Reddit Scraper for Depression Regimens – Ngrams

Reddit is a great source of information containing posts about depression treatments, supplements, diets, and nootropics. Since only specific psychotropic medications are prescribed for depression and anxiety and go through clinical trials with large enough sample sizes, for others we only have anecdotal stories from online users. I can’t perform a randomized controlled trial for green tea matcha’s possible antidepressant qualities without a lab and a grant, but we can use natural language processing to at least summarize some information based on user’s reviews of various supplements.

Below are top ngrams (unigrams, bigrams, and trigrams), based on the text from posts and comments from the depressionregimens subreddit. For this data sample only the top posts and top comments were selected. Posts or comments of word length less than three were removed. The data sample consisted of 1,458 documents (each document being a post of a comment). Data cleaning included removing html tags, expanding common contractions, removing newlines and tabs, removing urls, spelling correction (python’s SymSpell), lemmatization, lowercasing, and removing special characters and extra whitespaces. A list of names that included supplements, neurotransmitters, antidepressants, and other psychotropic medications, was created and excluded from spell check, in order to avoid changing these words (for example we don’t want to change ‘ssris’ to ‘saris’, which is what the SymSpell library was doing).

The ngrams were selected such that each ngram appears in less than 70% of the documents. Absolute and relative frequencies were calculated for each ngram. The top unigrams were as follows: get, depression, feel, go, try, thing, day, work, take, make, help, time, good, one, also.

Examples of posts/comments (original text, before data cleaning) with these top unigrams:

I am going to write this down somewhere.. and then take steps to figure out how to work them all away…I do all of these.. The social media/phone time one is the hardest for me. Maybe I’ll invest in one of those timer boxes I can throw it into. Then I’ll have no choice but to be productive and hopefully more creative. My depression always gets so bad around shark week. So hard to sleep and stay asleep. So for a few days out of the month I really don’t have a choice on that one. But it can easily spiral out of control if I’m not putting in constant effort. I am very tired but also wired feeling right now.

Being diagnosed with terminal cancer you will probably die. There are a lot alternatives to treat depression, regular cardio, different therapy methods, drugs and non-drugs treatments (rTMS, ECT etc.), and if you try everything and nothing work, you can survive until a new treatment arrives. Anyway, I read a lot people refusing antidepressant because “side effects”, so I think depression isn’t so bad for them, Because think about this: a guy/girl with terminal cancer will take any treatment on market if he/she can pay, ignoring side effects because she/he want live.

Thanks for sharing – having a particular difficult day today, it’s nice to hear a success story. I’ve researched this in my area, seems quite expensive, hence I’ve not been able to try it, though I’ve wanted to. Has it been that way for you?
Also, I’ve been told several times that those dependent on benzodiazepine medications do not respond as well (or at all) to IV ketamine, so those must be discontinued before infusions. During the 25 years of so many medicines, did you take benzodiazepines at all?
> But I’m stable. I actually know what happiness
feels like. And most importantly, I’m alive.
Amazing to read! Thanks again for a real success story. I wish you the very best of continued health and happiness!

The top bigrams were as follows: side effect, every day, make feel, feel well, mental health, long term, year ago, depression anxiety, treatment resistant, treat depression. Below are some post/comment examples with the top bigrams:

Ketamine crushed rumination that I had been trapped in my whole life. Repeating intrusive negative thoughts of the past. Wiping out the massive, crippling fog of depression was wonderful but that side effect of stopping those negative thoughts was life altering. Glad we found it, even if I am approaching 50 years old.

I broke the sleep/ work depression routine by walking at first. Hour long walks at a quick pace, fast enough that it was challenging. Did that for a month or so. I actually managed to lose 5 pounds that first month so there was a nice bonus. It got me thinking my diet needed improving so I cut out fast food as much as I could and starting making lean meals for myself as much as I could. After another month, that “swollen” feeling you describe started to lessen. So two months in, down 12 pounds, I joined a gym but never touched free weight. Just cardio. It was more intense than walking and took a bit to adjust to the new pace. I left a sweaty mess every day. Did that for about 6 months. I was in decent shape. Down about 30 pounds overall. My brain felt clearer and I had more energy. It’s important to isolate the depression, give it less ammunition to use against you. **One way to do that is to not let it use your body against you.**

