Depression How Should We View Ourselves

There are many different ways of looking at ourselves, but which way is correct?

We can view ourselves through society’s standards and expectations, which are commonly revealed through the mass media including film, television, radio, magazines, and the internet, as well as through schools, the home, and social settings.

Unfortunately, society says that our worth depends upon our intelligence, attractiveness, education, money and achievements. Our society places too much value upon being successful, and often rejects or criticises people who attempt something but fail. Such people may become so disillusioned that they stop trying.

Society also teaches the theory of evolution, telling us that humans have evolved from animals as a result of random chance, and are therefore have no significance.

We can also view ourselves through our parents’ eyes. As a person’s self-esteem is formed during the early years of their childhood, it is important that parents encourage and build-up their children so that they develop a positive self image. Sadly, this is often not the case, as some parents criticise, shame, reject or over discipline their children. Such unnecessary criticisms and negativity gives the children a negative view of themselves. Upon reaching adulthood, such children often view themselves through their parent’s eyes, and even continue to treat themselves as their parents treated them, criticising, rejecting, even hating themselves.

Many parents also place unrealistic or impossible standards or goals before their children. They expect their children to be successful or famous. If the child fails, or is not interested, the parents say that they are hopeless, or punish them harshly.

The way that our friends and peers view us can also have a large influence on the way we view ourselves.

If we do not behave like them, they can be critical or reject us. Throughout my years at school, I watched some classmates bully and mock any child who was different. Some children tried to change so that the bullies would accept them, even doing what was wrong in order to please them. Other children suffered beneath the yoke of such oppression every day.

Another way to view ourselves is through our own eyes. This is not healthy either. If we have had a difficult childhood, we tend to carry that baggage into adulthood, falling into the trap of being too hard on ourselves, especially if we have made a mistake. And if we stumble and sin, even though we repent and receive God’s forgiveness, waves of guilt and condemnation continue to plague us long after the event. Pursuing unattainable goals and setting unrealistic expectations causes us to become even further disillusioned with ourselves. If we fail when attempting something too hard, we may conclude that we are a failure, no good at anything, or that no-one likes us.

So then, how should we look at ourselves?

We should view ourselves through the eyes of the One who loves us so much that He died for us, so that we may live with Him, both now and for eternity.

Hebrews 12:2 says Let us fix our eyes on Jesus, the author and perfector of our faith, who for the joy set before him endured the cross, scorning its shame, and sat down at the right hand of the throne of God. What was that joy set before Jesus that motivated Him to die for us? The answer is in 1 Thessalonians 5:10 He died for us so that, whether we are awake (on earth) or asleep (in heaven), we may live together with him. Jesus treasures us so greatly that He wants us to share our whole life with Him.

God did not wait for us to be perfect before He loved us. While we were still sinners, He reached out to us, drawing us, dirt and all, into His loving arms. That means that we are significant, that we are special. But God demonstrates his own love for us in this: While we were still sinners, Christ died for us. Romans 5:8

God forms His children, those who believe in Jesus, into new creations, conformed into Christ’s wonderful likeness. Therefore, if anyone is in Christ, he is a new creation; the old has gone, the new has come! 2 Corinthians 5:17

God thinks of us as His treasure. Keep me as the apple of your eye; hide me in the shadow of your wings. Psalm 17:8

2 Corinthians 5:21 tells us that, God made Jesus, who had no sin to be sin for us, so that in Jesus we might become the righteousness of God. So if God looks at us and sees the righteousness of Jesus in us instead of our sinful nature and problems, we should look at ourselves in the same way.

Zephaniah 3:17 is one of my favourite verses in the Bible, because it shows so clearly how God thinks of His children. The LORD your God is with you, he is mighty to save. He will take great delight in you, he will quiet you with his love, he will rejoice over you with singing."

Instead of looking at ourselves through the eyes of society, parents, friends, or ourselves, let us look at ourselves through the eyes of Jesus. Then we will know that we are accepted, appreciated, treasured, and loved.

