Albert writes about self esteem and three stages of cultivating compassion towards yourself. When you consider the concept that “depression is anger turned inward”, cultivating compassion becomes a critical component of healing the self. For Albert,

“When I found out I was a Highly Sensitive Person – reading the psychological research on the character and biological trait – I cannot describe how healing it was to my self-esteem. Understanding and realising there was nothing wrong with me – it was just a character trait, one the world had shunned.”

I’m also a sensitive person, although I’ve found that with practice, I’ve developed some protective callouses around my sensitive muscle. I’m now better at letting other people’s emotional baggage bounce off me instead of internalizing it. On the other hand, I can get highly stressed and high-strung, and that’s something I’ve learned to accept and work with instead of trying to “fix”.

Andrew writes about shortcut to happiness and two ways to find and maintain happiness: choosing happiness and maintaining happiness as an ongoing process. I was just speaking with a colleague today about a lecture I’ll be delivering in April on figuring out what we want to do with our lives. My colleague said that it’s important to do what makes us happy, and I agreed with the caveat that many of us haven’t figured out what “happy” means for us personally. If you don’t define “happiness” for yourself, you may not recognize it even if you tripped over it. Andrew writes:

Remember there are no shortcuts to happiness. You have to take some alone time and start writing what it is in your life right now that makes you unhappy. Make a big list, and then prioritize all the issues you come up with.

(Let me throw a wrench in this one: if the law of attraction asserts that what we focus on, expands, then would making a big “unhappy” list keep these unhappy things in our consciousness, even if it is meant to help us rid of these unhappy things?)

Rena believes that she is a poster child for Prozac, after being put on medication and light therapy following a failed suicide attempt:

So, to make a long blog post short, I used affirmations, Prozac and the love of a good dog and great family to dump the abusive guy, go back to America and start my own freelance writing business. I look forward to getting out of bed now.

What I found interesting was that in the same blog, by a different author, was a short article on “treating depression with minimum medication” and focusing on managing the environment stressors in the person’s life.

Walter is “a PhD-trained biochemist working in genomics and cancer biology who’s interested in understanding the molecular and cellular mechanisms that control health and disease.” He sent an interesting article on the genetics of panic disorder by citing studies looking at the blood cells of people with- and without panic disorder. Walter’s article is written at a level that not everyone may understand, even though most of the concepts on there should have been covered in high school biology - for example, “phenotype, lymphocyte, gene expression, functional cluster analysis”. (I read somewhere that we should be writing at an 8th grade level.)

It’s also important to note that the study cited uses a very small sample size - less than 20 patients in each study group (or “study arm” as clinical trial researchers call them). This was not listed among the problematic factors of a study looking at genes that may be different in people who experience panic disorder, but I think the small sample size is a big problem especially when the study was then used to create a predictive test. The potential consequence is causing people to panic about possibly having a panic disorder and maybe even receiving unnecessary or inappropriate treatment for their (mis)-diagnosis.

Thank you for submitting your best blog articles and personal stories on depression, bipolar disorder, and mental health to my blog carnival. Due to the large number of submissions, I am unable to include all submissions for this edition, but personally visit and read each entry.

Until next time!
Jane

Acomplia (rimonabant, manufactured by Sanofi-Aventis) is an anti-obesity drug that was supposed to be a big hit in the U.S. However, earlier this year, U.S. FDA decided not to approve the drug here in the states because the drug was found to increase suicidal thoughts and depression. Acomplia is, however, approved and available in Europe. This week, medical journal The Lancet published a review of clinical trials involving Acomplia to look at the safety and efficacy of this drug.

According to the review analysis (a meta analysis) of 4 past clinical trials involving a total of over 4100 patients, Acomplia did reduce more weight after 1 year of treatment than placebo. However, patients taking Acomplia were more than twice as likely as patients taking placebo to stop treatment because of depression. More anxiety was also seen in the Acomplia treatment group than in placebo. Even though patients with a history or risk of depressive mood were excluded from clinical trials, the observation that depression and anxiety still arose when Acomplia was taken suggests that the drug increases the risk of depression of anxiety. The study researchers suggest that doctors should monitor patients taking Acomplia for these serious psychiatric side effects. Also reported by Reuters.

The Lancet 2007; 370:1706-1713
DOI:10.1016/S0140-6736(07)61721-8

Efficacy and safety of the weight-loss drug rimonabant: a meta-analysis of randomised trials

Robin Christensen MSc a, Pernelle Kruse Kristensen BSc a b, Else Marie Bartels DSc c, Prof Henning Bliddal MD a and Prof Arne Astrup MD email address b Corresponding Author

Since the prevalence of obesity continues to increase, there is a demand for effective and safe anti-obesity agents that can produce and maintain weight loss and improve comorbidity. We did a meta-analysis of all published randomised controlled trials to assess the efficacy and safety of the newly approved anti-obesity agent rimonabant.

Methods
We searched The Cochrane database and Controlled Trials Register, Medline via Pubmed, Embase via WebSpirs, Web of Science, Scopus, and reference lists up to July, 2007. We collected data from four double-blind, randomised controlled trials (including 4105 participants) that compared 20 mg per day rimonabant with placebo.

Findings
Patients given rimonabant had a 4·7 kg (95% CI 4·1–5·3 kg; p<0·0001) greater weight reduction after 1 year than did those given placebo. Rimonabant caused significantly more adverse events than did placebo (OR=1·4; p=0·0007; number needed to harm=25 individuals [95% CI 17–58]), and 1·4 times more serious adverse events (OR=1·4; p=0·03; number needed to harm=59 [27–830]). Patients given rimonabant were 2·5 times more likely to discontinue the treatment because of depressive mood disorders than were those given placebo (OR=2·5; p=0·01; number needed to harm=49 [19–316]). Furthermore, anxiety caused more patients to discontinue treatment in rimonabant groups than in placebo groups (OR=3·0; p=0·03; number needed to harm=166 [47–3716]).

Interpretation
Our findings suggest that 20 mg per day rimonabant increases the risk of psychiatric adverse events—ie, depressed mood disorders and anxiety—despite depressed mood being an exclusion criterion in these trials. Taken together with the recent US Food and Drug Administration finding of increased risk of suicide during treatment with rimonabant, we recommend increased alertness by physicians to these potentially severe psychiatric adverse reactions.

Affiliations
a. The Parker Institute, Musculoskeletal Statistics Unit, Frederiksberg Hospital, Frederiksberg, Denmark
b. The Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
c. Copenhagen University Library, Copenhagen, Denmark

“Broken” wrote about his experience in the middle of the night, when he described finding himself unable to sleep and have rationale thoughts.

I wanted to share this post because of three things that “Broken” did for himself that probably saved his life:

1. He recognized something wasn’t right, and saw a “danger” signal.

3. He asked for help, continuously.

Having personally experienced that “bottomless abyss”, I can say that asking for help (#3) was most difficult for me, yet it’s probably the most critical. When the illness disrupts your connection to yourself, sometimes connecting with other people is a round-about way of reconnecting with yourself again. This is why it’s so important to have people who are willing to just listen to you as you purge that tangled mess in your mind.

You CAN get through this. I believe it is just like any skill that we learn and become better with practice; at least, that is what I’ve found true for myself.

Once you’ve pulled yourself through an episode, no matter how dark how frightening how long it seems to last - you realize that you CAN pull through, that you HAVE pulled through, and that you WILL be able to pull through if darkness calls again.