Reflections From A Chair

Forbes published an article today entitled “Early Bedtime May Help Stave Off Teen Depression.”

It discusses recent research on teens and sleep by James Gangwisch of Columbia University Medical Center.

The study found that “Teens whose parents insist on 10 p.m. or sooner for lights out were 25 percent less likely to be depressed and 20 percent less likely to have suicidal thoughts, compared with kids who hit the sack at midnight or later.”

The National Sleep Foundation (NSF) has a fact sheet about teens and sleep on their website. They suggest that “Teens need about 9 1/4 hours of sleep each night to function best (for some, 8 1/2 hours is enough). Most teens do not get enough sleep — one study found that only 15% reported sleeping 8 1/2 hours on school nights.”

The NSF conducted a poll in 2006  and found that “73% of those adolescents who report feeling unhappy, sad, or depressed also report not getting enough sleep at night and being excessively sleepy during the day.”

The NSF also finds that sleep and depression have a reciprocal relationship. “Research shows that lack of sleep affects mood, and a depressed mood can lead to lack of sleep. To combat this vicious cycle, sleep experts recommend that teens prioritize sleep and focus on healthy sleep habits. Teens can start by getting the 8.5 to 9.25 hours of sleep they need each night, keeping consistent sleep and wake schedules on school nights and weekends, and opting for relaxing activities such as reading or taking a warm shower or bath before bed instead of turning on the TV or computer.”

The article also has an extensive list of pointers to help improve sleep hygiene.

On another front, Science Daily highlights another study today. Their article has a self-explanatory title: Insomnia With Objective Short Sleep Duration In Men Is Associated With Increased Mortality.

They write that “men with insomnia and sleep duration of six or fewer hours of nightly sleep are at an increased risk for mortality…men with insomnia and less than six hours of nightly sleep were at highest risk of mortality.”

This is based on a study conducted in Pennsylvania over the course of fourteen years.

So ask the teens and men in your life: “Got Sleep?”

The Globe and Mail reviewed “The Spirit Level: Why More Equal Societies Almost Always Do Better,” by Richard Wilkinson and Kate Pickett, Allen Lane.

The reviewers write that:
“This is the authors’ “big idea”: People’s health depends on the quality of their social relationships, and the most important determinant of the quality of social relationships is the level of inequality.”

The book argues that as inequality increases so, too, does infant mortality, illiteracy, obesity, mental illness, incarceration, homicide, drug use and teenage pregnancy. Life expectancy decreases where inequality rises.

It’s well worth the time to read the article.

In a reverse of what I thought I have clinically seen, a recent prospective study finds that low thyroid functioning is not associated with depression. In fact, they found the opposite to be true: a high thyroid function is associated with depression.

Evidently, I was not alone in thinking that low thyroid levels are associated with depression. The study’s authors write that: “Medical guidelines for clinical practice, produced by the American Association of Clinical Endocrinologists, state that ‘the diagnosis of subclinical or clinical hypothyroidism must be considered in every patient with depression.’”

The study, Thyroid Function and the Natural History of Depression: Findings From the Caerphilly Prospective Study (CaPS) and a Meta-analysis, by Williams, Harris, Dayan, et. al., was published on 05/12/2009 in Clinical Endocrinology. Unfortunately, I cannot give you a link because this comes from a subscription service via Medscape. But you can register for this service here.

Here’s a brief summary.

The authors undertook a

“prospective cohort study of 2269 middle aged men (45–59 years) with thyroid function (total T4 only, TSH unavailable) measured between 1979 and 1983 and with repeat measures of minor psychiatric morbidity (GHQ-30) over a mean of 12·3 years follow-up. We also undertook a systematic review and meta-analysis of population-based studies examining thyroid function and mood.”

Their conclusion is that:

“we find no evidence…that low thyroid function is associated with depression over the life course. In contrast, we provide evidence…that high normal thyroid function (lower TSH and higher T4) is associated with depression.”

In this case at least, anecdotal clinical evidence was turned upside down.

A new study takes a look at the effectiveness of various treatments for teenage depression. Unfortunately, I cannot give you a link to the article as it is on a subscription service. But here’s the citation for the article:
Treatment of adolescent depression: what we have come to know
Benedetto Vitiello, M.D
Depression and Anxiety
Volume 26, Issue 5, 2009.
Pages: 393-395

Three months after starting treatment, fluoxetine (Prozac) brought about a higher response rate than cognitive behavioral therapy (CBT). A response rate is a reduction in some but not all of the symptoms. Whereas the elimination of all symptoms of the depression is called a remission. 61% of the patients studied showed improvement from fluoxetine alone versus 43% of the patients who had CBT by itself. So fluoxetine is clearly better at bringing more adolescents into the response range than CBT or placebo. And fluoxetine is more cost-effective (cheaper than) psychotherapy at the three month point.

But a combination of fluoxetine and CBT was most effective at achieving remission of symptoms at three months (37%). Furthermore, “the combination (of medication and psychotherapy) was also superior to (medication alone or CBT alone) at improving functioning, overall health, and quality of life at the 3-month assessment.”

“(A)t the 9-month assessment, fluoxetine, CBT, and their combination did not differ in response rate (81, 81, and 86%, respectively) or remission rate (55, 64, and 60%, respectively). Thus, it appears that the value of antidepressant medication consists in speeding up the process of improvement and recovery, whereas psychotherapy gradually catches up and, given enough time, it does not seem to make too much difference which treatment modality was used.”

There was “a greater incidence of suicidal events (a category including suicide attempts and suicidal ideation) was found in the fluoxetine condition (14.7%) than on CBT (6.3%).” But there appears to be “a protective role of CBT when used in conjunction with medication” because “the suicidality rate in the combination group” dropped down significantly to 8.4%. And this level of suicidality was not statistically higher than when patients were treated with CBT alone.

In conclusion, the study found that “Although fluoxetine was clearly the most cost-effective treatment modality during the first 3 months…, combined treatment was more cost effective than fluoxetine when the entire 9-month outcomes were taken into account, primarily due to the higher number of suicidality-related hospitalizations in the fluoxetine group.”

NPR had a nice piece on the emotional impact of the economic recession. From resilience to panic to suicide attempts, NPR covers it all.

You can read it here: Economic Crisis, Unemployment Take Emotional Toll.

Or you can listen to it here.