After trying over 15 different medications and several rounds of Ketamine IV infusions for my severe treatment-resistant depression, I was about to give up. On everything. I saw a couple posts on this group about how some people have had success with Trintellix, so in a last ditch effort in desperation, I talked to my doctor and started it about a month ago. Within a week my life had changed. The existential dread had lifted. I became interested in things again. For the first time since I can remember I wasn’t exhausted in the middle of the day. I had energy. I smiled. I felt some joy. And it has continued and it’s only been getting better. I think what really happened was that it gave me the jumpstart I needed to start a small exercise regimen and care about eating right, which made me feel even better. It did make me extremely nauseous for the first week but it helped to take it with food and then the side effect went away. Thank you to those who shared their experience and I hope maybe this helps someone as well. There is hope, just keep swimming.

The top trigrams were as follows: treatment resistant depression, major depressive disorder, sexual side effect, make feel good, make feel well, mental health issue, get new psychiatrist, severe treatment resistant, stay bed day, time every day. Below are some post/comment examples with the top trigrams:

Speaking from personal experience, the only type of medication that improved my symptoms were the MAOIs.
These are more old school, and more dangerous. But many have said they are a life saver for
treatment resistant depression.
Contrary to conventional antidepressants, they don’t just boost serotonin/dopamine/norepinephrine – they also boost a range of neurochemicals such as trace amines like b-phenylethylamine, which themselves promote the release of neurotransmitters.
MAOIs are so powerful that you have to watch your diet and abstain from a whole range of other drugs.

The sexual side effects, tiredness, agitation and added anxiety all pushed me away from SSRIs. I did like being numb though. Except in the genital area… that created a huge depression in itself. Been off for months now.

Wait, you’ve told your psychiatrist about this, and they didn’t do anything? If so, you need to get a new psychiatrist.
I don’t want to make a diagnosis but have you considered the possibility that you might have bipolar depression? SSRIs can cause hypomania and are considered dangerous for patients with BP. That’s why I said a new doctor is in order. Thankfully, there are antidepressants that don’t cause this reaction, as well as mood stabilizers to prevent the crash you talked about.
Lastly, it sounds like you’re also dealing with a lot of stuff from your past. Are you seeing a therapist right now? They can help you work through those memories and deal with the intense emotions you get in a way that makes your life better and not worse.

We can even obtain some four grams: severe treatment resistant depression, job really well respected, amazing job really well, previous alcoholism push man, girl ever meet amazing.
Post/comment examples below. I really enjoyed reading the first story as I have not heard previously about diphenidine and it was interesting to find out about this substance and the user’s experience.

