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What Is Depression?
Depressed Men With ED at Risk for Heart
Lead researcher Elisa Bandini and her team from the University of Florence interviewed 2,000 men for sexual dysfunction and depressive symptoms.
It's been understood that both ED and depression independently elevate a man's risk for developing heart disease or experiencing a heart attack, but the study, which appears in the Journal of Sexual Medicine, found that depressive symptoms in men with sexual dysfunction made for the presence of especially likely cardiovascular problems.
Researchers noted that depression is common in men with ED, but results showed that taking antidepressants didn't weaken the relationship between depression symptoms, ED and the potential for heart attacks.
"Recognizing depressive symptoms in subjects with erectile dysfunction is mandatory not only for improving their sexual life, but also for preventing cardiovascular diseases," Bandini said in a statement.
Irwin Goldstein, editor-in-chief of the Journal of Sexual Medicine and director of sexual medicine at Alvarado Hospital in San Diego, said the results of this study should impact the way we perceive sexual dysfunction and its causes.
"What is important about this study is the broader concept of the
sexual medicine problem no longer being just about a man's
performance in the bedroom, but about his psychological mood and his
cardiovascular health," he said. "This is a valid reason for a woman
to encourage her partner to seek help for his erectile
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Quitting Smoking Offers Benefits;
Unsuccessful Attempts May Change View Of Health Risk
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Depression Hurts Heart Bypass Recovery
Users' Higher Depression Rates
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Can Caviar Cure Depression?
In one study, people with bipolar disorder -- previously known as manic depression -- had significantly fewer depressive episodes when their diets were supplemented with omega-3. And earlier research comparing 10 countries found that depression was much lower in areas where fish is a dietary staple.
Omega-3 -- abundant in cold-water fish (such as salmon and mackerel), some nuts, and flaxseed -- has already been shown to protect against heart disease. The evidence is so strong that the American Heart Association now recommends eating salmon or tuna at least twice a week. Studies also indicate that the fatty acid may benefit people with rheumatoid arthritis, stomach or intestinal diseases, and even certain cancers.
"We know that omega-3 is good for your body, and there is certainly enough evidence to suggest there is at least something there to improve mood," says Andrew Stoll, MD, who directs the psychopharmacology research lab at McLean Hospital in Belmont, Mass. "Almost every patient in my practice has tried [fish oil] supplements, and most are still on them."
In a 1999 study, Stoll and colleagues gave 30 patients with bipolar disorder either 10 grams of omega-3-rich fish oil capsules a day (the equivalent of 30 cans of tuna), or placebo capsules containing olive oil. All of the participants had experienced bipolar episodes within the previous year, and all but eight were on medication during the study. People with bipolar disorder have episodes of depression alternating with times of mania -- when their bodies are so revved up and hyper that they can't even sleep.
After four months, half of the patients given placebo capsules had relapsed into depression, compared to just two of the 15 patients taking fish oil supplements. Stoll is now conducting a four-year study involving 120 patients in an effort to confirm the results. And he says several other studies examining fish oil and depression should be published soon.
"Our earliest study used very high doses, but it looks like 1 to 2 grams per day of EPA, which is the active ingredient in fish oil, is all you need," Stoll tells WebMD. "But all fish oil supplements are not equal, so you have to read the labels to find out how much EPA [one type of fish oil] you are getting."
Salmon, mackerel, sardines, and anchovies are the fish with the highest amounts of omega-3, Stoll says.
A serving of salmon contains about a gram of omega-3. Certain brands of eggs are also rich in omega-3, and flaxseed and walnuts are also good dietary sources.
While some heart studies suggest that food sources are more protective than supplements, most people in this country get very little omega-3 in their daily diets. In that case, Stoll favors supplements and recommends that people take vitamin E and C as well. He has written a book on the health benefits of fish oil titled The Omega-3 Connection.
"Omega-3 is not intended to replace other medications for
depression," Stoll says. "But the evidence is mounting that it can
play a role in treatment. And there is no downside to eating an
Source: Salynn Boyles, my.webmd.com/content/article/1674.53106
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Are you depressed?
