According to the BBC, the British recession and spending cuts are making us all depressed.


They found that between 2006 and 2010, prescriptions for SSRI antidepressants rose by 43%. They attribute this to a rise in the rates of depression caused by the financial crisis. OK there are a few caveats, but this is the clear message of an article titled Money woes 'linked to rise in depression'. To get this data they used the Freedom of Information Act.

What they don't do is to provide any of the raw data. So we just have to take their word for it. Maybe someone ought to use the Freedom of Information Act to make them tell us? This is important, because while I'll take the BBC's word about the SSRI rise of 43%, they also say that rates of other antidepressants rose - but they don't say which ones, by how much, or anything else. They don't say how many fell, or stayed flat.

Given which it's impossible to know what to make of this. Here are some alternative explanations:

• This just represents the continuation of the well-known trend, seen in the USA and Europe as well as the UK, for increasing antidepressant use. This is my personal best guess and Ben Goldacre points out that rates rose 36% during the boom years of 2000-2005.
  
• Depression has not got more common, it's just that it's more likely to be treated. This overlaps with the first theory. Support for this comes from the fact that suicide rates haven't risen - at least not by anywhere near 40%.
  
• Mental illness is no more likely to be treated, but it's more likely to be treated with antidepressants, as opposed to other drugs. There was, and is, a move to get people off drugs like benzodiazepines, and onto antidepressants. However I suspect this process is largely complete now.
• Total antidepressant use isn't rising but SSRI use is because doctors increasingly prescribe SSRIs over opposed to other drugs. This was another Ben Goldacre suggestion and it is surely a factor although again, I suspect that this process was largely complete by 2007.
  
• People are more likely to be taking multiple different antidepressants, which would manifest as a rise in prescriptions, even if the total number of users stayed constant. Add-on treatment with mirtazapine and others is becoming more popular.
• People are staying on antidepressants for longer meaning more prescriptions. This might not even mean that they're staying ill for longer, it might just mean that doctors are getting better at convincing people to keep taking them by e.g. prescribing drugs with milder side effects, or by referring people for psychotherapy which could increase use by keeping people "in the system" and taking their medication. This is very likely. I previously blogged about a paper showing that in 1993 to 2005, antidepressant prescriptions rose although rates of depression fell, because of a small rise in the number of people taking them for very long periods.
  
• Mental illness rates are rising, but it's not depression: it's anxiety, or something else. Entirely plausible since we know that many people taking antidepressants, in the USA, have no diagnosable depression and even no diagnosable psychiatric disorder at all.
• People are relying on the NHS to prescribe them drugs, as opposed to private doctors, because they can't afford to go private. Private medicine in the UK is only a small sector so this is unlikely to account for much but it's the kind of thing you need to think about.
• Rates of depression have risen, but it's nothing to do with the economy, it's something else which happened between 2007 and 2010: the Premiership of Gordon Brown? The assassination of Benazir Bhutto? The discovery of a 2,100 year old Japanese melon?
  

Across at Wired, Amy Wallace has a long but riveting article about Amy Bishop, the neuroscience professor who shot her colleagues at the University of Alabama last year, killing three.

It's a fascinating article because of the picture it paints of a killer and it's well worth the time to read. Yet it doesn't really answer the question posed in the title: "What Made This University Scientist Snap?"

Wallace notes the theory that Bishop snapped because she was denied tenure at the University, a serious blow to anyone's career and especially to someone who, apparantly, believed she was destined for great things. However, she points out that the timing doesn't fit: Bishop was denied tenure several months before the shooting. And she shot at some of the faculty who voted in her favor, ruling out a simple "revenge" motive.

But even if Bishop had snapped the day after she found out about the tenure decision, what would that explain? Thousands of people are denied tenure every year. This has been going on for decades. No-one except Bishop has ever decided to pick up a gun in response.

Bishop had always displayed a streak of senseless violence; in 1986, she killed her 18 year old brother with a shotgun in her own kitchen. She was 21. The death was ruled an accident, but probably wasn't. It's not clear what it was, though: Bishop had no clear motive.

