Article Examining Depression

The article mentions standards such as medication and counseling, but perhaps the best way to reduce high depressive rates in the population is to restructure society to make it much better for most people than it is currently.

Clinical depression has surged to epidemic proportions in recent decades, from little-mentioned misery at the margins of society to a phenomenon that is rarely far from the news. It is widespread in classrooms and boardrooms, refugee camps and inner cities, farms and suburbs.

At any one time it is estimated that more than 300 million people have depression – about 4% of the world’s population when the figures were published by the World Health Organization (WHO) in 2015. Women are more likely to be depressed than men.

Depression is the leading global disability, and unipolar (as opposed to bipolar) depression is the 10th leading cause of early death, it calculates. The link between suicide, the second leading cause of death for young people aged 15-29, and depression is clear, and around the world two people kill themselves every minute.

While rates for depression and other common mental health conditions vary considerably, the US is the “most depressed” country in the world, followed closely by Colombia, Ukraine, the Netherlands and France. At the other end of the scale are Japan, Nigeria and China.

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Things have improved since people with mental illness were believed to be possessed by the devil and cast out of their communities, or hanged as witches. But there remains a widespread misunderstanding of the illness, particularly the persistent trope that people with depression should just “buck up”, or “get out more”.

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The WHO estimates that fewer than half of people with depression are receiving treatment. Many more will be getting inadequate help, often focused on medication, with too little investment in talking therapies, which are regarded as a crucial ally.

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There have been positive experiments with both ketamine and psilocybin, the active ingredient in magic mushrooms. Further hopes for a new generation of treatments have been raised by recent discoveries of 44 gene variants that scientists believe raise the risk of depression. Another controversial area of research is treatment for low immunity and mooted links between depression and inflammation.

Countries are increasingly recognising the need to train more psychologists to replace or complement drug treatments.

And perhaps most importantly, there is a cultural movement to make it easier for people to ask for help and speak out about their illness.

Why It Can Be a Very Bad Idea to Call the Police on a Suicidal Person

The police in America have killed mentally ill suicidal people after breaking into their homes, and this latest case where it could have happened to whistleblower Chelsea Manning is another reminder of this. It’s better to try to contact friends or family that care instead.

Shortly after Chelsea Manning posted what appeared to be two suicidal tweets on May 27, police broke into her home with their weapons drawn as if conducting a raid, in what is known as a “wellness” or “welfare check” on a person experiencing a mental health crisis. Manning, a former Army intelligence analyst turned whistleblower and U.S. Senate candidate, was not at home, but video obtained by The Intercept shows officers pointing their guns as they searched her empty apartment.

The footage, captured by a security camera, shows an officer with the Montgomery County Police Department in Bethesda, Maryland, knocking on Manning’s door. When no one responds, the officer pops the lock, and three officers enter the home with their guns drawn, while a fourth points a Taser. The Intercept is publishing this video with Manning’s permission.

“This is what a police state looks like,” Manning said. “Guns drawn during a ‘wellness’ check.”

Welfare checks like this, usually prompted by calls placed to 911 by concerned friends or family, too often end with police harming — or even killing — the person they were dispatched to check on.

Manning was out of the country at the time of the incident, said Janus Cassandra, a close friend who was on the phone with her that night. “If Chelsea had been home when these cops arrived with guns drawn, she would be dead.”

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The problem, mental health experts say, is that police should not be the ones to check on suicidal people in the first place. In 2017, mental illness played a role in a quarter of 987 police killings, according to a tally by the Washington Post. People of color experiencing mental health crises are particularly at risk.

In 2018 alone, police have shot and killed at least 64 people who were suicidal or had other mental health issues, according to the American Civil Liberties Union. “This January, Alejandro Valdez was suicidal and threatening to kill himself. The police shot and killed him,” Susan Mizner, the group’s disability counsel, wrote in a recent post. “In February, Orbel Nazarians was suicidal and threatening himself with a knife. The police shot and killed him. In March, Jihad Merrick was suicidal and pointing a gun at his head. The police shot and killed him. In April, Benjamin Evans was making suicidal comments. Police shot and killed him.”

“There is absolutely no excuse for sending armed police to the home of someone who is having a suicidal episode,” said Cassandra. “As we’ve seen countless times, cops know that no matter what happens, they will be shielded from any accountability whatsoever.”