The New Depression
David Ramsey just built a new house 3,100 square feet of custom living space set on an acre of land in the North Carolina woods. He has a pretty young wife with long, brown hair, and the money she makes as an attorney pushes their annual income well into six figures. They travel a lot together, vacationing in Puerto Vallarta, Maui, and the Cayman Islands.
David Ramsey also has two blond sons, ages 7 and 2, who consider Dad their hero. Theres a full-time nanny to take care of them when he and his wife arent around. And although he often works long hours, its for no one but himself. As the owner of a distributing business, hes his own boss.
Yes, David Ramsey has it all. Yet in his bedroom, locked in a nightstand, is a black Glock 9 millimeter that he cant seem to chase from his thoughts. Although hes never slipped in the magazine and put the barrel to his head, hes thought about it more than once.
And David Ramsey has just one question: Why?
From his car phone, Ramsey, 39, calls to ask a question that tens of thousands of men like him are asking: "Why arent I happy?"
"From the outside looking in, my life is unbelievably great," he says. "Right now, for instance, Im driving through Fayetteville, North Carolina, and its an absolutely beautiful afternoon. Not one soul has said an unkind word to me all day, and Im heading home to spend the evening with my family. Yet Im not happy. I never am. And I cant understand why."
Ramsey is not alone. After we heard similar complaints from dozens of friends, coworkers, and relatives and finally were unable to dismiss their grumblings as so many midlife crises we posted a small ad on the Mens Health Web site that read, "Were looking for unhappy guys with perfect lives. If you have a great job, a great family, a great house full of great stuff, but youre still feeling unfulfilled and, at times, even miserable, then wed like to hear from you."
It was a tiny baited hook, but the attention it drew was remarkable.
"Im definitely in a rut," wrote Dennis, 30, a regional vice president, new homeowner, and proud father. "I have every reason to be happy with my life, yet I feel lost."
"Im an anesthesiologist," wrote Andrew, 39. "Been married for 9 years, couple of houses, dog, snowboard, kayak, just spent 3 weeks vacationing in Australia. But Id chuck it all to be as happy as I was in medical school. It seems when I had less, I felt better."
The e-mails go on and on, stacks of them. Evidently, there are a
lot of dissatisfied men out there, guys who youd never guess
were unhappy, men who would otherwise evoke feelings of admiration
and even jealousy. They come forward tentatively, ashamed about
complaining. Not all of these men are suicidal, of course, but they
cant see themselves continuing like this indefinitely.
Happiness is a reward theyve earned, and theyre tired of
waiting to claim it.
The Problem No One's Treating
I Dont Want to Talk About It. Theres a second type, one that even many psychologists dont recognize. Its called covert depression or, as its known clinically, dysthymia.
Overt depression is what we expect from a mood disorder. Its "a state of profound impairment, utter despair, thorough debilitation," Real explains. "A truly depressed man would lie in bed in the morning, staring at the ceiling, too apathetic to drag himself off to another meaningless day."
First identified in 1974, yet seldom reported on afterward, dysthymia is far less obvious--both to the sufferers and to the people around them. "Its the life of quiet desperation that Thoreau wrote about," says Real. "Most men dont view it as a disease but as a weakness. It is a disorder of selfesteem." Its textbook symptoms include at least 2 years of depressed mood, plus at least two of the following: poor appetite or overeating, insomnia or oversleeping, fatigue, low self-esteem, poor concentration or difficulty making decisions, and hopelessness.
"Any person with a chronic sense of unhappiness or dissatisfaction in spite of the success and happiness in his life almost always has a mood disorder and often has dysthymia," says Richard C. Shelton, M.D., professor of pharmacology and psychiatry at Vanderbilt University. "The condition is grossly underrecognized and undertreated, especially among men."
The reason it has received so little popular attention is because of the shame men feel about it. Not only are we far less likely than women to seek professional help for depression, but for reasons of pride and/or simple embarrassment we wont even discuss it.
