
disturbance, mood destabilization and interpersonal relationships, to eating
habits, work productivity, and more.

The questions are the same as those commonly found on
accepted psychological questionnaires based on research and used by mental
health professionals. As the website suggests, it can be useful to take the
test once a week for a while to establish consistency, but it’s worth repeating
that if you believe you are suffering from depression, it’s best to walk away
from this app and seek help from professional resources.

You cannot imagine of how many people suffer symptoms of depression, but yet
they are often unaware of the implications of their symptoms. Sometimes, the
cultural, gender, or religious considerations prevent them from accepting that,
and consequently, the medical treatment comes too late to make the substantial
improvement to the health and wellbeing. Years and years are lost in blues,
while the normal life is passing by.

Usage of this application on a sustained basis for at least 6 weeks, when
paired with proper note-taking, will shed light on self-diagnosed feelings of
sadness, sorrow, worry, guilt, and hopelessness. This is a comprehensive
self-test application, however it is not a medical device, so do not rely
solely on the outcomes for making decision to seek medical assistance.

Device Requirements:

* Compatible with iPhone, iPod touch, and iPad

* Requires iOS 3.0 or later

* Available for $.99 from the iTunes
Store.

Sources and Additional
Information:

http://prmac.com/release-id-31297.htm

http://www.chipchick.com/2011/09/depression-iphone.html

Should you Disclose your Depression on Job Application?

Why would they hire me, if there were someone else out there with the same educational credentials and with no history of illness? The stigma is crazy. I guess because mental illness, in general, affects work performance badly, affects decision making, affects people mind (and body as well). I guess I fear disclosing that I'm mentally ill, because people wouldn't trust me or WORSE...start fearing me. People tend to stay away from things they don’t understand or don’t want to understand, or perhaps have no time to understand (From Healthboards Message Board).

Overview

Every employer is looking for the most appropriate employee, matching to the announced position requirements. The logic of job selection involves elimination of candidates until only one candidate remains, but the expectation is that this inevitably discriminatory process should be fair. Among people with a disability and professional rehabilitation counselors there is a widespread conviction that this is not the case for jobseekers with a medical history of depression. There can be no doubt that people with depression or any other disability may experience vocational discrimination. The reasons for this are multiple, interactive and complex but a major contributing factor for this exclusion has to do with employers whose negative attitudes are kept in place by myths regarding people with a depression as workers and a desire to avoid 'risky hires'. In some cases, the worst employer nightmare can be even true, if the hired employee will experience a major depressive episode, which is going to negatively affect the performance.

Job Application: Disclose or Not Disclose?

First of all, unlike insurance policies where the applicant has a positive obligation to disclose information about the medical conditions, prospective employees do not have to provide information about themselves. If prospective employees choose to provide information they should ensure the information is true and not misleading.

Yes, as a general rule, you employer does not have any rights, as such, to request information from a prospective employee about medical condition, but honestly, if the candidate wants the job, it would be wise in certain cases to supply the required information as long as it is a reasonable and lawful request. Note that employer may find multiple legal excuses why you are not the best candidate for the position, while the real reason is the fact that you have depression. You will not be able to claim unfair business practices after all, since you will no real facts to prove your conditions was the roadblock for hiring.

If you decided to disclose your medical conditions, in any case, there is no need to give a full disclosure of your past medical records/history. You may disclose just your recent medical history/records relating the period of sickness in question. Past medical records are not relevant, and not required.



While it is well known that almost everyone has/will suffer some form of depression in their lives, and theoretically the fact of disclosure should not affect your chances of being hired, the real life is different.

A different story is when your medical condition requires special accommodations. To enable an employer to make reasonable adjustments for a candidate with severe depression, the employer should be honestly informed in details, what the conditions are and what is needed to make it work.

Note that If the position requires the employee to meet certain medical requirements then the employer could ask the employee to complete an additional health questionnaire and make this and the successful medical assessment a condition of employment.

Also, for some positions, the particular medical conditions are not posted on the job description, but they are quite understandable. Some medications might jeopardize the performance, and the warning to operate machinery, to drive, etc. can be located on the label. If that is a case, and you are well aware that the restricted operations are those, you will have to perform at the new position, it is your moral and legal obligations to tell the truth. As far as your medical condition may impact yourself or others at job, you should not hide the fact, and the consequences might be far worse that not to be hired.

You should think twice before not disclosing you medical conditions, while you are on medications, if you are aware that the company is known be regular random drug testing or as you apply for a government job.

What employer can do, if he learns that you failed to disclose your medical conditions at job application?

If the employee has failed to disclose the medical conditions, deliberately giving false answers to the directly posted questions on the job application or additional medical history forms, the employer could argue there has been a breach of the duty of mutual trust and confidence. The employee's employment could be fairly and lawfully terminated. The challenge for the employer is determining if the lie could justify termination and ensuring their actions are not discriminatory. If the employee provided the information as a condition of their employment and/or the employer relied on this information to recruit the employee, the employer could claim there has been a breach of the contract or a misrepresentation that led to the employer into entering into the contract. The employee could face a civil court claim to recover damages and to answer claims of fraud and negligence.