This was a lesson that the Lord re-taught me while stuck in the pit of severe depression:

From my diary, 15/5/1990 –
Self-hate keeps descending upon me like a swarm of angry hornets.
I look at myself and find nothing but contempt
for this pathetic person that I have become.
But I know that this is wrong.
If I examine myself through Jesus eyes, I see someone special.
I see how much He loves me, and cares for me,
how much I mean to Him, and that He understands.

Nairobi Parenting Clinic Stress depression and the holidays Coping Tips

Nairobi Parenting Clinic: Stress, depression and the holidays: Coping Tips: Stress and depression can ruin your holidays and hurt your health. Being realistic, planning ahead and seeking support can help ward of...

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Treatment Resistant Depression and Borderline Personality Disorder

On October 18, 2013, John Gunderson, perhaps the most internationally recognized expert on borderline personality disorder (BPD), wrote a piece in the American Psychiatric Association’s newspaper, Psychiatric News. He opined that many if not the majority of cases of treatment resistant depression (TRD - depression that does not respond to antidepressant drugs) may in fact be undiagnosed cases of patients with BPD.  This opinion is totally consistent with my own clinical experience.

John Gunderson, M.D.

Of course, the psychiatric-industrial-Pharma complex immediately went on the offensive. On his Medscapeblog, Nassir Ghaemi - a fan of  bipolar m.a. - wrote a two part rebuttal. He expressed the opinion, asserted and not backed by any particular review of the literature, that the DSM criteria for BPD are invalid. In the past, he has also expressed the belief that the DSM duration criteria for manic and hypomanic episodes in bipolar disorder are far too restrictive, and seems to liberally substitute his own personal criteria for these disorders in his arguments

He goes on to assert that the “…bland, broad DSM definition allows Dr Gunderson and other borderline experts to diagnose the condition in a large chunk of persons with mood illness, not just bipolar illness but also simple depression, since depression entails relationship problems, is often associated with irritability and paranoia, frequently involves mood reactivity, often involves suicidal attempts, and can also entail nihilistic thoughts of feeling abandoned or empty.”

Nassir Ghaemi, M.D.

As I shall discuss a little later, these symptoms, when all taken together as a group, are not typical for your average run-of-the-mill case of Major Depressive Disorder (MDD), but are extremely typical of depression in BPD.

Dr. Ghaemi's statement here is misleading, because, while any given patient with major depression and no BPD may indeed have any one or two of these characteristics, they usually do not have almost all of them together. Omitting mention of this pertinent fact is a tactic frequently employed in arguments from the everyone-who-is-moody-is-bipolar crowd.

As a reference for his assertion, Ghaemi cites a study by Angst, who is another bipolar disease monger whose circular pseudo-logic I dissected in a previous post.  

Ghaemi then goes on to focus on one of Gunderson’s statements in his article: Gunderson cited a study that showed that the presence of BPD was a major predictor of persistence of depression over time in a sample of persons who met MDD criteria.

I agree with Dr. Ghaemi that such a study does not prove, in isolation and by itself, that BPD is the most common cause of TRD, as there could very well be very many other even more common causes.

His impeccable logic: “It does not follow that if x makes y worse, then most cases of treatment resistant y are examples of x. Substance abuse makes the course of MDD worse; but it does not follow - it is scientifically incorrect and illogical - to then conclude that most cases of TRD are cases of substance abuse, end of story."

Of course, the fact that Gunderson cited this one particular study did not mean that he thought he was providing a complete literature review, but Ghaemi seems to be implying that Gunderson is saying that this one study is the onlyevidence he is relying upon - which he didn’t say. There are a host of studies, btw, that show that severe personality disorders are often predictive of a poor response to all sorts of psychiatric medications for all sorts of psychiatric disorders.

Ghaemi himself, on the basis of some highly questionable studies, opines that the most common cause of TRD is “unrecognized bipolarity.” He of course cites references produced by his fellow bipolar m.a. disease mongers in Hagop Akiskal’s incredibly biased Journal of Affective Disorders.

