Posts tagged ‘depression’
Depression can make us physically older by speeding up the ageing process in our cells, according to a study.
Lab tests showed cells looked biologically older in people who were severely depressed or who had been in the past.
These visible differences in a measure of cell ageing called telomere length couldn’t be explained by other factors, such as whether a person smoked.
The findings, in more than 2,000 people, appear in Molecular Psychiatry.
Experts already know that people with major depression are at increased risk of age-related diseases such as cancer, diabetes, obesity and heart disease.
This might be partly down to unhealthy lifestyle behaviours such as alcohol use and physical inactivity.
But scientists suspect depression takes its own toll on our cells.
To investigate, Josine Verhoeven from the VU University Medical Centre in the Netherlands, along with colleagues from the US, recruited 2,407 people to take part in the study.
More than one third of the volunteers were currently depressed, a third had experienced major depression in the past and the rest had never been depressed.
The volunteers were asked to give a blood sample for the researchers to analyse in the lab for signs of cellular ageing.
The researchers were looking for changes in structures deep inside cells called telomeres.
Telomeres cap the end of our chromosomes which house our DNA. Their job is to stop any unwanted loss of this vital genetic code. As cells divide, the telomeres get shorter and shorter. Measuring their length is a way of assessing cellular ageing.
People who were or had been depressed had much shorter telomeres than those who had never experienced depression. This difference was apparent even after lifestyle differences, such as heavy drinking and smoking, were taken into account.
Furthermore, the most severely and chronically depressed patients had the shortest telomeres.
Dr Verhoeven and colleagues speculate that shortened telomeres are a consequence of the body’s reaction to the distress depression causes.
\”This large-scale study provides convincing evidence that depression is associated with several years of biological ageing, especially among those with the most severe and chronic symptoms,\” they say.
But it is unclear whether this ageing process is harmful and if it can be reversed.
UK expert Dr Anna Phillips, of the University of Birmingham, has researched the effects of stress on telomere length.
She says telomere length does not consistently predict other key outcomes such as death risk.
Further, it is likely that only a major depressive disorder, not experience of or even a lifetime of mild-to-moderate depressive symptoms, relates to telomere length, she said.
Depression is the second most common cause of disability worldwide after back pain, according to a review of research.
The disease must be treated as a global public health priority, experts report in the journal PLOS Medicine.
The study compared clinical depression with more than 200 other diseases and injuries as a cause of disability.
Globally, only a small proportion of patients have access to treatment, the World Health Organization says.
Depression is a big problem and we definitely need to pay more attention to it than we are now”
Dr Alize FerrariUniversity of Queensland
Depression was ranked at number two as a global cause of disability, but its impact varied in different countries and regions. For example, rates of major depression were highest in Afghanistan and lowest in Japan. In the UK, depression was ranked at number three in terms of years lived with a disability.
Dr Alize Ferrari from the University of Queensland’s School of Population Health led the study.
“Depression is a big problem and we definitely need to pay more attention to it than we are now,” she told BBC News.
“There’s still more work to be done in terms of awareness of the disease and also in coming up with successful ways of treating it.
“The burden is different between countries, so it tends to be higher in low and middle income countries and lower in high income countries.”
Policy-makers had made an effort to bring depression to the forefront, but there was a lot more work to be done, she added.
“There’s lots of stigma we know associated with mental health,” she explained.
“What one person recognises as disabling might be different to another person and might be different across countries as well, there are lots of cultural implications and interpretations that come in place, which makes it all the more important to raise awareness of the size of the problem and also signs and how to detect it.”
The data – for the year 2010 – follows similar studies in 1990 and 2000 looking at the global burden of depression.
Commenting on the study, Dr Daniel Chisholm, a health economist at the department for mental health and substance abuse at the World Health Organization said depression was a very disabling condition.
“It’s a big public health challenge and a big problem to be reckoned with but not enough is being done.
“Around the world only a tiny proportion of people get any sort of treatment or diagnosis.”
The WHO recently launched a global mental health action plan to raise awareness among policy-makers.
Prescribing self-help books on the NHS is an effective treatment for depression, a study suggests.
