Depressed? Net-based Treatments Can Help

Jung and the Restless writes "Researchers at an Australian university have found that regular visits to therapeutic and educational web sites can successfully treat depression. Researchers directed patients to The MoodGYM, a cognitive behavior therapy site, and BluePages, a depression education site. After 12 months, users of both web sites reported improvement, with the educational site working out better than the behavior therapy site. A psychotherapist who did not participate in the study says that the results aren't all that surprising. 'Cognitive behavioral strategies — sometimes in conjunction with medication — are the most effective means of treating depression,' and 'a person who is visiting an educational site like BluePages is taking the necessary steps with her own self-care. That's a key component of successful treatment for depression'"

Comments

Where's the control group?

[Ed Avis]

As the article points out, someone who visits any website at all is taking steps to deal with their depression and so you'd expect them to get better. Surely they needed a placebo website, with 'neutral' content, that could act as a control group. They get a little of that by comparing one website against another, but they haven't shown that either is a better choice than just browsing. They could even be a bit worse.

Re:Where's the control group?

[rev9]

If you had RTFA and actually checked the links there, you would have noticed that beside the 'am-I-depressed-tests' there is also a community. Take a look at the blueboard: http://blueboard.anu.edu.au/ In my opinion that's a huge thing for someone who is really depressed and afraid of talking about it with his family/friends.

Re:Where's the control group?

[thePowerOfGrayskull]

That's unethical. You can't treat someone for a disease with a placebo.

Of course you can. How do you think drug trials work? Ethical or not, an untreated control group is the only way to ensure that the treatment is effective, and that any improvement isn't due to environmental/unrelated factors.

Another option is to use standard treatments combined with your new therapy, and then have a control group do standard treatments alone.

This is also a valid option, but what happens when the standard treatements can't be combined with the new treatments?

Re:Where's the control group?

[Lurker2288]

Depression (at least in mild cases) is one of the few diseases where people taking placebo do get better, actually. And while the use of 'active comparators' in drug trials is becoming more common (mainly because it allows you to demonstrate better results, and thus demand better reimbursement from Medicare and HMOs, e.g.) using placebo is still very common. As long as the patient knows when they sign up that they might not be getting the study drug, it's perfectly ethical.

The exception would be in cases where effective treatment exists, and withholding it would be a death sentence. For example, you probably won't see many placebo-controlled trials of new HIV drugs. In these cases active comparator trials are the only way to fly.

Psychologists need to learn more than this

[Anonymous Coward]

I'm one of those depressed people psychologists treat (I've been more than I can remember in the last twenty five years) and while cognitive behavioural therapy is one of the big tools in their arsenal, I'm afraid most of them consider CBT + Antidepressants to be the ONLY tool they'll use. It's done little to help me, yet when I see a psych, it's more laying on thick CBT with another round of antidepressants. My past experience with it is ignored, and they'll go so far as to say I'm clearly getting better despite evidence to the contrary.

Moving sideways for an analogy, it's like going into hospital with a stab wound and being given aspirin. When that doesn't work, more aspirin is given, and the doc insists it's better, despite nothing healing and the pain being just as bad. 18 months later, when the doc has done nothing more than to give more aspirin, I realise it's another bum move, and I try another doctor. The next doctor says he has just the right treatment... and whips out some aspirin.

Psych training is pretty damned poor in Australia.

Re:Psychologists need to learn more than this

[DamnYouIAmALion]

I had this same problem, the doctors were going the medication route - but I also had anxiety, so giving medication with poor documentation and statistics just made things worse. In the end I managed to spend time with a psychologist (not easy, they're either very expensive or very busy) which helped a great deal - although not until some time after the fact when you process and understand what they're saying.

They get you only so far - and at that point you'll eventually get the willpower to 'pick yourself up' and start building your life back. It takes time, but it's really worth it.

- Andy.

Re:Psychologists need to learn more than this

[Anonymous Coward]

The problem is that CBT and medication are the best ways to treat depression. They are both better than "talk" therapy for nearly all patients, though the medication route is a bit problematic - most patients get the best medication for them after trying quite a few different types. So, if one type of drug isn't working, you shouldn't be afraid to try different ones, possibly of a different class.

It is true that for a significant minority of sufferers of depression, that even trying both of these treatments they get little response. For people with refractory depression like this, I believe there isn't much other than trying to "wait it out" with standard treatment, or going the more severe route of electroshock therapy. There are new drugs coming out all the time, so people who have refractory depression are often shuttled onto new drugs as they become available. There are also new experimental treatments like electrical brain stimulation that may prove helpful for some...

It can be a struggle, but hang in there - doctors are getting better at successfully treating it all the time (well, they can't get worse anyway ;).

