Double trouble: Hopelessness key component of mood disorder

Mon, 23 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) According to Thomas Joiner, Florida State University Distinguished Research Professor and the Bright-Burton Professor of Psychology, who has identified hopelessness as a distinguishing feature of double depression in a new paper published in the Journal of Affective Disorders. The finding could help therapists diagnose and treat the mood disorder.

Double depression occurs when an individual who suffers from dysthymia, a persistent case of mild depression marked by low energy, falls into a major depressive state. It is not a new concept, but psychologists know little about the characteristics that distinguish double depression from dysthymia or major depression alone, according to Joiner.

ï¿½Itï¿½s clinically important because it is under-recognized and harder to treat than either dysthymia or major depression by themselves,ï¿½ Joiner said. ï¿½The hopelessness result is significant, and it suggests that therapists should especially focus on this feature early and often in the treatment of double-depressed patients.ï¿½

Joiner, along with FSU doctoral student Kathryn Gordon, Joan Cook from the Veterans Affairs Medical Center in Philadelphia and Michel Herson from Pacific University in Oregon, studied the psychological assessments of 54 adults who entered a community-based psychiatric outpatient facility for non-psychotic adults ages 55 and older. Questionnaires were given to patients before starting treatment to measure depression, hopelessness, anxiety and their sense of control over their own lives.

They found that double-depressed patients had high levels of hopelessness, whereas patients with either major depression or dysthymia alone showed more moderate levels of hopelessness.

ï¿½A patient who is hopeless has really just given up,ï¿½ Joiner said. ï¿½They feel that the world is against them, the future is bleak and they are incapable of fighting back.ï¿½

This entrenched sense of hopelessness is one likely reason why double depression is so hard to treat, according to Joiner. The chronic nature of the underlying dysthymia is another.

ï¿½Any chronic condition is harder to treat than a less chronic one, and that is true for medical and psychiatric conditions alike,ï¿½ he said. ï¿½Second, people with dysthymia come to view depression as just part of who they are, and so they donï¿½t come in to treatment as often, even when they dip down into a major depression. When they do come in, issues of motivation to do the treatment are common.ï¿½

In addition to differences in the level of hopelessness, the researchers found that people with dysthymia alone and those with double depression felt little control over their own lives. People with these conditions felt that external forces -- other people or fate -- determined their future. Those suffering from major depression alone did not have this characteristic.

Joiner cautioned that the studyï¿½s findings must be interpreted in light of the studyï¿½s limitations, namely its small sample size. Still, the results could have important implications for treatment of double depression. Cognitive therapy, which focuses on changing negative thinking patterns, and antidepressant drugs are particularly helpful in treating symptoms of hopelessness and perceptions of a lack of control over oneï¿½s own life, he said.

Light Therapy to treat SAD

Tue, 05 Apr 2005 17:26:38 PST

( from http://www.rxpgnews.com ) A study commissioned by the American Psychiatric Association and led by a psychiatrist at the University of North Carolina at Chapel Hill School of Medicine has found that light therapy effectively treats mood disorders, including seasonal affective disorder (SAD) and other depressive disorders.

A report of the study, which appeared April 1 in the American Journal of Psychiatry, also finds that the effects of light therapy, also known as phototherapy, are comparable to those found in many clinical studies of antidepressant drug therapy for these disorders.

The findings were based on a meta-analysis, a systematic statistical review of 20 randomized, controlled studies previously reported in the scientific literature. These represented only 12 percent of 173 published studies that the authors had originally considered for review.

"We found that many reports on the efficacy of light therapy are not based on rigorous study designs. This has fueled the controversy in the field as to whether or not light therapy is effective for SAD or for non-seasonal forms of mood disorders," said lead author Dr. Robert Golden, professor and chairman of psychiatry at UNC and vice dean of the medical school.

"But when you throw out all the studies that are methodologically flawed and then conduct a meta-analysis of those that are well-designed, you find that light therapy is an effective treatment not only for SAD but also for depression."

The use of bright artificial light for people with SAD, a recurring depression that develops in the fall or winter and spontaneously disappears during spring or summer, was first described in the Archives of General Psychiatry in 1984. Since then, the treatment has been tried in clinical and research programs for non-seasonal mood disorders, Alzheimer's disease, jet lag, insomnia, eating disorders and other behavioral problems.

A more recent light therapy approach is "dawn simulation," which attempts to simulate an earlier dawn through exposure to artificial light. This follows the theory that SAD is triggered by the reduced period of bright daylight during winter.

The method attempts to recreate the increased intensity of sunlight that occurs in nature in the summer when the sun rises earlier in the day. "The logic here is that it might put people with seasonal affective disorder into remission," Golden said.

Still, the exact mechanisms by which light therapy works remain unclear, the researchers said.

The studies selected by the authors for inclusion in their meta-analysis were grouped into four categories: bright light for SAD, bright light for non-seasonal depression, dawn simulation for SAD and bright light as an adjunct therapy combined with conventional antidepressants for non-seasonal affective disorder.

These study groups were limited to adults ages 18 to 65 years who met a criterion-based mood disorder diagnosis.

The meta-analysis demonstrated statistically significant treatment effects for SAD, dawn simulation for SAD and bright light treatment of non-seasonal depression, the report said.

"The effect size of the light therapy intervention in our meta-analysis was comparable to what has been described in the clinical literature for conventional medications to treat depression," Golden said. "The findings are as strong or as striking."

More research is needed on the safety of light therapy, particularly among children and the elderly, Golden said. The study did not look at safety or adverse effects, as very few reports contain controlled, or comparison, data on side effects or toxicity, the authors reported.

In addition, they added, the responses of children, adolescents and the elderly to light therapy may differ, compared to non-geriatric adults. For example, at each end of the age spectrum, the requirements for light therapy dosing might differ. Also, children and adolescents may need lower doses than the elderly. "And if eye problems such as cataracts are more prevalent among the elderly, might light therapy aggravate the problem, even slightly?", Golden added.

As to efficacy of light therapy for SAD and other non-seasonal depressive mood disorders, Golden said this study largely answers the question: The treatment is effective.

"The study also points to the importance of conducting systematic literature reviews in areas of controversy using well-defined standards of what constitutes good study design, and to follow this up with meta-analyses so that the data can speak for themselves. "And when you can separate the wheat from the chaff, the findings are much more valid."

RxPG News : Mood Disorders

Double trouble: Hopelessness key component of mood disorder

Light Therapy to treat SAD