Patients offered books, plus sessions guiding them in how to use them, had lower levels of depression a year later than those offered usual GP care.
The effect was seen in addition to the benefits of other treatments such as antidepressants, Scottish researchers report in the journal Plos One.
Such an approach may help the NHS tackle demand for therapy, they said.
More than 200 patients who had been diagnosed with depression by their GP took part in the study, half of whom were also on antidepressant drugs.
Some were provided with a self-help guide dealing with different aspects of depression, such as being assertive or overcoming sleep problems.
Patients also had three sessions with an adviser who helped them get the most out of the books and plan what changes to make.
After four months those who had been prescribed the self-help books had significantly lower levels of depression than those who received usual GP care.
Depression saps people’s motivation and makes it hard to believe change is possible”
Prof Christopher Williams
A year later, those in the self-help group were more likely to be keeping on top of their depression.
Study leader Prof Christopher Williams, from the University of Glasgow, who also wrote the books called Overcoming Depression and Low Mood, said the guided sessions were the key to getting people engaged.
The sessions can be delivered in general practice without referral to a specialist, taking pressure off waiting lists.
In Scotland, a telephone support service has now been set up to help support those using the books, which can be freely copied and disseminated, he added.
“We found this had a really significant clinical impact and the findings are very encouraging,” he said.
“Depression saps people’s motivation and makes it hard to believe change is possible.”
The challenge for the NHS, where self-help books are already used in many places, is how to implement this model so people have easy supported access in primary care, he said.
‘Worth investing in’
There has been huge investment in better treatment for depression in the UK in recent years with the Improving Access to Psychological Therapies programme in England set up to widen access.
It has been estimated this approach could save the NHS up to £272m and the wider public sector £700m.
But, says Prof Williams, despite the huge levels of investment, it is just not possible to refer everyone with depression to mental health services.
Dr Paul Blenkiron, consultant in adult psychiatry at Leeds and York Partnership NHS Foundation Trust, said the results showed that guided self-help is effective and is “something the NHS should be investing in”.
He is currently advising on behalf of the Royal College of Psychiatrists, on a National Books On Prescription Scheme, to be rolled out across UK public libraries this year.
Thirty books, including the one used in the study, have been selected.
But Dr Blenkiron said self-help would not be suitable for everyone: “The key thing is that the person is committed to doing some work.”
Depression can happen during pregnancy too
More than a third of women who become depressed during their pregnancy have suicidal thoughts, suggests a snapshot survey carried out by the Royal College of Midwives and Netmums.
The poll of 260 mothers with antenatal depression found they were at greater risk of worsening mental health problems then women with postnatal depression.
Only 22% sought help from their GP.
Experts say women with the condition need more support.
The Department of Health has announced that £25m will be made available to improve maternity facilities for mothers and babies, and an NHS information service for parents is to include videos on how to spot signs of postnatal depression.
If we can identify women as early as possible then we could prevent them declining into much more serious mental health problems”
Cathy Warwick Royal College of Midwives
Antenatal depression, which occurs during pregnancy, is less known and talked about than postnatal depression, which happens after the birth of a baby.
This small survey suggests that those who suffer from depression during pregnancy are at greater risk of worsening mental health problems than those who have postnatal depression alone.
According to the survey, 80% of women with depression in pregnancy also went on to have postnatal depression.
About 56% of those surveyed had problems during their first pregnancy but almost 66% said they had problems during their second.
Just over half of the women said their illness had affected their relationship with their baby and 38% said they had problems bonding with their baby.
Only 30% were warned about antenatal depression by midwives and most of the women said it took a few months before they realised that they had a problem.
Just 22% sought medical help from their GP at that point – perhaps because only one in three women were aware of the possibility of becoming depressed during pregnancy.
Just 27% reported being asked how they felt emotionally during their pregnancy.
Hayley was 12 weeks pregnant when she started feeling awful.
“I had bad sickness and I just thought I was really tired, but it was getting worse,” she says.
“I was constantly crying. I didn’t want to talk about being pregnant and I kept imaging things were wrong with the baby.”
Everyone kept telling Hayley she was lucky to be pregnant, particularly since she had been told she would never conceive.