Sources and Additional Information:

http://findarticles.com/p/articles/mi_m0825/is_4_69/ai_n27685177/

http://www.personneltoday.com/articles/2009/02/09/49245/legal-q.html

http://www.healthboards.com/boards/showthread.php?t=749022

http://www.netmums.com/coffeehouse/working-childcare-692/working-689/544113-disclosing-depression-anxiety-job-application-form.html

Anxiety Diary Freeware

Anxiety Diary v1.0 is a user-friendly electronic medical diary system from http://www.anxietyzone.com/ that can be used to log daily events, appointments, keep a record of symptoms, monitor therapy, keep track of medications and chart the progress of your recovery. Records can also be printed out and shown to your doctor or therapist.

 Anxiety Diary should be useful for people suffering from Generalized Anxiety Disorder (GAD), Hypochondria, Panic Disorder, Clinical Depression, Specific Phobias, Post-Traumatic Stress Disorder (PTSD), Social Anxiety Disorder, Obsessive-Compulsive Disorder (OCD) and an array of other anxiety-related disorders.

Anxiety Diary v1.0 comes with a wealth of features, is completely customizable and easy to use.

Anxiety Diary v1.0 is FREE!

Main Software Features:

* Create a compact, electronic diary for online or offline reading.

* Attractive interface with dynamic menu system.

* Perfect for keeping daily progress logs, monitoring therapy, etc.

* Clean, neatly-formatted code with clear and easy-to-understand commenting.

* Uses an external configuration file for easy editing of CSS values and diary style.

* Multi-browser compatible (Internet Explorer, Netscape, Mozilla, Firefox, Opera, etc)

* 99% code - extremely low bandwidth/resource usage

* Completely generic which means it can be used to create any type of electronic diary.

* Includes all major META containers.

* Quick and easy customization - no complex tables or image maps to decipher.

* A place to add your favicon for easy visitor bookmarking.

* Professional-looking design

* Use one of 25 built-in custom cursors (.ani or .cur) with no plugins needed

* Totally customizable rollover effects for navigation menus

* Customizable colored scrollbars

* 27 copyright-free MIDI loops

* 25 Page transitions

* 146 page markers and bullets

* 109 miniature icons

Website: http://www.anxietyzone.com/

Direct Download: http://www.ziddu.com/download/9824429/ad10.zip.html

Screenshot:

Bipolar Disorder

Overview

Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.

Statistics

About 5.7 million Americans, or 2.6% of the American population over the age of 18, have bipolar disorder.

Symptoms

The manic phase may last from days to months and can include the following symptoms:

• Agitation or irritation


• Elevated mood



• Hyperactivity


• Increased energy


• Lack of self-control


• Racing thoughts




• Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)


• Little need for sleep


• Over-involvement in activities


• Poor temper control


• Reckless behavior



• Binge eating, drinking, and/or drug use


• Impaired judgment


• Sexual promiscuity


• Spending sprees




• Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:

• Difficulty concentrating, remembering, or making decisions


• Eating disturbances



• Loss of appetite and weight loss


• Overeating and weight gain




• Fatigue or listlessness


• Feelings of worthlessness, hopelessness and/or guilt


• Loss of self-esteem


• Persistent sadness


• Persistent thoughts of death


• Sleep disturbances



• Excessive sleepiness


• Inability to sleep




• Suicidal thoughts


• Withdrawal from activities that were once enjoyed


• Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.

How does bipolar disorder affect someone over time?

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

1. Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.


2. Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.


3. Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.


4. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.  Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder.  Rapid cycling affects more women than men.

Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.  Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.

Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

Treatment

For the manic phase of bipolar disorder, antipsychotic medications, lithium, and mood stabilizers are typically used. For the depressive phase, antidepressants are sometimes used, with or without the manic phase treatment.

There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. However, in studies that followed patients for 2 years, lithium and some antipsychotics were found to be moderately successful.

Antipsychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.

Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.

Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.

Risk factors for bipolar disorder

Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.

Genetics

Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person's chance of developing the illness. Genes are the "building blocks" of heredity. They help control how the body and brain work and grow. Genes are contained inside a person's cells that are passed down from parents to children.

Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had:

• Missed work because of their illness


• Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders


• Been treated or hospitalized for bipolar disorder.

The researchers also identified certain traits that appeared to run in families, including:

• History of psychiatric hospitalization


• Co-occurring obsessive-compulsive disorder (OCD)


• Age at first manic episode


• Number and frequency of manic episodes.

Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.

But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person's environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

Brain structure and functioning

Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.  Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain's structure and activity.

Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with "multi-dimensional impairment," a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia.  This suggests that the common pattern of brain development may be linked to general risk for unstable moods.

Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.

Tests & diagnosis

A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:

• Ask about your family medical history, particularly whether anyone has or had bipolar disorder


• Ask about your recent mood swings and for how long you've experienced them


• Observe your behavior and mood


• Perform a thorough examination to identify or rule out physical causes for the symptoms


• Request laboratory tests to check for thyroid problems or drug levels


• Speak with your family members to discuss their observations about your behavior


• Take a medical history, including any medical problems you have and any medications you take

Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.

Prognosis

Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.

Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early manic states may feel good, discontinuing medication may have very negative consequences.

Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.

Complications

Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:

• Alcohol and/or drug abuse as a strategy to "self-medicate"


• Personal relationships, work, and finances suffer


• Suicidal thoughts and behaviors

This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.

When to contact a doctor

Call your health provider or an emergency number right way if:

• You are having thoughts of death or suicide


• You are experiencing severe symptoms of depression or mania


• You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms

If you have suicidal thoughts



Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:

• Contact a family member or friend.


• Seek help from your doctor, a mental health provider or other health care professional.


• Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.


• Contact a minister, spiritual leader or someone in your faith community.

Sources and Additional Information:

https://health.google.com/health/ref/Bipolar+disorder

http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

http://en.wikipedia.org/wiki/Bipolar_disorder

http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=symptoms

http://health.nytimes.com/health/guides/disease/bipolar-disorder/background.html

Group, Family and Couples Therapy for Depression Treatment

Group Therapy



As the name suggests, group therapy (including family and couples therapy) is a form of treatment involving a small group of individuals, generally between 4 and 12 in number, who meet regularly to talk, interact, and discuss problems with each other. Therapy groups are typically run by one or more group therapists who keep the group organized and on track therapeutically. Therapy groups can be highly structured in nature (with specific goals set for each meeting) or flexible (group members discuss whatever is important). Groups are often set up to address particular therapy agendas. For instance, a therapy group might address men's issues, or women's issues, or focus on anger management, social anxiety, or chronic illness support. Participants are typically invited into the group based on the degree to which they fit the profile of an ideal member (e.g., having issues that the group is designed to address; being the right gender, etc.) and how likely it is that they may be able to contribute to the group as a whole.

However they are structured, most therapy groups have some basic ground rules that are usually discussed during the first session. Individuals are usually asked not to share what goes on in therapy sessions with anyone outside of the group. This rule protects the confidentiality of the other members and encourages people to be open and honest in their comments. Group members may also be encouraged to avoid seeing other members socially outside of therapy because of the harmful effect it might have on the dynamics of the group.



The emphasis on the patient-therapist relationship in individual forms of therapy is, in group therapy, replaced with an emphasis on patient's relationships with other patients. Group therapists set agendas within the therapy setting, but they are most happy when they are able to get out of the way and allow group members speak to one another directly. Patients are often more receptive to feedback they get from peers than they are to feedback they get from therapists who are often perceived as authority figures.



In a group therapy session, members are encouraged to openly and honestly discuss the issues that brought them to therapy. They try to help other group members by offering their own suggestions, insights, and empathy regarding discussed problems. A well functioning therapy group offers its members a safe and secure place where they can discuss and work out problems and emotional issues. Participants gain insight into their thoughts and behavior by listening to peers who are struggling with similar issues, by offering support and feedback to peers, and by accepting the support and feedback of other members.



Group therapy is often an ideal therapeutic environment for people who are having interpersonal difficulties, including depression (and anger and social anxiety problems, etc.), as the therapy is inherently interpersonal in nature. Affected group members usually benefit from the social interactions that are a basic part of the group therapy experience.



Group therapy provides a sense of identity and social acceptance for some participants. It can be very comforting to realize that other depressed people have similar symptoms, emotional issues, and life stressors. Learning how others cope with depressive symptoms provides new strategies or ideas that people can try in their own lives. Group interactions can also offer people unique insight into their own behavior, and provide immediate feedback about the success of new skills. For instance, many people are not aware of their negative body language (tendency to slump, look down, sit with crossed hands and feet, etc.) or style of communication unless it is pointed out to them directly. Group members may also offer one another social support by providing each other with words of encouragement and empathy. Lastly, by helping others in the group work through their problems, members can gain a personal sense of self-esteem.



As is the case with individual therapy, group therapies may draw on different psychological theories. For example, a depressed person may participate in a cognitive behavioral group that uses the meetings as a workshop for teaching cognitive restructuring and similar exercises involved in monitoring and changing thoughts and behavior. Alternatively, a group might be run more dynamically in nature and focus on interpersonal relationships, both at home and within the group itself. Sometimes, group therapy is used as a way to transition people out of individual therapy. Groups can also be a cost effective way to continue therapy after insurance benefits run out (group therapy sessions usually cost substantially less than individual therapy sessions). Group therapy is probably not helpful as a sole therapy for severely depressed individuals (unless it occurs in the context of a larger therapeutic program). However, research suggests that cognitive behavioral group therapy can be very effective for people with mild to moderate depression.

