The Mind-Body Connection: Depression and Its Effects On Physical Health

Posted on by
2

I will return to the theme of happiness in a few more days, but today we will continue with our series about depression, based on Peter Cramer’s book Against Depression, which I heartily recommend to anyone who wants to learn more about depression.

Depression is not just a psychological disease. It impacts the whole body, and especially impacts the cardiovascular system. Depression is one of the strongest predictors of cardiac disease. Even minor depression increase the risk of cardiac disease by 50 percent. Major depression increases risk by 3 to 4 times. For those with pre-existing coronary artery disease, risk is increased 5 times!

You might be thinking that this is no surprise. Perhaps depressed people smoke more, exercise less, eat more bacon, etc. What is surprising is that the numbers in the preceding paragraph are after adjusting for lifestyle and behavior! The raw numbers are even higher!

Why is this? What is the mechanism by which depression reeks havoc with the cardiovascular system?

There are several possible mechanisms. One is through the impact on blood clotting.

Blood clotting is controlled by cells in the blood called platelets. The stickier the platelets are, the more likely you are to develop blood clots, which can lead to stroke or heart attack. Depressed patients have stickier platelets.

Another mechanism is stress. Depressed patients are under constant physiological stress, with excess stress chemicals circulating in their blood. This may raise blood pressure and cause other changes that affect the cardiovascular system.

So what happens if you treat depression? Does this reduce risk of cardiovascular disease?

Studies of antidepressants given after heart attack show a 30 to 40 percent reduction in subsequent heart attacks and deaths.

Antidepressants improve the outcomes after stroke as well. When stroke patients were given either antidepressants or placebo, 66 percent of the antidepressant group survived 2 years, but only 35 percent of placebo group.

Other physical triggers like treatment with interferon for hepatic C and melanoma can also cause depression. In fact, 50 percent of patients who receive interferon will get seriously depressed. Depression in these cases is serious because it can cause the person to stop taking a potentially life-saving treatment.

Antidepressants help even in these cases of drug induced depression. One study found that treatment with Paxil, an antidepressant, reduced depression from 45 percent to 11 percent.

What are the implications of these finding?

  1. All patients who have had a heart attack or a stroke should probably take an antidepressant.
  2. All patients taking long-term interferon treatment should begin taking an antidepressant several weeks before starting the interferon.
  3. Probably most seriously ill cancer patients should take an antidepressant as well.
  4. Counseling that focuses on evaluating and treating depression should be part of any seriously ill medical patient’s treatment regimen.

Copyright 2007 The Psychology Lounge/TPL Productions

All Rights Reserved


Your Junk is My Treasure! The Psychology of Compulsive Hoarding

Posted on by
3


Today I am going to write about a very different type of psychological problem, called compulsive hoarding. The Boston Globe had a very interesting article about hoarding. Researchers Gail Steketee and Randy Carlson have a new book, called “Buried in Treasures,” which documents their new approach to treating this disorder.

First of all, what is compulsive hoarding? It’s when you can’t get rid of anything, and can’t put in order what you have, so much so that you end up having difficulties using the spaces you live or work in.

Are you a hoarder? Of course not! But Steketee and her colleagues developed a simple photo test for hoarding . Take a look at these photos, and pick out the one that looks the most like your bedroom. If it is number 4 or higher, then you probably have a problem with hoarding. (Hoarders, it turns out, are very accurate at identifying the level of chaos in their spaces.)

Your official Lounge Wizard, Dr. Psychology took the test, and scored a 2 or 3, which puts him in the normal range, but right on the borderline of hoarding. So this article is close to his heart.

What causes hoarding? It’s not what most non-hoarders think; laziness, messiness, or even depression. Although many hoarders have some elements of depression or anxiety, the core of hoarding is that they have strong attachments to things. They are sentimental about possessions, and often have very intense feelings about them. They tend to be creative, and can think of many uses for objects.