I meant to post about this sooner and regret not doing so, but hopefully it’s helpful to some and doesn’t break any rules I’m not aware of. I know this subreddit has a focus on safe and researched substances and realise that this is an entirely anecdotal report concerning a not very well-researched substance, but I hope it’s not a problem and think it’s valuable information for someone suffering from severe treatment-resistant depression.
Back in 2015, my husband (23 years old, weight 62 kg) had been feeling severely depressed with suicidal ideation for several weeks. It got to the point where I felt I had to either call in the mental-health people (whom I knew from previous experience to be quite inept) or take a drastic pharmacological measure.
I had read about the rapid and long-lasting antidepressant responses to NMDA-receptor antagonists like ketamine before, and acquired samples of two of ones that are orally active (diphenidine, as well as methoxphenidine, also known as MXP).
NMDA-receptor antagonists appear to produce their antidepressant effects by causing an increase in levels of brain-derived neurotrophic factor (BDNF) that can last for days or weeks following a single dose, whereas the most commonly used antidepressants produce a similar increase in BDNF only after weeks of continuous administration, while also causing many side effects.
Neither of us had ever used any kind of dissociative before, just classical psychedelics, stimulants and marijuana (while visiting a country where that’s legal), so, given his fragile psychological state, I wanted to start with a very careful small dose.
Looking at people’s comments on diphenidine and methoxphenidine online, I couldn’t find anything related to attempts at therapeutic use, nor a clear consensus on a preference for either one. I ended up looking up dosage information for diphenidine, and read that 50 mg was considered a threshold dose.
I first gave him 10 mg of diphenidine in a capsule the first time to be safe; as expected, that had no noticeable effects.
2 hours later I gave him another 20 mg, which still led to no noticeable effects, except possibly a very mild numbing of the senses.
Another 2 hours later I gave him another 30 mg. About 15-20 minutes after this, he reported that he was maybe starting to feel slight derealisation effects.
Until this point he had been playing Skyrim to try to take his mind off his bad feelings; he really wasn’t expecting this to work at all, but he trusted my knowledge of drugs and figured it couldn’t hurt to at least try it.
When the effects started to set in, I told him I’d read that some people like to lie in bed while on drugs like this, and he did so.
His mood didn’t seem much changed, but after lying in bed for a bit, he started talking to me about some of the things that had been bothering him. He sounded sad while talking about these things, but I tried to steer the conversation toward solutions that we could decide on that would make life more satisfying for him.
After chatting for a bit, he seemed to be getting somewhat amused by the effects of the drug; he said things he touched felt very different, and everything felt strange, but not in a bad way.
As we talked some more about his issues, his mood slowly lifted (I think this was around the peak of the experience, which lasted a good portion of the day), and suddenly he got a little smile on his face and said that he was starting to feel… happy. Of course this made me really happy.
He started saying how things felt “solid”, “thick”, “real” and “tangible”, in contrast not only to the way things normally felt but also to the way things had been feeling to him particularly during his weeks of feeling depressed. He related this more solid experience of physical objects to an improved outlook on life.
Interestingly, despite diphenidine being a dissociative drug, it appears to have triggered a reversal of symptoms of dissociation/derealisation that accompanied his depression prior to the treatment.
He said he kind of felt similar to being very drunk, I assume in relation to physical coordination.
He also reported feeling significant time dilation, “in a good way”. (He contrasted this with the time dilation he feels on classical psychedelics, which he tends to find uncomfortable or scary, as though a moment will last forever.)
He then seemed to get a big urge to get up and do lots of tidying and cleaning around our apartment, and he started doing so; I helped. We folded clothes, organised the living room, cleaned the kitchen, stuff like that.
He said that he felt like everything was being put in its place again, both physically and mentally; that his mind was tidy again.
Around this point, he seemed to have this constant feeling of awe at how content he was feeling with life. This wasn’t some kind of unnatural euphoria, just a very strong feeling of contentness, which had obviously been missing from his life for a long time.
Several times, he seemed to have tears in his eyes in awe of how at peace he felt with the world.
Seeing someone emerge from such a deep depression in a matter of hours was really beautiful.

Several times, he hugged me and told me how grateful he was to me for finding this drug for him.
I imagine the talking was therapeutic (which could also have happened without the drug, but was, I imagine, stimulated by it), but mainly I’m certain the drug caused a biochemical change in his brain that has reversed, at least for a time, the natural process that makes him prone to feeling depressed all the time.
The dissociative effects did not fully diminish until he slept; he had no trouble sleeping.

Two days later I asked him how he was feeling, and he smiled and said he was feeling just fine.
More than two weeks later, his depression still had not returned.
This was a massive change. It seems diphenidine can be a powerful medicine. 🙂


He later took it again, this time at 60 mg in one go (about 1 mg/kg), and he felt that this reinforced the antidepressant effects, and that repeating this every few weeks would probably keep him happy in the long term, and the interval we settled on was one dose every 12 days (taken right after waking up to avoid impacting sleep the next night).
In the 5 years that followed, he continued to benefit enormously from diphenidine, and he continues to take it every 12 days. Although after a while there was some tolerance and it no longer led to complete resolution of symptoms, he continues to find it well worth it. The dosage has slowly had to be raised from 60 mg 5 years ago to around 125 mg currently (by about 16% per year) to maintain a similar level of acute effects. We’ve also discovered that adding 200-250 mg of black pepper (which contains piperine, a bioavailability enhancer) in the same capsule makes it a lot more potent.


I wonder how many people commit suicide every year who could have been saved by something like this… granted not a lot of research has been done on using NMDA-receptor antagonists for this indication and there may be unknown risks, but when someone has severe depression that cannot be managed effectively with approved medication or is even ready to commit suicide, I think there’s a very strong case to be made that something like diphenidine should be tried, at least as a last resort.

Of course it’s important to be careful not to use substances like this too frequently, since they have been known to lead to addiction with very frequent use (although, having tried it myself, I personally don’t see how the effects of this particular one could be considered enjoyable by most people). But for my husband, there has been no addiction or any other ill effect over 5 years of regular use.
He is now also taking the MAOI tranylcypromine (Parnate); based on the limited research that has been done, and our experience, there is no interaction between it and diphenidine, although there probably would be with various other dissociatives.

