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Hearts and Minds

Now this is very interesting. Young people with a close family history of depression but no depression themselves showing elevated risk factors for cardiovascular disease (hypertension, stiffened arterial walls, insulin resistance…).

Put that together with the emerging evidence that poor diet is associated with an increased rate of depression (and is not only secondary to the depression), and that young people who are obese have an elevated risk of adult depression, and the importance of proper healthful eating and physical activity starts to become very clear.

The mind, and its moods, are of course nothing more than functions of the brain, which being just a part of the body, must have evolved with the same basic requirements as the rest of the body. An organism that needs one set of conditions for proper brain function and another for proper cardiovascular function is not going to get far. So it makes sense that the two are this linked.

In fact, it’s not "the two", is it? It’s all one.

Fit Teenagers, Happier Adults

There’s an interesting paper just published by the British Journal of psychiatry, that seems to demonstrate that better cardiovascular fitness as a teenager is correlated with decreased risk for later serious depression: press release here.

As I’ve been blithering about here – and have decided to move mostly to my shiny new Tumblr: The Running Reprobate, I’ve become a convert to running. I’ve experienced a really interesting lifting of mood every time I run – even if it’s only for 20 metres or something; running properly simply feels good.

Couple that with the evidence (at least suggestive; wish I knew where I’d seen it … Or maybe I heard it at the Brain Science Institute seminar last year – that could be it) that exercise is a really major factor in cognitive development/maintenance, and we really start to see that we should never stop running.

We know that exercise is good for depression (recent press notwithstanding), and that less fit adults – like adults with worse diets – are more likely to be depressed. Now it seems that fitness (and I’d lay good odds on diet as well) when younger has long-lasting effects on depression risk – suggesting that it is important in the brain developing properly.

So. Again: run, and don’t stop running.

And eat good noms: grains, nuts, oily fish, veggies…

A Non-Starter

 An envelope came for me in the internal mail. From a drug company. It invited me to request starter packs for a medication that is not subsidised on the PBS. After some deliberation, I’ve decided against doing so, even though I am rather interested in the possibilities of this medication, and wonder if it might turn out to be a more useful antidepressant approach (at least for some people) than what he currently have available (with subsidy).

So why have I decided against it? Surely it would be good to have these starter packs, as then I can use it….

It’d be good for the drug company, certainly. The evidence is that when medications are available to hand out to patients, doctors are more likely to use those, even when there are other appropriate – and cheaper – options.

Sure, I might see myself as immune to the wiles of the pharmaceutical industry – but so does everyone, and we’re all wrong.

So it’s better that I don’t get the samples. If I want to use the medication I can see about asking the drug company to provide it pending PBS subsidy, I can entreat our pharmacy to provide it, the patient can pay (as much as my socialistliberalhumanistpinkoswine self hates that idea) … 

… or I can use another medication, or non-pharmacological treatment.

King of the World

The death of Jani Lane has prompted quite a bit of thinking and talking between mrs tsuken and me, fuelled in part by an excellent, articulate and insightful post by Sebastian Bach.

Fame, it seems, is a harsh mistress. There is a striking – and superficially surprising – dichotomy evident in the world of the popular musician. The rest of the world sees glamour, riches, obnoxious self-indulgence, glitz, parties and excess .. Oh, and quite a few early deaths. Yeah… There is that… Kind of a bummer, really.

But we then hear about how the dead star was lonely and unhappy, and feel kind of puzzled, because the image presented to us is of success and hedonism. We certainly don’t see them as alone, because they always appear to be surrounded by others. And if we see them unhappy we often regard it as spoiled petulance. I mean, how can they have anything to really be unhappy about? Look at their glamourous life and all the stuff and fabulous friends they have.

Right?

I guess Jani Lane might disagree were he here to do so….

The life these idols lead, it seems to me, is self-sustaining, but also self-defeating. As Sebastian Bach describes in the post I linked earlier, once the gig is done, and the after-party is finished, and everyone goes home, the star goes to their hotel room. Silent and alone. But all the rest of their existence is the total opposite, so how do they deal with that?

A common theme in rock star’s descriptions of their lives is that they basically exist on stage, and in buses and hotel rooms. So they are thrown wildly between adulation and abandonment. It’s no wonder that the latter is hard to deal with. No wonder the star often wants to just keep partying – because they know when it ends they’ll be alone.

A relatively common thing to see on twitter in a rock star’s feed is them retweeting positive things other people have tweeted about them. Sometimes this is remarked upon (not kindly). The more you think about it though, the less surprising it becomes. Of course, as the positive comments are just about the external appearance of their existence – them as an idol, rather than them as people – it is ultimately as defeating as it is immediately sustaining. It can prop up the ego, but that just leaves more space to crash into when the hotel room empties, as it were.

