STARD – Treatment used in the Study

NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study — All Medication Levels

The NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study was conducted to determine the effectiveness of different treatments for people with major depression who have not responded to initial treatment with an antidepressant. This is the largest and longest study ever conducted to evaluate depression treatment. This page provides information about the study.

What were the treatments used in the study?

In level 1, participants were given the antidepressant citalopram (Celexa) for 12 to 14 weeks. Those who became symptom-free during this time could move on to a 12-month follow-up period during which the citalopram was continued, and patients were monitored. Those who experienced intolerable side effects or did not become symptom-free during this level could go on to level 2.

Citalopram is representative of the class of antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs). It was chosen as the first treatment because it generally is not associated with troublesome withdrawal symptoms when it is stopped, is easy to administer (once a day), and has been shown to be safe for older adults and medically fragile patients. It does not appear to interact unfavorably with other medications that some participants may have been taking for other medical problems.

Level 2 was designed to help determine an appropriate next treatment step if the first step did not work. Thus, in level 2, participants had the option of switching to a different medication or adding on to their existing citalopram.

Those who joined the “switch” group were randomly assigned to either sertraline (Zoloft), bupropion-SR (Wellbutrin), or venlafaxine-XR (Effexor). These medications were chosen for comparison because they represent three different types of medications. Sertraline is an SSRI, the same class as the citalopram used in level 1. Bupropion belongs to another class of antidepressant medications that work on different neurotransmitters than SSRIs. Venlafaxine is a “dual-action” medication that works on two neurotransmitters at the same time.

Those who joined the “add-on” group were prescribed either the non-SSRI antidepressant bupropion-SR (Wellbutrin), or buspirone (BuSpar), which is not an antidepressant but enhances the action of an antidepressant medication. Participants could also switch to, or add on, cognitive psychotherapy.

As in level 1, those who became symptom-free with their level 2 treatment could continue with that treatment and entered the follow-up period. Those who did not become symptom-free, or who experienced intolerable side effects, could continue on to level 3.

In level 3, which like level 2 was designed to compare medications that are thought to work differently in the brain and produce different results, participants again had the option of either switching to a different medication or adding on to their existing medication. Those who chose to switch their medication were randomly assigned to either mirtazapine (Remeron) — a different type of antidepressant — or to nortriptyline (Aventyl or Pamelor) — a tricyclic antidepressant — for up to 14 weeks. Both work differently in the brain than the SSRIs and other medications used in levels 1 and 2.

In the level 3 add-on group, participants were randomly prescribed either lithium — a mood stabilizer commonly used to treat bipolar disorder — or triiodothyronine (T3) — a medication commonly used to treat thyroid conditions — to add to the medication they were already taking. These medications were chosen because they have been shown to boost the effectiveness of antidepressant medications.

In level 4, participants who had not become symptom-free in any of the previous levels (and therefore considered to have highly treatment-resistant depression) were taken off all other medications and randomly switched to one of two treatments — the monoamine oxidase inhibitor (MAOI) tranylcypromine (Parnate) or the combination of venlafaxine extended release (Effexor XR) with mirtazapine (Remeron). These treatments were chosen for comparison because previous research had suggested that they may be particularly effective in people who had not received sufficient benefit from other medications.

How were participant’s doses decided and how was their progress measured?

To ensure that every participant had the best chance of recovery with each treatment strategy, a systematic approach called measurement-based care was used. This method requires routine, consistent measurement of symptoms and side effects at each treatment visit with easy-to-use measurement tools. It also involves the use of a treatment manual that describes when and how to modify medication doses and dose adjustments to best tailor them for individual participants so as to minimize side effects, maximize safety, and provide the best chance of therapeutic benefit. This enabled STAR*D practitioners to provide consistent, high-quality care.

STAR*D employed easy-to-use rating tools of symptoms and side effects in a systematic and consistent way. These tools can readily be incorporated into real-world medical and psychiatric settings. Use of this measurement-based care may have caused greater than expected remission rates.

Patients were asked to self-rate their symptoms. The study demonstrated that most depressed patients can quickly and easily self-rate their symptoms and estimate their side effect burden in a very short time. Their doctors can rely on these self-rated tools for accurate and useful information to make informed judgments about treatment. The patients can also use these tools to help manage their illness at home in much the same way that hypertensive patients can measure their own blood pressure.