Amy had said something that upset her father. That morning they’d squabbled, and at about 11:30 am, Sam, a film professor at Northeastern University, left the family’s Victorian home to go shopping... Amy, 21, was in her bedroom upstairs. She was worried about “robbers,” she would later tell the police. So she loaded her father’s 12-gauge pump-action shotgun and accidentally discharged a round in her room. The blast struck a lamp and a mirror and blew a hole in the wall...

The gun, a Mossberg model 500A, holds multiple rounds and must be pumped after each discharge to chamber another shell. Bishop had loaded the gun with number-four lead shot. After firing the round into the wall, she could have put the weapon aside. Instead, she took it downstairs and walked into the kitchen. At some point, she pumped the gun, chambering another round.

...[her mother] told police she was at the sink and Seth was by the stove when Amy appeared. “I have a shell in the gun, and I don’t know how to unload it,” Judy told police her daughter said. Judy continued, “I told Amy not to point the gun at anybody. Amy turned toward her brother and the gun fired, hitting him.”

According to a disturbing BBC news story, South African drug addicts are stealing medication from HIV+ people and using it to get high:

'Whoonga' threat to South African HIV patients

A fascinating new paper: Morgellons Disease, or Antipsychotic-Responsive Delusional Parasitosis, in an HIV Patient: Beliefs in The Age of the Internet

Weapons of Mass Destruction. Nuclear, chemical and biological weapons. They're really nasty, right?

Well, some of them are. Nuclear weapons are Very Destructive Indeed. Even a tiny one, detonated in the middle of a major city, would probably kill hundreds of thousands. A medium-sized nuke could kill millions. The biggest would wipe a small country off the map in one go.

Chemical and biological weapons, on the other hand, while hardly nice, are just not on the same scale.

Sure, there are nightmare scenarios - a genetically engineered supervirus that kills a billion people - but they're hypothetical. If someone does design such a virus, then we can worry. As it is, biological weapons have never proven very useful. The 2001 US anthrax letters killed 5 people. Jared Loughner killed 6 with a gun he bought from a chain store.

Chemical weapons are little better. They were used heavily in WW1 and the Iran-Iraq War against military targets and killed many but never achieved a decisive victory, and the vast majority of deaths in these wars were caused by plain old bullets and bombs. Iraq's use of chemical weapons against Kurds in Halabja killed perhaps 5,000 - but this was a full-scale assault by an advanced air force, lasting several hours, on a defenceless population.

When a state-of-the-art nerve agent was used in the Tokyo subway attack, after much preparation by the cult responsible, who had professional chemists and advanced labs, 13 people died. In London on the 7th July 2005, terrorists killed 52 people with explosives made from haircare products.

Nuclear weapons aside, the best way to cause mass destruction is just to make an explosion, the bigger the better; yet conventional explosives, no matter how big, are not "WMDs", while chemical and biological weapons are.

So it seems to me that the term and the concept of "WMDs" is fundamentally unhelpful. It lumps together the apocalyptically powerful with the much less destructive. If you have to discuss everything except guns and explosives in one category, terms like "Unconventional weapons" are better as they avoid the misleading implication that all of these weapons are very, and equivalently, deadly; but grouping them together at all is risky.

That's WMDs. But there are plenty of other unhelpful concepts out there, some of which I've discussed previously. Take the concept of "major depressive disorder", for example. At least as the term is currently used, it lumps together extremely serious cases requiring hospitalization with mild "symptoms" which 40% of people experience by age 32.

A reader pointed me to this piece:

Boy Without a Cerebellum Baffles Doctors

Argh. This is going to be a bit awkward. So I'll just say at the outset that I have nothing against kids struggling with serious illnesses and I wish them all the best.


The article's about Chase Britton, a boy who apparantly lacks two important parts of the brain: the cerebellum and the pons. Despite this, the article says, Chase is a lovely kid and is determined to be as active as possible.

