It is claimed that chocolate has the capacity to improve mood, and make people feel good. Chocolate is made from cocoa, butter and sugar. Milk chocolate contains extra milk solids and fats, white chocolate is akin to milk chocolate without the cocoa. That’s why white chocolate to my opinion is not chocolate. Attempts have been made to identify any psychoactive substance in chocolate. Several candidates were identified but their concentrations are too low to have a significant psychoactive effect and they are also present in higher concentrations in non-craved foods. Milk chocolate is the most preferred but if psychoactive substances were involved dark chocolate should be the most preferred. At least I prefer the dark chocolate.
Interaction between chocolate and neurotransmitter systems that contribute to appetite, reward and mood regulation were studied but no antidepressant mechanism of chocolate was found.
Chocolate can be the quality of chocolate graving, only chocolate will satisfy that craving. When experiencing an aversive mood state any carbohydrate will suffice in an attempt to achieve relief. This last form of behavior is also called emotional eating, food preference can be altered across a range of mood states. It is useful to distinguish between these two separate phenomena: chocolate craving and carbohydrate craving. The two phenomena can, however, co-exist in the same individual by virtue of the dual status of chocolate as being specifically desired and being more generally craved as a carbohydrate at times of emotional eating.
For most people chocolate is a substance of pleasure and extravagance. When taken in response to a dysphoric state as an emotional eating strategy it may provide a transient comforting role but it is more likely prolonging this state. It is not an antidepressant.
For an excellent review please read: Mood state effects of chocolate.
Parker G, Parker I, Brotchie H. J Affect Disord. 2006 Jun;92(2-3):149-59.
In the last couple of years antidepressants were accused of causing suicide in patients using them. More recently a subgroup of patients, adolescents were assumed to be of increased risk for suicide when using antidepressants. This is a reference to an article on The Corpus Callosum, a scienceblog.
This blog has already dedicated a number of posts about this subject. This recent post discusses: Suicide Attempts Among Patients Starting Depression Treatment With Medications or Psychotherapy and an editorial Antidepressants and Suicidal Behavior: Cause or Cure? in the latest (July 2007) issue of the American Journal of Psychiatry.
The main finding of the article was this: the temporal pattern of suicide attempts was the same regardless of treatment modality, and it was the same regardless of the age span of patients studied. Note that the pattern was the same, although the rates were different.
The treatment modalities were antidepressants prescribed by a primary physician, antidepressants prescribed by a psychiatrist and individual psychotherapy.
The risk of suicide attempts peaks before the onset of treatment, these data show a pattern that is exactly the opposite of what one might expect if antidepressants were associated with increased suicidal risk.
This and other studies are observational studies and observational studies can never definitively demonstrate causality, prospective studies are needed for that. However, the results of both studies are consistent with a protective role of treatment against emergent suicidal behavior.
A new candidate drug for bipolar disorder is being designed by researchers in Chicago and New York. It works as well in mice as do the currently prescribed drugs. They hope that it will ultimately provide relief without the side-effects of present treatments.
Bipolar disorder, which afflicts about 1% of adults, is typically treated with drugs called mood stabilizers, especially lithium is used. Lithium is thought to act by blocking the function of an enzyme called glycogen synthase kinase-3beta (GSK-3beta) in the brain.
Kozikowski and colleagues did two things. First, they looked for a way to improve binding to the enzyme. They also altered the enzyme so that it could get from the blood into the brain, which involves passing through a water-resistant membrane.
They made a whole family of molecules, and tested how well each of these blocked the enzyme’s chemical behavior. They identified the best of them and looked at whether it would work in animals. In a mouse model of ‘mania’, hyperactive mice were calmed and moved around much less when given the new candidate drug. The new compound looks promising, but a lot of work remains to be done before it will be ready for human trials.