STARD – Results of the Study on Depression Other Treatments

NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study — All Medication Levels

The NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study was conducted to determine the effectiveness of different treatments for people with major depression who have not responded to initial treatment with an antidepressant. This is the largest and longest study ever conducted to evaluate depression treatment.

What were the results?

In most clinical trials of treatment for depression, the measure of success (outcome) is called “response” to treatment, which means that the person’s symptoms have decreased to at least half of what they were at the start of the trial. In STAR*D, the outcome measure was a “remission” of depressive symptoms—becoming symptom-free. This outcome was selected because people who reach this goal generally function better socially and at work, and have a better chance of staying well than do people who only achieve a response but not a remission.

In level 1, about one-third of the participants reached remission and about 10-15 percent more responded, but did not reach remission. Still, these are considered good results because study participants had high rates of chronic or recurrent depression and other psychiatric medical problems.

It took an average of six weeks of treatment for participants to improve enough to reach a response and nearly seven weeks of treatment for them to achieve a remission of depressive symptoms. In addition, participants visited their care providers an average of five to six times. Participants who achieved remission stayed on the treatment for an average of 12 weeks before going on to a 12-month follow-up period.

In the level 2 switch group, about 25 percent of participants became symptom-free. All three of the switch medications performed about the same and were equally safe and well-tolerated. In the add-on group, about one-third of participants became symptom-free. Those who added bupropion experienced less troublesome side effects and slightly more reduction of symptoms than those who added buspirone.

In levels 2 and 3 where participants were allowed to either add-on or switch medications, most participants found only one or the other treatment strategies acceptable. Because most participants did not agree to be randomly assigned to one or the other treatment strategy, the findings of the add-on and switch approaches cannot be compared. It is likely, however, that people being treated in the real world also tend to limit their treatment preferences to switching or adding on medications. In addition, the people in the switch and add-on groups were a little different. The group who chose and were assigned to a switch medication had more problematic side effects while taking the preceding medication (citalopram) than the group who chose and were assigned to an add-on medication.

Level 2 also included cognitive psychotherapy as a switch or add-on treatment. Results for the psychotherapy treatment are not yet available.

In the level 3 switch group, 12 to 20 percent of participants became symptom-free, and the two medications used fared about equally well, suggesting no clear advantage for either medication in terms of remission rates or side effects. In the add-on group, about 20 percent of participants became symptom-free, with little difference between the two treatments. However, the T3 treatment was associated with fewer troublesome side effects than lithium.

In level 4, seven to 10 percent of participants became symptom-free, with no statistically significant differences between the medications in terms of remission, response rates or side effect burden. However, those taking the venlafaxine-XR/mirtazapine combination experienced more of a reduction in depressive symptoms than those taking the tranylcypromine. Also, those who were treated with tranylcypromine were more likely to discontinue the treatment citing side effects as the reason. It is also possible that the dietary restrictions associated with taking an MAOI could have limited its acceptability as a treatment.

In conclusion, about half of participants in the STAR*D study became symptom-free after two treatment levels. Over the course of all four treatment levels, almost 70 percent of those who did not withdraw from the study became symptom-free. However, the rate at which participants withdrew from the trial was meaningful and rose with each level—21 percent withdrew after level 1, 30 percent withdrew after level 2 and 42 percent withdrew after level 3.

What lessons are learned from the results?

For the first time, doctors and people with depression now have extensive data on antidepressant treatments from a federally funded, large-scale, long-term study directly comparing treatment strategies.

Results from level 2 indicate that if a first treatment with one SSRI fails, about one in four people who choose to switch to another medication will get better, regardless of whether the second medication is another SSRI or a medication of a different class. And if patients choose to add a new medication to the existing SSRI, about one in three people will get better. It appears to make some—but not much—difference if the second medication is an antidepressant from a different class(e.g. bupropion) or if it is a medication that is meant to enhance the SSRI (e.g. buspirone). Because the switch group and the add-on group cannot be directly compared to each other, it is not known whether patients are more likely to get better by switching medications or by adding another medication.

Results from level 3 apply to those who do not get better after two medication treatment steps. By switching to a different antidepressant medication, about one in seven people will get better. By adding a new medication to the existing one, about one in five people will get better. Level 3 results also tell us that adding T3 may have some advantages over adding lithium for patients who have tried two other treatments without success.

Finally, for patients with the most treatment-resistant depression, level 4 results suggest that tranylcypromine is limited in its tolerability and that up to 10 percent may benefit from the combination of venlafaxine-XR/mirtazapine.