Another example with four gram:

We’ve all been there brother. I lost the best girl I’ve ever met, an amazing job at a really well respected business and a lot of good friends through my previous alcoholism. You just have to push through it man. Even making the tiniest changes in your life will snowball into a world of difference, life always finds a way of working itself out.

1985 Article – Food and Psychiatry

Interesting article all the way back from 1985 on correlation between specific foods and psychiatric symptoms. For some reason though diet is still not really discussed with patients by psychiatrists. I assume general diet concerns do get mentioned – such as is the patient eating too much sugar, not enough protein, is malnourished, etc., but in my experience no psychiatrist had discussed with me specific ingredients that could potentially increase anxiety.

I would say that diet was not discussed much with me except some questions such as whether I ate full meals. I did eat full meals, I never had trouble eating, but no one asked whether I experienced any abdominal pain after meals and what my meals contained. I was asked whether I drank alcohol, I did not, but no one asked how many Starbucks drinks I had, and how much sugar each drink contained. I never thought that I was overconsuming sugar, I was not checking how many grams of sugar per day I was eating, which was probably over 100 grams. I have also never heard at that point, during my initial psychiatric visits, that there could be any possible link between a food component and mood. No psychiatrist so far has ever mentioned this to me, nor agreed with me that it was possible. I, on the other hand, am quite certain that cow dairy protein causes intrusive thoughts and anxiety for me and that a high lactose consumption decreases my energy and increases depressive symptoms.

Even though for some reason psychiatrists right away focus on prescribing medication, without any discussion of changes in diet potentially improving symptoms, there has been numerous papers pointing to a link between specific foods and psychiatric issues, also links between diet causing changes in gut bacteria, and in turn affecting mood and anxiety. It was interesting to find this short article from 1985 describing research on certain foods and possible link to mood disorders. The study was performed by the University of Chicago.

https://www.chicagotribune.com/news/ct-xpm-1985-09-08-8502280775-story.html

“Some of the first solid evidence indicating that certain foods can cause mood disorders in some people has been found in a University of Chicago study that implicates a faulty immune system as the culprit.

”A lot of people said it was impossible to know if food related mood changes were real or if they were all in a person`s mind,” said Dr. John Crayton, associate professor of psychiatry. ”We have found that it may not be all in their minds.”

The findings tend to support the contention of other doctors, such as Dr. Theron Randolph, that depression, anxiety, irritability, inability to concentrate and other mood disorders may be caused by such foods as sugar, milk, wheat, corn, and chocolate, he said.

While other studies have suggested mood changes from food, the U. of C. study is the first to show major changes in the function of the immune system that occur with behavioral changes after certain foods are consumed, said Crayton.

Wheat and milk produced the most marked reactions, while chocolate was less reactive, he added. The immune reactions should not be confused with traditional food allergies that produce rashes or hives, he explained.

Neural Network Predicting Subreddit Karma and Comments for Mental Health Topics

Introduction:

Problem Description:

This project analyses whether the attributes of the subreddit posts’ content are predictive of social support (karma points and number of comments) posts receive.

Context of the Problem:

Mental health problems tend to go under-reported and under-addressed, which places a high social-economic cost on the society. Research shows that social support is valuable for improving quality of life for people with mental health illnesses.

This project examines what content attributes of anonymous social media posts on reddit platform elicit higher levels of social support in the form of karma points and comments.

Limitation About other Approaches:

We have examined two most relevant papers on the topic, [1] and [2]. Neither Schrading, N. et al. [1], nor De Choudhury, M. & De, S. [2] use subreddit indicator variables (i.e., indicators for schizophrenia, depression, anxiety, etc.) in their analysis. It is likely that posts are treated differently, depending on a mental illness indicated (as per Mann, C. E. & Himelein, M. J. [3], “stigmatization of schizophrenia was significantly higher than stigmatization of depression”). Also, De Choudhury, M. & De, S. [2] used a resource intensive manual labelling approach to arrive at keywords.

Solution:

In this project, the analysis includes subreddit indicators in the neural network model predicting social supports for reddit posts. The figure below shows statistics for subreddit indicators for a sample dataset. It can be seen that the mean for the target variables is very different between subreddits.

Additional inputs include counts of frequent bigrams and emotion labelling of keywords. Emotion labelling was done through an NLP approach, using an already existing emotions lexicon.