Most hoarders function fairly well outside their homes. They have jobs, friends, and active involvements. Where hoarding seems to impact them is in romantic relationships. The hoarders I know tend to not have long term romantic relationships, which isn’t surprising, as girlfriends and boyfriends tend to want to come over to your house, and for a hoarder than is a painful experience. “Why do you have all of this stuff? Why don’t you get rid of all this junk? I can’t believe you live this way!” are all typical comments they may hear. Needless to say, there are no more invitations after that. Steketee finds that at least 50% of hoarders are single.

So is there any hope for hoarding? One thing that doesn’t seem to work very well is traditional medicines for depression like antidepressants. Although these medicines work well for regular obsessive compulsive disorder (OCD) they don’t appear to do much for hoarding. Traditional psychotherapy doesn’t work either.

Steketee and colleagues have developed a very nice cognitive behavioral model for treating hoarding. They find that hoarders have similar cognitive models. For instance, hoarders have four common fears: 1) missing important information or opportunities, 2) forgetting something important, 3) experiencing loss, and 4) being wasteful. They tend to focus on lost opportunity, so getting rid of a newspaper entails a possibility of losing some opportunity that was in the newspaper. In general, all of their possessions get elevated in value.

Another common issue is needing to keep things in sight. This is tied into the need to not forget anything. “Out of sight, out of mind,” is the hoarder’s mantra. This causes the visual chaos that creates many of the problems of hoarding, since if one just had many possessions, but they were well organized and stored, hoarding would not be a big problem.

So it is not surprising that Steketee’s treatment plan focuses on helping hoarders learn to organize their space, rather than focusing on getting rid of stuff. This is more palatable goal for most hoarders, who know that their space is poorly organized.

The treatment also focuses on helping hoarders overcome the need to acquire things. The rules for acquisition are: 1) immediate need for the object (this week), 2) time enough to acquire and use the object, 3) money to buy it, and 4) an appropriate space for the object. This nips the problem in the bud.

The treatment works, but it’s not a miracle. According to Steketee, it’s not unusual for someone to move from 7 to 3 on a 9 point scale where 1 is neat and organized, and 9 is total mess. But relapse is always a danger, as there is something very compelling about hoarding.

So what is the core of hoarding? Even Steketee and her colleagues are a little baffled about this. As a borderline hoarder who closest friends include some hoarders, I can give some intriguing answers.

Hoarding is about possibility. The thought “I could use this item someday,” is central to the decision to hold onto something. For instance, I have a box of scrap pieces of wood and plastic, which I keep because I might have a use someday. Every once in a while, I use a piece from my scrap box. And that reinforces keeping it.

Or papers. I used to clip articles from papers, thinking I would write about the topic someday. I had many files of articles on travel, psychology, and technology. The technology innovation that has changed that is computers, and more specifically, the email program Gmail. Instead of printing out articles, now I email them to myself. Since Gmail can hold thousands of articles, and with a simple search I can find any of them, I’ve tossed out my article files.

One of the beauties of computers is that even massive hoarding of articles or writing takes very little space on a hard drive. I can hold every email I’ve ever written in my life on a single USB memory stick. So if you are a hoarder of articles, or papers, consider buying a scanner, and using computer technology to hoard more effectively.

Another aspect of hoarding is sentiment. I hate throwing out something that reminds me of a good time in my life, or almost anything that has significant meaning. So I’d never throw away a photograph or a letter from someone I care about. I will throw out cards, though, unless they have a significant written message inside.

And some of hoarding is simply about difficulty in making decisions. For instance, I have too many books. But it is hard to figure out which books to toss. Some rules are easy. A bad paperback novel is easy to toss. But a good novel is tougher; maybe I will want to reread it sometime.

And reference books are still arder. Will I need the information in this book sometime? I try to ask myself realistically if the info is something I’ll need in the foreseeable future, and especially if the information is still even relevant. Thus old computer books are easy to toss, since in the computer world things date quickly.

One trick I’ve used successfully in de-hoarding is to remind myself that one of the advantages of getting rid of things is that you can get new things! For instance, if you go through one’s clothes closet and toss all the clothing that doesn’t fit and doesn’t look good, then you get to buy some cool new threads! The same is true with books. The key is to replace less than you toss.