"Its hard to talk to friends about this, because they dont understand how I could have anything to complain about," admits Tony, 34, a debt-free, college-educated newlywed with a prestigious job in San Francisco. "In fact, Ive gone to therapists, and even they just sort of look at me as if to say, Whats your problem?"
Although men like these may tell themselves theyre just a little down, that nobody can be happy all of the time, such rationalization is inaccurate.
"Humans are, by nature, a happy breed," says David Lykken, Ph.D., a professor emeritus of psychology at the University of Minnesota and author of the book Happiness. "Thats because happiness is protective. Happy people get sick less often and get well sooner than unhappy people. Its an adaptive trait. The typical person has above-neutral feelings of well-being most of the time."
After extensive research, Lykken has concluded that each of us has a "happiness set point" that is genetically predetermined. Our mood may occasionally rise above or fall below this point, but eventually we all return to it. And in most cases, its well above neutral. When someone feels chronically unhappy, theres something wrong.
Whats perplexing is why so many young, successful men are suddenly noticing their unhappiness.
"Let me give you an analogy," says Stephen Braun, a dysthymia sufferer and author of The Science of Happiness. "Before the invention of eyeglasses, what was considered normal eyesight was probably on the blurry side. But as soon as glasses were invented, normal vision became 20/20. I think were at the same stage with happiness. With so many new and effective antidepressants available, any mood thats the least fuzzy is being viewed as abnormal."
Add to this such social factors as a booming economy, record-low unemployment, and a relatively peaceful world, and the result is less for men to worry about and strive for. When the living is so easy, happiness should be an affordable commodity. Its continued slipperiness is disconcerting.
"I took a psychology class in college in which the professor had us write a letter to ourselves listing all our goals," says Jon, a teacher with two advanced degrees. "He told us to call him in 10 years, and hed mail the list to us. Well, I did, and Id nailed every one--the degree, the job, the marriage, the kids, the house, the car. Im 36. So, now what?"
And theres another factor: pop culture. "The degree of upbeatness on television, for instance, is incredible," says Steven Treistman, Ph.D., a professor of pharmacology at the University of Massachusetts medical center. "Every other commercial has people singing and dancing, as though thats the way everyone lives." Against such a yardstick, even mild happiness can seem negative.
"Ive had a certain level of dissatisfaction for the past 6
years," says Dale, 42, a wealthy insurance agent. "But it has only
started getting to me recently. Its a slow burn of increasing
A Blurry Gray Zone
Dysthymia isnt something you can typically conquer on your own. Although its relatively easy to treat with the right kind of professional help, its very difficult to recognize and manage by yourself. Unlike classic, overt depression, which barges into life and usually lasts between 1 and 2 years, dysthymia sneaks in and lingers for 10 to 20 years, says Dr. Shelton. In some instances, it never goes away. Although it does not always lead to more serious depression, he says that under stressful circumstances it makes depressive episodes more likely to occur. In fact, its usually when a person seeks help for one of these episodes that the underlying dysthymia is detected.
Unfortunately, when men do muster the courage to seek help, their trouble isnt always pinpointed. One study found that 67 percent of overtly and covertly depressed men were misdiagnosed by their doctors. William Pollack, Ph.D., director of the Center for Men and Young Men at McLean Hospital/Harvard Medical School, blames this on biased assessment criteria that miss common male symptoms ("Women get weepy, men get busy") and on stubborn macho stereotypes that incline physicians to prescribe fortitude rather than psychiatric care.
Reals theory, drawn from more than 20 years of practicing family therapy, is that men cope with covert depression by masking its symptoms. Typically, they use work, exercise, spending, and drinking. Because its considered unmanly to admit sadness, Real says men try to distract themselves from it with behaviors that bolster self-esteem.
"The less time I have to think about how I feel, the better," says Dennis, the regional vice president. "So I keep busy and immerse myself in my work. The more down I feel, the harder I drive myself."
"I go to the gym," says Andrew. "Exercise makes me feel dramatically better and gives me a sense that I can control my mood."