Types of Depression Group Therapy



There are many different types of depression group therapy available. You can find groups that have a specific type of depression they deal with (like bipolar or seasonal depression), groups that are gender or age specific but are not defined by the type of depression, some that deal with depression in conjunction with other problems (like child abuse or substance abuse), groups that are religiously based are also helpful because they offer spiritual solutions as well as the group therapy. You can try out various groups until you find one where you feel you fit in or that offers you the type of therapy you are looking for.



Offerings of Depression Group Therapy



Depression group therapy offers you the benefits of bonding between members of the group which creates a good support system and it is always led by a mental health care professional. People who are slow to open up may find that they feel comfortable among people who share a similar illness and it can help improve the progress of their other treatments.



Most people who take on group therapy also have individual or family based therapy in addition to any drug treatment that may be necessary. Many mental health care professionals recommend depression group therapy in conjunction with individual therapy because it helps the depressed person adjust to dealing with other people and breaks the isolation for depression. This type of therapy works for people with various levels of depression, from mild to severe. The therapy may use any of a number of therapy types which include:



• Cognitive Behavioral Therapy (CBT) – focusing on the thoughts and behaviors that lead to depression and ways to change those thought and behavior patterns.



• Interpersonal Therapy (IPT) – focusing on other peoples’ roles in your depression. Your interactions with people in your life may affect the way you feel and your interpretation of those interactions can lead to depressive states.



• Psychodynamic Therapy (PDT) – focusing on trauma in your early life that may have led to the depression. This is an older form of depression talk therapy.



Suitability for Group Depression Therapy



Not everyone is a suitable candidate for depression group therapy. Group therapy is generally not advised for people in the middle of a stressful or traumatic life event. People who are suicidal, experiencing delusions, or suffering from other depression complications are not appropriate candidates for group therapy. Such people may be candidates for group therapy after receiving antidepressants or other treatment.



Some people find it too unsettling to talk about their problems in group therapy, or are too sensitive to criticism from other group members. Such people are better suited to individual types of psychotherapy. A good group, however, can have a very positive effect on depression treatment.



Also, recent studies shows gender related difference in terms of suitability for group depression therapy. For example, one of the researches suggests, that for depressed men seeking support for severe grief, group therapy may not be the best choice. A study of men and women in group therapy found that men did not benefit as much as women. “Men and women respond differently to the group therapy format,” Dr. Anthony S. Joyce of the University of Alberta in Edmonton told AMN Health.

Family and Couples Therapy



Couples therapy occurs when intimate relationship partners (married or otherwise) enter therapy together. Family therapy occurs when an entire family comes for therapy. Both of these forms of therapy tend to take a Family Systems approach to therapy. Therapists working from this approach treat the entire unit in front of them (e.g., the entire couple; the entire family) as the patient, and the individual members of these social groups are seen as components of that single patient. Though entry of couples and families into therapy may be motivated by problems that a single individual within the couple or family is having, the family systems therapist will tend to view the identified problem as a problem shared by all system members. In this way of doing therapy, a husband's depression is considered, at least in part, as a symptom of something going wrong with the relationship, and not simply something going wrong with the husband.

Family therapy and couples therapy sessions delve into the details of the interactions between partners, or family members as a core component of treatment. Both therapies examine the role of the depressed member in the overall psychological well-being of the family (or couple), as well as the role of the family (or couple) in creating depressive symptoms. Both family therapy and couples therapy aim to identify and then change destructive relationship patterns that may be contributing to the system's difficulties. For instance, if a family has been scapegoating one of it's members, and that member has become depressed, the therapist will call attention to this scapegoating behavior. If one spouse is enabling the other's abuse of alcohol, and both spouses are depressed, the therapist will call attention to this dysfunction too. Family and couples therapy can also uncover hidden issues and/or teach people new strategies for dealing with emotions and behavior.

Family and couples therapy isn't generally viewed as a good primary means of obtaining therapy for depressed individuals, but it can be an excellent adjunctive therapy strategy, as depressed individuals are both affected by and affect their relationship partners. Family or couples therapy is most useful when a person's depressive symptoms are: 1) seriously jeopardizing his or her marriage and family functioning, and/or 2) clearly being caused (or maintained) by dysfunctional marital and family interaction patterns. Patients with mood disorders have a very high rate of divorce. Many people (approximately 50%) report that they would not have married their spouse if they knew that he or she would develop a mood disorder. Family and couples therapy, therefore, can be a crucial and effective component of treating depression.





Sources and Additional Information:

http://www.gulfbend.org/poc/view_doc.php?type=doc&id=13029&cn=5

http://abcnews.go.com/Health/DepressionTreatment/story?id=4361100

http://www.survivingdepression.net/living/grouptherapy.html

http://patient-health-education.suite101.com/article.cfm/group_therapy_for_depression

http://www.health.am/ab/more/group_therapy_not_always_best_choice_for_men/

Historical retrospectives of depressive disorder

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time.

Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.

In the 1950s and 60s, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job.

The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it can also be used to describe other types of psychological depression, more precise terminology is preferred for the disorder in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide have depression or another mood disorder.

Major Depressive Disorder

In the 1970s and 80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive disorder? Although there is some argument even today (as in all branches of medicines), most experts agree that:

1. A depressive disorder is a syndrome (group of symptoms) that reflects a sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal.


2. Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished activity and participation.


3. Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.


4. Depressive disorders are a huge public-health problem, due to its affecting millions of people.

·         The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism.

·         In a major medical study, depression caused significant problems in the functioning of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in two categories of problems, as often as coronary artery disease.

·         Depression can increase the risks for developing coronary artery disease, HIV, asthma, and some other medical illnesses. Furthermore, it can increase the morbidity (illness/negative health effects) and mortality (death) from these conditions.

5. Depression is usually first identified in a primary-care setting, not in a mental health practitioner's office. Moreover, it often assumes various disguises, which causes depression to be frequently under-diagnosed.


6. In spite of clear research evidence and clinical guidelines regarding therapy, depression is often undertreated. Hopefully, this situation can change for the better.

Major Depressive Disorder

Sources and Additional Information:

http://www.medicinenet.com/

http://en.wikipedia.org/wiki/Major_depressive_disorder

Medical marijuana is an effective treatment for depression: True or False?

As any point of discussion, related to the medical marijuana use, the possibility to use cannabis for the clinical depression draws a lot of controversy both in the medical scientific world and among general population common views. As expected, different researchers come to the opposite conclusions on the subject. While I, personally, find the marijuana positive impact conclusions more scientifically supported by obtained results, I will provide both points of view to your consideration.

Probably, the most logical conclusion has been made as result of the recent Canadian Study, which somehow balances the negative and positive view in regards to Marijuana use for clinical depression treatment.

THC, the active ingredient in marijuana, increases serotonin when smoked in low doses, similar to SSRI antidepressants, such as Prozac, according to researchers from McGill University and Le Centre de Recherche Fernand Seguin of Hфpital in Quebec and l’Universitй de Montrйal in Montreal.

But at higher doses, the effect reverses itself and can actually worsen depression and other psychiatric conditions like psychosis.

During the study, published in the October 24, 2007 issue of The Journal of Neuroscience, laboratory rats were injected with the synthetic cannabinoid WIN55, 212-2 and then tested with the Forced Swim test - a test to measure “depression” in animals.

The researchers observed an antidepressant effect of cannabinoids and an increased activity in the neurons that produce serotonin. However, increasing the cannabinoid dose beyond a set point completely undid the benefits, said Dr. Gabriella Gobbi of McGill University and Le Centre de Recherche Fernand Seguin of Hфpital Louis-H. Lafontaine.

"So we actually demonstrated a double effect: At low doses it increases serotonin, but at higher doses the effect is devastating, completely reversed," she said in a news release.

The antidepressant and intoxicating effects of cannabis are due to its chemical similarity to natural substances in the brain known as "endo-cannabinoids," which are released under conditions of high stress or pain, said Gobbi. They interact with the brain through structures called cannabinoid CB1 receptors. The study demonstrated that these receptors have a direct effect on the cells producing serotonin, which is a neurotransmitter that regulates the mood, she said.

Let’s review other specialists’ points on the topic, but let’s make our own mind, how solid provided arguments are.

PRO - Cannabis use for Depression Treatment

1. Frank Lucido, MD, a private practice physician, stated in his article "Implementation of the Compassionate Use Act in a Family Medical Practice: Seven Years Clinical Experience," available on his website:

With appropriate use of medical cannabis, many of these patients have been able to reduce or eliminate the use of opiates and other pain pills, ritalin, tranquilizers, sleeping pills, anti-depressants and other psychiatric medicines...

2. George McMahon, an author and medical marijuana patient of the U.S. Federal Drug Administration’s Investigational New Drug (IND) Program, stated in his 2003 book Prescription Pot:

People who have never struggled with a life threatening or disabling illness often do not comprehend how debilitating the resulting depression can be. Long days spent struggling with sickness can wear patients down, suppress their appetites and slowly destroy their wills to live. This psychological damage can result in physiological effects that may be the difference between living and dying.

The elevated mood associated with cannabis definitely affected my health in a positive manner. I was more engaged with life. I took walks and rode my bike, things I never considered doing before in my depressed state, even if I had been physically capable. I ate regular meals and I slept better at night. All of these individual factors contributed to a better overall sense of well-being.

3. Tod Mikuriya, MD, a psychiatrist and medical coordinator, co-wrote in the 1997 book Marijuana Medical Handbook:

The power of cannabis to fight depression is perhaps its most important property.