Conquering hoarding is about psychological growth. Central to the process of growth is letting go of the old in order to make room for the new. New things, new people, and new experiences. Another aspect of de-hoarding is traveling through life less encumbered. That gives you more flexibility to move, and change. The irony of hoarding is that the biggest hoarders I know love to travel. And when they travel, they leave almost all of their stuff behind. And they are perfectly happy living out of a suitcase or backpack, and don’t miss their stuff at all.

Maybe this is really a metaphor for our psychological baggage. Travel light, and leave the junk behind. Throw out old stuff, and organize what you keep. Let go of things, and make room for new things.

Copyright 2007 The Psychology Lounge/TPL Productions

Forbes Magazine Endorses Cognitive Behavioral Therapy! In a Faceoff between Cognitive Behavioral Therapy and Antidepressant drugs, Therapy Wins!

Posted on by
Reply


As regular readers know, your editor is a big fan of a type of psychotherapy called Cognitive Behavioral Therapy (CBT). Cognitive therapy is a modern non-drug therapy that teaches clients new ways of thinking and feeling. The basic concept is that it is our distorted thinking that creates psychological problems of anxiety, depression, panic, etc. The cognitive therapist combines teaching cognitive skills with behavioral techniques that allow the client to overcome their difficulties.

And much to his surprise, this week Forbes Magazine put CBT on their cover! The Forbes article about Cognitive Behavioral Therapy was very positive. They summarize 30 years of research, including studies that show that CBT works well for insomnia, hypochondria, anxiety, depression, bulimia, obsessive compulsive disorder, preventing suicide, and even matches surgery for low back pain. Here is a video demonstration of exposure treatment for an elevator phobia.

They also compare the effectiveness of CBT to antidepressant medication. Although both work, in the long run CBT is more cost effective, and leads to less relapse. In one study comparing Paxil to CBT, only 31% of the CBT group relapsed within one year of completing treatment, compared to 76% of the Paxil group! This is a very big difference. The skills that clients learn seem to have a lasting impact on preventing future depressions.

Even in terms of cost, CBT beats antidepressant medications, at least with the assumptions the Forbes editors made. After three months of treatment, they estimate the costs of cognitive therapy at $1200 and the costs of medication treatment with Effexor at $502, which includes one psychiatrist visit at $200, and $302 in drug costs. At one year, they estimate the costs of cognitive therapy at $2000, and drug treatment at $2009, which includes $800 for four psychiatrist visits at $200 each, and $1209 for the Effexor.

As much as I like the comparison, it is based on faulty assumptions. First of all, it’s not clear how many sessions of cognitive therapy they are estimating. The $2000 would pay for 20 sessions at $100, but only 13 at $150. It’s probably optimistic to believe that a good outcome would come out of only 13 sessions. And because the primary group of professionals who perform cognitive therapy are psychologists, who typically charge more than masters level therapists, $100 is probably too low.

So let’s fix the numbers. Let’s assume 25 sessions of cognitive therapy, at $150 per session, which comes out to $3750. That’s probably a fairer assumption.

Now let’s look at the other assumptions. Effexor is an expensive, non-generic anti-depressant, which costs $100 a month, or even more. But the generic version of Prozac, called fluoxetine, can cost as little as $10 a month. And four psychiatrist visits in a year is also too optimistic. In my experience, patients need every two week visits initially to get the medication adjusted, and after 6 or 8 weeks, can graduate to once a month, and after another 3 visits, can be seen every three months. Also, psychiatrists typically charge at least $300 for the initial evaluation, and less than $200 for the follow-up visits which tend to be shorter visits.

So by these assumptions, the psychiatrist visits would cost $1380 at least. This brings the total cost of one year of treatment with Effexor to $2589. Of course, if fluoxetine was substituted then the total costs would only come to $1500!