When he was 1 year old, doctors did an MRI, expecting to find he had a mild case of cerebral palsy. Instead, they discovered he was completely missing his cerebellum -- the part of the brain that controls motor skills, balance and emotions.

"That's when the doctor called and didn't know what to say to us," Britton said in a telephone interview. "No one had ever seen it before. And then we'd go to the neurologists and they'd say, 'That's impossible.' 'He has the MRI of a vegetable,' one of the doctors said to us."

Chase is not a vegetable, leaving doctors bewildered and experts rethinking what they thought they knew about the human brain.

Could social networks be more important than the media in the spread of eating disorders?

There's a story about eating disorders roughly like this: eating disorders (ED) are about wanting to be thin. The idea that thinness is desireable is something that's spread by Western media, especially visual media i.e. TV and magazines. Therefore, Western media exposure causes eating disorders.

It's a nice simple theory. And it seems to fit with the fact that eating disorders, hitherto very rare, start to appear in a certain country in conjunction with the spread of Westernized media. A number of studies have shown this. However, a new paper suggests that there may be rather more to it: Social network media exposure and adolescent eating pathology in Fiji.

Fiji is a former British colony, a tropical island nation of less than a million. Just over half the population are ethnic native Fijian people. Until recently, these Fijians were relatively untouched by Western culture, but this is starting to change.

The authors of this study surveyed 523 Fijian high school girls. Interviews took place in 2007. They asked them various questions relating to, one the one hand, eating disorder symptoms, and on the other hand, their exposure to various forms of media.

They looked at both individual exposure - hours of TV watched, electronic entertainment in the home - and "indirect" or "social network" exposure, such as TV watched by the parents, and the amount of electronic entertainment their friends owned. On top of this they measured Westernization/"globalization", such as the amount of overseas travel by the girls or their parents.

So what happened? Basically, social network media exposure, urbanization, and Westernization correlated with ED symptoms, but when you controlled for those variables, personal media exposure didn't correlate. Here's the data; the column I've highlighted is the data where each variable is controlled for the others. The correlations are pretty small (0 is none, 1.0 would be perfect) but significant.


They conclude that:

Although consistent with the prevailing sociocultural model for the relation between media exposure and disordered eating... our finding, that indirect exposure to media content may be even more influential than direct exposure in this particular social context, is novel.

In trying to explain what happened to Charlene, local reporters often simply copied out of American diagnostic manuals. The mental-health experts quoted in the Hong Kong papers and magazines confidently reported that anorexia in Hong Kong was the same disorder that appeared in the United States and Europe...

As the general public and the region's mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in [Hong Kong psychiatrist] Lee's patient population appeared to transform into the more virulent American standard. Lee once saw two or three anorexic patients a year; by the end of the 1990s he was seeing that many new cases each month.

Many of the best things in life are terrible.


We all know about the fun to be found in failure, as exemplified by Judge A Book By Its Cover and of course FailBlog. The whole genre of B-movie appreciation is based on the maxim of: so bad, it's good.

But could the same thing apply to psychotherapies?

Here's the argument. Freudian psychoanalysis is a bit silly. Freud had pretensions to scientific respectability, but never really achieved it, and with good reason. You can believe Freud, and if you do, it kind of make sense. But to anyone else, it's a bit weird. If psychoanalysis were a person, it would be the Pope.

By contrast, cognitive-behavioural therapy is eminently reasonable. It relies on straightforward empirical observations of the patient's symptoms, and on trying to change people's beliefs by rational arguments and real-life examples ("behavioural experiments"). CBT practitioners are always keen to do randomized controlled trials to provide hard evidence for their success. CBT is Richard Dawkins.

But what if the very irrationality of psychoanalysis is its strength? Mental illness is irrational. So's life, right? So maybe you need an irrational kind of therapy to deal with it.