Background:

ReferenceExplanationDataset/InputWeakness
Schrading, N. et al. [1]They trained and compared multiple classifiers on content of reddit posts to determine the top semantic and linguistic features in detecting abusive relationships. Subreddit posts with comments that focus on domestic abuse, plus subreddit posts with comments unrelated to domestic abuse as a control set.Future studies could be implemented on datasets from multiple websites to compare online abuse patterns across forums.
De Choudhury, M. & De, S. [2]They trained a negative binomial regression model on content of reddit posts (i.e., length, use of 1st pronoun, relationship words, emoticons, positive and negative words, etc.) to predict social support variables (karma points and number of responses).Posts, comments and associated metadatafrom several mental health subreddits, including alcoholism, anxiety, bipolarreddit, depression,mentalhealth, MMFB (Make Me Feel Better), socialanxiety, SuicideWatch.– Out of the top 15 discussed predicting variables used in the regression model, the highest coefficient have the intercept and the use of the 1st pronoun. – There is no discussion about correlations between predicting variables (for example, the study uses such variables as negative emotion, positive emotion and number of emoticons, which could be correlated).

Methodology

Schrading, N. et al. [1] reported that out of the post features they analyzed, ngrams were the most predicting ones when detecting abusive relationships in reddit posts. De Choudhury M. & De, S. [2] tried to predict social support variables for mental health related reddit posts using post length, emoticons, unigrams, variables built based on presence of emotionally charged unigrams, etc.

In this project, to predict social support variables (scores and number of comments) for mental health related reddit posts, the model was built using the neural networks approach and with emotionally charged unigrams as indicators of 10 different emotions, emotions count, post length, part of speech frequencies (counts of verbs, pronouns, adverbs and adjectives), count of first pronouns, number of question marks, post length, count of frequent bigrams, and subreddit indicators as predictive variables.

Below is the list of the input used in the models for predicting the score and number of comments:

‘anger’, ‘anticipation’, ‘disgust’, ‘fear’, ‘joy’, ‘negative’, ‘positive’, ‘sadness’, ‘surprise’, ‘trust’,’len_post’, ‘len_post_orig’, ‘first_pronoun_count’, ‘freq_bigram_count’, ‘q_count’, ‘verb_count’, ‘pronoun_count’,’adverb_count’, ‘adjective_count’, Subreddit(display_name=’BipolarReddit’), Subreddit(display_name=’Anxiety’), Subreddit(display_name=’depression’), Subreddit(display_name=’schizophrenia’), Subreddit(display_name=’bipolar’), Subreddit(display_name=’mentalhealth’), Subreddit(display_name=’depression_help’), Subreddit(display_name=’BPD’), Subreddit(display_name=’socialanxiety’), Subreddit(display_name=’mentalillness’)

Emotion lexicon

A public lexicon dataset was used to determine counts of specific emotion words. The NRC Emotion Lexicon is a list of English words and their associations with eight basic emotions (anger, fear, anticipation, trust, surprise, sadness, joy, and disgust) and two sentiments (negative and positive).

https://nrc.canada.ca/en/research-development/products-services/technical-advisory-services/sentiment-emotion-lexicons

Below are examples of posts with most frequent bigrams highlighted. Frequent bigrams ‘feel like’, ‘feels like’ are consistent with the finding by De Choudhury M. & De, S. [2] of frequent unigrams related to emotional expression.

N-grams

For this project we identified most popular bigrams and trigrams. The counts of most frequent bigrams and trigrams were used while testing various models, and the most useful data turned out to be counts of most frequent 16 bigrams, which were used as one of the inputs to the model.

Below is the list of the most popular bigrams used and a few examples of their usage in raw texts.


Implementation

Data Collection

Obtained data via a public API from 10 mental health subreddits: “depression”, “anxiety”, “bipolarreddit”, “mentalhealth”, “socialanxiety”, “depression_help”, “bipolar”, “BPD”, “schizophrenia”, and “mentalillness”.

  • First, checking 10 hot posts for each subreddit indicator
  • Collecting data

top_posts dimensions: (9949, 9)

hot_posts dimensions: (9890, 9)

new_posts dimensions: (9896, 9)


Preparing the Data

reddit data scraping is limited to a maximum of 1000 records per subreddit per each of 3 post categories (“hot”, “top” and “new” posts). To maximize the dataset size, we collected posts of all 3 categories and removed duplicate records that have categories overlapping. As mentioned by De Choudhury M. & De, S. [2], reddit posts reach most of their commentary within the first 3 days from being posted. Thus, we removed posts that were “younger” than 3 days old at the data collection time.

