This issue's In The News contains two press releases announcing early results from a major depression study at the National Institute of Mental Health (NIMH).  The study was undertaken because depression is a major problem in the United States.

According to NIMH, as many as 20 million Americans suffer from a form of depression each year.  Unfortunately, despite the availability of very effective treatments, many people do not seek help for depression.

Anti-depressant drugs and therapy (especially cognitive therapy) are the main treatments for depression and each has been proven repeatedly to be very effective for most patients.  Recent research has shown that people who do not respond to a specific drug initially may benefit from the addition of a second drug.  Also, researchers are beginning to focus on identifying which types of treatment specific people will best respond to.  One study recently found that a functional MRI may be able to predict who will benefit from therapy versus medication.  Advances in treatment and our general knowledge about depression are progressing rapidly as depression receives more attention as a major societal problem.

Why am I writing about depression, and why are there so many articles on depression in the newsletter?  Because, while it has not been proven conclusively, there is significant evidence that depression is a serious issue among Chiari and syringomyelia patients.

What is the link between Chiari and depression?  At this point, we don't know.  It could be that the disruption of spinal fluid somehow changes the chemical balance in the brain and makes Chiari patients more prone to depression.  It could be that many Chiari patients are in constant pain and chronic pain has been shown to lower serotonin levels in the brain which can lead to mood problems.  It could be that the thought of dealing with what can be a chronic condition and the disability that can come with it is just too much for some people.

While it is important to study depression in Chiari people, we don't need to know the details to know that Chiari patients who are depressed should get help.

I strongly encourage every Chiari patient, every family member, and every caregiver to be on the lookout for signs of depression and take action if necessary.

According to the National Mental Health Association (a nonprofit), the symptoms of clinical depression include:

• Persistent sad, anxious or “empty” mood
• Sleeping too much or too little, middle of the night or early morning waking
• Reduced appetite and weight loss, or increased appetite and weight gain
• Loss of pleasure and interest in activities once enjoyed, including sex
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment (such as chronic pain or digestive disorders)
• Difficulty concentrating, remembering or making decisions
• Fatigue or loss of energy
• Feeling guilty, hopeless or worthless
• Thoughts of suicide or death

Chiari by its nature puts people through ups and downs.  Everyone dealing with lingering symptoms will have bad days and good days, and periods of anger and feeling down; but if the bad days start to take over, if hope disappears and is replaced by despair, if you're in trouble and you just can't seem to get out, please, please, get the help you need.  Get the help you deserve.  Talk to a medical professional, talk to a friend or family member and ask for their help.

I don't know if depression treatments are as effective with Chiari patients as with the general population, but I know if a loved one needed it, I would want them to try.

National Institute of Mental Health:  www.nimh.nih.gov

National Mental Health Association:  www.nmha.org

--Rick Labuda

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