Tag Archives: Depression

Gallup Survey Shows Stay-At-Home Moms Suffer More Depression

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Are stay-at-home moms more depressed than working mothers? In a Gallup poll released last week, stay-at-home moms showed a 28% depression rate compared to 17% of working mothers and 17% of working women without children.

Stay-at-home mothers reported more anger, stress, sadness, and worry. They were more likely to report themselves as struggling and suffering!

This is very important data. According to Gallup, stay-at-home moms make up 37% of mothers with kids living at home.

So who are these stay-at-home moms? Contrary to the mythical model of the rich stay-at-home mom who bounces between yoga class, tennis, pilates, and home to the nanny, the reality of stay-at-home moms is much grimmer. They tend to be poorer on average, younger, Latina, less likely to have graduated from high school or college, and more likely to have been foreign-born.

Here’s some more data directly from the Gallup report, which explored the well-being of 60,000 U.S. women in 2012.

In terms of worry 41% of stay-at-home moms reported worry, compared to 34% of employed moms and 31% of employed women without children.

In terms of sadness 26% of the stay-at-home moms reported it, compared to 16% of employed moms and 16% of employed women without children.

In terms of depression, almost a third of the stay-at-home moms (28%) reported depression, while only 17% of employed moms and 17% of employed women without children reported depression.

The only negative emotion that didn’t vary very much was stress. 50% of stay-at-home moms reported stress, but 48% of employed moms and 45% of employed women without children also reported stress. So apparently stress is pretty much the same across the board for women.

In terms of anger, 19% of stay-at-home moms reported it, while 14% of employed moms and only 12% of employed women without children reported anger.

What about positive emotions? Even though Gallup makes much of the lower ratings of positive emotions for stay-at-home moms, the numbers don’t reflect very large differences. 42% of stay-at-home moms reported themselves as struggling, while 36% of employed moms and 38% of employed women without children reported themselves as struggling. Not a very large difference and probably not statistically significant. What’s interesting about this data is that so many women, regardless of their parenting status, report themselves as struggling. This is quite troubling. I’d be very curious to see comparative data on men.

This is interesting research and completely consistent with some other research that was conducted by Daniel Kahneman and associates on women’s experienced happiness performing various activities. He looked at the percentage of time that women spent in unhappy mood states. Parenting activities showed a 24% on happiness ratio as compared to 18% for housework, 12% for socializing, 12% for TV watching, and 5% for sex! Even though children are delightful, parenting is hard work, and there are many negative emotions associated with it. Working outside the home has negative emotions also, with a 27% unhappy emotion ratio, but it also has rewards and recognition that the lonely job of parenting does not have.

So what should we make of all this research? What wasn’t investigated by Gallup is the relative advantages versus disadvantages for the children of stay-at-home moms versus working moms. So we don’t know if there are significant benefits to the children, which might compensate for the higher levels of suffering reported by stay-at-home moms. I may come back to this issue in a future blog post.

In any case, it suggests that stay-at-home moms need much better support systems from our society, and that we also need to develop better ways for women split time at home and work. Currently there are few options for women who wish to work part-time at satisfying jobs. Because child care in the United States is so expensive, it is difficult for poorer women to stay in the workforce. This may lead to higher levels of depression and suffering in women.

From a clinical perspective, psychotherapists need to be alerted to be extra careful to screen stay-at-home moms for depression and anxiety disorders. I have a quick depression screening test on my website which stay-at-home moms can use to identify if they are suffering depression. If so, call someone for help. Don’t suffer in silence.

Changing Thoughts May Be Better Than Changing Behavior in the Early Stage of Psychotherapy for Severe Depression

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A recent study took a close look at what predicts improvement in depression in the first five sessions of cognitive behavioral therapy. They looked at the degree to which the therapists used either cognitive therapy methods, practiced structuring the sessions clearly, and how much they used behavioral methods/homework. They also examined whether the patients cooperated with these parts of cognitive behavioral therapy. They also measured the strength of the therapeutic alliance.

