Sleep Deprivation as Cure for Depression

History of Approach

Nearly 30 years have passed since Anna Wirz-Justice, MD, first prescribed a night without sleep for a severely depressed 80-year-old woman. "She used to just sit around all day, feeling suicidal," says the Swiss neurobiologist. "She hardly spoke or moved.''

The remedy worked.  By the next morning, the elderly woman "was talking and moving around as if she were actually another person," Wirz-Justice says. "She told me that at about two or three in the morning, she felt like a black cloud had been lifted from her shoulders."

Was Wirz-Justice on to something? She and other researchers thought so -- at first. There is no denying that sleep deprivation temporarily eases depression. Up to 60% of depressed people will show a 30% improvement after just one night awake, according to a review article published in the January 1990 issue of the American Journal of Psychiatry. People who feel the most depressed in the morning and improve later in the day seem to benefit the most from a night without sleep.

But there was a problem: Patients tended to relapse into depression as soon as they did get a good night's sleep. Moreover, habitual sleep deprivation may be linked to long-term health problems such as high blood pressure and diabetes. The challenge then became to find a way of relieving depression by tinkering with sleep-wake cycles.

Does it Work?

If a depressed mother stays up all night, or even the last half of the night, it is likely that by morning the depression will lift.  Although this sounds too good to be true, it has been well documented in over 1,700 patients in more than 75 published papers during the last 40 years. Sleep deprivation used as a treatment for depression is efficacious and robust: it works quickly, is relatively easy to administer, inexpensive, relatively safe and it also alleviates other types of clinical depression. Sleep deprivation can elevate your mood even if you are not depressed, and can induce euphoria. This throws a new light on insomnia.



This remarkable result is not well known outside a small circle of sleep researchers for three good reasons.  First, sleep deprivation is not as convenient as taking a pill.  Second, prolonged sleep deprivation is not exactly a desirable state; it leads to cognitive defects, such as reduced working memory and impaired decision making.  Finally, depression recurs after the patient, inevitably, succumbs to sleep, even for a short nap.  Nonetheless this is an incredibly important observation; it shows that depression can be rapidly reversed and suggests that something is happening in the sleeping brain to bring on episodes of depression.  All this offers hope that studying sleep deprivation may lead to new, unique and rapid treatments for depression.

How does it Work?

Neuroscientists have been trying to solve this puzzle.  The first hint of what may be happening during sleep came from J. Christian Gillin, at the University of California at San Diego. Using imaging, he found that a small area of the cerebral cortex in the front of the brain  — the anterior cingulate cortex — which was consistently overactive in depressed patients, quieted to normal levels of activity after the patients were deprived of sleep. And when the patients were allowed to sleep, the activity in this area returned to the elevated levels.

Helen Mayberg at Emory University has shown that electrical stimulation of the anterior cingulate cortex, which disrupts normal activity, also reduces depression.  Some patients reported feeling immediate relief and calm after the procedure.

This tells us where in the cortex to look, but we also need to understand the changes that occur in the cortex during sleep. As you fall asleep, neurons in the brain stem that project throughout the cortex and keep it activated stop firing. The reduced stimulation from the brain stem disconnects the cortex from sensory input and there is a major shift in the pattern of electrical activity in the cortex. During the early part of the night the cortex is in a state of slow-wave sleep punctuated by brief periods of rapid-eye movement sleep (REM), which become more frequent and longer lasting toward early morning.

One major class of antidepressants, tricyclics, blocks REM sleep, which suggests that sleep deprivation may work against depression the same way. This is consistent with the tendency for depressed individuals to sleep longer than they do when they feel normal. Additional support for this hypothesis comes from genetic studies of families with short REM latency — the tendency to enter REM early in the sleep cycle. This condition disrupts slow wave sleep and extends REM sleep. The risk of depression is much greater if you come from a family with this genetic background. While this is a rare genetic defect that can only account for a small fraction of all depressed patients, these special cases give us valuable clues to conditions that predispose some people to clinical depression.

Power of Hormones

Today, researchers are experimenting with ways to make use of the body's biological clock -- its circadian, or 24-hour, rhythms -- without asking patients to abandon rest altogether. The solution may lie in timing sleep to benefit from certain hormones that ebb and flow throughout the day.

For instance, thyroid stimulating hormone (TSH) helps control our metabolism and, indirectly, our levels of energy. An estimated 25% to 35% of depressed patients have low TSH levels. In recent years, researchers at the National Institute of Mental Health have found that sleep inhibits the release of TSH, while staying awake through the night and the early morning hours boosts it.