Coping strategies such as these are effective in the short term, but they eventually backfire, says Real. Either the behavior itself becomes addictive and destructive (alcoholism, bankruptcy), or one of the crutches unexpectedly snaps (athletic injury, loss of job). With no support left for the ego, overt depression can result.
The danger of masking persistent feelings of unhappiness is that it can become life-threatening. According to Dr. Shelton, suicide rates for long-term covert depression and short-term overt depression are similar (about 10 percent of untreated cases).
The thought of suicide is what finally prompted Braun, the 43-year-old author, to recognize and treat his dysthymia. "I was driving along one evening, and I had this sudden feeling of pointlessness," he recalls. "I had no reason to be sad. And yet, I had this powerful sense of meaninglessness. And as I eased onto the exit ramp, a black thought bubbled up: I could just kill myself. Thats when I knew something was wrong."
Braun sought psychiatric help, experimented with various antidepressants, and eventually came to an important realization. "Mood disorders are like an eclipse. The center is totally black, then there is a much bigger area, a penumbra, around that black center. If the center is depression, then that surrounding area is dysthymia. The tricky thing is, theres no sharp boundary between normal and dysthymic. Its a blurry, gray zone."
This Way Out
If youve read this far, youre probably either nodding your head in self-recognition or thinking of someone you know who has all these symptoms. The problem is, the way out of dysthymia can be just as labyrinthine as the way in. Heres where to begin:
Take a quick emotional inventory. As weve seen, men often cover up their depression by working longer, training harder, or drinking lots of beer. If you find yourself constantly doing one of these and not deriving any pleasure from it, there could be an underlying problem, says Pollack.
Find someone to spill your guts to. If your wife or girlfriend is the supportive type--meaning shes not the kind wholl either (a) tell you to grow up, or (b) blame herself she can probably help. But you should also seek out men whose integrity you trust. You just might find someone whos feeling exactly the same way. If you dont have anyone you can talk to, see "The Gripe Vine" for a way to get in touch with other men who feel the way you do.
Define what has real meaning for you. Write down three goals youd like to realize by this time next year. But heres the catch. Dont make them materialistic. Not a higher salary, not a nicer car, not a boob job for the missus. Instead, stay away from fickle, performance-based self-esteem and pick three goals with inherent meaning, such as spending more time with your kids, getting to know your parents better before they die, or developing a closer relationship with your wife.
Get help if you need it. Eighty percent of people who are treated for depression, regardless of type, report substantial relief. "Ive had men say to me, I cant believe I lived my whole life that way," says Real. "They never knew what being happy felt like." The best treatment, studies show, is a mix of psychotherapy and antidepressants.
Real says men require a different kind of therapy than women--not the sappy, stereotypical, "tell-me-everything-youre-feeling" brand, but a more dynamic, opinionated style of coaching. To find a therapist like this, he recommends interviewing candidates. Call around and ask two questions: Do you have experience helping men reconnect, and do you have an active or passive style? And demand progress. "If youre in therapy for 6 months and you feel 5 percent better, thats not good enough," he says.
Speak to your doctor about St. Johns wort. Some claim that this herb is useful for treating depression. Studies are not conclusive, but side effects are minor, so it may be a good first step for those hesitant to take antidepressants. Frank Dattilio, Ph.D., a clinical psychologist and faculty member at the University of Pennsylvania school of medicine, points out that you need to take it for 2 to 4 weeks (300 mg doses three times daily) before you see any improvement.
Dont be afraid of antidepressants. Most of the men we spoke to were hesitant about resorting to drugs, but Real says theyre worth a shot. "This isnt heroin," he says. "If you try it and either it doesnt do much for you or the side effects are awful, then stop. But at least youll have given it a try."
Stay challenged. Men are not maintainers, we are builders. (Thats why vacuuming holds no allure for us.) We are happiest when were creating something a career, a home, a family. Make sure theres always a project on your workbench, something new youre trying to accomplish.
"Heres my best advice, as someone whos been through it," says Braun. "First, do everything you can to eliminate stress and conflict in your life. If you have a bad relationship, try to make it better. Second, if youre still not feeling very good, then get yourself to a doctor. But dont just accept the first drug he gives you. Try different ones. Be open to the idea that happiness can have something to do with chemistry."