Their logic has always been a one or another version of the following:

Treatment resistant depression is often accompanied by symptoms such as racing thoughts or  hyperactivity

Racing thoughts, hyperactivity, and other such symptoms can look vaguely similar to symptoms of mania

Therefore, such patients must be bipolar

This is every bit as invalid as the logic that Ghaemi is attributing to Gunderson. In fact, anxiety disorders can and do produce, superficially, all of the symptoms that Ghaemi and his buddies attribute to an underlying “bipolarity.” When looked with a more discerning eye, of course, the symptoms of anxiety disorders and mania look very, very different.

A certain type of anxiety mixed with depression, is, as I shall discuss in a bit, one of the major qualitative factors that distinguish depression in BPD from other types of depression. I think the articles that Ghaemi is quoting are not only consistent with what Gunderson is arguing, but could have been used by him as clear evidence for his main thesis!

I have met Professor Gunderson. I think he is more than capable of telling the difference between BPD and bipolar disorder. 

It’s not subtle.

Dr. Ghaemi shows such limited understanding of BPD that I suspect that, in all likelihood, he has never or rarely sat down with such patients in long-term psychotherapy and painstakingly dissected the environmental and interpersonal context in which their depressive symptoms come and go.

Another person who, like myself, has done this with patients is my colleague, academic psychiatrist Ken Silk. He did a far more complete literature search [“The Quality of Depression in BPD and the Diagnostic Process.” Silk, K. Journal of Personality Disorders 24 (1), 2/2010] than was presented in the discussions by either Dr. Ghaemi or Dr. Gunderson.

Kenneth Silk, M.D.

He points out that, rather than restricting the diagnosis of MDD to those who clearly display a biologic depression - the cases that used to respond to tricyclic antidepressants back when they were the dominant drugs - the diagnosis has spread along with the assumption that most presentations of depression are some form of major depression and, even if not MDD, should respond to antidepressants. The term depression is now used in academic discussions to refer to a mood rather than an actual diagnostic construct.

He lists the qualitative difference between the symptoms of MDD and those of depressed BPD’s. Besides the fact that the BPD patients meet criteria for BPD, not to mention that they also exhibit the family dynamics typical of those with the disorder, the quality of their depression is characterized by the following [My comments in italics]:

1.      A“mad-bad” depression closely tied to anger and hostile behavior.

2.      Mood symptoms that are very sensitive to interpersonal situations in which the patient feels abandoned, lonely, or empty in the absense [or in the presence for that matter] of a longed-for important other.

3.      Depressed moods can come on quickly and disappear quickly [the opposite of true MDD] depending on the reactions of an attachment figure.

 

4.      The depression is at times more closely related to chronic self-criticism and a feeling of intrinsic “badness” than in MDD without BPD.

 

5.      It is associated with chronic self destructive behavior [including self-injurious behavior like cutting].

 

6.      It is associated with a loss of gratification and frustration.

 

7.      Recovery from BPD facilitates recovery from MDD when it is co-occurring, rather than the other way around.

 

8.      The depression often comes from exhaustion and demoralization from repeated unsuccessful battles with chronic and overwhelming anxiety. [BPD often is accompanied by panic disorder].

9.      Patients with BPD often exhibit impulsive aggression (a hair trigger leading to rage). [Patients with true major depression, especially of the melancholic variety, tend not to show this characteristic at all. They are usually extremely passive because they do not have the energy to strike out].

Important questions glossed over by Dr. Ghaemi include: in what contextdo symptoms appear? How attached is the low mood to specific interpersonal events? Is affective dysregulation (high reactivity to interpersonal problems) prominent? 

An important additional point is that these qualitative differences in depression  that Dr. Silk lists are not measured clearly by any of the standard symptom rating scales used in the vast majority of psychiatric studies. Therefore, citing any studies which employ these instruments in this debate is sort of irrelevant to the basic question. 