Re:Psychologists need to learn more than this

[Anonymous Coward]

Have to disagree with you there OMF. I thought the same things for half my life until in my 20s I started getting serious
depressions. I still get them, but by god I know enough about psychology, psychiatry and medication now. There is quackery
on all sides of mental health. You think anybody actually understands the mechanism of antidepressants? Only in a fuzzy
and ad hoc experimental way, the biochemistry is bewildering. Most doctors and even some specialists haven't a clue. What is
scary is the way they are often puppets of the drug companies pushing their latest "cures". The DSM guide is practically
a crock of shite, and all the pros know it is deep in their hearts, but it's the best tool they have and the only
picture of mental dysfunction available as a common reference. Most psychs get the diagnosis wrong for the first
few times, they are too pressured to jump to a conclusion, always get a second and third opinion. The only thing that actually
worked for me was one on one talk therapy, but in most juristictions it's too expensive or simply unavailable on national
health insurance programmes. Funny thing is I studied cognitive science for many years, but that was formal schemas, predicate
logic and Boltzmann machines which obviously had no bearing my own problems. It made interesting conversation with psychologists
though, to be able to correct them when they are getting too fuzzy and explain how neural networks actually function.
Upshot of all is that I still get depressed, less often and less severe, but I manage it, anticipate it and accept it better now.
The best pieces of wisdom I received are roughly as follows, so this might save some of you some money :) .....

1) Most the causes *are* deeply rooted in childhood formative experiences and you need to remember your life context
and reinterpret your emotions in that light. Until you do you have no idea what crazy buttons the world is pushing for you.
I think of them as hidden methods in my brain object that get called by backdoor sploits ;)

2) Intelligence works against you. How many blissfully thick people do you know who suffer? Remember that line from the wife of
John Nash in Beautiful Mind - you can't use your mind to fix your mind when the tool itself is broken. By sheer force of will you
can sometimes bootstrap yourself back, but external input is a vital part of an expedient recovery.

3) Depression is a sane reaction to an insane environment. The world is barking insane. It's full of other stupid, lazy, damaged
people (increasing the ones running the show). There is war, misery, death, pointless waste, arrogance, fear, greed... our modern
Western existence is practically designed to send smart people insane. All the things that offer security and continuity in
modern life, the church, the state, employment - those are all fucked, they are crumbling away as we speak.
Most people use two coping mechanisms, denial and distraction. If you can't engage in either of these two self comforting drugs
then you have only one option left, change your environment. Throw out your television. Stop reading the FUD stories on /. designed
to provoke insecurity and outrage. Build new friendships and visit new places etc.

4) Acceptance. Get used to the idea that you have a lifelong incurable disease. Understand how it affects your capabilities and
dreams and learn to recognise the signs of the highs and lows. Make hay while the sun shines high and prepare for the winters.

5) Talk to your partner, family and friends. Part of the disease is isolation and trying to fight it on your own. It takes many years
to work out that friends *don't know* you are depressed when you don't call for 4 months because you are up every night hacking away
because it's the only thing that stops you going mental. Tell them and explain your situation and needs. Most will stick by you
and the ones who won't were never your real friends anyway.

Re:Psychologists need to learn more than this

[Hatta]

Ketamine works like an SSRI but blocks a different group of neuro thingies

Please don't spread misinformation like that. The action of ketamine is entirely unlike that of SSRIs. Sure they both inhibit some proteins in neurons but hell, if that's your criteria for "works like" you could say aspirin "works like" SSRIs. Your statement is so vague as to be misleading. SSRIs block the reuptake of neurotransmitters presynaptically so that there is more neurotransmitter available to cause a post-synaptic response. Ketamine blocks the postsynaptic NMDA receptor, inhibiting a post-synaptic response. SSRIs work on the serotonin system, ketamine on the glutamate system.

The antidepressant response to ketamine is a truely novel phenomenon. I suspect it has some similarities to the response to electroconvulsive therapy, since many of the same players (NMDA receptor, CaMKII) are involved in each.

In other news involving novel theraputic uses of recreational drugs, MDMA seems to help treat parkinsons symptoms. Check it out at the New Scientist. Maybe we can get Michael J. Fox to come out in favor of medicinal MDMA?

Interweb

[Wellington Grey]

But what if it's spending so much time on the internet that makes me depressed?

-Grey

Always Get The Proper Help

[DamnYouIAmALion]

I used to have depression, and have only recently (this month) gone back to work. I think these sites are interesting, but use them as an 'extra' to getting proper help. Go and see your doctor, they'll help identify what the best course of action is, and go from there.

Of course, realising that you are depressed isn't easy and realising you need help is even harder. Actually going and getting help is the hardest of all, but you'll never be so glad when you finally do. And remember, your friends and family are there to help too - don't feel embarrassed asking for their help, everyone needs help at sometime in their life

- Andy.

psychotherapist

[56ker]

I think a psychotherapist would have a field day with slashdot users. Either that or they'd end up needing therapy themselves. ;)

There's always a catch

[Joebert]

Cutting back on masturbating cured me of depression, though, now I have anger management issues.

Another Site of Interest

[darrenadelaide]

Hi,

Just thought you may find http://www.beyondblue.org.au/ of interest.

Strenuous excercise

[Colin Smith]

Increases serotonin levels, and for guys testosterone completely naturally. You start to look good and feel good about yourself. There are a bunch of other beneficial side effects. It seems that the human body is designed to be physically stressed on a regular basis.