Some researchers are trying to manipulate the body's hormonal tides by having patients stay awake through the early morning hours for about a week. Doctors at the University Hospital of Freiburg in Germany tried this experiment on a group of depressed patients who felt better after one night without sleep: They told the patients to go to sleep at 5 p.m. that evening and rest until midnight the next night -- a total of 31 hours. Then the patients gradually eased back to a normal sleep cycle over the course of the week. One night they slept from 6 p.m. until 2 a.m., the following night from 7 p.m. until 3 a.m., until finally they returned to an 11 p.m. to 6 a.m. sleep cycle. Remarkably, the majority -- 75% -- didn't relapse into depression, according to results published last fall in the European Archives of Psychiatry and Clinical Neuroscience.

Methods

There are two methods of using sleep deprivation as a treatment for depression: total or partial deprivation.

Partial deprivation - sleeping the first half of the night only, and waking up halfway through - proved more effective than going to sleep later, or sleeping only the second half of the night. It is thought that partial sleep deprivation, sleeping up to 4 hours a night, will have the same antidepressant benefits as total sleep deprivation. Whereas with total sleep deprivation, the benefits are felt the following day, but are not long-lasting, sleeping four hours can be done continuously, over several days or even weeks, so naturally the benefits here are superior.

Even in patients with bipolar disorder can benefit. Research shows patients with bipolar disorder after sleep deprivation, are pulled from their depressed state to manic state. Manic states can cause sleep deprivation, lasting weeks and even months, so the cycle continues. The patient feels great, lighter in mood, and feel no need for sleep. Of course one should limit this, because of other health risks in prolonged sleep deprivation. Partial deprivation, up to 4 hours sleep is definitely the way to go for long-term treatment.

The ideal way to try for yourself, seems to be to stay awake a full night the first night, then limit yourself to 4 hours a night after that. Try this for a week or two, and see how you feel. I think in most cases, you will have positive results.

If you know someone suffering with severe depression, who barely has energy to talk to you, and no matter how you try to animate them, you have no success, try visiting them in the evening and keeping them awake all night. You will find the next morning their mood will be elevated, they will be more lucid and talkative, and more likely to want to move around and do things. Try then to convince them to use an alarm clock and wake themselves up after only four hours, they'll see for themselves how much better they feel.

The optimum time for sleep appears in some studies, to be from 10pm-2am, 11pm-3am, or12-4 am, underlining the fact that sleeping only the first half of the night provides the best results. In other reports, however, 2-6am 3-7am was optimal. It would depend presumably on your normal bedtime.

Sleep deprivation treatment was popular in the 1970s, but with the discovery of new and effective antidepressant medications, it was soon deemed old-fashioned and unhelpful. Nowadays doctors are reconsidering and endorsing this treatment, finding it helpful even alongside these medications, as the body seemed to accept medication more easily. Many psychiatrists were convinced by remarkable transformations of severely depressed, psychotic and even suicidal patients, back to relative normality after only a few hours. Antidepressant medication alongside sleep deprivation, has proven to help prevent relapse into the depressed state, although these studies are still ongoing.

But Is It Practical?

Doctors admit that sleep deprivation regimen is tough to follow. Patients should probably try such sleep manipulation only under supervision and perhaps in a group to make the experience more enjoyable, says Edward DeMet, PhD, who studies sleep deprivation at the Veterans Affairs Medical Center in Long Beach. "Obviously, if you need to be driving the next day, you shouldn't do this," he says.

There are other ways to manipulate sleep to improve depressive symptoms. For instance, patients who go one night without sleep and who are exposed to bright light in the morning appear to prolong the emotional benefits of that sleepless night. People who try sleep deprivation while taking antidepressant medicine are also less likely to relapse, according to a study by Wirz-Justice and colleagues published in the August 1999 issue of the journal Biological Psychiatry.

Because antidepressants such as Prozac or lithium often take weeks to work, sleep deprivation may be most useful as a temporary tool that gives people a lift before the drugs take effect.

"It's much easier to pop a pill in the morning than stay up all night," says Wirz-Justice, a professor at the Psychiatric University Clinic's Chronobiology and Sleep Laboratory in Basel, Switzerland. "But sleep deprivation is very cheap and it's very fast. For patients who are severely depressed, the experience for that one day lets them know it's possible to get better. They finally have hope."

Sources and Additional Information:

http://www.medicinenet.com/script/main/art.asp?articlekey=50800

http://opinionator.blogs.nytimes.com/2010/04/07/in-sleepless-nights-a-hope-for-treating-depression/

http://hubpages.com/hub/depressionandsleep

http://www.psychforums.com/depression/topic23253.html

May Clinical Depression Be Contagious?