A few final caveats.  People with BPD can still have depression that does respond to an antidepressant. And even when the depression in BPD does not improve with SSRI antidepressants directly, other symptoms such as panic attacks can improve dramatically with these drugs (especially if the SSRI is combined with certain benzodiazepines).  SSRI’s can also decrease reactivity by raising the bar, so to speak, so that it takes somewhat more extreme behavior by an attachment figure to create a severe emotional reaction. 

In patients in which either or both of these two things happen, their depression may improve indirectly because of the effects of the drug on the other symptoms, as opposed to in MDD, in which the decrease in low mood is a direct effect of the drugs.

Finally, patients can also have both BPD and true bipolar disorder. In fact, patients with bipolar disorder, when not in the midst of a manic or a depressive episode (when they are euthymic), can have just about any psychological or psychiatric reaction or personality issue in addition to bipolar disorder.  That is because, when they are euthymic, they are basically just like anyone else! 

Writers in the Journal of Affective Disorders just love to merely assume that any emotional reaction a patient with bipolar disorder has simply must be due to the underlying bipolar disorder.  What hogwash.

How Do You Know if You Should Try Treating Your Depression With Medication

I have frequently blogged in this venue about the efficacy of antidepressants in “depression.”  I have pointed out that “depression” has a wide variety of different meanings, and that there are also several different syndromes of depressive disorders in the diagnostic manual, the DSM.  While there is considerable overlap in the symptoms of the various syndromes, some are far more likely to respond, and respond dramatically, to antidepressant medication than others.

I have also ranted against physicians who use “symptom checklists” or other self-report “tests” to make a diagnosis of depression, rather than use an extensive clinical interview.  The tests often say very little about whether a symptom a patient complains of is clinically significant for a certain diagnostic syndrome or not.  Aside from not looking at the psychosocial context in which the symptom occurs, the tests usually say very little about three important qualities of clinically significant symptoms – their pervasiveness, persistence, and whether or not they are pathological.  They also do not clearly show whether the symptoms all cluster together at the same times.

As I have pointed out several times, in order to make sure the patient is giving the doc an accurate and complete picture of their mood state, a good doctor must often ask one or even several follow up questions whenever a patient says “yes” or “no” in answer to a question about the presence of a symptom.

But how about a potential patient?  How does a non-professional know whether or not to even consult a physician about their mood state?  Why not just ignore it and see if it goes away?  Alternately, why not just go to a psychotherapist and handle it with psychotherapy alone?

That’s a very important question.  A similar question has recently been widely featured in the media in response to a proposed change in the DSM.  How does a patient or a doctor know when normal grief after the death of a loved one morphs into a clinical depression that would respond to medication?  The argument has mostly been about how long a doctor should wait after such a death before making a diagnosis of clinical depression, (major depressive disorder). 

While it is good that a doctor should not be overly hasty about making a diagnosis in this situation, in some genetically-prone individual, a stress of that severity can indeed trigger a major depressive disorder in a relatively short period of time.  Should that patient have to wait to be relieved of his or her suffering?  Certainly, any proposed “waiting period” specified in the DSM would have to be somewhat arbitrary.

To help patients figure out who to consult and when to consult a physician, a new self-report instrument is available that is significantly superior to the usual ones.  It is called the Post-Bereavement Phenomenology Inventory. It is meant to distinguish normal grief from major depression, but potentially it could also be used to distinguish major depression (likely to respond to meds) from another depressive syndrome, dysthymia (much less likely to respond to meds).

It was meant for physicians and not for patients to review for themselves, but even though it is better than most self-report instruments, IMO it should still not be used in place of a complete and wide-ranging clinical interview.  Context, prior history of major depressive disorders, family history of depression, and a whole host of factors need to also be considered.

But as a screening tool for patients, I think it might be helpful.  It uses a strategy called prototype matching.  This strategy focuses on the difference between depressive syndromes rather than the similarities.  The questions contain different descriptions of how each depressive symptom would present itself in classic cases of the two syndromes, and asks the patient, “[Which of the two descriptions] better describes how you have been feeling, thinking, or behaving for the past one to two months?”