Re:The problem, as I see it..

[cerberusss]

Have you any idea how condescending you sound? There's a difference between feeling low and feeling depressed. And if you haven't been through the latter, then you wouldn't suggest to 'realize that life isn't a dance on roses'.

You can't imagine how it's like to drive on the highway with 90 mph and thinking "I might as well turn the steering wheel real quick and be done with it". For weeks on end. Every day.

So cut the "know-it-all" attitude and accept that there are thing you don't know a rat's ass about. Asshole.

Re:Annoying...

[Bambi Dee]

I've seen highly creative and active people fall into depression for no external reason whatsoever. Is it so inconceivable that it can be a serious illness, and that it's hard to fight that illness with the very organ afflicted by it?

Even if depression is purely reaction, a being-overwhelmed - once you're choking on insidiously persuasive infinite loops of "I'm filth, everyone can see it, I have no right to ask for help, I have no right to feel better", once self-injury sounds like a perfectly reasonable punishment for being yourself, once meeting your friends makes you cry with fear, once writing, painting, coding, loving, laughing all seem increasingly bizarre - how do you chill out with that shit screaming in your head?

Please excuse the angst and drama. I suppose it's exactly the kind of stuff people love to make fun of... but it's my description of depression. Not a "light" depression, maybe, but what kind of depression could ever be "light"?

Maybe you can chill out in that state and look forward to working on your projects or spending time with your kids or what have you. That's great... quite amazing, actually. And I suppose it does help having built up a sensible life - ideally before falling to pieces. But even then there's no guarantee you'll recognise it once push comes to shove. Well, I guess I shouldn't presume to speak for you.

Re:Annoying...

[WuphonsReach]

Kid, I'd wish a bout of severe depression on you, but that's not even something I'd do to my worst enemy. When you say "people have really unimportant lives", you're making a value judgement that you have no place making. Don't argue with me now, just think about that and come back and argue 20 years from now.

Depression is a very difficult disease to deal with. It's also a complicated disease (or set of diseases) where the symptoms of all the different types of depression are pretty much the same. There are multiple causes and they often feedback on themselves which makes things a whole lot worse. It's not a trite saying to say that depression has a significant fatality rate as a disease. It needs to be treated as a potentially life-threatening disease. But like all diseases, there are various levels of severity ranging from mild to severe.

There's external-induced (events, relationships, or other things not under your control) depression which overloads the individual and causes them to give up hope. That's more amenable to talk therapy or even simple counseling where someone sits down with you and helps you formulate a plan. Some of the exercises are learning how to separate / identify which things you can change and which things are out of your control, then focusing on changing what is possible. Other goals of therapy are to help you identify which thoughts are incorrect views of reality ("everyone thinks that I'm ugly / worthless / stupid / etc") and to take steps to challenge those thoughts. See "Feeling Good" by David D. Burns for a good book about CBT.

Then there's the chemical side of the disease where the brain (other organs) don't make the right chemicals, or the receptors for those chemicals aren't working right. (This is where things get very experimental, theoretical, and understandings are constantly revised.) Even though there are no external events that would seem to cause depression, the individual spends their waking hours in pain and is seriously considering suicide as a viable solution to end the pain. Speech becomes slow and slurred, there's mental confusion, short-term memory issues, and you feel like you're viewing the world through a piece of gauze (or an oily lens).

And the two major sides of the disease often combine in a particular case, making it even more difficult and twisted. They'll feed off of each other, as the individual starts to sabotage relationships which makes them feel even worse as a person. And which also destroys the person's support network (unless the friends understand what is going on, which is rare) making recovery an even more difficult road.

Where things get tricky is that when you are depressed, it is very difficult to seek treatment. Seeking treatment requires you to believe that you can get better, which is 180 degrees in opposition to how you feel about yourself at that point in time. You'll be worried that they'll lock you up (resulting in friends, family, coworkers, bosses thinking that you're simply "crazy"). Or you could simply be worried about being branded as "crazy" or "seeking attention" by the above people. There's a huge social stigma towards mental disease and popular culture (TV, Movies) usually perpetuate the misunderstandings and misinformation in order to make for more 'engaging' story lines.

The reality of the matter is far different. Once you've been through a successful cycle of treatment, a lot of depressives become very outgoing and honest about their disease with others. Basically, you decide that the potential stigma is nothing compared to the pain and suffering that you've been through and that your suffering was increased because you were trying to hide the fact that you have depression. That relieves a lot of the pressure and you start trying to educate people around you about the disease (if they're willing to listen). Often, that forwardness and truthfulness results in someone else realizing (or admitting to themselves) and seeking treatment.

Moo

[Chacham]

Alot of depression is actually lack of sleep. Seriously. If someone is depressed, and they go to sleep, they will usually be happy. I'd even venture to say that the vast majority of depression cases would be cured, if they went to sleep for eight hours a night. Though, real results are seen after a week or two (as the body gets used to the rythem).