A man is walking a very long road from one village to another. At the outskirts of the new village he encountered a farmer laboring in his field, cutting hay. He said to the farmer, “I have walked a great distance to come to this village of yours. I have left my village looking for a new home, perhaps I will find it here. Tell me, how are the people in this village? What kind of people are they?” The man in the field thought a moment, then asked, “What were the people like in the village you came from?” The traveler replied, “They were uncaring, self-absorbed, cynical, and unfriendly. That’s why I left.” The farmer paused before replying and then said, “I think that’s how you’ll find the people here, too.” The traveler replied, “In that case, I’ll just move on and look somewhere else.” A couple of days later, the farmer was again out in his field when another man approached him and said, “My village was destroyed and the people scattered. I am looking to find myself a new home, perhaps in this village. Can you tell me, how are the people in this village? What kind of people are they?” The farmer asked, “What were the people like in your village?” The traveler replied, “They were wonderful people. Loving, close, helpful, and I will miss them terribly.” The farmer said, “I think that’s how you’ll find the people here, too.”

How many of you out there have ever wondered if depression is in fact contagious? The reactions so many of us get when we tell loved ones of our condition would lead us to believe that they fear catching depression, like one would catch a cold or chicken pox. Their denial, fear, misunderstanding, or abandonment of us is a strong testament to this contagen theory. However, science tells us that depression is a result of physical changes occurring in the brain, which leads to chemical imbalances, hence the depression.

Both fact and fiction aside, there can be no worse experience for the depressed person than to see someone they love act so negatively. This kind of reaction can make a depressed person feel even more isolated and hopeless then before. To have those people who we trust so deeply reject us; can there be no greater setback for us?

Instead, what we need from our loved ones is their support, understanding and willingness to help see us through the depression, especially the initial period following diagnosis. To ensure our loved ones' support, we must educate ourselves as to what depression is beyond the complex feelings that we experience. By doing this, we can better convey to our loved ones what depression is, how common it is, and especially how treatable it is. Instead, if we choose to be unprepared and uneducated, the chances are far greater that those around us will react unfavorably towards us, leaving us to feel all sorts of negative things about ourselves because we could not get from them what we need most…understanding.

Some studies show that if one spouse is depressed, the other can become depressed, and that up to 40 percent of people whose spouses have bipolar disorder get clinical depression. That's according to Dr. Igor Galynker, director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in New York and professor of clinical psychiatry at Albert Einstein College of Medicine. "We can mimic other people's facial expressions," Galynker said. "When we mimic other people's facial expressions, we also can adopt the mood that these people are in. It affects us, even on a superficial level." But such mimicry can go beyond the superficial and become emotional. Studies in which monitors track brain activity while a subject is shown smiling or frowning faces show that the areas associated with happy or sad emotions are active when the subject is presented with the corresponding face.  This ability to tune in to other people's feelings, or empathize, can be useful, but it can also get a person in trouble if they are around someone who has depression.

"If a genetic predisposition exists, and a person is surrounded by people with a behavior, that may give rise to or create an environment that would fertilize that behavior," said Steven Lappen, a writer and frequent public speaker who has bipolar disorder. Also, it is important to note that depression has a hereditary factor associated with it. In such a situation, it is possible that one or both parents may have depression. That fact is possibly increasing the chances that their offspring will develop this condition. If the parental depression is present but has never been diagnosed, their negative reaction toward their child could be even greater.

In addition, the fear of receiving a negative reaction can compel some of us not to seek help. The idea of family or friends becoming aware of our condition can have a debilitating affect on us. This fear can prevent us from seeking the necessary confirmation of the condition and seeking professional help. This avoidance of diagnosis and treatment is far more serious than any negative reaction that may come from our loved ones.

To deal with all situations, we must remind ourselves that our physical and emotional well being is paramount. We must convince ourselves that seeking professional help is more important than what others think. That treatment for depression can allow us an opportunity to regain a positive outlook on life. To deny us of this opportunity is to deny ourselves the freedom and dignity that each and every one of us prizes above all else. To lock ourselves within a world of internal depression by hiding behind doors, never going out, and never speaking to others is the greatest harm we can do to ourselves.

The choice is ours and ours alone to make. We can worry about what others think or how they will act or we can concern ourselves with our needs and seek out the professional help that we so desperately need. It is up to us to do the right thing before it's too late. By seeking professional guidance and educating ourselves about depression, we can show those we love that depression is NOT contagious.

One of the well-researched forms of psychotherapy called interpersonal therapy (IPT) emphasizes the importance of having positive and healthy relationships and provides skill-building strategies for developing them. There is good evidence that when people improve their relationship skills, their depression improves. When people feel better about themselves, they get better feedback from the world around them. They feel empowered instead of victimized, and they finally feel like they are a part of something more compelling than themselves and their depression.