  • Removing stop words and punctuation
  • Created ngrams (bigrams, trigrams and fourgrams)
  • Applying smoothing for trigrams and removing extra words referring to posts, unrelated to this analysis (i.e., moderator’s posts)
  • Creating emotions dataframe, count POS (part of speech) tags, and topic/subreddit dummies

Reddit score prediction model – results based on first layer weights:
In a multi-layer neural network it is hard to interpret raw internal weights, but it looks like mental health-specific variables (such as indicators for fear or surprise, or subreddit indicators) are more important than generic (such as verb count or the length of the post, which looks to be least useful). In particular most subreddit indicators (“depression_help”, “depression”, “schizophrenia”, etc.), which were not used in other papers, are in top 10 for total weights.


Conclusion and Future Direction

In conclusion, neural network results showed that the model inputs do have some predictive power for social response variables ‘number of comments’ and ‘score’, as the sums of weights for input variables were found to be greater than zero. Also during model testing, starting with fewer input variables, adding the rest of the input variables reduced the absolute mean errors.

One of the future improvements for this analysis could be incorporating a variable that indicates whether the post is from a throwaway account or an existing long-term reddit account, as De Choudhury, M. & De, S. [2] mention that reddit’s throwaway accounts allow individuals to express themselves more honestly and to ‘discuss uninhibited feelings’.

Also, while content and length of post titles and how users action on posts (click, read, and reply) might have an impact on post’s score, neither of the research papers cited, nor this analysis used title analysis as a part of the model. As such adding title attributes and post actioning statistics variables to the model could be a potential area for improvement.


References:

[1]: Schrading, N., Alm, C. O., Ptucha, R., & Homan, C. M. An Analysis of Domestic Abuse Discourse on Reddit, The 2015 Conference of Empirical Methods in Natural Language Processing, Lisbon, Portugal, September 2015, pages 2577-2583.

[2]: De Choudhury, M. & De, S. Mental Health Discourse on reddit: Self-Disclosure, Social Support, and Anonymity. Eights International AAAI Conference on Weblogs and Social Media, North America, May 2014, pages 71-80. Available at: https://www.aaai.org/ocs/index.php/ICWSM/ICWSM14/paper/view/8075/8107.

[3] Mann, C. E. & Himelein, M. J. Factors Associated with Stigmatization of Persons with Mental Illness. Psychiatric Services, Vol. 55, No. 2., February 2004, pages 185-197. Available at: https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.55.2.185.

Great toxicology YouTube channel… and celiac disease misdiagnosed as paranoid schizophrenia?

A really great guy – a toxicologist with his own YouTube channel telling real life ER stories. Here is a link to one of his episodes. A woman with delusions read on the internet about a specific colon cleanse, which led her to drinking 1 liter of soy sauce in two hours. 1 liter of soy sauce contains 200 grams of salt. What happened then to her brain? Why did she choose to drink the soy sauce in the first place? Was it due to paranoid schizophrenia, or was something else also going on?

A Woman Drank 1 Liter Soy Sauce Colon Cleanse In 2 Hours. This Is What Happened To Her Brain.

It’s not always about some serotonin imbalance… let’s pay more attention to neurology

I get articles recommended by my Anroid phone, I assume based on an algorithm that performs some sort of machine learning model based on my browsing history. I actually like this feature, because I find the recommendations often actually interesting. So thumbs up for machine learning!

Today I came across an article about a woman with recurring severe depression, and in her case for many years no medical tests were performed, and her psychiatrist kept prescribing her different kinds of antidepressants, without considering any other potential causes or treatments. This reminds me of my own experience with autoimmune encephalitis, luckily I did get treated after two years from my first hospitalization in the psychiatric unit, not after more than a decade. In the case of this woman, eventually a brain tumour of a significant size was found, in 2019. She had recurring episodes of severe depression starting from 2002. As I understood, it’s not possible to find out at this point when the tumour actually originated, and whether it was the cause of depression, but it’s clear from the story that after the treatment of the tumour, the woman’s life significantly improved – she went back to her scientific career, finding a job as a scientist in a biotech firm. She got married, resumed activities she used to enjoy, and was weaned off antidepressants. Given these observations, it seems to me that the tumour and her depression were not just a correlation, but there is a causation here.