4. The Journal of Clinical Investigation stated in an Oct. 13, 2005 article "Cannabinoids Promote Embryonic and Adult Hippocampus Neurogenesis and Produce Anxiolytic- and Antidepressant-like Effects" by Xia Zhang et al.:

We show that 1 month after chronic HU210 [high-potency cannabinoid] treatment, rats display increased newborn neurons [brain cell growth] in the hippocampal dentate gyrus [a portion of the brain] and significantly reduced measures of anxiety- and depression-like behavior. Thus, cannabinoids appear to be the only illicit drug whose capacity to produce increased hippocampal newborn neurons is positively correlated with its anxiolytic- and antidepressant-like effects.

5. The Journal of Acquired Immune Deficiency Syndrome, stated in a Jan. 2004 article on a study designed by Prentiss, Power, Balmas, Tzuang and Israelski "to examine the prevalence and patterns of smoked marijuana and perceived benefit" among 252 HIV patients:

Overall prevalence of smoked marijuana in the previous month was 23%. Reported benefits included relief of anxiety and/or depression (57%), improved appetite (53%), increased pleasure (33%), and relief of pain (28%).

6. Jay Cavanaugh, PhD, National Director for the American Alliance for Medical Cannabis, wrote in his 2003 article "Cannabis and Depression," published on the American Alliance For Medical Cannabis website:

Numerous patients report significant improvement and stabilization with their bipolar disorder when they utilize adjunctive therapy with medical cannabis. While some mental health professionals worry about the impact of cannabis on aggravating manic states, most bipolar patients trying cannabis find they ’cycle’ less often and find significant improvement in overall mood. Bipolar disorders vary tremendously in the time spent in the depressive versus manic states. Those who experience extended depressive episodes are more likely to be helped with cannabis.

Patients who use cannabis to ’relax’ may be treating the anxiousness sometimes associated with depression. Cannabis aids the insomnia sometimes present in depression and can improve appetite. Better pain control with cannabis can reduce chronic pain related depression. While cannabis cannot yet be considered a primary treatment of major depression it may improve mood when used under physicians supervision and in combination with therapy and/or SSRI’s.

7. Bill Zimmerman, PhD, former President of the Americans For Medical Rights, stated in his 1998 book Is Marijuana the Right Medicine For You?:

Some patients have found the mood altering effects of marijuana to be helpful for treating mood disorders such as anxiety, depression and bipolar (manic-depressive) illness. Using marijuana to treat mood disorders was described in medical writings in the 19th and early 20th centuries...

However, using marijuana to treat mood disorders can be very tricky... If you intend to use marijuana for this purpose, it is very important that you thoroughly discuss it with your doctor. Patients who respond well report that marijuana not only diminishes their undesirable moods, it also motivates them to productivity. For some of these patients, depression was a by-product of a debilitating disease or illness for which marijuana provided a welcome remedy. For others, the marijuana seems to have acted directly on the depression.

The mental component of the pre-menstrual syndrome (PMS) often causes psychological problems and is now technically classified as an atypical (not typical) depression. Many women report benefit from using marijuana to improve the symptoms of PMS.

CON - Cannabis use for Depression Treatment

1. Health Services at Columbia University (HSC), in the GoAskAlice section of their website, stated in a Feb. 4, 2005 response to a question from "a concerned boyfriend" who asked "She says smoking pot is like self-medicating - it is better than using anti-depressants. She also claims smoking pot helps with depression because of how it helps produce Seratonin in the body.... Does smoking pot really help with managing your anxiety, depression, etc.?":

Marijuana DOES NOT produce serotonin. However, it does affect a substance in the brain called anandamide. Anandamide causes a soothing sensation in the body when it reacts with THC (tetrahydrocannabinol), the active substance in marijuana. It is the anandamide that causes your girlfriend to relax when using marijuana in low to medium doses....

While marijuana use may seem like a soother to your girlfriend, she may need to know about the negative effects... Marijuana appears to increase the risk of developing depression and/or schizophrenia the more that one uses it....

[Y]our girlfriend believes that she is self-medicating, when she may be contributing to her depression. Her depression could manifest itself in the future, since marijuana users typically withdraw from social situations, adding to depression.

Also consider what it is about antidepressants that are so abhorrent to your girlfriend. Why would marijuana, an illegal substance, be preferable to a controlled medication taken under medical advisement to manage her stress and depression?...

[S]he may agree to see her medical or primary care provider for a medical exam and evaluation. If she then has a diagnosis of depression and/or anxiety, or is referred to someone who specializes in working with people with these conditions, then chances are she will feel better than when she ’prescribes’ marijuana for herself.

2. Karen Cameron, RNC, MSN, Correspondent for WebMD, stated in a June 14, 2004 WebMD article "Are Depression and Marijuana Linked?":

It is pretty well known that the psychoactive chemicals in marijuana interfere with the balancing process that antidepressants work toward.