1. Kozikowski, A. P. et al. J. Am. Chem. Soc. 129 , 8328-8332 (2007).
Activity scheduling is an attractive treatment for depression because it is relatively uncomplicated, time-efficient and does not require complex skills. Activity scheduling is a behavioral treatment of depression in which patients learn to monitor their mood and daily activities, and how to increase the number of pleasant activities and to increase positive interactions with their environment. This treatment was developed about three decades ago because it was evident that depressed patients find fewer activities pleasant, engage in pleasant activities less frequent and obtain therefore less positive reinforcement than other individuals.
Researcher form the department of clinical psychology of the Vrije Universiteit in Amsterdam, The Netherlands did a meta-analysis to examine the effects of activity scheduling on depression, on the relative effects of activity scheduling compared to other treatments and on the longer term effects. Their literature search produced 16 studies with a total of 780 subjects. In four studies subjects were recruited from clinical settings. In only five studies the participating subjects had to meet diagnostic criteria for depressive disorder, the other studies included subjects who scored high on a severity rating scale for depression or used other definitions. Activity scheduling was compared to other psychological treatments. Activity scheduling was compared to cognitive therapy in 10 studies.
They concluded that activity scheduling is effective in the treatment of depression and equally effective as cognitive therapy also at follow-up periods up to 6 months.
The limitations of this review were:
1. number of studies was small
2. studies used very small sample sizes
3. only one study compared with antidepressants
4. the quality of the studies was not always optimal
5. few studies used clinical samples
It is remarkable that activity scheduling received so little attention. Since activity scheduling is as effective as other psychological treatments for depression it is possible that the effects of treatment are achieved by common factors such as the intensive relationship between patients and therapist, the expectation of the patient of being cured, the ritual of the therapy, and the presentation of a rationale. Advantages of activity scheduling is that it is simple and easy to understand, no need of complex skills, and time efficient.
If you want to know what activity scheduling is and you don’t want to waste to much time before starting some exercise or looking for a therapist, please have a look at this excellent blog on Finding Optimism. There is also a recent article in cooperation with zen habits about Top 42 Exercise Hacks. Besides there is much more about fighting depressed mood in different ways on this blog.
Informative links on this subject:
More Evidence for Antidepressant Properties of Exercise
Nearly 30 million Americans suffer from some form of depression. Many people with depression do not seek help, even though most of those with severe cases can be helped. Kidney disease patients are at an increased risk of suffering from depression. Understanding Depression in Kidney Disease and When Your Loved One is Depressed, gives readers an understanding of what depression is, what may cause it and how it is treated.
The American Association of Kidney Patients (AAKP)has published a brochure in the AAKP Understanding series. To download an electronic copy of this brochure, please visit the AAKP site.
It is an excellent brochure with an accurate account of what a depression is and how it is treated. Different treatment options are explained.
It is stated on this website that kidney disease patients are at an increased risk of suffering from depression. Since we did some research about depression and chronic inflammatory liver disease I am a little reluctant about scattering around this diagnoses. Would need to do a thorough literature search before answering this important question. With patients with liver disease a high prevalence of depression was only found by using a depression severity scale. Using severity scales to screen for depressive disorders in chronic somatic patients yields a prevalence that is too high. With a structured psychiatric interview prevalence is usually less and comparable with the prevalence in the general population for patients with a chronic inflammatory liver disease. It is possible that patients with a chronic somatic illness have some features of a depressive disorder, but lack all the features required for the DSM-IV diagnosis.
In conclusion patients with chronic somatic illness can have “psychiatric complaints” sometimes due to a psychiatric disease but most of the times due to their somatic illness.
The European Committee supports the request of the pharmaceutical companies for “direct-to-consumer-advertising”. The International Society of Drug Bulletins warns against this legislation. It is wrong to confuse information with advertising.
