Can a change in neuroticism improve depression? Part 2

Tang and colleagues looked to see if the SSRI, Paxil (brand name Seroxat), had effects beyond just treating depression symptoms. In their study they noticed dramatic changes not only in depression but a significant drop in neuroticism and marked increases in extroversion. "Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extroversion as placebo patients matched for depression improvement," said Tong Tang

"Those are very dramatic, notable changes. At the beginning of the treatment, they were way out there. Their neuroticism was abnormally high. By the end of treatment, they moved back into the boundary of the normal range." Tang mentioned that all SSRI would possibly have a similar effect.

If these studies can be duplicated, then it will change the way physicians treat depression. Says Dr Ian Cook of the David Geffen School of Medicine at the University of California Los Angeles, "The conventional wisdom has been for many years that the changes in personality that one sees during treatment tend to be thought of as a reflection of getting the depression under control," he said. He further stated that these observations may help better predict who is at risk for depression and which of these individuals may benefit most from treatment.

Archives of General Psychiatry 2009.

Can a change in neuroticism improve depression? Part 1

Depression when severe can present with a variety other symptoms like paranoia, anxiety and sometimes delusions. Sometimes it is the individual personality that is often very prone to these symptoms. Now a study using the drug paroxetine suggests that by controlling personality features or neuroticism, the symptoms of depression can be better controlled.

Says Tony Tang a psychology professor at Northwestern University in Evanston, Illinois, "Our data suggests that modern antidepressants work partly by correcting key personality risk factors of depression."  Tony Tang and his colleagues observed that individuals who tend to be neurotic, experience not only more negative emotions but tend to be very emotionally labile, and experience wild mood swings frequently.

"It's the basic tendency toward having negative emotions," Tang further added. In their analysis it was observed that people who tend to be highly neurotic were also at a higher risk of developing depression. Further these researchers observed that extroverted individuals who tend to be outgoing and more sociable were less likely to develop depression.

It has been known for years that personality traits are affected by certain brain chemicals and that is why this study was undertaken. Perhaps instead of targeting the  symptoms, the researcher could target the personality.

Depression during Pregnancy

While most people are aware that depression occurs after pregnancy, not many health professionals are aware that depression is also common during pregnancy. In the last decade, several studies have shown women are in fact more likely to suffer from depression during pregnancy than the post partum period. Estimates indicate that about 20% of women develop some type of depressive symptom during pregnancy. In North America, there are about 4 million live births annually, and this equates to about 500,000 pregnancies that are associated with depression each year. The risk of depression is a lot higher in women who have a history of depression prior to pregnancy. At least 70 percent of women who discontinue their anti depressant medications relapse during pregnancy.

A recent study showed that depression is quite common at 32 weeks of pregnancy than 8 weeks after birth. However, in the majority, depression finally disappears 8 months after giving birth.

Depression during pregnancy is often difficult to diagnose because the symptoms often mimic symptoms associated with pregnancy. Symptoms like decreased energy, irritability, changing mood and poor concentration are common during pregnancy. However, women who are depressed are more likely to have poor prenatal care and are more likely to smoke, use alcohol or other drugs. The other problem is that many pregnant women with mental illness like depression are less likely to access care. In addition, even when they have access, they are unable to afford the medical treatment.

Universal symptoms of depression, such as reduced sleep and decreased appetite, may also have an unfavorable impact on pregnancy. Suicidal ideation and self-harm during pregnancy is also unpredictably high.

Now there is evidence indicating that a mother’s mood during pregnancy may affect her unborn child. Depression during pregnancy is linked to inferior obstetrical results such as premature birth, pre-eclampsia, low birth weight and a higher rate of admission to baby care units. More important is the fact that depression during pregnancy also continues into the postnatal period. Other data indicate that the ongoing materal depression also has an adverse affect on mother infant bonding and leads to dysfunctional behavior in the growing child. Based on these findings, researchers are urging physicians to recognize the importance of treating prenatal depression.

Can I take 5-HTP (L-tryptophan) for my depression?

5-HTP is a well-known dietary supplement also known as l tryptophan. The amino acid is easily available in many health food stores and sold for the treatment of depression, pain disorders, sleep difficulties, obesity, anxiety and obsessive-compulsive disorders. 

The problem is that l tryptophan has never been fully assessed clinically in randomized clinical trials and so all reports about its efficacy are anecdotal. In the last few years the quality and quantity of L tryptophan sold has also come under question. Moreover, no two same products of L-tryptophan contain the same dose. 

Alternative health care practitioners recommend anywhere from 50- 1,500 mg per day of L tryptophan. As to whether it really works for any disorder is anyone’s guess. Reports on cyberspace indicate that it does jack-shit. 

If you do decide to use L-tryptophan, a word of warning. Often health supplements come from the Orient and are often spiked with real pharmaceutical drugs- so knowing where to buy your health supplements is also very important.

My doctor has recommended Electroconvulsive therapy for me? Is it safe?

Unlike the olden days, ECT is a lot safer and is a bona fide treatment for depression. Unfortunately, the treatment is surrounded by many myths chiefly because of ignorance. ECT does have a few side effects but complications are rare. Today, it is very rare to see someone with fractured bones and heart attacks after ECT therapy.

The most common side effects seen today in individuals undergoing ECT include:

Mental confusion: After ECT is completed; most individuals will develop some degree of mental confusion and clouding. The degree of confusion is variable but it is quite obvious in most people. After therapy, the majority of individuals will appear to have limitations in concentration and awareness. These side effects may last anywhere from a few minutes to 48 hours. The majority, however, do recover within the first 24 hours. One should be aware that with more ECT treatments, this period of mental clouding does get prolonged. However, in all cases the condition does improve with time. The mental confusion may vary from mild agitation to varying degrees of mental confusion.

Memory loss is common after ECT. Immediately after ECT, most individuals will have memory loss. The degree of memory loss is quite variable and will often last a few weeks to a few months. Individuals will have difficulty remembering events, dates or family members. The most significant finding is that most patients will have loss of short-term memory leading up to the procedure. In most cases, the memory loss does recover with time. While the majority of individuals fully recover from the memory loss, a few percentage of individuals have permanent memory loss.

Heart and Blood Pressure: Because ECT involves the release of neurochemicals from the brain; some of these chemicals may cross into the peripheral circulation. The potent excitatory chemicals can affect various organs, notably the heart. Individuals who a have a history of heart disease or are being treated for high blood pressure are at a slightly increased risk of developing heart damage or even a heart attack. In most cases, the anesthesiologist attempts to have better control of the blood pressure during the procedure and thus these problems are minimized. Today, individuals who have problems with high blood pressure or have a history of heart disease are properly evaluated by doctors prior to undergoing ECT.

Generalized pain: ECT induces a violent seizure under controlled conditions. Nevertheless, the entire body convulses and the muscles in the body do contract. After the procedure, some individuals will complain of pain around the joints and muscles. Others will complain of nausea, headaches and generalized fatigue. The pain varies in severity but is generally mild. During the procedure, there is no pain because adequate pain medications are administered. The generalized pain and muscle aches do subside over a period of a few weeks.

Final Point: Not all individuals develop side effects after ECT. However, in the majority of cases the side effects do resolve in a few weeks. One can rest assured that you will not become a Zombie-that my friend only happens in movies.