Here it is.  I hope this will help potential patients decide whom to consult.  The first descriptions in each question are of the symptom presentation seen in major depression, while the second are of depressive symptoms that are less likely to respond to medication.  Of course, this is hardly foolproof, but generally the more you answer the questions one way or the other, the more likely you are to be experiencing one syndrome or the other. 


If someone's depression seems to conform mostly to the first prototype rather than the second, there are certain things that people often say to them that are both inappropriate and counterproductive.  An excellent list of such things can be found at http://www.medicalbillingandcoding.org/blog/11-things-you-should-never-say-to-someone-with-depression/

1.       I am filled with despair nearly all the time, and I almost always feel hopeless about the future.

versus

      I feel sadness a lot of the time, but I believe that eventually, things will get better.

2.      My sadness or depressed mood is near­ly constant, and it isn't improved by any positive events, activities, or people.

versus

       My sadness or depressed mood usually comes in "waves" or "pangs;' and there are events, activities, or people who help me feel better.

3.      When I am reminded of my loss (of a loved one, friend, job, etc), I feel nothing but pain, bitterness, or bad memories.

versus

    

       When I am reminded of my loss (of a loved one, friend, job, etc), I often feel intense grief or have painful memories, but sometimes I have good thoughts and pleasant memories. 

4.      I will probably never get back to feeling like my "old self" again.

versus

       Things are really tough now, but I'm hopeful that with time I will feel more like my "old self.”

5.      I feel like a worthless person who has done mostly bad things in life, and has let my friends, family, and loved ones down.

versus

       I feel like I'm basically a good person and that, in general, I have done my best for my friends, family, and loved ones.

6.      All I can think about lately is me and how miserable I feel; I hardly think about friends, family, or loved ones, ex­cept to blame myself for some failing.

  versus

       Even though I'm less social and out­going since my loss, I still think a lot about friends, family, and loved ones, often with good feelings about them.

7.      When friends or family call or visit and try to cheer me up, I don't feel anything or I may feel even worse.

   versus

       When friends or family call or visit and try to cheer me up, I usually "perk up" for a while and enjoy the social contact.

8.     I often have persistent thoughts or im­pulses about ending my life, and I often think I'd be better off dead.

     versus

     I sometimes feel like a part of me has been lost and I wish I could be reunited with the person or part of my life I am missing, but I still think life is worth living.

9.      Almost nothing that I used to like do­ing (reading, listening to music, sports, hobbies, etc) is of any comfort or con­solation to me anymore.

     versus

   The things that I have always liked do­ing (reading, listening to music, sports, hobbies,etc)  give me some comfort and consolation, at least temporarily.

10.  I feel "slowed down" inside, like my body and mind are stuck or frozen, and like time itself is standing still.

   versus

       My concentration isn't as good as usu­al, but my body and mind aren't slowed down, and time passes in the usual way.

   

     

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Do we have to Fully Recover from Depression Before we Can Get Back out There

Depression is a debilitating illness, and it is normal for someone suffering from depression to withdraw from life, doing little more than hiding and waiting. This is especially true during depression’s darkest phase.

This is what I wrote while in that phase:

What is this storm that rages within me?
Why won’t it abate, why won’t it subside?
It comes in like a storm, and devours me.
And it won’t go away. It’s near four months now.
Four months of doing nothing, just hiding, hiding, and waiting.

In my previous post I spoke about the foundation for my recovery that had been laid during those dark months. This included going onto anti-depressant medication to dull the pain, counselling from a Christian counsellor to help me to face and find the correct perspectives regarding the deep fears and traumas in my life. Many other things also played their role, such as physical exercise, pursuing hobbies and interests, and so on.

In July ’90, after eight months of despair and hopeless, I read “Self Help for Your Nerves” by Dr Claire Weeks. Everything changed after that, as hope returned to my life, I finally understood what was wrong with me, how I had gotten into such a state, and had a strategy for recovery.

In October ‘90 I went to see my counsellor again. Since reading “Self Help for Your Nerves” three months earlier, many of depression’s symptoms had gone, while most if not all others had reduced in severity and duration.