An overall analysis of the STAR*D results indicates that patients with difficult-to-treat depression can get well after trying several treatment strategies, but the odds of beating the depression diminish with every additional treatment strategy needed. In addition, those who become symptom-free have a better chance of remaining well than those who experience only symptom improvement. And those who need to undergo several treatment steps before they become symptom-free are more likely to relapse during the follow-up period. Those who required more treatment levels tended to have more severe depressive symptoms and more co-existing psychiatric and general medical problems at the beginning of the study than those who became well after just one treatment level.

These results underscore both the need for a better understanding of how different people respond to different depression treatments, and the challenges in finding broadly effective, short- and long-term depression treatments. Future research may help identify which treatments work for which patients.

What do the STAR*D results mean to people with MDD and their doctors?

The results reiterate the need for high-quality care and attention to the individual needs of patients. Doctors should provide medication at optimal doses, be aware of and offer treatment choices, and maintain diligent monitoring of patients both during treatment and after they become symptom-free so as to avoid relapse.

Like other medical illnesses, depression affects different people in different ways, but a wide range of effective treatments exist. People with depression should not give up if their initial treatment attempts do not result in full benefits. They should continue to work with their doctors to find the best treatment strategy.

In addition, patience is required. While some people may experience benefits in the first six weeks of a treatment strategy, full benefits may not be realized until 10 or 12 weeks have passed. During this time, doctors should work with their patients to adjust dosages so as to find an optimal level, and avoid stopping a treatment prematurely.

Four Different Biotypes of Depression

Is there a role of Biological balance and Biotypes in the onset and prognosis of depression in people? Born with unbalanced biochemistry, many people struggle with depression for most of their life. After taking anti-depressants such as Prozac and Zoloft, or acid therapies like 5-HTP, etc. or other herbal remedies, people realize that over time, their symptoms have worsened rather than soothing. Some of these medications helped little, but due to presence of nasty side-effects they actually make you feel worse.

Lot of psychiatrists believe that depression is caused by low levels of the neurotransmitter serotonin, which makes SSRI (Selective Serotonin Reuptake Inhibitors) to be the standard medication. This approach does not consider the unique biochemical imbalances and different symptoms of each individual.

There was a research conducted by William J. Walsh, Ph.D., at the Walsh Research Institute, and clinical applications by Drs. Albert Mensah. They condicted detailed study of about 300,000 blood and urine test results and 200,000 medical history from approximately 2,800 patients diagnosed with depression, They found that there are majorly 4 depression biotypes.

Typical symptoms of Patients with different Subtypes

Patient with Subtypes 1 and 2 – these people often report more fatigue. Subtype 1 were more likelier to benefit from transcranial magnetic stimulation (TMS). Many people take the antidepresant based treatment although their subtypes wants them to be treated with TMS.

Patients of Subtypes 3 and 4 often have difficulty in feeling pleasure. Brain on one hand have reduced connectivity in its network causing depressive anxiety, fear, etc., on the other hand people with subtype 3 and 4 has hyperconnectivity between stimuli center and brain control.

This subtyping helped in greater diagnostic precision, as well as finding accurate prognosis for patients bringing lot more relief with proper indivisualized treatment.

Different Biotypes in Depressive population

1. Type 1 – Undermethylators

2. Type 2 – Overmethylators

3. Type 3 – Pyrroluria or Pyrrole Depression

4. Type 4 – Copper Overload

7 Strengths for 7 Stressors of Today

The modern world today has been the worst all across human history for the stress effects on our daily life. There are many people who are feeling the psychological burden. Lot of us are feeling very tired and withdrawn from everyday routine and daily activities. The constant exposure to media is aggravating the situation towards the downward spiral because of the environmental and social events happening all around us and in the world we live.

Here are some of the top stressors in the current times and how we can overcome them to live a simple yet fulfilling life. Following these tips will mobilize your strengths towards achieving greater resilience and buoyancy in daily life.

1. The world is going through tough times and going to a shallow bottom – there are many horrific events like fires, earthquakes, hurricanes, and flooding. The political environment all around is also not giving any sense of stability either.

To cope up, remember that in all the times of despair and calamity, we see many resources being mobilized by people to care for others whom they do not know or never met. This is the human nature which has made us coexist since so long. The feeling of altruism, sympathy, and empathy are still in all of us fundamentally. Be helpful and provide hope for yourself and others.

