Communicating and socializing are tough when you’re feeling down. The internet is much easier. You can chat online without worrying about how you look, how your voice sounds or how to maintain eye contact. It isn’t threatening. You are anonymous in the chat room, just as you are on MySpace, Facebook and Bebo. Or you can lose yourself in an online game.

Researchers at Carnegie Mellon University found that just a few hours on the internet each week can increase a persons experience of depression and loneliness. This seems far-fetched, since the internet is such a sociable place. So are the researchers’ conclusions correct?

Initially the researchers found a drop in time spent interacting with family and friends, in direct proportion to the amount of time spent on the internet. No cigar there. But relationships built via the internet are typically more shallow than face-to-face relationships, and they do not have the support and reciprocity that is vital for psychological security and happiness. So the result is a decline in the feeling of being connected with other people.

Another study, published in April this year, concludes that Internet addiction is correlated with symptoms of depressive disorders.

So which comes first: depression or heavy internet use? Is using the internet a coping strategy for depression or a partial explanation for its cause? Some research concludes that heavy internet usage directly contributes to depression. Other studies don’t go so far, but still find a correlation between being online and depression. Of course a person’s activities on the internet will explain variations away from the norm. Someone who frequents gambling sites is much more susceptible to depression than someone using the internet for research.

Here are some red flag questions to ask yourself:

• when you are offline do you think about being online a lot?
• do you often stay online longer than you intended or said you would?
• does the Internet provide relief or help you to escape from your depression?
• does your online habit put strain on a significant relationship, your job or other important area of your life?
• have you lied to your partner, family, therapist or others to conceal the amount of time you spend on the internet?

One researcher describes the hook of an addiction as giving you “feelings and gratifying sensations that you are not able to get in other ways. It may block out sensations of pain, uncertainty or discomfort. It may create powerfully distracting sensations that focus and absorb attention. It may enable a person to forget or feel “okay” about some insurmountable problems. It may provide an artificial, temporary feeling of security or calm, of self-worth or accomplishment, of power and control, or intimacy or belonging.”* It’s understandable that people come back for more. They enjoy the benefit that addiction brings, no matter how temporary it is or that the problem worsens in the long-run.

If this describes you then you need to cut your internet hours right back and seek some professional help. Quite seriously. Internet addiction is similar to other addictions with respect to the potential for damage. In the last few years the problem has been labeled “Internet Addiction Disorder”, and while many clinicians aren’t on board with the term, there is consensus that excessive online activity can be terrible for your mental well-being.

For the Record
In March 2005 the Chinese government opened a clinic for Internet addicts, to treat the effects of long hours on gaming and chat sites. They reported the effects to be anxiety, depression, and lack of sleep. Treatments have included total internet bans, counseling, physical activity, antidepressants, and enforcement of strict, regular sleep times.

Resource List:

Research paper published April 2007 on Internet Addiction and Mental Illnesses

Center for Internet Addiction Recovery
* See page 8 of the paper titled Internet Addiction: Symptoms, Evaluation, and Treatment

Researchers find sad, lonely world in cyberspace

What is St John’s wort?
It is a perennial herb with a yellow flower, that is commonly used to treat mild depression. It is sold as capsules, teas and extracts.

How Does It Work?
St John’s wort has many chemical compounds, some of which are believed to inhibit the reabsorption of serotonin, dopamine and noradrenaline. These are chemicals in the brain that are closely linked with depression.

Clinical trials have found that for mild or moderate depression St John’s wort is an effective treatment, and for some people it may be as effective as taking antidepressants. Interestingly, there are also many reports of people who have had no benefit from St John’s wort whatsoever. For severe or biological depression there is no evidence that St John’s wort is effective, and it carries significant risks in these cases.

What are the Pluses?

• It provides much needed relief for many people with mild or moderate depression
• It is an alternative for some people who find antidepressants to be ineffective
• The unpleasant side-effects experienced by some from anti-depressants may not be present
• Some aren’t willing to take antidepressants, but are happy to use herbal remedies
• The cost is a lot lower than antidepressants, and it is sold over the counter (except in Europe where it is widely prescribed).

What are the Minuses?

• In many countries where it is available over the counter, the active ingredients are not as precisely controlled as for drugs. Products can differ in content from brand to brand and batch to batch.
• It can interact with other medications, including antidepressants, HIV medications, some heart medications, the contraceptive pill and anticonvulsants for epilepsy. Treatment with St John’s wort needs to be medically supervised.
• Possible side effects include photosensitivity (increased sensitivity to sunlight), fatigue, dizziness and gastrointestinal symptoms
• It is not suitable for treating severe or melancholic / biological depression
• It shouldn’t be combined with many prescription drugs.