So drug treatment costs less than cognitive therapy, right? It either costs a lot less ($1500 compared to $3750) or somewhat less ($2589 compared to $3750).

But there is still a glitch in the assumptions. We are only looking at the first year costs. Remember the statistics mentioned above, that up to 76% of patients who stop taking antidepressants relapse back into depression. Those are pretty bad odds. If a patient stayed on Effexor for 5 more years, their total cost of treatment would skyrocket to $6756, assuming psychiatrist visits 4 times a year. Compared to this cognitive therapy looks good!

There is another, unmentioned advantage to cognitive therapy, which is incredibly important, and which too often is left out of this debate. Here’s the dirty little secret the drug companies don’t want you to know—most antidepressants ruin your sex life! With really just a few exceptions (Wellbutrin, and Emsam) almost all of the major antidepressants make it much harder to have an orgasm for both men and women, and for men may make it difficult or impossible to get or maintain an erection. Antidepressants should really be called anti-sex drugs! (Caveat: not everyone will have the sexual side effects, but most will.) Here is a good article about the sexual side effects of antidepressants.

And this leaves out all of the other side effects of antidepressants. Here’s a link to common side effects of antidepressant medication Dry mouth, dry eyes, blurred vision, nausea, insomnia, headaches, the list goes on and on. How do you place a value on the costs of side effects?

Cognitive therapy obviously has no sexual side effects, or any other side effects. So for this reason, and for the advantage in preventing relapse, I believe cognitive therapy should be the first choice therapy for those patients suffering depression, providing they can afford therapy or have good insurance coverage for therapy. If not, then having your regular doctor prescribe and monitor a generic antidepressant such as fluoxetine (Prozac), sertraline (Zoloft), or bupropion (Wellbutrin) is the best option, with the downside being that you will most likely need to take the medications long-term to avoid relapse, and that you will most likely have physical side effects. Thus it may be worth taking a loan from your credit card in the form of a cash advance, or simply using a credit card to pay for cognitive therapy. After all, that’s how most people pay for their next car, or flat screen television set.

So here’s the executive summary. Cognitive therapy works for a large variety of common psychological problems, and even a few physical problems. Although initially it costs a little more, the effects are longer lasting than medication treatment. And in the long run, it can end up saving money. Best of all, other than working a little bit on therapy homework, there are no side effects of therapy! Conclusion: If you are depressed, anxious, having insomnia, obsessive compulsive disorder, hypochondriasis, phobias, or relationship problems, your first move should be to find a psychologist who specializes in cognitive therapy. Borrow the money if you don’t have it, or put it onto your credit card, but don’t miss out on this effective treatment out of some false sense of economizing.

Copyright 2007 The Psychology Lounge/TPL Productions

Cheer Up! It Gets Worse, Then Better (Depending On Your Age)

Posted on by
2

 

This week I am starting a series of articles on that magical quality we call happiness. I’ve been studying the scientific literature on happiness for a while now, and it’s not all just common sense. There is some gold in the ore. In fact, much of what science has discovered about happiness goes against what we commonly believe. For instance, it turns out that money does buy happiness, but only if you have almost no money. Once you acquire the basics, food, shelter, a car, more money has relatively little impact on happiness. Or take having children. Everyone assumes that having children brings joy. But the research doesn’t support this very strongly. Marriages suffer when children enter the scene, and parenting is rated relatively low in the grand scheme of activities. In fact, what the science of happiness suggests is that we are remarkably bad at predicting what will make us happy. Hence the high rates of job change, house selling and rebuying, and of course, divorce.

But I will write more on these matters later. For today I want to talk about an interesting new study that looks at happiness over the course of a lifetime. This latest study, performed by economists David Blanchflower of Dartmouth and Andrew Oswald of Warwick, looks at how happiness changes as people age. Using data from about 45,000 Americans, and 400,000 Europeans, they looked at the average ratings of happiness by age.