I was not better, though, not by a long shot – that would take another four years. At this stage I still felt uncomfortable or slightly disturbed most of the time, I was still suffering from fatigue to the extent that I needed a 45 minute rest every day when I got home from work, I still struggled with anxiety, had occasional panic attacks and heart palpitations, and felt pretty gross when I woke in the mornings.

However, in seeing how much I had improved compared to what I had been like earlier in the year, and noticing that a spring had returned to my step, my counsellor told me that her impression of me was that I was hiding behind Jesus like a small child hides behind his father’s legs, watching the world but too cautious or scared to get out there and experience it.

She told me that although I was still suffering from plenty of depression’s symptoms, she said that I was better enough to stop getting counselling and to get back out there.

Had she said this earlier, I would have been terrified, but as she gave me this advice, I knew she was right. I felt the Lord confirming that it was time for me to stop hiding and waiting and get back into life.

It took four more years for me to recover from depression, but I spent those four years living an almost normal life. I accepted the remaining symptoms of depression as being part of my life, and was content to let them be there like background music to my day, and got on with living.

After that final meeting with my counsellor I joined a new home fellowship group and became the group’s pianist. I joined all the social activities this group ran such as jazz and badminton nights – all things I could not have done even a few months previously. A few months later I started teaching Sunday school again. I asked if I could be a helper, but the organiser laughed (he had more confidence in me than I did) and put me in charge of an entire class, a responsibility I was able to handle with ease.

Everyone recovers from depression at their own rate, there is no formula. But it is encouraging to know that we do not have to wait until we have completely recovered before we can get back out there and enjoy life again.

And the good news is that we do not have to do this by our own strength. Jesus is there, ready to help and empower us with His divine strength.

I can do everything through him who gives me strength. Philippians 4:13

I love the way the Amplified Bible says this:

I have strength for all things in Christ Who empowers me [I am ready for anything and equal to anything through Him Who infuses inner strength into me; I am self-sufficient in Christ's sufficiency]. Philippians 4:13 (AMP)

“Remain in me, and I will remain in you. No branch can bear fruit by itself; it must remain in the vine. Neither can you bear fruit unless you remain in me. I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing.” John 15:4-5

But he [Jesus] said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong. 2 Corinthians 12:9-10

Facebook Depression Major Threat to Teens or False Alarm

A few weeks ago, a sometimes-visitor to this blog, Cara,  emailed me a link to a news article about this report from the American Academy of Pediatrics on teens and social media. Although it's actually a pretty balanced report, it does include one paragraph on what it calls "Facebook Depression". You can find that report here, but the paragraph in question is below:

Researchers have proposed a new phenomenon called “Facebook depression,” defined as depression that develops when preteens and teens spend a great deal of time on social media sites, such as Facebook, and then begin to exhibit classic symptoms of depression. Acceptance by and contact with peers is an important element of adolescent life. The intensity of the online world is thought to be a factor that may trigger depression in some adolescents. As with offline depression, preadolescents and adolescents who suffer from Facebook depression are at risk for social isolation and sometimes turn to risky Internet sites and blogs for “help” that may promote substance abuse, unsafe sexual practices, or aggressive or self-destructive behaviors.

If you read this paragraph carefully, it clearly implies that spending "a great deal of time" using social media causes depression in some teens. Specifically, the "intensity of the online world" may "trigger" the problem.




Whoa. That's serious. I mean, at least three-quarters of teens use some type of social media. And we know that depression is a serious problem (I've blogged about it here and here).  So to say that use of social media can cause depression? Yipes! And remember, the people making this claim are not from Joe Blow's Emporium of Discount Docs, they are the AMERICAN ACADEMY OF PEDIATRICS. Double yipes!

But then some folks took a closer look at the articles cited in that report that supposedly supported this conclusion. Turns out four of the six of them were third party news reports, not original research studies. And neither of the two actual peer-reviewed studies they cited used the term "Facebook depression" or established that use of social media can cause depression. Actually, the studies they cite show it's a lot more complicated than that--for example, only teens with "low quality friendships" show this tendency toward depression with increased social media use. Teens with solid, high quality friendships aren't affected.