This is almost the argument advanced by Robert Rowland Smith in a short piece In Defence of Psychoanalysis:

...The irony is that in becoming more “scientific”, CBT becomes less therapeutic. Now, Freud himself liked to be thought of as a scientist (he began his career in neurology, working on the spinal ganglia), but it’s the non-scientific features that make psychoanalysis the more, not the less, powerful.

I’m referring to the therapeutic relationship itself. Although like psychoanalysis largely a talking cure, CBT prefers to set aside the emotions in play between doctor and patient. Psychoanalysis does the reverse. To the annoyance no doubt of many a psychoanalytic patient, the very interaction between the two becomes the subject-matter of the therapy.

The respected therapist and writer Irvin Yalom, among others, argues that depression and associated forms of sadness stem from an inability to make good contact with others. Relationships are fundamental to happiness. And so a science that has the courage to include the doctor’s relationship with the patient within the treatment itself, and to work with it, is a science already modelling the solution it prescribes. What psychoanalysis loses in scientific stature, it gains in humanity.

So apparently: Left wing or right wing? It's written in the brain

A bombshell has just gone off in the continuing debate over XMRV, the virus that may or may not cause chronic fatigue syndrome. Actually, 4 bombshells.

A set of papers out today in Retrovirology (1,2,3,4) claim that many previous studies claiming to have found the virus haven't actually been detecting XMRV at all.

Here's the rub. XMRV is a retrovirus, a class of bugs that includes HIV. Retroviruses are composed of RNA, but they can insert themselves into the genetic material of host cells as DNA. This is how they reproduce: once their DNA is part of the host cell's chromosomes, that cell is ends up making more copies of the virus.

But there are lots of retroviruses out there, and there used to be yet others that are now extinct. So bits of retroviral DNA are scattered throughout the genome of animals. These are called endogenonous retro-viruses (ERVs).

XMRV is extremely similar to certain ERVs found in the DNA of mice. And mice are the most popular laboratory mammals in the world. So you can see the potential problem: laboratories all over the world are full of mice, but mouse DNA might show up as "XMRV" DNA on PCR tests.

Wary virologists take precautions against this by checking specifically for mouse DNA. But most mouse-contamination tests are targeted at mouse mitochondrial DNA (mtDNA). In theory, a test for mouse mtDNA is all you need, because mtDNA is found in all mouse cells. In theory.

Now the four papers (or are they the Four Horsemen?) argue, in a nutshell, that mouse DNA shows up as "XMRV" on most of the popular tests that have been used in the past, that mouse contamination is very common - even some of the test kits are affected! - and that tests for mouse mtDNA are not good enough to detect the problem.

• Hue et al say that "Taqman PCR primers previously described as XMRV-specific can amplify common murine ERV sequences from mouse suggesting that mouse DNA can contaminate patient samples and confound specific XMRV detection." They go on to show that some human samples previously reported as infected with XMRV, are actually infected with a hybrid of XMRV and a mouse ERV which we know can't infect humans.
• Sato et al report that PCR testing kits from Invitrogen, a leading biotech company, are contaminated with mouse genes including an ERV almost identical to XMRV, and that this shows up as a false positive using commonly used PCR primers "specific to XMRV".
• Oakes et al say that in 112 CFS patients and 36 healthy control, they detected "XMRV" in some samples but all of these samples were likely contaminated with mouse DNA because "all samples that tested positive for XMRV and/or MLV DNA were also positive for the highly abundant IAP long terminal repeat [found only in mice] and most were positive for murine mitochondrial cytochrome oxidase sequences [found only in mice]"
• Robinson et al agree with Oakes et al: they found "XMRV" in some human samples, in this case prostate cancer cells, but they then found that all of the "infected" samples were contaminated with mouse DNA. They recommend that in future, samples should be tested for mouse genes such as the IAP long terminal repeat or cytochrome oxidase, and that researchers should not rely on tests for mouse mtDNA.

Remember the 90s, when No Fear stuff was cool, and when people still said "cool"?