Sixty patients with major depression participated in the study. Their sessions were videotaped and trained raters rated how much the therapists used cognitive versus behavioral methods.

What they found was only two aspects of therapist behavior predicted improvement between sessions. Depression was measured after every session, and these measurements showed that patients felt better when therapists used cognitive techniques, but didn’t improve when the therapists focused on behavioral techniques.

Patients also showed greater improvement when they adhered to suggestions made by the therapist, which is not surprising.

The behavioral methods used were techniques such as having patients schedule their activities to become more active, and tracking how they actually spent their time. This is called behavioral activation, and previous studies have suggested it is an effective approach to treating depression. The behavioral activation model is that depressed patients tend to do very little, and this leads to further depression. Patients are encouraged to schedule activities that are fun, or activities that provide a sense of mastery or success. This leads to a lessening of depressive feelings.

The cognitive methods were techniques such as writing down what your thoughts are, and using cognitive therapy to challenge or modify distorted thinking.

So how to interpret the results of this study?

It’s only one small study and I would be cautious about taking too much from it. It does suggest that at least in the early sessions of therapy, cognitive methods may be superior to behavioral methods. This makes sense to me because early in therapy depressed patients feel a lot of pain and lethargy, and getting them to suddenly increase their activity can be very challenging and perhaps too difficult. This may lead to a sense of failure which increases depression rather than reducing it. On the other hand, using cognitive methods may lead to more immediate sense of control and relief, which would tend to reduce depression levels.

My sense is that later in therapy behavioral activation techniques are very useful. But typically in order to get patients to cooperate with these techniques there needs to be a strong alliance with the therapist. This takes some time to build.

It would have been interesting if they had continued the study beyond the first five sessions, and looked at whether over time the relative importance of the cognitive versus behavioral techniques would have shifted.

The study shows that therapist behavior in sessions does matter. This is one of my pet peeves. Many psychotherapists claim to use cognitive behavioral therapy, yet fail to actually use any cognitive behavioral techniques on a regular basis in sessions. This study shows that therapist adherence to structuring sessions and using cognitive techniques matters.

So from a consumer point of view there are a few take-home lessons.

1. If you are seeking cognitive behavioral therapy, make sure your therapist actually does cognitive behavioral therapy during sessions. This means they should structure the sessions clearly, as opposed to simply letting you talk about whatever is on your mind. It also means they should be asking you to track your self talk in written form, during sessions go over those thoughts, helping you learn to identify and correct distortions in the thoughts. If they don’t do these behaviors, and therapy feels free-form, then you’re probably not getting cognitive behavioral therapy, and you might want to look elsewhere. If you don’t regularly get homework to do between tasks, you aren’t receiving cognitive behavioral therapy.

2. At least in the early part of therapy pure cognitive therapy techniques may be more effective than behavioral techniques. You may want to focus your own homework more on identifying and changing your inner thoughts, rather than trying to increase positive behaviors. This probably will yield more relief of depression.

3. The study also confirmed that when clients cooperate and are more involved using cognitive therapy techniques, they improve faster. So even if you’re feeling skeptical, try to fully participate during sessions and in between sessions, as that provides you the best chance of more rapid relief.

Your off to analyze his thoughts psychologist,

Andrew Gottlieb, Ph.D.

Copyright © 2010 Andrew Gottlieb, Ph.D. /The Psychology Lounge/TPL Productions

Which Anti-depressant Should You Take? Now We Know

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Accepted wisdom for a number of years has been that all modern anti-depressants work equally well, and that drug selection depends more on the side effect profile desired. Thus a lethargic patient might benefit from an activating antidepressant like Prozac, and an anxious patient would be better off with Paxil. Often prescribing practices are based on individual doctors’ preferences and biases. But a newly published study suggests that this may be wrong. There may be antidepressants that not only work better, but are easier for patients to tolerate.

A terrific new study was recently published in the Lancet medical journal. A team of international researchers, led by Andrea Cipriani at the University of Verona in Italy, reviewed 117 studies of antidepressants which included 25928 patients, two-thirds of whom were women. These studies, done all around the world, compared various antidepressants to either placebo or other antidepressants.