2. Are we destroying our planet and making it inhabitable – The population of the world has been growing ad currently it is over populated, due to which we are consuming more and more resources. This causes Earth to suffer due to waste, deterioration of resources, oil reserves, etc.

Well, think that the basic step starts from you. We must do all that we can individually and collectively to make our planet better.

3. Feeling Lonely – We are living in a mobile world where people are moving constantly for school, work, leisure, etc. Therefore, we are often lonely with extended family living at distance, whether hundred miles or thousands of miles. Disintegration of community and relatives is making us get lesser and lesser emotional support.

To cope up with feeling of loneliness, we do need to be with others and feel part of a group. Invite friends over for dinner or extended an invitation to someone for coffee. Be inspired and extend yourself to an activity or an invitation and savor some connection.

4. There is so much anger around us with people upset naturally always. – The frustrations of life comes out in any form at any time with minimal or no provocation at all. Well, you might have heard it million times before, but the coping mechanisms remain same – exercise, meditation, friends and family, vacation time, etc are all the ways to reduce the daily life frustration. Do what you enjoyed once and stopped doing it due to time and its relevance.

5. How can I help or how can I get help – Healthy stepping back from your own world can take you to the longer road of good and destressed life. Keep in mind that grief and loss are part of life. What does loss or grief mean to you? How have you managed your own loss or grief in life? What helped, what didn’t? How can you cultivate them? Time to introspect and help others introspect.

6. Accept that stress is part of life – When stressful situations arise, remind yourself that they are part of life and will come and go. Nothing in this life is permanant – neither does your stress. So take a relaxed approch towards stress in life.

7. Have a realistic outlook about everything in your life. Do not see the world through rose-colored glasses rather have your own outlook which is realistic. You also need to check the silver lining in the tough circumstances. Stressful circumstances are there to make you become stronger and better.

Are you having Self Control over yourself?

Self control is defined by the experts as the impulse control or the ability to delay displaying gratification and controlling emotions. According to the prominent university research, if the person has a better self control, then it leads to better health and prosperity further discouraging crime and substance abuse. It is a vital ingredient in day to day behavior for achieving desired goals and remove all the harmful impulses or emotions.

Questions To Ask Yourself

Do you want to know where you stand towards the self control aspect and how do you think it is going to impact your life? Try answering these questions and know how control you have over yourself?

Are you Emotionally Stable – Do you have generally stable and peaceful mood which does not change drastically within span of hours or minutes, until and unless there is any reason/event for such change?

Are you feeling stable with respect to Self-Image & Life Goals – Do you know who you are and where you are going in your life? Are you certain about your position, standing and journey in life?

Do you have a stable personal relationship – Are you in a stable relationship and you are living peacefully in that relation?

Do you exhibit caution while taking important decisions in your life? – Do you think carefully before saying something or taking some action?

Do you follow genuineness in your day to day life? – Do you have theatrical or attention-seeking ways of speaking and acting?

Do you maintain Chasity in your like and avoid having casual sex (“one night stands”)?

Ten Things You Can Do for Your Mental Health

Each and every one of the us are important and so our thoughts in their individual way are important. We need to take care of our mental health along with the physical health. There has to be a balance which is needed to keep things under positive routine. Follow these tips to help find the right balance in your life.

We should be Valuing ourself – You should be treating yourself with kindness and respect. You should not opt for self-criticism, since it tend to take things in wrong direction. Take your timeout for hobbies and favorite projects, Spend time for something like crossword puzzle, planting in garden, dance lessons, learn to play musical instrument or learn another language. Challenges as well as satisfaction you get by overcoming these hobby related challenges gives greater sense of self respect and value.

Start taking god care of your body since healthy mind resides in a healthy body. Take some of the important steps such as eat nutritious meals, say no to cigarettes, drink lots of water, do regular exercise and get enough rest or sleep. Researchers have time and again proven that sleep deprivation is one of the leading cause of people becoming depressed or mentally unfit.

Always be in company of good and positive people. You can just surround yourself with people who take life as it comes and live it to the fullest. According to research in different universities across locations, people with strong family or social connections are healthier than those who lack a family support network. If being with family is a challenge, then you should participate in activities where you can meet new people, such in a club, class or support group.

Give your services and time for someone else. You can volunteer your time and energy to do something for others which can be tangible for helping others in need.