“It’s not necessary for police to be the first responders when somebody calls 911 and says they’re suicidal,” said Carl Takei, a senior ACLU attorney focusing on policing, in an interview. “In the same way that if I were to call 911 and say I’m having a heart attack, I would expect a medical response. As a society, we should expect a mental health response when somebody calls 911 and says they are suicidal, rather than dispatching somebody who is armed with a pistol and most of whose training is directed at enforcing criminal law and how to use force with people whom they suspect are breaking the law.”

When police do become the first responders in mental health crises, Takei added, the ways in which they handle them vary greatly between departments.

“Some have specially trained crisis intervention teams that are dispatched when there’s a call involving a mental health crisis; some departments provide some level of crisis intervention training to all officers; some departments provide no training at all,” said Takei. “And, of course, if a department provides no training or very little training on how to deal with situations involving a person in a mental health crisis, the officers are going to default to the training they received, which is very much based on a command-and-control culture.”

Link Between Depression and Increased Brain Aging in Older Adults Found

The new research shows another reason to take mental health problems seriously. Suboptimal cognitive function in older adults both decreases general welfare and leads to worse outcomes via less informed decisions in political democracy.

Psychologists at the University of Sussex have found a link between depression and an acceleration of the rate at which the brain ages. Although scientists have previously reported that people with depression or anxiety have an increased risk of dementia in later life, this is the first study that provides comprehensive evidence for the effect of depression on decline in overall cognitive function (also referred to as cognitive state), in a general population.

For the study, published today, Thursday 24 May 2018, in the journal Psychological Medicine, researchers conducted a robust systematic review of 34 longitudinal studies, with the focus on the link between depression or anxiety and decline in cognitive function over time. Evidence from more than 71,000 participants was combined and reviewed. Including people who presented with symptoms of depression as well as those that were diagnosed as clinically depressed, the study looked at the rate of decline of overall cognitive state — encompassing memory loss, executive function (such as decision making) and information processing speed — in older adults.

Importantly, any studies of participants who were diagnosed with dementia at the start of study were excluded from the analysis. This was done in order to assess more broadly the impact of depression on cognitive ageing in the general population. The study found that people with depression experienced a greater decline in cognitive state in older adulthood than those without depression. As there is a long pre-clinical period of several decades before dementia may be diagnosed, the findings are important for early interventions as currently there is no cure for the disease.

Lead authors of the paper, Dr Darya Gaysina and Amber John from the EDGE (Environment, Development, Genetics and Epigenetics in Psychology and Psychiatry) Lab at the University of Sussex, are calling for greater awareness of the importance of supporting mental health to protect brain health in later life.

Dr Gaysina, a Lecturer in Psychology and EDGE Lab Lead, comments: “This study is of great importance — our populations are ageing at a rapid rate and the number of people living with decreasing cognitive abilities and dementia is expected to grow substantially over the next thirty years.

“Our findings should give the government even more reason to take mental health issues seriously and to ensure that health provisions are properly resourced. We need to protect the mental wellbeing of our older adults and to provide robust support services to those experiencing depression and anxiety in order to safeguard brain function in later life.”

44 Genomic Variations Linked to Major Depression in New Research

Genetic variations (variants) are the roughly 0.5% share of DNA that makes individuals unique, as about 99% of human DNA is shared across humans. The word genome represents the entire set of genetic material someone’s made of. With that being said, this research is important because major depressive disorder can be a really crippling affliction, and the more that’s known about it, the more effectively it can be treated or prevented.

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A new meta-analysis of more than 135,000 people with major depression and more than 344,000 controls has identified 44 genomic variants, or loci, that have a statistically significant association with depression.

Of these 44 loci, 30 are newly discovered while 14 had been identified in previous studies. In addition, the study identified 153 significant genes, and found that major depression shared six loci that are also associated with schizophrenia.

Results from the multinational, genome-wide association study were published April 26 in Nature Genetics.

The study was an unprecedented global effort by over 200 scientists who work with the Psychiatric Genomics Consortium. Co-leaders of the study are Patrick F. Sullivan, MD, FRANZCP, Yeargen Distinguished Professor of Psychiatry and Genetics and Director of the Center for Psychiatric Genomics at the University of North Carolina School of Medicine; and Naomi Wray, PhD, Professorial Research Fellow at the University of Queensland in Australia.

“This study is a game-changer,” Sullivan said. “Figuring out the genetic basis of major depression has been really hard. A huge number of researchers across the world collaborated to make this paper, and we now have a deeper look than ever before into the basis of this awful and impairing human malady. With more work, we should be able to develop tools important for treatment and even prevention of major depression.”