As you may already know, depression is a biochemical illness -- an imbalance in chemicals in the brain. Those antidepressants help things become better balanced, but they can’t do the job nearly as well if one is smoking marijuana.



Marijuana contributes to depression and destroys natural sleep. There really is no good reason to continue smoking it.

3. The UK’s National Health Service (NHS) stated in its Feb. 9, 2006 website article "Does Cannabis Interact With Antidepressants Or Lithium?":

It is not clear how often cannabis itself can cause depression, but research suggests that this can happen. It is therefore recommended that if you are depressed, and you use cannabis regularly, you should try giving up and see if that helps. One small study suggests that a chemical in cannabis might cause severe anxiety and unease in people with moderate to severe depression.

Tachycardia (an abnormally fast heart-beat), dizziness, anxiety, drowsiness, nausea, vomiting, difficulty sleeping and confusion are all possible side effects of cannabis. These side effects can also be caused by certain antidepressants, so using cannabis at the same time can make them worse.

Laboratory work suggests that cannabis might affect the way these [anti-depressant] medicines work. It is not clear what affect this may have on people, so MAOIs and cannabis should not be taken together.

There is no published research that has looked at taking these medicines and cannabis. However, they are too new to be sure and a problem might have been missed. Therefore the newer antidepressants should not be taken with cannabis due to lack of information.

4. Nancy Schimelpfening, the About Guide to Depression for About.com, stated in her About.com article "Is It A Bad Idea to Use Marijuana to Relieve Depression":

Although there is preliminary evidence that marijuana may have antidepressant properties, many argue there are also some important drawbacks to it’s usage. There is a well-known phenomenon called ’amotivational syndrome’ in which chronic cannabis users become apathetic, socially withdrawn, and perform at a level of everyday functioning well below their capacity prior to their marijuana use.

Although the depressed person may feel relief from their symptoms, this may be an illusion of well-being if the person loses motivation and productivity. Furthermore, if the drug is smoked, it can be far more harmful to the respiratory system that tobacco use because of the fact that it is not filtered.

I would also like to mention a USC College study finding no link between symptoms of depression and regular marijuana use, denying popular accusation of Marijuana as being one of the suspects for the depression development. The study results confirmed that Marijuana smokers are less depressed than those who never smoke. Interesting is that study results were not expected even by the researchers.

College doctoral candidate Tom Denson co-authored the study on marijuana and depression to be published in the journal, Addictive Behaviors. Denson wrote the report with psychologist Mitch Earleywine, a former College associate professor and author of Understanding Marijuana (Oxford University Press, 2002).



While the study found that those who smoke marijuana for medical reasons were more depressed than other smokers, they were less depressed overall than nonsmokers.



Rather, daily or weekly marijuana users - including those smoking the drug for medical rather than recreational reasons - had fewer symptoms of depression than nonusers. Further, marijuana users were more likely to report positive moods and fewer somatic complaints such as sleeplessness, poor appetite and trouble completing their daily routine, the study stated.



The Internet study questioned more than 4,400 marijuana users and non-users. The researchers said the online study made it possible to include the severely depressed or those who would not participate in an in-person or telephone survey about an illicit drug.

After a story about the study appeared in the Nov. 18, 2005 Albany Times Union, Denson received correspondence from researchers who said their similar-smaller scale studies resulted in the same findings.

Sources and Additional Information:

http://medicalmarijuana.procon.org/viewanswers.asp?questionID=000226

http://www.foxnews.com/story/0,2933,304996,00.html

http://health.usnews.com/articles/health/brain-and-behavior/2008/05/09/teen-depression-worsened-by-marijuana-government-says.html

http://www.doctordeluca.com/Library/WOD/WPS3-MedMj/DecreasedDepressionInMjUsers05.pdf

Montgomery-Asberg Depression Rating Scale

The Montgomery-Asberg Depression Rating Scale (MADRS) is a ten-item diagnostic questionnaire which psychiatrists use to measure the severity of depressive episodes in patients with mood disorders. It was designed by British and Swedish researchers as an adjunct to the Hamilton Rating Scale for Depression (HAMD), which would be more sensitive to the changes brought on by antidepressants and other forms of treatment. There is, however, a high degree of statistical correlation between scores on the two measures.