The researcher compared the results of 12 new generation antidepressants in terms of efficacy and acceptabiltiy. They defined efficacy as the proportion of patients who improved at least 50% on a depression rating scale by 8 weeks of treatment. They defined acceptability as the proportion of patients who did not drop out of the study. They made an attempt to adjust for dosages, and did very sophisticated statistical analyses to compare all of the drugs. They used fluoxetine (Prozac) as the common comparison drug, since it has been on the market for the longest time.

What were the results? The winners in terms of short term effectiveness were: (drum roll) mirtazapine (Remeron), escitalopram (Lexapro), venlafaxine (Effexor), and sertraline (Zoloft). The winners in terms of acceptability were: escitalopram (Lexapro), sertraline (Zoloft), citalopram (Celexa), and bupropion (Wellbutrin) were better tolerated than other new-generation antidepressants. Note that the overall winners for effectiveness combined with tolerability were escitalopram (Lexapro) and sertraline (Zoloft). Two of the best drugs in terms of effectiveness (mirtazapine (Remeron) and venlafaxine (Effexor)) were not among the best tolerated medicines.

The losers in terms of both effectiveness and tolerability were reboxetine (Edronax), fluvoxamine (Luvox), paroxetine (Paxil), and duloxetine (Cymbalta). The worst drug of all was reboxetine (Edronax).

So what about cost? I’ve developed a spreadsheet of all of the drugs’ costs based on a 30 day supply, paying full retail price at Costco pharmacy, and using generic equivalents when available. Of the winners in terms of effectiveness and tolerability, the clear cost winner was sertraline (Zoloft), at $12 a month. The other winner, escitalopram (Lexapro), was a loser in terms of cost at $88 a month! The other winners in terms of effectiveness were quite cost effective too, with mirtazapine (Remeron) at $14 a month, and venlafaxine (Effexor) at $28 a month.

So what should doctors and patients do? For patients, the two best drugs appear to be escitalopram (Lexapro) and sertraline (Zoloft), with sertraline the clear winner if you pay much for prescription drugs. Doctors might want to consider costs as well, as this can help with overall health care inflation. If you can tolerate the side effects, consider trying mirtazapine (Remeron), or venlafaxine (Effexor).

Now there are of course a few caveats about this study. It is possible that another meta-analysis could find different results. One criticism was that the study only looked at effectiveness over 8 weeks of treatment. It is possible that some drugs work more slowly, and at 12 or 16 weeks might have different results. But most patients want results in two months or less, so this is not a major criticism.

Another issue is funding bias. Although none of the authors of this study were paid by drug companies, many of the studies they analyzed were funded by drug companies, and may have reflected some bias. But for now, this is the best information we have in terms of effectiveness and toleration of antidepressant medications.

So who’s the winner? Sertraline (Zoloft) was the clear winner by effectiveness, tolerability, and cost!

Should you change medications if you are not on one of the winners? No, of course not. If your medication is working, don’t change it. But if it’s not working, then talk with your doctor about switching.

And no, I don’t receive any funding or sponsorship from any drug companies…

 

Here’s the table of drug price comparisons.
Comparison of Antidepressant Costs for 30 Day Supply (Costco Pharmacy, Generic Equivalents if possible)
Bolded Drugs were most effective

Drug            Generic Name         Cost          Dose(mg)

Celexa             citalopram                   $3                 40
Prozac             fluoxetine                    $6                  20
Zoloft             sertraline                       $12             100
Remeron     mirtazapine                    $14               30
Luvox              fluvoxamine               $24             100
Effexor         venlafaxine                    $28                75
Welbutrin      bupropion                   $74             200
Lexapro       escitalopram                 $88                10
Paxil                paroxetine                   $91             37.5
Cymbalta       duloxetine                   $128              60

 

Copyright © 2009 Andrew Gottlieb, Ph.D. /The Psychology Lounge/TPL Productions