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Welcome
Lead Story: Yoga for Depression
Also in
this issue: That time of year, FDA antidepressant
warning follow-up, More meds prescribed than ever, Treating
melancholia, Vitamins for the brain, Depression and
dementia, Geodon-SSRI combo, Two depression profiles, Depression
on the job, Suicides in Iraq, Capt Edward Bruno, Expert patients,
The perils of urban living, Noise and depression, Marvin Gaye and
Kurt Cobain, Happy holidays, McMan's Web, Donations
Living with Eyes Wide Open
Back in 1985, Amy
Weintraub’s therapist told her that, psychically, she would always
have empty pockets. "And I visualized myself, like Virginia Woolf,"
she wrote, "filling those empty pockets with stones and stepping
into the river." Instead, through yoga practice, she filled them
with fresh air and divine light, and slowly pulled her way out of
her chronic depression, an accomplishment that transformed her and
changed her life.
Books on yoga and
meditation offer us age-old insights into the nature of suffering,
together with time-tested techniques to alleviate that suffering.
Depression and self-help books provide a more contemporary focus.
Amy’s new book, "Yoga for Meditation: A Compassionate Guide to
Relieve Suffering Through Yoga," proves the twain of Patanjali and
psychology can meet. Amy is a Kripalu-trained senior yoga
instructor and writer who has thoroughly researched depression.
"Living in this
mortal body," she quotes the Buddha, "is like living in a house on
fire." We suffer. "Depression," says psychologist and yogi Stephen
Cope, "is the common cold of the deluded human being." Don’t take
this personally - we’re all deluded, including your psychiatrist
and therapist. But we’re also all divine, or at least we’re
connected to the divine. Yoga is about establishing this sense of
oneness. It is probably fair to say a good many people take up
yoga simply as a proven stress-buster or alternative to Richard
Simmons, but they may also find themselves reaping unexpected
rewards, such as beatific inner calm or heightened awareness. Some
also find it helps their depression.
In a UCLA study
published last month, 28 mildly-depressed young adults attended
two one-hour yoga classes twice a week for five weeks. Midway into
the course, subjects "demonstrated significant decreases in
self-reported symptoms of depression and trait anxiety," which
they maintained to the end. Subjects also reported decreased
negative mood and fatigue following class.
What is going on in
the body, says Amy, is muscular relaxation, restored natural
diaphragm breathing, improved oxygen absorption and carbon
monoxide elimination, and increased alpha wave activity.
Yoga is an
eight-limbed path which uses postures, breathing, and meditation
as both a means and an end. Back bends, which open up the chest
and increase lung capacity, are especially useful for depression.
So are inversions such as headstands and shoulder stands, which
stimulate the brain (but which should not be attempted without the
guidance of a qualified yoga instructor). Some positions are meant
to be calming and others energizing. Anxious types are advised to
employ calming positions while energetic positions are de rigor
for those who find it hard to get out of bed. (Since reading this
book, I find myself doing a short energizing routine in the early
afternoon to get me through the rest of the day and a longer
calming routine ending in a short meditation at night.)
Breathing exercises
follow the same energizing/calming dichotomy. One reason so much
emphasis is placed on the breath is that most of us have forgotten
how to breathe. Instead of using the diaphragm, we use the chest,
which is not as efficient since the lower portions of the lungs
are not exposed to air. The yogis imbue the air we breathe with a
spiritual quality called Prana (with a capital P). "When we
restrict the breath," writes Amy, "we are diminishing the spirit.
When we relearn to breathe fully and deeply, we are enlarging the
spirit and reconnecting with the Self." She cites an Indian study
that found reduced violence and disciplinary infractions in a
juvenile prison population that had been practicing a specific
breathing technique for eight weeks.
What may be going
on, speculates Amy, is the release of the anterior pituitary
("feel good") hormones, including oxytocin, prolactin, and
vasopressin.