Stress is present in all phases for all types of people. The only solution to stress is to learn how to deal with it. You can start by practicing good stress coping skills like following One-Minute Stress Strategies, do Tai Chi, exercise, take a nature walk, or write a journal Remember that a good laugh can boost your immune system and reduce stress.

Empty your mind from negative thought and make it free from noise. You can do this for meditation, mindfulness and prayers. It can help improve your state of mind and outlook on life.

Expectation, whether from self or from others are doomed to fail someday. The only solution to this common issue is to set realistic and acheivable goals. Whether the situation is academic, professional or personal, write simple steps which can make you realize your goals. Try not to over-schedule. Progressing towards your goals make you get the satisfaction and determine your own self-worth.

Keep changing your routine things to ensure any monotonous fatigue creeping in your mind. You should break the monotony and perk up a tedious schedule. Someday, try to change your jogging route, take a unplanned road trip, choose different park for your daily meetup, etc.

Say a big NO to alcohol and drugs. These things can only aggravate problems and gives no relief, whether temporary or permanant.

Reach out for help when you think you have some trouble in your daily life and you have tried some of the above tips without remarkable changes. Asking for help is a sign of strength and it is in no sense a type of weakness. In order to lead a full, rewarding life, we should take advice and help from the experts and other people with similar experiences. At the end we are the social animals and the only way to solve our problems is to discuss and seek help.

The Subtle Signs of Depression

Depression doesn’t always “present” as it should. Prolonged sadness, lack of hope, or loss of interest in previously enjoyed activities are the most commonly mentioned symptoms on mental health websites and in antidepressant ads, and they can certainly be the most affecting. But sometimes the disorder is subtler, and harder to identify, since it can make itself known in stranger ways than we’d like. Below are some of the less obvious, but nonetheless important, symptoms of depression – those you should be aware of (and which you should make your psychologist/psychiatrist aware of, if you’re seeing one). Knowing that depression can play out in counterintuitive ways is important, since knowing that you’re depressed is the first step in seeking help for it.

Externalized Symptoms

Depression can poke through in unexpected ways, both physical and behavioral – it’s kind of like depression is finding a way out, if it isn’t being acknowledged otherwise. “Some people, particularly men, are more likely to externalize their depression,” says psychologist and author of When Depression Hurts Your Relationship, Shannon Kolakowski, PsyD. “Depression symptoms come out through excessively drinking alcohol, seeking out an affair outside of the relationship, becoming aggressive, or withdrawing from those you love. Similarly, physical symptoms like backaches or low sexual desire are less recognized as depression because they’re externalized.” Extreme fatigue – both mental and physical – is a common symptom (of course it can be indicative of other things, so it’s important to get checked out), as are changes in eating habits (not eating, or conversely, overeating) or sleep patterns.

Lashing out

This is an extension of the one above, but worth highlighting, since it’s more specific, and may actually indicate a more severe form of depression. Sometimes the disorder can emerge as irritability or anger – when some part of you is at a loss internally or feeling helpless or hopeless, it’s easy to lash out. “Experiencing irritability, hostility, anger, and being sensitive to rejection are all common symptoms when depressed,” says Kolakowski. “Less well known is the fact that not only is irritability a sign of depression, but that it often signals a more severe level of depression. Hostility and irritability are also linked to a higher likelihood of having other mental illness, like anxiety. Other emotions such as sadness, shame, or helplessness often underlie the irritability, but irritability is what shows up on the surface.” If you’re noticing that you’re very short-tempered, or yelling at your spouse or kids a lot, or otherwise lashing out, take some time to think about what might emotion/s might be driving that behavior.

Perfectionism

Perfectionism and depression have been long connected to each other, and research studies have underlined the association for years. “Having all-or-nothing, rigid, and exceptionally high or unrealistic expectations are all symptoms of perfectionism, and can all contribute to depression,” says Kolakowski. “Perfectionism in depression tends to belie the idea that others will only love and accept someone if they’re perfect.” Self-esteem is what seems to mediate the link between perfectionism and depression, since perfectionists often think that they must be “perfect” to be acceptable, both to peers and themselves. “To perfectionists, to make a mistake is a sign of a personal defect or flaw, rather than the fact that it’s human to make mistakes, and that we all make mistakes. To counter the self-blame, fear of failure, and shame that comes with this, practicing self-acceptance and compassion are essential.” That may be very hard to learn to do on your own, so might need the help of a capable psychologist.