Well, a new paper has brought No Fear back, by reporting on a woman who has no fear - due to brain damage. The article, The Human Amygdala and the Induction and Experience of Fear, is brought to you by a list of neuroscientists including big names such as Antonio Damasio (of Phineas Gage fame).

The basic story is nice and simple. There's a woman, SM, who lacks a part of the brain called the amygdala. They found that she can't feel fear. Therefore, it's reasonable to assume that the amygdala's required for fear. But there's a bit more to it than that...

The amygdala is a small nugget of the brain nestled in the medial temporal lobe. The name comes from the Greek for "almond" because apparently it looks like one, though I can't say I've noticed the resemblance myself.

What does it do? Good question. There are two main schools of thought. Some think that the amygdala is responsible for the emotion of fear, while others argue that its role is much broader and that it's responsible for measuring the "salience" or importance of stimuli, which covers fear but also much else.

That's where this new paper comes in, with the patient SM. She's not a new patient: she's been studied for years, and many papers have been published about her. I wonder if her acronym doesn't stand for "Scientific Motherlode"?

She's one of the very few living cases of Urbach-Wiethe disease, an extremely rare genetic disorder which causes selective degeneration of the amygdala as well as other symptoms such as skin problems.

Previous studies on SM mostly focussed on specific aspects of her neurological function e.g. memory, perception and so on. However there have been a few studies of her "everyday" experiences and personality. Thus we learned that:

Two experienced clinical psychologists conducted "blind" interviews of SM (the psychologists were not provided any background information)... Both reached the conclusion that SM expressed a normal range of affect and emotion... However, they both noted that SM was remarkably dispassionate when relating highly emotional and traumatic life experiences... To the psychologists, SM came across as a "survivor", as being "resilient" and even "heroic".

A man, whom SM described as looking “drugged-out.” As she walked past the park, the man called out and motioned for her to come over. SM made her way to the park bench. As she got within arm’s reach of the man, he suddenly stood up, pulled her down to the bench by her shirt, stuck a knife to her throat, and exclaimed, “I’m going to cut you, bitch!”

SM claims that she remained calm, did not panic, and did not feel afraid. In the distance she could hear the church choir singing. She looked at the man and confidently replied, “If you’re going to kill me, you’re gonna have to go through my God’s angels first.” The man suddenly let her go. SM reports “walking” back to her home. On the following day, she walked past the same park again. There were no signs of avoidance behavior and no feelings of fear.

"Wikileaks is great. It lets people leak stuff."

"Hang on, so you're saying that no-one could leak stuff before? They invented it?"

"Well, no, but they brought leaking to the masses. Sure, people could post documents to the press before, but now anyone in the world can access the leaks!"

"Great, but isn't that just the internet that did that? If it weren't for Wikileaks, people could just upload their leaks to a blog. Or email them to 50 newspapers. Or put them on the torrents. Or start their own site. If it's good, it would go viral, and be impossible to take down. Just like Wikileaks, with all their mirrors, except even more secure, because there'd be literally no-one to arrest or cut off funding to."

"OK, but Wikileaks is a brand. It's not about the technical stuff - it's the message. Like one of their wallpapers says, they're synonymous with free speech."

"So you think it's a good thing that one organization has become synonymous with the whole process of leaking? With the whole concept of openness? What will happen to the idea of free speech, then, if that brand image suddenly gets tarnished - like, say, if their founder and figurehead gets convicted of a serious crime, or..."

"He's innocent! Justice for Julian!"

"Quite possibly, but why do you care? Is he a personal friend?"

"It's an attack on free speech!"

"So you agree that one man has become synonymous with free speech? Doesn't that bother you?"

"Erm... well. Look, fundamentally, we need Wikileaks. Before, there was no centralized system for leaking. Anyone could do it. It was a mess! Wikileaks put everything in one place, and put a committee of experts in a position to decide what was worth leaking and what wasn't. It brought much-needed efficiency and respectability to the idea of leaking. Before Wikileaks, it was anarchy. They're like... the government."

"..."