Unfortunately it seems rare that psychiatrists would order any medical tests even in the case of treatment resistant depression. I had to switch a few family doctors, and in the end went to one whom my mother knows for decades, and she agreed to order an MRI for me, and blood tests for thyroid hormones, infections, and antibodies. My psychiatrist never proposed to do any tests. Only after I received back the results, and some of them were abnormal, specifically the antibody levels, I was able to refer myself to neurology. Seems that we, psychiatric patients, have to often be very proactive in demanding medical testing. For this reason I think it is important to be aware of cases where depression was resistant to standard antidepressant treatments, but later on a specific medical cause was found.

Not ‘just depression.’ She seemed trapped in a downward mental health spiral.

  • Blaine’s first bout of depression occurred in 2002 when she was in her first year of a doctoral program in materials science at the University of California at Santa Barbara
  • She was prescribed Prozac, recovered and returned to California. Six months later she left school for good and found full-time work in a coffee shop
  • In 2005, Blaine began working as a research associate at a polymer film company
  • Her illness seemed to follow a pattern: after a few years the antidepressant inexplicably stopped working; her psychiatrist would prescribe a new drug and she would get better
  • In 2018 Blaine had lost her job of 10 years and she seemed trapped in a downward spiral
  • She left her job as a research scientist in 2018 and began working as a server at a variety of restaurants in Charlottesville
  • By late summer Blaine had developed what she assumed were frequent migraine headache, sometimes her balance was off and she complained that her vision had deteriorated and she needed new glasses, psychiatric medication was not effective
  • On Jan. 2 2019, a hospital psychiatrist doubled the dose of her antidepressant
  • Several days later Blaine suddenly collapsed and began vomiting, at the ER where she was diagnosed with a “vasovagal episode” — fainting that results from certain triggers including stress
  • Her sister and mother insisted doctors take a closer look, Blaine underwent an MRI scan of her brain
  • MRI findings showed a tumor the size of an orange had invaded the right frontal lobe of Blaine’s brain, there was evidence of herniation, a potentially fatal condition that occurs when the brain is squeezed out of position
  • During a 10-hour operation, University of Virginia neurosurgeon Ashok Asthagiri removed a grade 2 astrocytoma, a slow-growing malignancy that he said “could have been there for years.”
  • “especially in the setting of mental illness,” the neurosurgeon cautioned, “it is easy to disregard symptoms that maybe should be evaluated.” Doctors “need to be vigilant. Once [a patient] gets labeled, everything is viewed as a mental health problem.”
  • After recovering from surgery, Blaine underwent radiation and chemotherapy; she finished treatment in December 2019
  • Recently Blaine was hired as a scientist at a biotech firm. She has resumed the activities she previously enjoyed: rowing, cooking and walking her dogsHer psychological health has improved significantly and her new psychiatrist is weaning her off her antidepressant

More articles on this subject:

Why are women with brain tumours being dismissed as attention-seekers?

  • Women with serious medical conditions are more likely than men to have their symptoms attributed to depression and anxiety
  • Historically, women’s health has been viewed with a “bikini approach”, the primary focus being breasts and the reproductive system
  • One study drew data from 35,875 cardiac patients, 41% of them women, across nearly 400 US hospitals. It found that women faced a higher risk of dying in hospital, subsequent heart attacks, heart failure, and stroke. They were less likely to have an ECG within 10 minutes and to receive crucial medications. And women younger than 65 years old are more than twice as likely to die from a heart attack than men of the same age
  • A Bias Against Women in the Treatment of Pain, found that women were less likely to receive aggressive treatment when diagnosed, and were more likely to have their pain characterised as “emotional,” “psychogenic” and therefore “not real”

Woman misdiagnosed with anxiety actually had a brain tumour the size of a tennis ball

  • Laura Skerritt, 22, began suffering migraines, sickness and psychosis and was told her symptoms were caused by anxiety, depression – and even bi-polar disorder
  • She was prescribed anti-depressants but the medication had no effect on her condition which continued to deteriorate
  • By November 2018, the young swimming instructor, from Templecombe, Somerset, was struggling to walk and was having seizures.
  • A scan at Yeovil District Hospital revealed a tennis ball-sized brain tumour