If posture can take
us into breathing, breathing can take us into meditation, which,
says, Amy, "can create a calm, healing state in body and mind."
Pain doesn’t go away with meditation, she advises, but through the
practice of mindfulness we learn not to identify with the pain.
For people with major depression, she cautions, meditation may be
counter-productive at first, as depressed people tend to be stuck
in their negative thoughts. Since meditation may also bring up
flashbacks and bad memories, learning under a skilled instructor
is strongly encouraged.
Amy’s breakthrough
came in a yoga class while holding the bridge pose, suppine with
pelvis and chest thrust upwards She released the posture ten
minutes later to a flood of sensations and a "time-out for the
rational mind, a few moments of deep rest, a glimpse of samadhi
[cosmic consciousness]."
What if, she asks,
that intelligent awareness of bliss is not an altered state but
your natural state? "Eventually, through practice," she informs
us, "those moments of samadhi expand until they are firmly
established in your mind and you are living with your eyes wide
open."
There goes that
pesky common cold.
Keep in Mind
Through yoga, Amy
was able to go off her antidepressant, but she strongly advises
that yoga is not meant to replace meds, and that going off meds
should only be done under a physician’s guidance. She also
encourages people to seek out a competent yoga instructor.
Finally, she advises, like an antidepressant yoga is a daily
commitment.
Amazon.com
You can purchase
Yoga for Depression at Amazon.com and help support this
Newsletter in the process by clicking this link.
Your Support is Badly Needed
One last time for
now. NPR and PBS fans know the drill. It’s fund-raising season:
Since ending paid subscriptions a year ago, this Newsletter’s
survival has depended entirely on voluntary donations from readers
like yourself. Bringing you the quality of reporting you have come
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much more.
This Newsletter came
into being as part of my personal journey toward recovery.
"Knowledge is necessity" is my mission, which involves
disseminating to as many people as possible the type of
information we need to better manage our illness, in partnership
with our treating professionals. Your support is crucial, and
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FDA Under Fire
Congress is
investigating whether the FDA failed to act quickly over the
possible link between antidepressants and suicide in children.
Last month, following its own investigation and a public hearing,
the FDA announced it would require the makers of ten
antidepressants to strengthen the warnings on their labeling (see
Newsletter 6#7). The FDA assigned one of its medical officers,
Andrew Mossholder MD, to investigate, but his report was taken off
the agenda at the last minute and he wasn't allowed to testify.
CBS News reports that: "According to documents obtained by CBS
News, there were twice as many suicide-related events in children
who took antidepressants as those who only get sugar pills."
Prozac Nations (and Zyprexa and Ativan ... )
Several findings:
 | A
University of Arizona study of the prescriptions claims of
two million commercially-insured children and adolescents over
five years has found that antidepressant use among kids
increased from 1.6 percent in 1998 to 2.4 percent in 2002, at a
9.2 percent rate of annual increase. The growth was greatest
among girls (68 percent increase vs 34 percent increase in
boys). In 2002, antidepressant use among girls aged 15 to 18 was
6.4 percent. Among children under age five, the number of girls
on antidepressants doubled and for boys went up by 64 percent.
|
| A Norwich Union
Healthcare survey of 250 GPs in the UK has found that 81 percent
admitted to overprescribing antidepressants. A British Medical
Association spokesperson told
BBC News that GPs are often forced to prescribe
antidepressants, as other options have been closed down to them.