She went to GP for help but was given no support.
“Everyone is so aware of postnatal depression. They give you advice on the warning signs after you’ve had baby.”
Instead, she was crippled with fear and anxiety during her pregnancy and couldn’t get excited about the arrival of her first child.
“I went from being happy to living under black cloud.”
When Toby was born, everything changed and Hayley was on a real high.
During her second pregnancy, Hayley did not suffer antenatal depression, but she was diagnosed with delayed postnatal depression when her son Zac was two.
“I hit the black cloud again – but this time help was there immediately.”
Cathy Warwick, chief executive of the Royal College of Midwives, said the survey showed an urgent need to identify and help women with antenatal and postnatal depression.
“If we can identify women as early as possible then we could prevent them declining into much more serious mental health problems.”
Sally Russell, co-founder of Netmums, said depression and anxiety could make life very difficult for parents with a new baby.
“Midwives can do a lot to help and reassure, so they should be open with mothers and fathers-to-be about the condition and trained to spot the signs.
“Those suffering often don’t know who to talk to, so it’s essential they know they can be open and honest about how they are feeling with midwives.”
Health Minister Dr Dan Poulter, who announced the £25m fund to improve maternity services, said hospitals would be able to bid for en suite facilities, rooms where fathers can stay overnight or facilities like birthing pools.
“A new arrival in the family is a joyous time but can present challenges for mums and families, particularly new families. I want to help women and their partners as much as possible,” he said.
The NHS Information Service for Parents is available to every new parent to sign up to if their chid is under six months old. From next year it will support parents with babies and young children up to 18 months old.
Dr Poulter added: “Women with postnatal depression need care and support, not stigma. That’s why early diagnosis for this traumatic condition and support for parents is so important.”
In May, the government also pledged to recruit an extra 4,200 health visitors and give them training to diagnose postnatal depression.
Depression cases are increasing, data suggests
The number of people living with depression in England has increased by nearly half a million in three years, according to an analysis of NHS data.
The total number for 2010-11 stood at 4.7 million people.
Data analysis firm SSentif said there was also a large increase in the number of prescriptions for anti-depressants.
Charities said more people were speaking to their GP about depression, but the figure was likely to be the “tip of the iceberg”.
The data suggested the largest percentage increase was in Yorkshire and the Humber, where the number of registered cases increased by 19%.
SSentif managing director Judy Aldred said: “We have to remember that the real numbers are likely to be much higher as many people do not seek GP support.”
Depression Alliance chief executive Emer O’Neill said: “We’re still at the tip of the iceberg of what the figure could be.”
She said more people were being affected by job losses and relationship breakdowns in the current economic climate.
However, she said there had been a shift in society’s perceptions of depression and doctors had become better at diagnosing it.
“More people are coming forwards and they are coming forward because the level of support is better,” she said.
People can find it hard to keep on working when experiencing depression
One in 10 workers has taken time off because of depression, a poll of 7,000 people in seven European countries has found.
The Mori survey was carried out for the European Depression Association (EDA) in Britain, Germany, Italy, Denmark, Turkey, Spain and France.
Those in Britain, Denmark and Germany were most likely to be off work because of depression.
A UK expert said support for people with depression was improving.
Overall, 20% of the 7,000 polled had received a diagnosis of depression at some point in their lives.
The highest rate was in Britain, where 26% had been diagnosed and the lowest in Italy, where the figure was 12%.
Among workers experiencing depression, those in Germany (61%), Denmark (60%), and Britain (58%) were most likely to take time off work, while those in Turkey were the least likely (25%).
Researchers have previously estimated the cost of depression at €92bn (£73bn) in 2010 across the EU, with lost productivity due to time off or under-performance accounting for most of the costs.
We have moved forward significantly”
Emer O’Neill Depression Alliance
An average of 36 days were taken for the last episode of depression – but figures ranged from 41 in Britain to 23 in Italy.
Across the countries surveyed, one in four of with depression said they did not tell their employer.
One in three of them said they were worried it could put their job at risk.
A third of the 792 managers surveyed said they had no formal support in place to help them deal with employees experiencing depression.