There are times when people need an intervention in their lives to move in a healthy direction. You may have tried many times to cheer someone up, but to no avail. Your guilt will not help your loved one. It actually can hurt because it can prevent both of you from seeing what is really wrong. Once someone knows they are depressed, they can do something about it.

Here’s what you can do:   

1. Provide empathy. People who are depressed often feel they are crazy and life’s situations are hopeless. Share your own experiences with depression. Everyone who breathes has suffered through some depression at various times in their lives.


2. Provide encouragement. As hopeless as it seems in the moment, depression can go away in a short period of time given the right recovery tools. It may take longer to get to the deeper sources of depression, but along the way a helpful therapist can give you tools to enable you to pull yourself up from despair much quicker – and believe that it can happen. For instance, people who suffer from depression and have experienced some type of weight problems will benefit from going beyond treating the surface depression and looking toward what is underneath. Often past loss, trauma, extremely high expectations and other issues extend much deeper.


3. Show you continue to care. Send notes, cards or e-mail. Invite your loved one to activities. Keep your expectations low.


4. Do not assume responsibility for their depression. While you definitely want to show you care, you cannot change another person. That person has to do that. You can throw life lines. You can’t make them accept. That means if another person is raging out at you, don’t accept it. Their depression does not give them an excuse to hurt you. State that in clear terms. Otherwise, you accept responsibility and the depressed person becomes even less empowered. Be careful that you do not become isolated because that person doesn't want to do anything. Make sure you get out and circulate with a support system of your own because you may have temporarily lost support from a person very important to you.


5. Accept that you cannot do it alone. Many times it will take a professional’s assistance. See a licensed mental health counselor. This not only gives you a second opinion, it also spreads some of the assessment and caring around. The counselor has been trained to move people out of depression. You may have been trained to be a caretaker. Those things do not always mesh. Sometimes it takes letting go and moving out of someone’s way to support a loved one. The therapist may even want your loved one to consult with a psychiatrist. Sometimes medications are needed for a short-time or long term, due to changes in the body's chemistry. If their body chemistry is at odds with a person, they may need the boost medication can give before therapy is effective – no matter what their best intentions are. It is important your professional contacts spend time and listen to you. If a medicine isn’t working, tell them. As a concerned relative or friend, ask that your friend sign a release of information which allows the mental health professional to talk with you if you call. Even if you do not have that, you can call or write a message stating your concerns and specific symptoms you see. People often will not fully disclose or even be aware of their behaviors. An upset voice to one person may be a complete rageaholic to those around him. Family members may disclose their worry about someone staying in bed all the time. That same person may simply tell the doctor they sleep ok. Family members can provide vital information and often are important in therapy sessions, too.


6. It may take an intervention for a change to occur. These provide a loving, yet firm reminder that your loved one’s depression affects you and your relationship. In interventions, you ask them to listen, then talk about specific incidents and how it affected you. Share that you love and care about them, but that you will not be a part of their depression. You want them to seek professional help. Offer to go with the person the first time. It may ease their anxiety. However, make it clear you will not sit through the entire first session with a therapist, and thereafter will participate as invited by the patient-therapist team.


7. Recognize that healing may include changes you are not too comfortable with. For instance, a very compliant person who hid all her feelings may become more assertive. That can be an adjustment for family or friends.


8. Do not become totally absorbed. It is crucial you take care of yourself, get out with friends. Otherwise, you may also become severely depressed. If you are worried about leaving a loved one alone, definitely seek professional help. You need a trained outsider to help you through these times and ease your fears.


9. If someone you love or care about expresses thoughts of suicide or violence to others, seek help immediately.

Sources and Additional Information:

http://www.healingwell.com/library/depression/aitken2.asp

http://health.msn.com/health-topics/depression/articlepage.aspx?cp-documentid=100256871

http://abcnews.go.com/Health/MindMoodNews/story?id=4539059&page=1

http://www.forgetaboutdiets.com/depression/DepressionCanBeContagious.htm

Endogenous depression - basics, symptoms, treatment and curing

What is Endogenous Depression?

In most cases, a person who appears to suffer from a type of depression will often have a reason for it. In other words, the depression has been brought on or encouraged by an event, or something has happened to that individual, either in their youth or adulthood, that they have not been able to deal with. There are, however, cases where the individual does not seem to have a reason for their depression. They show all the symptoms of depression, but there just not seems to be any apparent cause for it. This is when the patient would probably be diagnosed with endogenous depression.

Endogenous means 'coming from within' and such depression were thought to be due to biochemical changes within the body, although there is still very little understanding of what triggered them.