|
| The
Wall Street Journal reports that last year GPs in the US
wrote 30 percent of the country’s prescriptions for
antipsychotics, up from 16.6 percent three years ago. Some of
these doctors may simply be refilling existing prescriptions,
but "others are diagnosing mental illnesses and putting people
on antipsychotics for the first time." Sales of atypical
antipsychotics exceeded $6 billion last year. Eli Lilly and
Johnson and Johnson have been particularly active in promoting
Zyprexa and Risperdal, respectively, to GPs, with sales force
visits and continuing education courses. |
| A University of
Michigan
study of the pharmacy database of 128,029 depressed patients
in 129 VA facilities has found that during 12 months 36 percent
received a benzodiazepine prescription - 78 percent of these for
90 days and 61 percent for 180 days. Elderly patients were more
likely to receive benzos. The authors of the study point out
that most treatment guidelines recommend that benzo use be
minimized, particularly among the elderly. |
Treating Melancholia
An article on
Medscape by Michael R. Liebowitz MD of Columbia University
suggests that depressed patients with melancholia (appetite loss,
middle or terminal insomnia, feel worse in the morning, loss of
pleasure) may do better with dual-action SNRIs than SSRIs. These
include the tricyclics, Effexor, and the yet-to-be-released
Cymbalta. Says Dr Liebowitz: "I have seen many melancholically
depressed patients who showed poor response to an SSRI do very
well when changed to [Effexor] or augmented with a tricyclic
antidepressant." Patients with agitated depression, he says, are
almost always melancholic. Treatment of choice for agitated
depression is an SNRI augmented initially with a benzodiazepine or
low dose atypical antipsychotic, with a view to tapering after
several weeks.
For nonmelancholic
depressed patients, Dr Liebowitz has not seen strong evidence
supporting one class of drug over the other.
Vitamins as Brain Food
An article in
Psychology Today reports that antioxidants scavenge and fight
off free radicals, those rogue oxygen molecules that damage cell
membranes and DNA. The brain, being the most metabolically active
organ in the body, is especially susceptible to free radical
damage. Free radical damage is implicated in cognitive decline and
memory loss, and may be a leading cause of Alzheimer’s. Studies
suggest that vitamins C and E may work synergistically to prevent
Alzheimer’s and to slow memory loss. The RDA for vitamin E is 22
international units (IU) and 75 to 90 mg for vitamin C, but
supplements may contain up to 1,000 IU of vitamin E and more than
1,000 mg of vitamin C. In the Alzheimer’s study, involving 5,000
individuals, the greatest impact occurred among those who took the
two vitamins in combination. Taking either of the vitamins alone
or taking multivitamins provided no protection.
The Depression-Dementia Connection
An article in
Psychiatric Times by Malaz Boustani MD, MPH.of Indiana
University and Lea Watson MD, MPH of Duke reports that depression
occurs in an estimated 30 to 50 percent of patients with dementia.
A 2001 review of previous studies found that a history of
depression doubled the risk of developing dementia.
Geodon-SSRI Combo
A Massachusetts
General Hospital
study of twenty severely depressed patients unresponsive to an
SSRI has found that of 13 patients who completed the study, eight
responded and five achieved remission after Geodon was added..
Two Depression Profiles
| A JD Power and
Associates
survey of more than 27,000 managed care members found that
11 percent had clinical depression. Of these, 41 percent
described their depression as mild, 46 percent moderate, and 13
percent severe. Only two percent of those with mild depression
and eight percent with moderate depression were unable to carry
out many of their daily activities vs 33 percent of those with
severe depression. More than 80 percent of depression patients
who see psychiatrists or family doctors used meds to treat their
depression. Eighty-seven percent felt that their primary
medication was effective or very effective, but only 24 percent
with severe depression felt the same way about their
antidepressant. Nearly 75 percent of patients with severe
depression have switched primary meds vs 30 percent of patients
with mild depression. |
| A Cambridge
study of 61 depressed patients tracked over eight to 11
years has found that 52 percent of the months were spent
asymptomatic, 15 percent at minor symptom level, 20 percent at
residual symptom level, and 13 percent at full depression level.
Thirty percent of months were spent in an episode of depression
and 18 percent of patients never achieved asymptomatic status.
|
Depression on the Job
The
NY Times reports that a University of Michigan survey of 443
depressed workers has found that only 41 percent felt they could
acknowledge their illness and still get ahead in their careers.