“We show that we all carry genetic variants for depression, but those with a higher burden are more susceptible,” Wray said. “We know that many life experiences also contribute to risk of depression, but identifying the genetic factors opens new doors for research into the biological drivers.”

“This pioneering study is incredibly important, for two reasons,” said Josh Gordon, MD, PHD, Director of the U.S. National Institute of Mental Health. Dr. Gordon was not an author on this paper.

“First, it reaffirms the value of large-scale collaborations, particularly in identifying the complex genetics underlying psychiatric illness. Second, it confirms the genetic roots for depression, offering important biological clues that we hope will lead to new and better treatments.”

“Major depression represents one of the world’s most serious public health problems,” said Steven E. Hyman, MD, former director of the U.S. National Institute of Mental Health who is now Director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard. Dr. Hyman was not an author on this paper. “Despite decades of effort there have been, until now, only scant insights into its biological mechanisms. This unfortunate state of affairs has severely impeded treatment development, leaving the many people who suffer from depression with limited options. This landmark study represents a major step toward elucidating the biological underpinnings of depression,” Hyman said.

Other findings of the study include:

  • The results can be used for improved therapies — targets of known antidepressant medications were enriched in the genetic findings
  • The genetic basis of depression overlaps importantly with other psychiatric disorders like bipolar disorder and schizophrenia
  • Intriguingly, the genetic basis of depressive disorder also overlaps with that for obesity and multiple measures of sleep quality, including daytime sleepiness, insomnia and tiredness

Ketamine Nasal Spray Shows Effectiveness at Treating Major Depression and Suicidal Thoughts

There’s definitely something to be said about ketamine’s apparent effectiveness at immediately making many suicidal people no longer want to end their lives. The importance of caution in using it should be noted though.

A nasal spray formulation of ketamine shows promise in the rapid treatment of symptoms of major depression and suicidal thoughts, according to a new study published online today in The American Journal of Psychiatry (AJP).

The double-blind study compared the standard treatment plus an intranasal formulation of esketamine, part of the ketamine molecule, to standard treatment plus a placebo for rapid treatment of symptoms of major depression, including suicidality, among individuals at imminent suicide risk. The study involved 68 participants randomly assigned to one of two groups — either receiving esketamine or placebo twice a week for four weeks. All participants continued to receive treatment with antidepressants throughout. The researchers looked at effects at four hours after first treatment, at 24 hours and at 25 days.

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The results of the study support nasal spray esketamine as a possible effective rapid treatment for depressive symptoms in patients assessed to be at imminent risk for suicide, according to the authors. Esketamine could be an important treatment to bridge the gap that exists because of the delayed effect of most common antidepressants. Most antidepressants take four to six weeks to become fully effective.

This study was a proof-of-concept, phase 2, study for esketamine; it must still go through a phase 3 study before possible FDA approval. It was funded by Janssen Research and Development, LLC.

The authors caution that more research is needed on the potential for abuse of ketamine. That caution is also the focus of an accompanying AJP editorial also published online today. In the editorial, AJP Editor Robert Freedman, M.D., along with members of the AJP Editorial Board, note the known potential for abuse and existing reports of abuse of prescribed ketamine. They discuss the need for additional research relating to the abuse potential of ketamine during phase 3 trials, such as monitoring of patients’ craving and potential ketamine use from other sources.

While it is the responsibility of physicians to provide a suicidal patient with the fullest range of effective interventions, the AJP Editor’s note, “protection of the public’s health is part of our responsibility as well, and as physicians, we are responsible for preventing new drug epidemics.” The Editors suggest the need for broad input in the development of effective controls on the distribution and use of ketamine.

Raw Fruits and Vegetables May Provide Better Mental Health Outcomes

Mental health problems are a really significant undercurrent issue in countries across the world today, and so even more minor studies like this can be helpful at addressing them.

Seeking the feel good factor? Go natural.

That is the simple message from University of Otago researchers who have discovered raw fruit and vegetables may be better for your mental health than cooked, canned and processed fruit and vegetables.

Dr Tamlin Conner, Psychology Senior Lecturer and lead author, says public health campaigns have historically focused on aspects of quantity for the consumption of fruit and vegetables (such as 5+ a day).

However, the study, just published in Frontiers in Psychology, found that for mental health in particular, it may also be important to consider the way in which produce was prepared and consumed.