The first I saw of this – though I didn’t really grasp it at the time – would have been watching The Jimi Hendrix Story. He really was quite alone, despite all the people around him. I recall later reading about Brian May suffering depression, and thinking “how can that happen?” He’s a rock star. He’s got everything.

Right?

… Guess not.

Rock stars are really like Birds of Paradise: it’s a sexual display on a massive scale. Consequently they attract many people – but it is, or can be, superficial. Particularly when the music business itself is factored in, and you think about all the hangers-on and various sycophants, how is the star to figure out the real motives of the people surrounding them? How do they find or keep real friends? That’s not necessarily the easiest thing in the world for the average person; how much less so for someone who feels they must constantly be second-guessing the intentions of any friend or acquaintance?

That led us to reflect on rock star tweets in general. They’re not exactly replete with suggestions of time spent with friends. Music biz acquaintances, yes. Other stars, the beautiful people, yes.

“Catch you all later I’m off to a BBQ with me best mate”? Not so much.

Ok maybe they just don’t want to share that sort of thing… But I’m not convinced it’s really that simple. It just doesn’t seem that the sort of relationships most of us take for granted are that easy or common for stars. So it appears there’s not much middle ground to balance out the extremes of idolisation and isolation.

Lest you think I’m pitying the dude with the badass hair whirling a guitar around onstage, with the adoring cries of tens of thousands ringing in his ears, let me be clear that they choose (if any of us can truly be said to choose) their path, and they do get plenty of rewards for doing so.

The litany of premature deaths, alone and sad, is pretty sobering though (apologies for the unpleasantly hyper-religious tone of that link, but it seems to have driven them to collate a fairly thorough list – though they’re not all suicide, or drugs etc, they’re all pretty young).

I’m not sure I have an overall point … Other than to highlight the dichotomy, and the way that pretty much every aspect of the lifestyle accompanying that type and degree of success reinforces it. Without a balancing middle ground then, the unhappiness that these people talk about becomes much more explicable.

As perhaps do the deaths.

In memory of Jani Lane, here’s my favourite Warrant song (though I was never a big Warrant fan, I really love this song):

Warrant – Heaven (Official Music Video). Watch more top selected videos about: Warrant (1975 film)

“I don’t need to be the king of the world.
As long as I’m the hero of this little girl.”

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A Little Bit Pregnant

Perhaps unsurprisingly, something has annoyed me today. :P Today’s something has to do with diagnostic rigour, and the impact that has on the appropriateness of the treatments offered to patients.

We often see people referred following some stress or conflict or other. Sometimes there is psychiatric illness behind it; often there is not. Sometimes when there is not, a suggestion is still made (not by me, nor generally by any member of my team) that involves medication (usually antidepressants, sometimes – perhaps often – quetiapine), and even referral for ongoing follow-up by a psychiatric team.

My question: why? Why would you give a psychiatric medication to someone not psychiatrically ill? Why would you have a psychiatric team have ongoing contact with someone not psychiatrically ill?

The usual response? They have “some depressive features”.

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Honestly, that is like being a little bit pregnant, or having some features of a heart attack. It’s stupid.

In other areas of medicine, including pregnancy and myocardial infarctions, we have investigations which can tell us if the condition really is present: we can do a serum βHCG, and ultrasound scans; we can check your troponin-I, and do ECGs.

In psychiatry we don’t. That’s why we have lists of symptoms -crucially, with thresholds: for both numbers and duration of symptoms. Without that, everyone in the world could be diagnosed with some psychiatric illness or other. The thresholds (eg at least 5 of the listed symptoms, for at least 2 weeks, for major depressive disorder) are there in an attempt to differentiate illness, or at least legitimate cause for clinical attention, from not.

Now, I’m one of the first to point out the problems with DSM (and probably would do so with ICD if I was as familiar with it). However, that doesn’t give me licence to ignore it. For people to prescribe antidepressants to someone who does not have a depressive disorder, only “some depressive features” goes against all the work that has gone into delineating major depressive disorder as a real entity. It is also not supported by evidence: not only are the trials that show antidepressants to be effective done in groups of people with actual major depressive disorder (not “some depressive features”), recent meta-analyses suggest (despite their shortcomings) that antidepressants might not even be much better than placebo for mild or moderate depression … So how likely is it that they would help “some depressive features”?

It’s too common though. A recent study (sorry, I can’t find the reference right now) looked at antidepressant prescribing – in the USA, but I don’t see that we have cause to assume we’d be different – and found that around a third of the prescriptions were written in the absence of major depression.

Any question as to why so many people find that their antidepressants don’t work?

Grrrrrumble.

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