But the situation was better in Britain, with most of the 117 managers questioned reporting good back-up from their HR department.
‘Attention and action’
Dr Vincenzo Costigliola, president of the EDA, said “The results of the survey show that much needs to be done in raising awareness and supporting employees and employers in recognising and managing depression in the workplace.
“We ask policymakers to consider the impact of depression on the workforce and charge them with addressing depression and workers and workplace safety.”
MEP Stephen Hughes, who holds the Employment and Social Affairs portfolio in the European Parliament, backs better support and protection for workers.
He said: “Depression in the workplace is an employment and societal challenge that is causing serious damage and which requires attention and action from the European Union.”
Emer O’Neill, chief executive of the Depression Alliance, said the situation in the UK was improving.
“We have moved forward significantly. Depression and anxiety is being talked about more and is more widely recognised. GPs are more receptive.
“In addition, employers are increasingly coming to groups like us to help them provide support and put procedures in place to allow people to go through this illness like they would any other.
The study asked participants to think of positive images and showed them how their brains responded
A brain training technique which helps people control activity in a specific part of the brain could help treat depression, a study suggests.
Cardiff University researchers used MRI scanners to show eight people how their brains reacted to positive imagery.
After four sessions of the therapy the participants had seen significant improvements in their depression.
Another eight who were asked to think positively but did not see brain images as they did so showed no change.
The researchers said they believed the MRI scans allowed participants to work out, through trial and error, which sort of positive emotional imagery was most effective.
The technique – known as neurofeedback – has already had some success in helping people with Parkinson’s disease.
But the team acknowledge that further research, involving a larger number of people, is needed to ascertain how effective the therapy is, particularly in the long term.
Prof David Linden, who led the study which was published in the PLoS One journal, said it had the potential to become part of the “treatment package” for depression.
About a fifth of people will develop depression at some point in their lives and a third of those will not respond to standard treatments.
Prof Linden added: “One of the interesting aspects of this technique is that it gives patients the experience of controlling aspects of their own brain activity.
“Many of them were very interested in this new way of engaging with their brains.”
Chris Ames, from the mental health charity Mind, said: “While these initial results are interesting, the research is clearly at an early stage.
“Further research should give a better idea of how beneficial this technique could be as a treatment for depression.”
At present, the NHS can refer patients for a course of supervised exercise sessions
Combining exercise with conventional treatments for depression does not improve recovery, research suggests.
In the NHS-funded study – published in the British Medical Journal – some patients were given help to boost their activity levels in addition to receiving therapy or anti-depressants.
After a year all 361 patients had fewer signs of depression, but there was no difference between the two groups.
Current guidelines suggest sufferers do up to three exercise sessions a week.
The National Institute for Health and Clinical Excellence (Nice) drew up that advice in 2004.
At the time it said that on the basis of the research available, increased physical activity could help those with mild depression.
The latest study, carried out by teams from the Universities of Bristol and Exeter, looked at how that might actually work in a real clinical setting.
Many patients suffering from depression would prefer not to have to take traditional anti-depressant medication”
Prof John Campbell Peninsula College of Medicine and Dentistry
All 361 people taking part were given conventional treatments appropriate to their level of depression.
But for eight months some in a randomly allocated group were also given up advice on up to 13 separate occasions on how to increase their level of activity.
It was up to individual patients what activity they chose to increase and by how much.
This approach produced good results in terms of encouraging people to do more over a sustained period of time – something which could have benefits to their general physical health.
But at the end of a year, researchers found no additional reduction in the symptoms of depression in the more active group.
Prof John Campbell, from the Peninsula College of Medicine and Dentistry, which also took part in the study, said: “Many patients suffering from depression would prefer not to have to take traditional anti-depressant medication, preferring instead to consider alternative non-drug based forms of therapy.
“Exercise and activity appeared to offer promise as one such treatment, but this carefully designed research study has shown that exercise does not appear to be effective in treating depression.”
But he added that GPs were often faced with patients with a number of health problems for whom encouraging an active lifestyle might be of overall benefit.