"Men like these often see themselves as inadequate or as losers," concludes Real. "But I consider them pioneers. Their unhappiness is not a personal failing but a thirst. By their very dissatisfaction, theyre saying the old male roles no longer work. Theyre eventually going to help us move beyond those old ideas to healthier values. In that respect, I think theyre heroes."
Welcome to the New Depression "Gripe Vine": Click here to air your
personal frustrations, or ask other men for advice on dealing with
covert depressions. Some of the experts quoted in this story will be
checking in periodically and lending their wisdom.
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How Much Is Stress Or Depression
A Factor In Sleep Problems In The Elderly?
This also occurs in older people who become depressed. Stress is an important cause, particularly for transient or short-term insomnia -- loss of a loved one, for example, or a change in life such as retirement.
In general, life transitions tend to occur more as people get
older and these transitions, such as changes in living location, can
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Depressed teens at risk for adult
"Almost 70% of adolescents who had experienced an episode of major depressive disorder (MDD) by age 18 suffered another episode of mental disorder between (ages) 19 to 24--that is, in a relatively short period of time," lead author Dr. Peter M. Lewinsohn, a senior research scientist with the Oregon Research Institute in Eugene, told Reuters Health.
In addition, many of the teenagers were diagnosed with other psychiatric problems in their later years, Lewinsohn and his colleagues report in the October issue of the American Journal of Psychiatry.
A follow-up study of 24-year-olds who were depressed in adolescence revealed that of 274 patients, "21.2%...suffered another episode of ('pure') MDD; 24.5% had another episode of MDD that was associated with another mental disorder; and 22.1% did not have a recurrence of depression, but developed a substance use disorder," Lewinsohn said.
The investigators found that girls who engaged in conflict with their parents were more likely than boys to have recurrent major depression.
A family or personal history of the condition, and borderline personality disorder symptoms were also predictive of major depressive disorder recurrence in young adulthood, the authors point out.
"We think that the findings emphasize the importance of efforts to identify adolescents and young adults who are at high risk for depression, in order to provide treatment to those who are depressed and preventative help to those who are at elevated risk," Lewinsohn stated.
These efforts should be a high public health priority that may involve periodic--perhaps annual--monitoring of such individuals, he suggested.
In a related editorial, Drs. Andres Martin and Donald J. Cohen note that only 20% of the adolescents in the study received some form of treatment. This, they write, "strongly suggests that in community settings, the adolescent window of therapeutic opportunity is, more likely than not, missed.
Further research is needed "to lead toward a sharper definition of
that window of opportunity that the timely identification and
effective treatment of adolescent depression promises to be," Martin
and Cohen conclude.
Smoking may lead to teen
Cigarette smoking was the "strongest predictor" of developing depressive symptoms among a group of 8,704 teenagers who were not depressed a year earlier, said study author Elizabeth Goodman of Children's Hospital Medical Center and the University of Cincinnati College of Medicine.
The adolescents who were not depressed at the start of the study--and may or may not have been experimenting with cigarettes--were four times more likely to have depressive symptoms if they were moderate or heavy smokers a year later.
The impact of nicotine or other cigarette additives on certain brain receptors could be to blame for the onset of depressive symptoms, Goodman said.
There has been some success in using anti-depressants to help smokers stop, suggesting a close link between the effects of cigarettes and the brain's chemistry that dictates mood.
Smoking prevalence among American teenagers remained high despite drops in adult smoking rates, Goodman reports in the journal Pediatrics, and researchers have been trying to figure out why.
Previous research has produced conflicting results, and the common belief was that smoking was a sought-after if temporary relief from depression.
"Typically, increased likelihood of smoking initiation and
progression have been viewed as consequences of depression," Goodman
wrote. But "high depressive symptoms were not predictive of smoking
progression in this study."
Twenty percent of Americans will suffer from depression in their
lifetime. - Psychology Today, 1202