Note that the way in which depressive illness is classified has been changed recently. In practice this is really only of interest to statistician and researchers, but you may know of someone, a friend or relative perhaps, who was given a particular diagnosis under the old system and wonder how that relates to a diagnosis that someone receives now. Until very recently, depression was classified as either reactive or endogenous. Reactive depression was believed to have been caused by a particular event in a person's life. In other words, the sufferer became depressed as a reaction to things that had happened, such as redundancy, bereavement, serious illness, etc.

Endogenous depression is a term, which is also used to describe those patients who do not respond to medication.

Symptoms

A person who suffers from endogenous depression will often exhibit similar symptoms as someone suffering from any other type of depression. The person could appear anxious, have a change in sleeping patterns, a change in eating habits, show fatigue, have low self-esteem and even sudden mood changes.

The symptoms of endogenous depression range from mild to more severe and not all patients exhibit the same symptoms. If the patient is suffering from an underlying health concern or any accompanying mental health illness, the symptoms may become more severe in nature. Like most other forms of depression the symptoms of endogenous depression are classified into 4 distinct categories.

Impact on your Thoughts:

• Lack of concentration


• Forgetfulness


• Inability to make spontaneous decisions


• Pessimistic attitude


• Guilt


• Self pity


• Thoughts of self destruction

Impact on your Behavior:

• Apathy


• Cry often


• Prefer to stay away from social situations


• Little to no sex drive


• Lack of personal grooming (in severe cases)


• Disinterest in work and routine activities

Impact on your Feelings:

• Feel tired all day


• Lack of motivation


• Occasional temper outbursts


• Irritability


• Worthlessness

Impact on your Physical Well Being:

• Prolonged fatigue


• Difficulty falling asleep


• Disturbed sleep patterns


• Experience bodily aches

If you do experience any or all of these symptoms, consider getting medical help at the earliest in order to initiate treatment and speed up recovery. Since there are different treatment options available, discuss all of them with your doctor to find out which one is best suited to your unique needs.

Causes

Since endogenous depression is a genetic mood disorder, patients predisposed to this form of depression generally develop the condition when the chemical imbalances in the brain become more severe. Stress along with other traumatic circumstances can also influence the onset of this condition but in most cases the patient will not be able to associate any particular event with the advent of the disorder. Endogenous depression can affect people of all age groups and most patients realize that they’re suffering from the disorder only after the symptoms are manifested.

Treatment

How is endogenous depression treated? Endogenous depression can be also called as biochemical depression. It tends to run in families, as in genetic factors, and is generated by brain chemistry and imbalances of serotonin (it’s one of the "feel good" hormones that helps us to sleep) or other neurotransmitters. Most of anti-depressant medications prescribed currently are chemicals that maintain or improve serotonin levels. Even the natural approach that utilizes diet, herbs, and amino acids is geared toward raising serotonin levels.

Often though, with endogenous depression, the sufferer has difficulty controlling depressive thoughts and as such, in this situation a very specific form of counseling, CBT or Cognitive Behavioral Therapy, is also indicated.

There are also certain food items and natural supplements which would be useful in alleviating endogenous depression, such as omega-3 fatty acids found in fish, vitamin B compounds, and folic acid found in broccoli, asparagus, and spinach. Research reports have indicated that increasing the intake of all three compounds is extremely effective in reducing the condition and / or preventing depression from setting in. Regular intake of salmon and other fish that are a rich source of omega-3 fatty acids has been found to relieve the symptoms of depression.

Self-Help

Self help for endogenous depression may seem like an unrealistic objective when you have absolutely no interest in anyone or anything outside the black hole you find yourself in. That is why you need to have someone who will call you every day. It can be a close friend or family member. That is the first self help for endogenous depression tip. A tiny first step in keeping a supportive relationship alive and well…

The second self help for endogenous depression tip is to make a list of all the things that you liked or even still like doing and which give you pleasure. This can range from food, music, a movie, a hot bath, a long walk or even playing with a dog or cat. If you can aim to do one or two of these things every day, that is a great start.

The third self help for endogenous depression tip is not to underestimate the power of exercise. Scientists now are absolutely certain that any form of exercise has such a beneficial effect on our mood (and also on our body) that it can sometimes even replace anti-depressants. If you are stressed out or just totally down, exercise can really lift your mood and get those endorphins going which in turn raise your serotonin levels. It is no accident that endorphins are called 'happy chemicals’. Brisk walking for thirty minutes a few times a week can do the trick if you have no will power to face the gym and all that goes with it.

Summary

Like any other type of depression, endogenous depression is treatable. While treatments may not seem to work at first, they will over time. It is important for anyone who wishes to work through their depression to be open and honest with their therapist so that the therapist can have a clear understanding about what the patient needs. With the proper information, the therapist can be sure to choose the right medication and/or other treatments that would best work in the patient’s favor. Depression is not something to ignore or shy away from getting help for. If anyone thinks they might be suffering from depression, they need to consult a therapist so they can get the help they need.