At present, the NHS can refer patients for a course of supervised exercise sessions as part of treatment for a number of illnesses, including depression.
These findings are therefore likely to be taken into account when Nice next reviews its guidelines.
The research was funded by the National Institute for Health Research, a government-backed programme.
Middle-aged men and women suffering from depression may be more susceptible to dementia down the line, a recent study reports in the Archives of General Psychiatry.
Previous studies have linked depression in older adults with dementia and Alzheimer’s disease, but it has never been clear which came first: was depression a risk factor for dementia or an early symptom? The new study sought to look at depression at younger ages to see if the condition preceded memory decline.
“We wanted to look at whether depression is truly causal, or if it’s a reaction to cognitive impairment, or if the changes in the brain are causing both depression and cognitive decline at the same time,” says study author Dr. Deborah Barnes of the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center.
To clarify the timing of depression and memory loss onset, the research team conducted a life-course study that first looked at the incidence of depression in midlife. The team included more than 13,000 people ages 40 to 55 who were part of the Kaiser Permanente Medical Care Program of Northern California and participated in a health examination called the Multiphasic Health Checkup between 1964 and 1973.
As part of the examination, the participants answered detailed questions about their health behaviors and medical histories, and had their height, weight and blood pressure recorded. Researchers were able to determine whether people had suffered from depression based on the self-reported information. The researchers then looked at the same people again between 1994 and 2000 to see if they were depressed in older age. Some years later, between 2003 to 2009, when the average age of the participants was 81, the researchers followed up to see whether they were diagnosed with dementia or Alzheimer’s disease.
The study found that 14.1% of study participants had midlife depression only, 9.2% had depression only in late life, and 4.2% were depressed during both life stages. During the final six years of follow-up, 22.5% of patients were diagnosed with dementia, 5.5% were diagnosed with Alzheimer’s disease and 2.3% were diagnosed with vascular dementia — a type of dementia resulting from brain damage due to impaired blood flow to the brain. (By contrast, Alzheimer’s disease is caused by protein deposits that interfere with brain function.)
Overall, compared with people who had never been depressed, those who had depressive symptoms in middle age (but not later in life) were about 20% more likely to develop dementia later on. People who became depressed in later life were even worse off: they were 70% more likely to develop dementia than their non-depressed peers.
Further, people with late-life depression were twice as likely to have Alzheimer’s disease as those who were depression-free, and those with both midlife and late-life depressive symptoms had more than a three-fold increase in vascular dementia risk.
Because of its observational nature, the study could not firmly establish a causal association, but the findings do suggest that depression precedes vascular dementia. “The people who had depression in their mid- and late-life had an increased risk of developing vascular dementia, and [the depression] could be a true causal risk factor,” says Barnes.
She notes that it’s possible that vascular changes in the brain attributable to depression — particularly in those who have chronic depression — may increase later dementia risk. “These ongoing vascular problems are probably why they had increased risk of vascular depression,” she says.
As far as the link with Alzheimer’s disease is concerned, however, Barnes says depression may more likely be an early symptom, a part of the overall neurodegenerative process that leads to memory loss. “Some of the neurons in the brain that are being influenced could deal with memory and cognitive functions, but some might also be related to mood changes,” says Barnes.
The authors say that further research is needed to confirm their findings, and they acknowledge that the current study had some weaknesses: for one thing, midlife depression was assessed using a single question on a questionnaire. The dementia diagnoses were also based only on reported symptoms and medical histories and did not involve brain imaging or tests of spinal fluid. The researchers also did not look at depression history prior to midlife nor did they take into account the influence of genetic factors on Alzheimer’s disease.
The authors are hopeful that continued research will explore all of these unanswered questions and, most importantly, determine whether treating depression in midlife can help stave off later dementia. It’s a difficult area of research since it is unethical not to treat someone with reported depression and thus hard to find comparisons.
“One of our take home messages is that depression in older adults is not something that should be ignored,” says Barnes. “Depression is not a normal part of aging. … Depression can be devastating by itself, but it can also be associated with increased risk of developing dementia and it is likely to a precursor to dementia. Older adults should be followed a little closer to see if they develop these impairments and depression.”