You can read an in-depth critique of the "Facebook depression" part of that AAP report at PsychCentral. One of the major criticisms is the basic confusion between correlation and causation. Two things can be related, but that doesn't mean one causes the other. Because of the prevalence of depression in teens, it's likely that many depressed teens use social media. But isn't it possible that depressed teens intensify their use of some social media as escape from the in-person world? Or to cope with the fact that they don't have great offline friendships? In those cases, depression or a predisposition to it would actually be causing increased use of social media in some kids, not the other way around.

The other major criticism was that this report didn't bother to cite conflicting evidence. It reads like ALL researchers have come to this conclusion. But there are several studies that show that use of social media actually has some positive outcomes for teens, including increased access to social support.

Now--if you're interested in this, I do suggest you read the entire report. In my opinion, most of it is pretty well-balanced and raises some pretty good points about teens and social media.

But the take-away message here: be careful, folks. When you see a report like this blared throughout the media, don't take it at face value. If it impacts you, do a little digging. You may be surprised to find there's no scientific consensus, or someone is grossly oversimplifying a nuanced issue, or perhaps the media has just latched on to something sexy and is making more of it than is warranted. All of those seem to be in play here.

Did you hear about this "new condition"? If so, what did you make of it? Is it believable that use of social media could trigger depression in a teenager (apart from cyberbullying, that is)? How about the other way around? Could it help an isolated teen reach out?

And if any of you ever have questions regarding the interpretation of psychological reports in the media or from one of those major professional groups (especially if it relates to children or adolescents), you can always do what Cara did and shoot it my way! I'd be happy to take a look.

This week, for the Sisterhood of the Traveling Blog, Lydia answers the question, "Does each story you write have an overarching theme, and if so, do you think of it ahead of time or discover it after?" And just in case you missed it, here's Laura's post from last week.

Can a 700 year old Chinese medicine help treat depression and anxiety

According to this, yes, it can. A recent study cited here points to the efficacy of Kami-shoyo-san in treating depression in rats. And another study (.pdf) linked to here claims this drug and another traditional Chinese medicine, Hange-koboku-to, can help treat panic, anticipatory anxiety, and agoraphobia. According to the first link:

Kami-shoyo-san consists of 10 medicinal herbs, including chai hu (柴胡, Radix Bulpleuri), bai shao (白芍, Radix Paeoniae), dang gui (當歸, Radix Angelicae Sinensis), and gan cao (甘草, Radix Glycyrrhizae), bo he (薄荷, Mentha haplocalyx), fu ling (茯苓, Poria cocos), mou dan pi (牡丹皮, Paeonia suffruticosa), 槴子 (Gardenia jasminoides), and ginger (Zingiber officinale). In Taiwan, its concentrated form was the most popular herbal drug for depression and anxiety and alike disorders. It is also a popular herbal drug to treat insomnia in Japan.

The formula first appeared in Song Dynasty (between 960 and 1279 AD.) in a TCM classic He Ji Ju (太平惠民和劑局). It was said to relieve muscular pain, dizziness, uneasiness, hot flashes, extreme sweating, insomnia, decreasing appetite and abnormal menstrual symptoms. In modern times, it has been used to treat many neuropsychiatric disorders, as well as liver diseases.

Literature shows that the formula has been shown to relieve panic attacks, anticipatory anxiety and agoraphobia. It has been used to treat irregularity of menstruation and anxiety involved with a menstrual cycle.

When used as an adjunct to carbamazepine (carbamazepine is an anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy and bipolar disorder. It is also used to treat schizophrenia and trigeminal neuralgia) in patients with bipolar disorders, the Kamo-shoyo-san combo treatment resulted in significantly greater clinical response rate in depressed patients. Kamo-shoy-san has proved to provide additive beneficial effects in bipolar patients, particularly for those in the depressive phase.

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