The dangers of “direct-to-consumer-advertising” are:
1. advertisements from drug companies are mostly limited to those drugs with the highest profit
2. efficacy is often exaggerated
3. risks are usually obscured
4. it confuses patients when suggested another drug by their physicians
5. it forces physicians to use the advertised drug
6. advertisements by drug companies lack comparison with drugs from other companies or other treatments, making it hard for consumers to compare different drugs or other treatment options
Another objection is the impartiality of the Pharmaceutical Forum preparing this proposal. This is done by the Pharmaceutical Forum. This forum is not elected and not less than 5 drug companies are part of this forum. Moreover the patients are represented by The European Patients’ Forum sponsored by the Drug Companies.
There are only two countries allowing “direct-to-consumer-advertising”: USA and New Zealand.
Another short but concise introduction to ECT for patients can be found on this page of webMD. It is short but on this blog more posts about sites with information on ECT for patients can be found. Use the tags on the right column.
The information is reviewed by the department of psychiatry from the Cleveland Clinic.
In a recent systematic review it is suggested that antidepressants, more specific the selective serotonin reuptake inhibitors (SSRIs) begin to have observable beneficial effects in depression during the first week of treatment. This conclusion is debated by the authors of a recent letter in the same Journal: Archives of General Psychiatry.
We argue that the criteria of including only studies reporting outcomes for at least 2 points in the first 4 weeks of treatment might have systematically selected positive trials, that is trials showing significant differences between placebo and active drugs during the early phases of the trial. In other words, it is possible that the authors of primary studies reported more often early outcome data suitable for reanalysis when differences emerged.
They also argue that probably most of these trials with the positive outcome were sponsored by the drug companies. And it is not unusual for these companies to not publish negative trials comparing SSRIs with placebo. The authors plead that scientific journals should require, before accepting reports of clinical trials, a statement in which authors agree that data may be accessed by organizations involved in research synthesis. Reports of clinical trials should not be accepted without such a statement. Only in this way would the damage of publication bias be mitigated.
Memory complaints after ECT a somatoform disorder . This needs some explanation. It is the title of an article by Prof M. Fink. A very distinguished physician with a tremendous amount of experience with ECT. In this article he summarizes the complaints of two patients treated successfully with ECT. They both have expressed their memory loss with great detail in the media and even psychiatric congresses. He also mentions Kitty Dukakis and her new published book and DVD: Shock.
The author doesn’t deny memory loss can occur after ECT but not to the extend as noted by the examples he mentions in this article. In his article he makes a case for defining these extraordinary cases with extensive personal memory loss as a somatoform disorder. This is a disorder consisting of unexplained physical complaints, inconsistent with known anatomy, physiology, or biology. According to the author:
The rare complaints of persistent loss of personal memories as a consequence of ECT are well within the family of these syndromes.
The demographic features of the complainants according to the author are well educated women, often nurses, with histories of prolonged depressive illness marked by somatic features and suicidal episodes. ECT was the last resort, reluctantly advised and administered, that resulted in relief of depression. The loss of personal memories is a new focus of illness making return to work impossible, however these patients function well in new roles as critics of psychiatry.
I don’t know, I can recognize his arguments but the problem is as stated in an earlier article that we do not know enough about the possible causes of memory loss. By that I mean the possibility that some patients are more vulnerable for this side effect. Vulnerable in a biological sense and the patients he describes could well be the ones we are looking for but we need better understanding of the etiology for discovery of high risk groups.
The Diet Plate ® system, invented by Kay Illingworth, centres around a portion control plate that literally takes all the guesswork from maintaining a healthy, balanced diet, but can also be learned from sites as https://tophealthjournal.com/1480/jenny-craig-vs-nutrisystem-which-one-should-you-choose/. That means there’s no counting calories, points or fat grams and no denial of essential food groups, so it doesn’t rely on having to eat starchy carbohydrate one day and protein the next.
They have studied the use of this plate with patients with type 2 diabetes in clinical trials. The results off this study are promising so they say. The article is being reviewed, but they already mention the effects being very positive. As stated earlier:
Research in this area is still underway so it is not possible to draw any firm conclusions but the evidence does suggest that it is worth trying to follow a healthy diet in order to protect our mental health.