Only 14 percent have taken advantage of employee assistance
programs for workers who suffer from depression. Eighty-two
percent of the depressed workers had difficulty concentrating, 83
percent lacked motivation, 24 percent complained of chronic
physical pain, and 50 percent missed one to three days of work
because of their illness.
Suicide in Uniform
The US military is
stepping up its
suicide prevention efforts in Iraq, in the wake of 23
self-inflicted deaths in Iraq and Kuwait last year. All Army
soldiers will be required to take a suicide prevention class
within three weeks of arriving in Iraq or Kuwait. In the past,
soldiers had one year in which to take the class. The 23 suicides
equates to a suicide rate of 17.3 per 100,000 vs 12.8 for the
entire Army. vs a 2001 civilian rate of 10.7 per 100,000.
The Unkindest Cut
Air Force Captain
Edward Bruno spent seven and a half years as a prisoner of the
North Vietnamese after his F-4 was shot down in 1965. Four months
after returning home in 1973, he killed himself in his wife’s
family’s home. This year, the Air Force reviewed Capt Bruno’s case
and ruled that his suicide was the direct result of both
psychological and physical wounds suffered in Vietnam, with a
recommendation that his name be added to the Vietnam Veterans
Memorial. But the President of the Vietnam Veterans Memorial Fund,
Jan Scruggs, is lobbying against the addition, claiming it would
result in a precedent that could add thousands more names to the
wall. "Societies do not condone certain behaviors, as
understandable and unfortunate as they may be, and suicide is one
of those behaviors," Scruggs told the
Washington Post.
The Veterans of
Foreign Wars estimates that anywhere from a few thousand to
180,000 (no typo) Vietnam veterans may have committed suicide
after the war.
The Expert Patient
This Newsletter’s
mission, "Knowledge is Necessity," is no empty phrase:
An
editorial in the British Medical Journal supports "expert
patients" who "are motivated to work in partnership [with their
physicians] to achieve successful results." Only 21 percent of
doctors in the UK, however, favor the idea of the government
educating patients, saying smarter, more inquisitive patients
would take up more of their time. The BMJ, however, cites two
Stanford studies showing a reduction of 42 to 44 percent in doctor
visits have been achieved by educating patients with chronic
diseases.
"Patients who have
the resources to find out about their illness and want
to take an active part in managing their own care are
to be welcomed as allies and partners," concludes the BMJ. "Long
live [quite literally, one presumes] expert patients ..."
Why City Living is Dangerous
A Swedish
survey of first hospital admissions for psychosis or
depression among the entire Swedish population has found that
those living in densely-populated areas had a 68 to 77 percent
greater risk of developing psychosis and a 12 to 20 percent more
risk of developing depression than non-urbanites.
Shoot the Leaf-Blower Guy
Time magazine reports that more than 10 million Americans
already suffer from noise-induced hearing loss and that 30 million
will eventually reduce their ability to hear as a result of
excessive noise. Noise in excess of 85 decibels may damage hearing
and noise in the 75 db range may lead to hypertension while noise
at 65 dbs "leads to stress, heart damage, and depression." A
telephone can ring at 80 db, a hair dryer blows hot air at 90 db,
and an ambulance siren can wail at 120 db.
In Memoriam
Twenty years ago
this week, soul legend Marvin Gaye, who was dogged by substance
dependence and depression, was shot and killed by his father. Ten
years ago this week, grunge rocker Kurt Cobain fatally shot
himself in the head.
Happy Holidays
It was my first
Passover Seder and it will be my new wife's first Easter. Have a
good one ...
McMan's
Web
Check out more than 250 articles on all aspects of depression
and bipolar, plus a bookstore, readers' forum, message boards, and
other features at:
http://www.mcmanweb.com
New:
Anxiety (how it is linked to mood)
Oldie but goodie:
Walking to California (Sophy's manic memoir)
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John McManamy
"Knowledge is necessity."
Copyright 2004 John
McManamy |
