Saturday, January 30, 2016

Research: Cognitive behavioral therapy, with medication reduces depression long-term

Adding behavioral therapy to meds reduces depression long-term

Doyle, K. (January 27, 2016). Reuters. Retrieved from:

(Reuters Health) - When depression does not respond to antidepressant medication, replacing it with cognitive behavioral therapy (CBT) or adding CBT to treatment may be effective and last for several years, according to a trial in the U.K.

Three to five years after having up to 18 CBT sessions, trial participants were less depressed than those who didn’t get the added behavioral therapy, suggesting a long-term benefit that makes CBT cost-effective, the authors conclude.

“Antidepressants are often prescribed for people with depression but we know that many people do not respond fully to such treatment,” said lead author Nicola J. Wiles of the Center for Academic Mental Health at the University of Bristol.

“We previously found that giving (cognitive behavioral therapy) in addition to usual care that included antidepressant medication was effective in reducing depressive symptoms and improving quality of life over a period of 12 months in patients whose depression had not responded to treatment with antidepressants,”

Wiles said by email. “However, prior to this study, there was little evidence of effectiveness over the long-term.”

Wiles’ team followed up on a trial done in 73 general practices in the U.K. Between 2008 and 2010, 469 patients aged 18 to 75 years who had taken antidepressants for at least six weeks and still had substantial depressive symptoms were randomly assigned to either continue receiving usual care or to usual care with the addition of CBT.

Those in the CBT group attended 12 to 18 sessions with a therapist over about four to five months.

Three to five years later, the researchers followed up using general practitioner notes and questionnaires mailed to patients. The questionnaires were designed to gauge depression and also quality of life. Of the original group, 248 patients completed and returned the questionnaires.

Compared to those who only got usual care, the average depressive symptom score was about 5 points lower, on a scale of 0 to 63, for those who had received the CBT, even though those sessions had ended an average of 40 months earlier.

“People who are depressed often think about themselves and the world in a different and more negative way compared with how they thought before their illness,” Wiles said. “Cognitive behavioural therapy, a type of talking therapy, is a way of helping people with depression change the way they think in order to improve how they feel and to change what they do.”

Patients learn skills to help them better manage their mood that they continue to use even after therapy sessions stop, she said.

In the trial, cognitive behavioral therapy cost an average of 343 British Pounds, or $489, annually per patient, the authors note in The Lancet Psychiatry.

“In our long-term follow-up, we found that CBT as an adjunct to usual care represented very good value for money for the health service,” Wiles said.

There have been initiatives to increase access to such treatments in England and Australia, but they have focused on so-called low intensity interventions like computerized therapy packages and guided self-help, for which there is little evidence of long-term effectiveness, Wiles said.

The high intensity therapy delivered as part of general practice care in the U.K. trial reduced the significant burden to patients and healthcare systems caused by depression that does not respond to antidepressants, she said.

“It is very clear but often forgotten that depression is a long-term disease and most of the evidence that we have about what works comes from very short term studies,” said Dr. Rudolf Uher of Dalhousie University in Halifax, Canada, who coauthored a commentary on the new results.

“This is the first demonstration that psychological treatment can be delivered efficiently in routine primary care,” Uher told Reuters Health.

High-quality psychological treatment is often only available with out-of-pocket payment, and isn’t standardized or promoted the way that pharmaceutical treatment is, he said.

“This shows that what would be considered a luxurious treatment actually pays for itself,” he said.

But, he emphasized, even in this trial many patients were still at least somewhat depressed after treatment, and most were not “cured.”

SOURCE: and The Lancet Psychiatry, online January 7, 2016.

Tuesday, January 26, 2016

Research: One out of 10 fathers experiences Postpartum depression

Postpartum depression affects one in 10 fathers

We don’t often hear about it, but fathers also suffer from postpartum depression, but talking about it can help

Billy Monk’s second child, an eight-pound, four-ounce boy named Conway with a mop of strawberry-blond hair, was born in the spring of 2014.

Soon after, the Burlington dad was hit by an overwhelming feeling: He wanted to run away from everything in his life. At his job as a software developer, Billy kept his head down, avoiding coworkers as much as possible. He tried to steer clear of neighbours while walking his dog. And friends? Billy stopped hanging out with them altogether. “I just wanted to be alone,” he recalls.

Back at home, where Billy couldn’t escape, life became a mess. “I would have these outbursts where I would more or less say, ‘Everything’s terrible, I’m unhappy, everything sucks, I don’t see the point in anything,’ ” he says.

It was a similar feeling to what he’d experienced after the birth of his older son, Nolan, but much more severe. The major eye-opener, according to his wife Danielle, was some silly disagreement where Billy just flipped. “He started yelling about how this isn’t his life,” she says.