“Our research has highlighted that the consumption of fruit and vegetables in their ‘unmodified’ state is more strongly associated with better mental health compared to cooked/canned/processed fruit and vegetables,” she says.

Dr Conner believes this could be because the cooking and processing of fruit and vegetables has the potential to diminish nutrient levels.

“This likely limits the delivery of nutrients that are essential for optimal emotional functioning.”

For the study, more than 400 young adults from New Zealand and the United States aged 18 to 25 were surveyed. This age group was chosen as young adults typically have the lowest fruit and vegetable consumption of all age groups and are at high risk for mental health disorders.

The group’s typical consumption of raw versus cooked and processed fruits and vegetables were assessed, alongside their negative and positive mental health, and lifestyle and demographic variables that could affect the association between fruit and vegetable intake and mental health (such as exercise, sleep, unhealthy diet, chronic health conditions, socioeconomic status, ethnicity, and gender).

“Controlling for the covariates, raw fruit and vegetable consumption predicted lower levels of mental illness symptomology, such as depression, and improved levels of psychological wellbeing including positive mood, life satisfaction and flourishing. These mental health benefits were significantly reduced for cooked, canned, and processed fruits and vegetables.

“This research is increasingly vital as lifestyle approaches such as dietary change may provide an accessible, safe, and adjuvant approach to improving mental health,” Dr Conner says.

* The top 10 raw foods related to better mental health were: carrots, bananas, apples, dark leafy greens such as spinach, grapefruit, lettuce, citrus fruits, fresh berries, cucumber, and kiwifruit.

U.S. Military Announces Development of Drones That Decide to Kill Using AI

Drone warfare (with its state terrorism causing numerous civilian casualties) is already horrifying enough — this AI drone development would likely be even worse. This announcement also raises the question of how much accountability those who write the algorithms that determine how the drone functions will face.

The US Army recently announced that it is developing the first drones that can spot and target vehicles and people using artificial intelligence (AI).

Whereas current military drones are still controlled by people, this new technology will decide who to kill with almost no human involvement.

Once complete, these drones will represent the ultimate militarisation of AI and trigger vast legal and ethical implications for wider society.

There is a chance that warfare will move from fighting to extermination, losing any semblance of humanity in the process.

At the same time, it could widen the sphere of warfare so that the companies, engineers and scientists building AI become valid military targets.

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Even with these drone killings, human emotions, judgements and ethics have always remained at the centre of war.

The existence of mental trauma and post-traumatic stress disorder (PTSD) among drone operators shows the psychological impact of remote killing.

And this actually points to one possible military and ethical argument by Ronald Arkin, in support of autonomous killing drones. Perhaps if these drones drop the bombs, psychological problems among crew members can be avoided.

The weakness in this argument is that you don’t have to be responsible for killing to be traumatised by it.

Intelligence specialists and other military personnel regularly analyse graphic footage from drone strikes. Research shows that it is possible to suffer psychological harm by frequently viewing images of extreme violence.

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The prospect of totally autonomous drones would radically alter the complex processes and decisions behind military killings.

But legal and ethical responsibility does not somehow just disappear if you remove human oversight. Instead, responsibility will increasingly fall on other people, including artificial intelligence scientists.

The legal implications of these developments are already becoming evident.

Under current international humanitarian law, “dual-use” facilities – those which develop products for both civilian and military application – can be attacked in the right circumstances. For example, in the 1999 Kosovo War, the Pancevo oil refinery was attacked because it could fuel Yugoslav tanks as well as fuel civilian cars.

With an autonomous drone weapon system, certain lines of computer code would almost certainly be classed as dual-use.

Companies like Google, its employees or its systems, could become liable to attack from an enemy state.

For example, if Google’s Project Maven image recognition AI software is incorporated into an American military autonomous drone, Google could find itself implicated in the drone “killing” business, as might every other civilian contributor to such lethal autonomous systems.

Ethically, there are even darker issues still.

The whole point of the self-learning algorithms – programs that independently learn from whatever data they can collect – that technology uses is that they become better at whatever task they are given.

If a lethal autonomous drone is to get better at its job through self-learning, someone will need to decide on an acceptable stage of development – how much it still has to learn – at which it can be deployed.

In militarised machine learning, that means political, military and industry leaders will have to specify how many civilian deaths will count as acceptable as the technology is refined.

Recent experiences of autonomous AI in society should serve as a warning.