Edit: See also The Last Psychiatrist's take.

Last week I was at a discussion about New Media, and someone mentioned that they'd been put off from writing content online because of a comment on one of their articles accusing them of being "stupid".

I found this surprising - not the comment, but that anyone would take it so personally. It's the internet. You will get called names. Everyone does. It doesn't mean there's anything wrong with you.

I suspect this is a generational issue. People who 'grew up online' know, as Penny Arcade explained, that

The sad fact is that there are millions of people whose idea of fun is to find people they disagree with, and mock them. And they're right, it can be fun - why else do you think people like Jon Stewart are so popular? - but that's all it is, entertainment. If you're on the receiving end, don't take it seriously.

If you write something online, and a lot of people read it, you will get slammed. Someone, somewhere, will disagree with you and they'll tell you so, in no uncertain terms. This is true whatever you write about, but some topics are like a big red rag to the herds of bulls out there.

Just to name a few, if you say anything vaguely related to climate change, religion, health, the economy, feminism or race, you might as well be holding a placard with a big arrow pointing down at you and "Sling Mud Here" on it.

The point is - it's them, not you. They are not interested in you, they don't know you, it's not you. True, they might tailor their insults a bit; if you're a young woman you might be, say, a "stupid girl" where a man would merely get called an "idiot". But this doesn't mean that the attacks are a reflection on you in any way. You just happen to be the one in the line of fire.

What do you do about this? Nothing.

Trying to enter into a serious debate is pointless. Insulting them back can be fun, just remember that if you find it fun, you've become one of them: "he who stares too long into the abyss...", etc. Complaining to the moderators might help, but unless the site has a rock solid zero-tolerance-for-fuckwads policy, probably not. Where the blight has taken root, like Comment is Free, I'd not waste your time complaining. Just ignore it and carry on.

The most important thing is not to take it personally. Do not get offended. Do not care. Because no-one else cares. Especially the people who wrote the comments. They presumably care about whatever "issue" prompted their attack, but they don't care about you. If anything, you should be pleased, because on the internet, the only stuff that doesn't attract stupid comments is the stuff that no-one reads.

I've heard these attacks referred to as "policing" existing hierarchies or "silencing" certain types of people. This seems to me to be granting them far more respect than they deserve. With the actual police, if you break the rules, they will physically arrest you. They have power. Internet trolls don't: if they succeed in policing or silencing anybody, it's because their targets let them boss them around. They're nobody; they're not your problem.

If you can't help being offended by such comments, don't read them, but ideally you shouldn't need to resort to that. For one thing, it means you miss the sensible comments (and there's always a few). But fundamentally, you shouldn't need to do this, because you really shouldn't care what some anonymous joker from the depths of the internet thinks about you.

Pont St. Esprit is a small town in southern France. In 1951 it became famous as the site of one of the most mysterious medical outbreaks of modern times.

As Dr's Gabbai, Lisbonne and Pourquier wrote to the British Medical Journal, 15 days after the "incident":

The first symptoms appeared after a latent period of 6 to 48 hours. In this first phase, the symptoms were generalized, and consisted in a depressive state with anguish and slight agitation.

After some hours the symptoms became more clearly defined, and most of the patients presented with digestive disturbances... Disturbances of the autonomic nervous system accompanied the digestive disorders-gusts of warmth, followed by the impression of "cold waves", with intense sweating crises. We also noted frequent excessive salivation.

The patients were pale and often showed a regular bradycardia (40 to 50 beats a minute), with weakness of the pulse. The heart sounds were rather muffled; the extremities were cold... Thereafter a constant symptom appeared - insomnia lasting several days... A state of giddiness persisted, accompanied by abundant sweating and a disagreeable odour. The special odour struck the patient and his attendants.

According to the BBC (and many others)...

Libido problems 'brain not mind'

Scans appear to show differences in brain functioning in women with persistently low sex drives, claim researchers.

The US scientists behind the study suggest it provides solid evidence that the problem can have a physical origin.