The rating should be based on a clinical interview moving from broadly phrased questions about symptoms to more detailed ones which allow a precise rating of severity. The rater must decide whether the rating lies on the defined scale steps (0, 2, 4, 6) or between them (1, 3, 5) and then report the appropriate number. The items should be rated with regards to the state of the patient over the past week. 1 - APPARENT SADNESS - Representing despondency, gloom and despair, (more than just ordinary transient low spirits) reflected in speech, facial expression, and posture. Rate by depth and inability to brighten up. 0 No sadness 1 2 Looks dispirited but does brighten up without difficulty 3 4 Appears sad and unhappy most of the time 5 6 Looks miserable all the time. Extremely despondent. 2 - REPORTED SADNESS - Representing reports of depressed mood, regardless of whether it is reflected in appearance or not. Includes low spirits, despondency or the feeling of being beyond help and without hope. Rate according to intensity, duration and the extent to which the mood is reported to be influenced by events. 0 Occasional sadness in keeping with the circumstances. 1 2 Sad or low but brightens up without difficulty. 3 4 Pervasive feelings of sadness or gloominess. The mood is still influenced by external circumstances. 5 6 Continuous or unvarying sadness, misery or despondency. 3 - INNER TENSION - Representing feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to either panic, dread or anguish. Rate according to intensity, frequency, duration and the extent of reassurance called for. 0 Placid. Only fleeting inner tension. 1 2 Occasional feelings of edginess and ill-defined discomfort 3 4 Continuous feelings of inner tension or intermittent panic which the patient can only master with some difficulty. 5 6 Unrelenting dread or anguish. Overwhelming panic. 4 - REDUCED SLEEP - Representing the experience of reduced duration or depth of sleep compared to the subject’s own normal pattern when well. 0 Sleeps as usual. 1 2 Slight difficulty dropping off to sleep or slightly reduced, light or fitful sleep 3 4 Sleep reduced or broken by at least two hours. 5 6 Less than two or three hours sleep. 5 - REDUCED APPETITE - Representing the feeling of a loss of appetite compared with when well. Rate by loss of desire for food or the need to force oneself to eat. 0 Normal or increased appetite. 1 2 Slightly reduced appetite 3 4 No appetite. Food is tasteless. 5 6 Needs persuasion to eat at all. 6 - CONCENTRATION DIFFICULTIES - Representing difficulties in collecting one’s thoughts mounting to incapacitating lack of concentration. Rate according to intensity, frequency, and degree of incapacity produced. 0 No difficulties in concentrating. 1 2 Occasional difficulties in collecting one’s thoughts. 3 4 Difficulties in concentrating and sustaining thought which reduces ability to read or hold a conversation. 5 6 Unable to read or converse without great difficulty. 7 - LASSITUDE - Representing a difficulty getting started or slowness initiating and performing everyday activities. 0 Hardly any difficulties in getting started. No sluggishness. 1 2 Difficulties in starting activities. 3 4 Difficulties in starting simple routine activities, which are carried out with effort. 5 6 Complete lassitude. Unable to do anything without help. 8 - INABILITY TO FEEL - Representing the subjective experience of reduced interest in the surroundings, or activities that normally give pleasure.The ability to react with adequate emotion to circumstances or people is reduced. 0 Normal interest in the surroundings and in other people. 1 2 Reduced ability to enjoy usual interests. 3 4 Loss of interest in the surroundings. Loss of feelings for friends and acquaintances. 5 6 The experience of being emotionally paralyzed, inability to feel anger, grief or pleasure and a complete or even painful failure to feel for close relatives and friends. 9 - PESSIMISTIC THOUGHTS - Representing thoughts of guilt, inferiority, self-reproach, sinfulness, remorse and ruin. 0 No pessimistic thoughts. 1 2 Fluctuating ideas of failure, self-reproach or self-depreciation. 3 4 Persistent self-accusations, or definite but still rational ideas of guilt or sin. Increasingly pessimistic about the future. 5 6 Delusions of ruin, remorse and unredeemable sin. Self-accusations which are absurd and unshakable. 10 - SUICIDAL THOUGHTS - Representing the feeling that life is not worth living, that a natural death would be welcome, suicidal thoughts, and preparations for suicide. Suicidal attempts should not in themselves influence the rating. 0 Enjoys life or takes it as it comes. 1 2 Weary of life. Only fleeting suicidal thoughts. 3 4 Probably better off dead. Suicidal thoughts are common, and suicide is considered as a possible solution, but without specific plans or intention. 5 6 Explicit plans for suicide when there is an opportunity. Active preparations for suicide.

The Montgomery-sberg Depression Rating Scale (MADRS) is administered by a trained interviewer, takes 20 minutes to complete and was designed as a measure of change in studies of the treatment of depression. It was developed by taking items from a longer scale. It is widely used in treatment trials, in both young and older patients. Specific instructions are given regarding the ratings and there is a comparative lack of emphasis on somatic symptoms, making it useful for the assessment of depression in people with physical illness. Cut-off scores have been suggested by Snaith:

• 0-6 indicates the absence of depression (or recovery in the setting of a clinical trial);
  
  
• 7-19, mild depression;
  
  
• 20-34, moderate depression; and
  
  
• 35 and above, severe depression.

Sources and Additional Information:

http://www.psy-world.com/madrs.htm

http://en.wikipedia.org/wiki/Montgomery-%C3%85sberg_Depression_Rating_Scale

http://www.fda.gov/ohrms/dockets/AC/07/briefing/2007-4273b1_04-DescriptionofMADRSHAMDDepressionR(1).pdf