Untreated, this mental condition can cause severe problems for the affected person and his or her loved ones. Several cases of untreated endogenous depression result in suicide, mainly because afflicted persons feel depressed for no particular reason and ultimately feel totally helpless and hopeless; they then finally contemplate ending their lives.

It is extremely important for family members to ensure that persons suffering from depression endogenous get proper professional help. Family and friends should also ensure that persons suffering from depression are encouraged to engage in activities which keep them occupied and interacting with people. If possible, affected persons should also try and enroll into an exercise routine, as well as yoga and meditation. These will help calm and relax them on a long-term basis.

Sources and Additional Information:

http://trusted.md/blog/completecounseling/2008/09/05/what_is_endogenous_depression

http://www.depression-guide.com/endogenous-depression.htm

http://www.wrongdiagnosis.com/e/endogenous_depression/intro.htm

http://www.brighthub.com/mental-health/depression-mood/articles/82754.aspx

http://www.all-on-depression-help.com/endogenous-depression.html

http://www.selfgrowth.com/articles/what_is_endogenous_depression_and_how_do_you_treat_it

Light Therapy for Depression

I have severe pain and trouble walking, I push myself 

to go outside in the sunlight. It makes the whole day 

change and lessons the intensity of pain. 

Of course it's hard for me to just sit there 

so I begin planting or just visiting my flower family. 

It truly works for me.

Marcella Floyd

About Light Therapy

What may be a good treatment for one type of depression may be good for another. Take light therapy for depression, for instance. Doctors have successfully treated seasonal affective disorder (SAD), a mild depression caused by reduced exposure to sunlight in winter months, with light therapy – spending a prescribed amount of time each day in front of artificial light that replicates the spectrum of sunlight. Light therapy may one day be used for general depression, too.

Researchers at the University of North Carolina at Chapel Hill School of Medicine discovered an interesting finding after reviewing 20 studies. “We found light therapy is an effective treatment not only for SAD but other types of depression as well,” says study leader Robert Golden, MD, professor and chairman of psychiatry.

Dr. Golden and his researchers reviewed studies of people aged 18 to 65 with a diagnosed mood disorder. Participants were grouped into four categories: bright light for SAD, bright light for non-seasonal depression, dawn simulation (simulating early dawn with artificial light at lower levels) for SAD and bright light with antidepressants for non-SAD. In every category, participants’ moods improved, with greater improvement found with a combination of antidepressants and light therapy. “The findings [for light therapy] are as strong or as striking” as those for conventional medications used as treatments for depression, according to Dr. Golden.

More studies are needed to provide definitive evidence on the effectiveness of light therapy for depression. Still, Dr. Golden says, “Light therapy may be a reasonable alternative to more established forms of treatment, including medication and psychotherapy.”

How much light are you getting?

Light therapy can treat more than just winter depression, though that's the main use. Here's why:  the amount of light reaching your eyeball from interior lighting is far less than the amount from the real thing. So unless you are outside much of the day in the winter, you are relying on electric light for your photons (in summer, there is so much light, most people get enough, even if they are indoors during their work hours). The following table shows you just how much less light you receive, indoors versus outdoors (Lux is a standard unit of light flow):

Brightness Values:

-        Candle light at 20 cm       10-15 Lux

-        Street light                       10-20 Lux

-        Normal living room lighting    100 Lux

-        Office fluorescent light    300-500 Lux

-        Halogen lamp                   750 Lux

-        Sunlight, 1 hour before sunset            1000 Lux

-        Daylight, cloudy sky        5000 Lux

-        Daylight, clear sky           10,000 Lux

-        Bright sunlight                 > 20,000 Lux

When to consider light therapy

Light therapy may be a treatment option for you if:

• You don't want to take medications such as antidepressants


• You can't tolerate the side effects of antidepressants


• You've tried antidepressants but they haven't been effective


• You want an alternative to psychotherapy


• You're pregnant or breast-feeding and are concerned about the effects of antidepressants on your developing fetus or baby


• You don't have insurance coverage for mental health services


• You lack access to mental health services

Conditions light therapy may help

Conditions and problems that may benefit from light therapy include:

• Seasonal affective disorder


• Nonseasonal types of depression


• Obsessive-compulsive disorder


• Premenstrual dysphoric disorder


• Postpartum depression


• Jet lag


• Certain sleep disorders


• Shift-work problems

Keep in mind that light therapy hasn't officially been approved by the Food and Drug Administration as a treatment for seasonal affective disorder or other conditions. But many mental health providers consider light therapy the main seasonal affective disorder treatment.