Inability to Concentrate

Everyone has problems concentrating from time to time, especially if something specific is on your mind. But pronounced concentration issues – so much that they affect your work or relationships – can also be a sign of underlying depression. “Concentration difficulties are a common symptom of depression, yet one that people may not associate with depression (think ADHD),” says psychologist Jon Rottenberg, PhD, author of The Depths: The Evolutionary Origins of the Depression Epidemic. “Many of the symptoms of depression are private experiences like sadness or feeling worthless, problems that people can conceal from others. What’s striking about concentration difficulties is that they directly impair functioning – these difficulties make it harder to work or go to school. Concentration problems can make people miss assignments or deadlines.”

He adds that it’s often these issues that prompt a person to get help in the end, since they’re less easy to hide from one’s coworkers, boss, or family. Concentration may be compromised because of another serious symptom of depression – rumination – in which a person turns certain topics over and over again in one’s head (past regrets, future worries), which can be time-consuming, futile, and depressogenic itself. And it can severely compromise one’s ability to concentrate on the present.

Extreme Guilt (about Ridiculous Stuff)

Guilt is obviously a natural sensation at times, but sometimes a deep feeling of guilt about many or most areas in your life can signal depression. Rottenberg calls it “pathological guilt,” and says, “what’s different for the depressed person is that the guilt can become all-consuming. He or she scans the past and sees only a series of failings. Sometimes the guilty thinking can become quite fanciful. The depressed person can feel guilty for being born, guilty for having had depression, and be unable to think of any major life role (friend, son or daughter, parent) without being consumed by feelings of regret.”

You Don’t See ‘Smiley Faces’

Being a “Debbie Downer” is sort of a funny joke, but there’s a much more macabre side to it: When you immediately pick out every negative element of a situation, and roundly ignore the positive, this pattern can escalate till it’s sabotaging. Humans are primed to pick up on negative cues, because they might indicate that action is required in the face of danger. So in a sense, negativity is an occupational hazard of being human – but when finding the negative colors your entire life, it starts to blur into depression. “It is striking that recent research suggests that someone with depression is less likely to visually focus on happy faces than a non-depressed person,” says psychologist Suzanne Roff-Wexler, PhD, founder of CompassPoint Consulting. “If we observed carefully, could we notice how a depressed person avoids happy faces or situations while being more ‘comfortable’ with the opposite? I wonder if someone with depression is even aware of this visual bias toward the negative.”

Being a “realist” can subtly shift into being pessimistic which can subtly shift into being negative and even feeling “at home” with depression. Watch yourself for how you react to neutral or even good news – does it seem good, or do you immediately discount it because it will surely turn out poorly in your mind?

Toggling

This is a critical one, because the “toggle” can be a big clue that something more serious is going on. When you’re depressed, a happy event can take you out of it, and things can seem fine, for a little while – but the depression typically returns once you acclimate to the event. “An interesting ‘symptom’ of depression that may not be well known,” says Roff-Wexler, “is when someone with depression is temporarily lifted out of that state due to a positive event, opportunity, or interpersonal connection. The depression is real and does not go away with a positive experience but it seems briefly alleviated, later to return. Think of it as toggling between being depressed and then not feeling depressed given outside circumstances.”

Self-Medicating

This is not such a subtle symptom, but is definitely worth mentioning. Depression often carries with it the comorbidity of addiction – people with depression are more likely to drink alcohol heavily, smoke, have eating disorders, and have other dependencies and addictions. After all, when you’re depressed, it’s natural to want to use the tools at your disposal to cope with it – the problem is that we’re not very good at picking healthy tools. It’s much easier to smoke and drink than to go to therapy and exercise. Of course, the former methods will ultimately make the depression worse, while the latter two will put you on track for recovery. If you notice that you’re engaging in any kind of substance or behavior more than you used to, or so much that it’s messing up your life in other ways, think seriously about talking to someone about it.

The subtler symptoms of depression definitely deserve attention if you’re experiencing any (or several) of them. Talk to a friend, or even better, reach out to a psychologist if you think you might be depressed. There’s no magic bullet for depression, but there are certainly treatments that are effective. It’s often just a matter of finding the right one, or the right combination. And remember you’re not alone: Lots of people deal with and recover from depression – and the more people talk about it, the easier the road to recovery becomes.