Further resources:
NCCAM - Herbs at a Glance
McMan’s Wort for Depression
Black Dog Institute Fact Sheet

This is the first of 4 articles on exercise, to be posted over the coming 4 weeks

About 5 years ago, during a long spell of health, I rode my bike everyday for up to two or three hours. My swan song was riding about 90 miles in a day, from one city to the next. I felt good, I looked healthy and my depression was under control.

Is there a link between exercise and mental health?

We all know that exercise benefits us physically, but there is also solid evidence that it benefits the mind. It is an effective treatment for depression. Most research is focused on the benefits for people who have mild or moderate depression, however there is also strong evidence that it is a very effective way to head-off a relapse of severe depression. A recent survey by the Black Dog Institute found that patients considered exercise to be the most helpful non-medical treatment option (see the previous post on “What Works for Depression“).

An inactive lifestyle increases the risk of depression, and depression increases the likelihood of an inactive life. The problem is getting up and going when you’re depressed. I know how hard it is. I’ve hardly touched my bike in 5 years!

So what are the specific benefits of exercise?

Exercise increases the serotonin levels in the brain, releases endorphins (”feel good” hormones), improves cardiovascular fitness, reduces cholesterol, reduces blood pressure, helps maintain a healthy weight and improves muscle tone.

Some other good reasons to exercise are:

• it gives you more of a sense of owning your own treatment
• it gets you out and about and meeting people e.g. walking with friends or playing a team sport
• it uses up adrenalin which reduces your stress levels
• it provides distraction from the negatives in your life and unhelpful patterns of thinking
• it tends to be less expensive than most other treatments
• there are no side-effects, except perhaps injury, compared with the many that can be experienced with medication.

There really is no excuse to not exercise. The trick is…how to start? Stay tuned!

In a recent report, Mind (National Association of Mental Health) revealed that 93 per cent of GPs in the UK have at times prescribed antidepressants due to a lack of alternative treatment options. What were they thinking?

There are many alternatives for depression that work well in addition to or in place of anti-depressants. For me it takes a combination of treatments to stay well; medication plus a healthy lifestyle ( good food, exercise, less coffee, more sunlight, avoiding stress).

Before I continue, let me make a clarifying point. A small proportion of people with depression have what is termed melancholic or biological depression. This includes people with bipolar disorder. For such people medicine is almost always needed to reach or remain in good health, while non-medical treatments are considered to be supplementary. For the more usual non-melancholic depression, treatments that use strategies other than medication are common.

Anyway, back to the merits of different treatments. If you want to look up one of the following terms the Medicine Net medical dictionary should have a definition.

The Centre for Mental Health Research (link below) did a survey of the scientific literature available, and ranked treatments according to the depth and quality of evidence supporting them.

Medical treatments

Antidepressants and electro-convulsive therapy are both ranked highly with strong scientific evidence for their effectiveness.

Psychological treatments

Cognitive behavioral therapy ranks highest with strong evidence for being very effective. Interpersonal psychotherapy, psychodynamic psychotherapy and bibliotherapy are all on the next tier. They are supported by scientific evidence as being effective, but the evidence is not as strong.

Lifestyle & Alternative Therapies

Exercise, light therapy and St John’s Wort are ranked on the second tier as useful treatments, with good evidence but not as strong as for, say, antidepressants. On the third tier there is a large group of other promising treatments with less evidence in support. It includes acupuncture, alcohol avoidance, massage therapy, relaxation therapy, vitamins and yoga.

The Black Dog Institute took a different approach, surveying what patients rated as the most helpful treatments. The leader of the study Professor Gordon Parker said that patients “do not necessarily share the views of professionals about effective therapies for depression”. Yes, we can be fairly incisive about what is or isn’t working!

2,692 individuals took part in the survey. Leaving aside medicines and “talk” therapies, people with depression rated exercise as being the most helpful. They considered yoga, meditation, relaxation and massage to be the next most beneficial. Acupuncture and homeopathy followed with moderate ranking scores, while the various herbal and Omega 3 preparations returned the lowest rankings.

So there you have it. My experience is that it takes more than drugs to get well. The more aggressively you pursue all of the the things that work for you, the more likely you are to maintain good health. Putting it into practice is the hard part!

Centre for Mental Health Research
Black Dog Institute (see the news release dated 18/2/07)
Previous post on green exercise