It was totally out of character. Billy — a hip-looking 31-year-old with colourful tattoos and a red-tinged beard — is a loving father, an optimist and “the most wonderful person,” as Danielle, 27, puts it.

But at the time, he was likely dealing with a condition people rarely talk about in men: Postpartum depression. 

While depression in women during and after pregnancy has long been discussed in parenting classes and media coverage, dads with the so-called “baby blues” are often left in the dark. And that’s a problem. PPD hits moms more often — up to 20 per cent of women who give birth every year have postpartum depression symptoms, according to the Centers for Disease Control — but a surprising number of men deal with it, too.

One 2010 American study, looking at data involving more than 28,000 men, found 10 per cent of new dads have postpartum depression. And, as a recent Canadian study shows, plenty of fathers experience depression before the baby is born as well. Led by a team from the Research Institute of the McGill University Health Centre, the Quebec-based research found around 13 per cent of expectant dads dealt with symptoms of depression during their partner’s pregnancy.

Other studies coming out of Europe and Australia have signalled similar rates of 10 to 14 per cent, says senior author Dr. Deborah Da Costa.

But dads often don’t hear about it. “When we would walk into clinics or prenatal classes, men were shocked that we would want to talk to them,” Da Costa says.

On top of that, experts say men are less likely to talk about their feelings than women, leading to a lack of understanding and awareness about depression in dads. While moms may be more inclined to show their sadness and stress outwardly by crying, dads tend to express it in different ways — often through anger — and may also self-medicate with alcohol, detach from family life and, as in Billy’s case, lash out at their partner.

Bernadette Kint, manager for healthy families with Toronto Public Health, says dads coping with depression can become hypercritical of themselves and others, and can sometimes resort to escapist behaviour like watching television for hours on end or staying out as late as possible.

If it goes unaddressed, depression can have a host of negative implications for child development, bonding between the dad and kids, and the relationship between the parents, says Brian Russell, provincial co-ordinator for Dad Central Ontario.

The good news? Men, just like women, can eventually overcome depression as a new parent — with some help.

Any dads struggling with depression symptoms should connect with their family doctor to get a referral for specialized treatment, says child psychiatrist Dr. Andrew Howlett, who runs the Fathers’ Mental Health Program at St. Joseph’s Health Centre in Toronto.

“Major depressive episodes without treatment can last months, with gradual improvements over time,” Howlett says. But for dads who do go through treatment, things can start to improve after just a few sessions.

Men also need to be open about what they’re going through — even if talking about their feelings is a bit foreign to them — and ask for help from their support network. “Whether it’s their own parents, siblings or friends, they’ve got to be able to talk with other people,” says Russell.

Communication between both partners is key as well, since each parent may go through a bout of depression, with the periods sometimes overlapping. That was the case for the Monks, with Billy’s depression spanning the first three or so months after each child’s birth, and Danielle’s following after.
Billy finally sought out help in the months after Conway’s birth — after urging from Danielle — and started opening up to others about his experience at a fathers group in Mimico.

“That was a big help,” he says. “In these groups, you’ll find people in a very similar situation to you. They’re a lot more likely to open up to you in a situation like that than someone would be in the office.”

Looking back on the parenting classes they took together before having kids, Billy says he never learned about PPD in men. The classes just stuck to the ABCs of being a parent, like how to change a diaper. “It didn’t broach the subject of the emotions — it did for women, but not for men,” he recalls.

Canadian researchers like Howlett and Da Costa are hoping to change things.

On Father’s Day in 2014, Howlett launched the Fathers Mental Health Network with fellow Toronto psychiatrist Dr. Benjamin Rosen. The network’s website is meant to be a mental-health information tool for both doctors and patients, linking dads to community resources, treatment programs and depression screening tools. 

Da Costa is also developing an upcoming website for dads, based on research that revealed many men aren’t satisfied with the information available for parents online since it’s usually tailored to moms.

Now armed with knowledge about the impact of depression, the Monks regularly go to counselling together and Danielle is on medication to help with her PPD symptoms. And, with baby number three on the way, they also have plans in place to exercise, watch their alcohol intake and maintain a healthy diet in hopes of staying healthy as parents in a growing family.

Despite the dark moments, Danielle says the experience brought their family closer together. “Every moment that we’re able to, we’re together and doing things and supporting each other. I feel so much pride looking at our family and what we’ve overcome, and how we’ve bonded as a result.”

As for Billy, who eventually overcame his PPD, he’s relishing every beautiful moment with his growing kids. “There’s no part of being a father that I don’t like,” he says.