What they discovered is very interesting. Basically happiness is high when people are young adults, early in their 20s. This is not surprising, as the early 20s are that magical point where one is freed from parental constraints, but doesn’t have a lot of other new constraints. Unfortunately, it’s all downhill from there. Happiness sinks gradually over the next 20 something years, and reaches in nadir on average around age 45. Depressing news for young people, eh?

But the news gets better. After age 45, happiness increases steadily on into old age. Wow! This isn’t what we’d expect at all. Elderly people happier than people in their 30s!

The European and American data were fairly similar, except that the Europeans reached their lowest happiness levels a few years earlier than the Americans.

So happiness is a U-shaped curve. Why? The research doesn’t answer the question. But they did rule out one explanation, the generational one. People born earlier still show the U-shaped happiness pattern.

The authors also looked at the influence of income on happiness. This data is fascinating! They found that the wealthier you are the happier you are on average, which is not surprising. But the decline is happiness from young adulthood to middle age is the equivalent to a 50% reduction in income, and the increase in happiness from age 45 to old age is equivalent to a doubling of income!

Finally, the authors found over the last hundred years, Americans have gotten much less happy. The difference in happiness between the generations born in the 1960s and the 1920s is the same as a tenfold change in income. So someone born in 1962 would need 10 times the income to be equally as happy as their grandfather who was born in 1922. This is a disturbing finding. Why are we so unhappy? I have some ideas, but I will come back to them in a future article.

One clue may exist in the differences in the European data. The generations that were born in Europe since 1950 have gotten steadily happier. Shorter work weeks, longer vacations, more social welfare and security, all may be part of the mystery, especially when compared to the opposite trends in the United States.

So cheer up. Adulthood brings with it a steady decline in happiness, but just when it’s looking pretty grim, things improve. And even though we all are going to get old and infirm, we can at least look forward to getting steadily happier.

Copyright 2007 The Psychology Lounge/TPL Productions

On Perfectionism and How to Overcome It

Posted on by
1

Today I am writing about perfectionism, that deadly trait that infects so many people, causing low self-esteem, depression, anxiety, and procrastination. Perfectionism is really about having unreasonable standards for your own or others’ performance. When you are a perfectionist, it means you never can live up to your internal standards. This causes unhappiness and depression. It may also cause anxiety.

Closely linked to perfectionism is all-or-nothing thinking. Although the real world is an analog world, we often think of it in binary terms. Our job is “good” or it is “bad.” A vacation is “wonderful” or “horrible.” People are “interesting” or “boring.” What makes all-or-nothing thinking part of perfectionism is that it makes your standards rigid and inflexible. There’s no grading on a curve with binary thinking. Your performance is an “A” or an “F.”

So what’s wrong with perfectionism anyway? Doesn’t it make one perform better?

The answer is no. Perfectionism actually leads to lower performance. When you have unreasonably high standards you are more likely to get disappointed when you fail to meet that standard. And disappointment makes people try less hard. It saps the will and depresses the spirit.

So you might be wondering how do I change my perfectionism? (And how do I do it instantly!) 🙂 The key to altering perfectionist tendencies is to do several things:

1. Set reasonable and flexible standards for your performance and others.

2. Reserve higher standards only for those tasks that truly require them.

3. Test out your standards. See if it’s necessary to actually be so perfect. Try doing things less well, and see if the sky falls.

4. Remember life is not just about performance. It is also about enjoyment, fun, and relaxation.

5. Think in terms of a continuum or grey scale. Instead of using all-or-nothing terms like “good” or “bad” instead use a 10 point rating scale. The dinner was a “6.” The movie was a “2.” This gets you thinking along a continuum, which is healthier and less stressful.

6. Always ask yourself before you decide on standards whether the task is actually worth doing at all. If something is not worth doing, then it is not worth doing perfectly. So for instance, when you purchase some small item that doesn’t work out, perhaps it makes sense to toss it out, or give it away, rather than gathering up the packing materials, driving 30 minutes, and returning it. Not perfect, but perhaps a better choice.

7.

The End (Notice the slight imperfection.)

Copyright 2007 The Psychology Lounge/TPL Productions