Risks

Risks and side effects associated with light therapy are uncommon but can happen. They can include:

• Eyestrain


• Headache


• Agitation


• Nausea


• Vomiting


• Irritability


• Fatigue


• Dry mouth


• Sleep problems


• Mania

When side effects do occur, they're usually mild. They may go away on their own within a few days of starting light therapy. You also may be able to manage these problems by reducing treatment time, moving farther from your light box, taking breaks during long sessions, or changing the time of day you use light therapy. Talk to your doctor for additional help and advice, or if your side effects don't go away or get worse.

Who shouldn't use light therapy

Some light boxes don't filter out or shield harmful ultraviolet (UV) light. UV light can cause skin and eye damage. Don't use light therapy without consulting your doctor first if:

• Your skin is sensitive to light


• You take medications that react with sunlight, such as certain antibiotics or anti-inflammatories


• You have an eye condition that makes your eyes vulnerable to light damage

Cautions for bipolar disorder, severe depression

Light therapy may trigger episodes of mania in people with bipolar disorder. Also, although rare, some people, particularly those with severe forms of depression, develop thoughts of suicide after light therapy. Be sure to talk to your doctor or mental health provider before starting light therapy or at any time during treatment if your condition gets worse.

What you can expect

Starting light therapy

The general recommendation for most people with seasonal affective disorder is to begin treatment with light therapy in the early fall, as soon as your symptoms start. Treatment generally continues until spring, when outdoor light alone is sufficient to sustain a good mood and higher energy.

Some people experience seasonal affective disorder in the summer. And others who typically have winter depression may notice symptoms during prolonged periods of cloudy or rainy weather during other seasons. You and your doctor can adjust your light box treatment based on the timing and duration of your symptoms.

For other conditions, talk to your doctor about the best time to begin light therapy.

During light therapy

During light therapy sessions, you sit or work near a light therapy box. To be effective, the light from the light box must enter your eyes indirectly. You can't get the same effect merely by exposing your skin to the light. While your eyes must be open, don't look directly at the light box because the light can damage your eyes.

Light therapy sessions are generally done each morning after you awake. Some light therapy boxes, however, are dawn simulators — they turn on in the morning while you're still asleep and gradually get brighter until you wake up.

Three key elements for effective light therapy

Light therapy is most effective when you have the proper combination of duration, timing and light intensity:

• Duration. When you first start light therapy, your doctor may recommend treatment for shorter blocks of time, such as 15 minutes. You gradually work up to longer periods. Eventually, your light therapy typically involves daily sessions ranging from 30 minutes to two hours, depending on your light box's intensity.


• Timing. For most people, light therapy is most effective if used in the morning, after you first wake up, rather than during the evening. Doing light therapy at night can disrupt your sleep. Because light therapy seems to work best in the early morning, you may need to wake up earlier than you normally would to match treatment with your natural biological rhythms. You may find it hard to wake up early, especially if depression leaves you feeling lethargic. Your doctor can help you find a light therapy schedule that works for you.


• Intensity. The intensity of the light box is recorded in lux, which is a measure of the amount of light you receive at a specific distance from a light source. Light boxes for light therapy usually produce between 2,500 lux and 10,000 lux, with 10,000 lux being typical. In contrast, the lighting in an average living room in the evening is less than 400 lux, while a bright sunny day may register 100,000 lux. The intensity of your light box may also determine how far you sit from it and the length of time you need to use it. The 10,000 lux light boxes usually require 30-minute sessions, while the 2,500 lux light boxes may require 2-hour sessions.

Results

Light therapy probably won't cure seasonal affective disorder, depression or other conditions. But with safe and effective light therapy, your symptoms can get better. You may feel better about yourself and life again, and have more energy.

Light therapy can start to improve symptoms within just a few days. In some cases, though, it can take two or more weeks.

Light Therapy Development

In the early 1980’s, scientists researching depression noted a consistent pattern of symptoms becoming more severe in many patients during the long winter months, particularly in the northern hemisphere. Significantly these symptoms eased or disappeared completely as the longer summer days returned.

In 1982 The National Institute of Health (NIH) identified winter depression and coined the term, ‘SAD’ for Seasonal Affective Disorder.

The scientists found that 'SAD' was related to an imbalance in the body's natural circadian rhythms. The Circadian rhythm, or the body’s inner clock governs the timing of sleep, hormone production, body temperature, and other biological functions.

In 1984 these pioneering scientists discovered that exposure to bright white light is very effective at treating seasonal affective disorder.