Dads Get Sad Too: Depressive Symptoms and Associated Factors in Expectant First-Time Fathers

This cross-sectional study aims to determine the prevalence and determinants of depressive symptoms in first-time expectant fathers during their partner’s third trimester of pregnancy. As part of a prospective study examining depressive symptoms in men over the first postnatal year, 622 men (mean age = 34.3 years, ±5.0 years) completed standardized online self-report questionnaires measuring depressed mood, physical activity, sleep quality, social support, marital adjustment, life events, financial stress, and demographics during their partner’s third trimester of pregnancy. The Edinburgh Depression Scale was used to assess depressed mood. Partners also completed the Edinburgh Depression Scale in the third trimester. The results revealed that 13.3% of expectant fathers exhibited elevated levels of depressive symptoms during their partner’s third trimester of pregnancy. Significant independent factors associated with antenatal depressive symptoms in men were poorer sleep quality, family history of psychological difficulties, lower perceived social support, poorer marital satisfaction, more stressful life events in the preceding 6 months, greater number of financial stressors, and elevated maternal antenatal depressive symptoms. These findings highlight the importance of including fathers in the screening and early prevention efforts targeting depression during the transition to parenthood, which to date have largely focused only on women. Strategies to promote better sleep, manage stress, and mobilize social support may be important areas to address in interventions tailored to new fathers at risk for depression during the transition to parenthood.                   

Tuesday, January 12, 2016

Seven Tips for Setting Realistic New Year’s Goals

              New Years Resolution image

7 Tips for Setting Realistic New Year’s Goals

Lana Dunn (

Happy New Year!

The start of the new year is the perfect time to reflect on the past and clarify the path forward.  These 7 tips will help you set realistic goals to make 2016 your most productive, successful and enjoyable year yet!
  1. Build on PAST SUCCESSES – A great way to start setting goals for the new year is to take the time to look backwards first. Review where you have come from.  Consider what worked last year; think about what goals you are carrying over; identify what didn’t work and the lessons you gained from those experiences.  Goals that are integrated into the bigger picture of your life have more meaning than “one offs”.
  1. Consider having a THEME for the year – Ask yourself, what is the foundation upon which my success this year will be built? Is it improved health?  Reaching a specific business target?  Dedicating more time to family?  Committing to a social cause?  Perhaps you have a personal or professional trait or skill that will help to elevate your life and your work to the next level.  Think of things likeintention or patience, decluttering or presence.  Those concepts can become your overarching theme, acting as the base upon which you can build your best year.
  1. Think QUALITY not QUANTITY – Defining three or four high quality goals offers you the chance to focus your energy, resources and intention in more specific ways. Using your theme as the launching pad, a handful of carefully constructed goals can act as the fuel to move you forward.  Having fewer but meaningful goals allows you to focus your attention.  Having too many serves only to dilute the time you have to dedicate to each one.
  1. Create BENCHMARKS – How will you know you are remaining on track? What are the crucial milestones for your goals?  When and how will you check in with yourself?  Like any work worth doing, you need to stay on top of the progress being made, and course correct as necessary.  Many goals are left by the side of the road due to inattention.  Keep your goals alive and measure your progress against your defined criteria.  It not only helps ensure you are staying true to the course, but also acts as a motivator to keep you on track.
  1. Remind yourself this is a MARATHON, NOT A SPRINT! – Be patient; Rome wasn’t built in a day. The journey towards achievement of your goals is rich with learnings; the benefits don’t only show up once the goal is reached.  Make note of lessons you learn, and incorporate them into your goals.  If your goals include breaking an old or developing a new habit or pattern of behaving, remember it takes time.  Developing a new habit requires consistent practice over many weeks (some say 21 days, other 30, still others argue for 45!).  If your goal is worth your time and attention, it is most certainly worth investing the time to see it come to fruition.
  1. Be willing to be FLEXIBLE – Do your goals need tweaking as you progress? Have circumstances changed?  Is new information available that suggests a different course of action?  Nothing is more frustrating than to spend your time and energy doing something well that never should have been done in the first place.  Stay intentional and purposeful as the weeks and months pass.
  1. Be SMART – The concept of setting “SMART” goals was first introduced in 1981. Though many authors have modified some of the letters, the original concept remains relevant today.   Ensuring your goals are Specific, Measureable, Achievable, Realistic andTimely has been shown to increase the likelihood of their successful achievement.     
I read a great quote about goal setting some time ago that resonated with me, and always helps me stay on track:
“A dream written down with a date becomes a goal.
A goal broken down into steps becomes a plan.
A plan backed by action makes your dreams come true.”  

There is little magic involved in goal setting and goal achievement.  Following the tips outlined above and then doing the work will provide you with the opportunity to move through 2016 with a purpose, and allow you to make significant growth in your life and work in a short time.

Lana Dunn, M.Ed., R. Psych.
Trainer, Crisis and Trauma Resource Institute

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