Internet Use And Depression

Excessive Internet Use Causes Depression and Related complications

No one can deny that the Internet is most influential force on society in the entire human history. We never had such an unprecedented access to news, knowledge, and entertainment from cultures all around the world, before the advent of Internet. Although this treasure of information is huge and precious, this wealth has led to something called digital information overload. The human minds cannot handle such kind of constant influx of information without making changes.

Internet addiction is recognized as a psychological disorder which can make people spend too much time on a computer.  This affects their health, job, relationships or finances. Whether it is depression which causes people to turn to the Internet for social fulfilment, or whether excessive use of the Internet can make people depressed – this is subject to research and discussion.

A new research study by psychologists at Leeds University, England postulated that people who spend 10 hours or more a day online are more likely to show signs of depression.

Over-engaging in websites that replaces the normal social interaction like Facebook might be linked to psychological disorders like depression and addiction. Moderate to severe depression is likely to happen among people who are addicted to the Internet.

Recognizing Depression due to surfing online

People who spend high amounts of time surfing online does not realize the impact of lack of social interactions. Slowly the depression symptoms start piling on them. Know these early signs of depression from the National Institute of Mental Health:

  1. Difficulty concentrating and making decisions
  2. Decreased energy and fatigue
  3. Feelings of guilt, worthlessness or helplessness
  4. Feelings of hopelessness or pessimism
  5. Insomnia, early-morning wakefulness or excessive sleeping
  6. Irritability and restlessness
  7. Loss of interest in activities or hobbies once found pleasurable
  8. Overeating or appetite loss
  9. Persistent aches or pains, headaches, cramps or digestive problems
  10. Persistent sad, anxious or “empty” feelings
  11. Thoughts of suicide or suicide attempts

Ketamine for Bipolar Disorder

Ketamine Helps Patients With Bipolar Disorder – All you need to know about Ketamines?

Ketamine is an anesthetic and if it is used in higher doses it can also relieve depression within hours when taken intravenously. According to a research by Morteza Jafarinia and colleagues in the Journal of Affective Disorders, oral ketamine can help in treatment of mild to moderate depression in people with severe pain.

In this study the scientists compared 150mg daily doses of oral ketamine to 150mg daily doses of the anti-inflammatory pain reliever Diclofenac over 6 weeks. The subjects were interviewed after week 3 and week 6 and the ketamine group reported fewer symptoms of depression than the Diclofenac group.

This effect of Ketamine is the result of the blockade of a particular receptor for the neurotransmitter glutamate (the NMDA glutamate receptor). Researchers originally thought that the NMDA blockade was linked to ketamine’s antidepressant effects, but this appears not to be the case.

How Ketamines works?

Ketamine are strange substance and they works in a completely different way from other medicines you have ever taken for depression, bipolar, PTSD, or anxiety. Most of the medicines work by manipulating the quantity of certain neurotransmitters in your brain, which can have miserable side effects. Ketamine works differently since it briefly blocks a certain type of receptor in the brain from being triggered. Ketamine is not a one-time, permanent cure but it has the potential for lasting relief.

In general, a series of multiple injections gives longer, faster and lasting relief than a single infusion, and younger patients tend to get longer relief than older ones. For patients who relapse, getting additional infusions can often restore the relief.

Further use of Ketamines

According to a study, adding two more existing drugs to Ketamines, prolongs the effect of Ketamine which otherwise has very short lived effects. They after the addition effectively reduce symptoms of depression and suicide in patients with bipolar depression.

Walking is the New Found Therapy

Walking can be your natural medicine for happiness as it helps release happy hormone called endorphin.

Walking not only helps you burn calories but is also considered the most effective anti-depressant. Almost 97 percent walkers revealed that it helped them improve their mental health and emotional well-being. The survey also revealed that walking helps control stress among people across age groups. While 42% of the elderly feel that walking helps beat stress, 50% of the millennials experience reduction of stress and hypertension, post walking, it added.

This is the highest for millennials. Interestingly, over 40% of the respondents are motivated to walk because of interesting walking apps and gadgets that help them track their health.

Usage of gadgets is more prominent among millennials. The Survey further said those who don’t walk regularly are more prone to depression nearly 15% of non-walkers admitted to be suffering from depression and high stress levels.

According to the survey, walking gives millennials time for self-introspection, while it gives 21% elderly the feeling of self-reliance. But there is a flip side as well. About 43% are unable to walk as long daily commute leaves them with no time for walking, 29% get bored while walking and believe that walking will not have a positive impact on their personality, 21% lack company to walk, and 21% are unaware of the benefits of walking on their mental health.