For many years doctors had relegated light therapy to the periphery of credible science. It wasn’t until 2001 that researchers from NIH, Thomas Jefferson Medical University and Apollo Health fully understood how exposure to specialized bright light, stimulates the production of brain chemicals to relieve the symptoms associated with seasonal depression.

Dr. George Brainard’s team at Thomas Jefferson Medical University, identified a photo receptor in the human eye, responsible for reacting to light and controlling the production of melatonin.

They found specifically that light in the range of 447-484 nm (nanometers) is responsible for suppressing melatonin production and shifting circadian rhythms. Indeed, this particular bandwidth of light is up to ten times more effective than other wavelengths. We now know this technology as BLUEWAVE. The light therapy is considered as an effective treatment for body clock corruption as well, helping to the patients fighting sleep disorders.

Bottom of Form

Sources and Additional Information:

http://www.arthritistoday.org/daily-living/stress/light-therapy-for-depression.php

http://www.psycheducation.org/depression/LightTherapy.htm

http://www.mayoclinic.com/health/light-therapy/MY00195

http://www.webmd.com/depression/tc/light-therapy-topic-overview

http://www.lighttherapy.com.au/

Therapeutic Gardening against Clinical Depression

Getting dirty might help lift our spirits, according to a new study which reveals that common soil bacteria could act like antidepressant drugs.



Mycobacterium vaccae, a harmless bacteria normally found in dirt, has been found to stimulate the immune system of mice and boost the production of serotonin, a mood-regulating brain chemical.

The bacterium has already been successfully used in people as a vaccine against tuberculosis. It is also being tested as a treatment for cancer patients and in asthma sufferers, as a way to control the allergic reaction and help 'rebalance' the immune system.



Now, studies on mice led by neuroscientist Christopher Lowry at the University of Bristol in England, suggests that the bacteria may have other applications as a treatment for mood disorders like depression.



"These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health. They also leave us wondering if we shouldn't all spend more time playing in the dirt," said Lowry.



Interest in the unusual antidepressant properties of M.vaccae arose by accident following an experimental treatment for human lung cancer led by cancer researcher Mary O'Brien at the Royal Marsden Hospital in London, England. Under that treatment, patients received heat-killed inoculations of the bacteria.



Following the tests, O'Brien's team observed not only fewer symptoms of cancer, but also improvements in their patients' vitality, emotional health and mental abilities.



Lowry and his colleagues speculated that the bacteria in these earlier experiments might have activated brain cells to release mood-lifting chemicals. To investigate the idea further, they injected heat-killed bacteria into a group of mice and found that they initiated an immune response, which activated serotonin-producing neurons in the brain.



Low levels of serotonin cause depression – an illness which afflicts around 1.3 million Australians. The most commonly prescribed antidepressant medications help treat depression by delaying the re-uptake of serotonin, thus raising levels in the brain.



According to Lowry, the strange effect of the bacteria may work by prompting the body's immune cells to release cytokines, chemicals known to activate sensory nerves that stimulate the brain. The findings are published in the journal Neuroscience.



"We believe that the brain then responds by activating serotonin neurons," he said. "These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health."



They also raise the question of whether exposure to common bacteria from a young age, could make us less vulnerable to disease. "We believe that prolonged exposure to [M.vaccae] from childhood could have a beneficial effect," said Lowry.

Further studies are required to confirm the effect in people and to see if other types of bacteria might have a similar effect, he said.



The study lends further support the 'hygiene hypothesis' whereby exposure to bacteria and pathogens from an early age helps balance the immune system. The idea is that some experience of disease early in life prevents our immune systems from attacking our own bodies - leading to allergies, asthma and other so-called auto-immune diseases.



Gardening benefits in combating depression are not limited exclusively to the bacteria related weaponry. Dr Cosmo Hallstrom, a psychiatrist in Chelsea and member of the Royal College of Psychiatrists, said gardening provides also a distraction therapy, vital in helping deal with depression.



"If I was seeing you in cognitive behavior therapy (CBT) I might say, 'Let's look at three things you enjoy doing,' and let's say you say one of them is gardening, I would then say, 'OK let's do one hour's gardening,' he said. "CBT is a modern form of psychological therapy dealing with the here and now as opposed to your past experiences looking at thinking and behavior and can include all manner of techniques.



"When you get depressed you stop doing things and get isolated which makes you more depressed. The theory is that if you do pleasurable things you will in time get better



"Gardening is a pleasurable activity and it focuses you away from thinking about your health problems.

"Why gardening and not running? Well I think at first it is a bit much doing things that are too physical. It is important to find something you enjoy."







Sources and Additional Information:

http://www.cosmosmagazine.com/news/1154/how-gardening-could-cure-depression

http://news.bbc.co.uk/2/hi/health/8027335.stm

http://www.epinions.com/content_3461390468

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