Brain tumor revealed by treatment-resistant depression

  • The 54-year-old woman had been depressed for 6 months, but treatment with the antidepressant fluoxetine and the anti-anxiety medication bromazepam was discontinued after 5 months because these were not found to be effective
  • She had suicidal thoughts, admitted self-accusation due to ineffectiveness in her job, and lost interest in her usual past times
  • A neurological examination was normal. However, a brain CT scan and MRI revealed meningiomatosis with a giant meningioma–the most common primary benign brain tumour–in her left frontal lobe
  • The patient underwent emergency surgery, and made a recovery. The depressive symptoms disappeared within one month
  • Recommendation – brain scan should be performed if the patient presents a late onset of depressive syndrome after 50 years of age, if a diagnosis of treatment-resistant depression is made or if the patient is apathetic

Improvement with lithium chloride supplement

I have extensive experience with psych meds, first prescription being abilify and seroquel in 2015, then mirtazapine, wellbutrin, risperidone, cymbalta, trazodone, and more. None of the meds worked for me. Last trial was of fluoxetine in November, which caused severe insomnia on only 10mg, and panic attacks. In March I also tried Zembrin which is a serotonin reuptake inhibitor (SRI). Zembrin also caused panic attacks for me and increased psychotic symptoms. I decided I don’t want to touch any additional SSRIs, SNRIs, nor SRIs.

I have also tried shrooms microdosing. I found that 1-4 gram occasional trips are better for me as microdosing makes me fatigued. While on shrooms though, a lot of thoughts came to me about reducing my caffeine intake and lithium. Lithium was mentioned to me several years ago by one consulting psychiatrist, but was never prescribed. I asked my current psych about it, but she refused to prescribe it.

While I was on Zembrin in March, by mid-month I started to get more paranoid and psychotic, as I was also in luteal phase of my cycle. A lot of women with mental illness experience PME – premenstrual exacerbation of symptoms. I unfortunately experience that as well. Mid-March I decided to stop Zembrin and any other supplements I was trying – mushroom coffee, rhodiola rosea, St. John’s Wort tea. I also stopped drinking coffee in general as I think it exacerbates my mood swings. I only continued with lithium orotate supplement that I purchased, but I stopped it as well as it seemed that it was causing more frequent urination. As I stopped these supplements and my period stabilized, my mental state somewhat stabilized to a point where I could better observe myself and think about what to do next. I decided that I still wanted to try lithium, but purchased a supplement which was in a different form – liquid which contains lithium chloride, instead of the lithium orotate tablets. I chose lithium chloride because there is more existing research on it than on lithium orotate. I also made homemade CBD oil from the Avidekel strain.

Well it has been over two months since mid-March and I’ve hard a lot more days which were just ‘alright’ instead of being a struggle with intrusive thoughts and depression. I’ve felt more calm and was able to read more throughout these two months, actually finished two books, on my third now. So in general a beneficial experience so far, will see how it goes.

Great psychiatry podcast. Impresionante podcast de psiquiatría.

Just wanted to post a link to a very interesting psychiatry podcast. For now I have specifically listened to the interviews with Dr. Cummings and I really enjoyed all the episodes. Dr. Cummings seems to be a very knowledgeable psychiatrist and provides a lot of information about areas of the brain, neurotransmitters, psychopharmacology. Currently I drive to work and back on a daily basis and I have been listening to the episodes in the car.

PSYCHIATRY & PSYCHOTHERAPY PODCAST

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Solo quería publicar un enlace a un podcast de psiquiatría muy interesante. Por ahora he escuchado específicamente las entrevistas con el Dr. Cummings y realmente disfruté todos los episodios. El Dr. Cummings parece ser un psiquiatra muy conocedor y comparte mucha información sobre áreas del cerebro, neurotransmisores, psicofarmacología. Actualmente conduzco diariamente al trabajo y de regreso y he estado escuchando los episodios en el auto.

1 gram of shrooms helped me realize that I have a caffeine addiction which negatively impacts my BPD symptoms

I recently did 1 gram of shrooms and even though it was not such a dose that I would see any visuals, it was a very useful experience for me.

I have been diagnosed with having borderline personality disorder traits, which then lead to depression and anxiety.

Caffeine definitely is not the cause of my BPD symptoms, but the recent shrooms experience helped me realize that I do have a caffeine addiction which negatively impacts my life. I think I have been denying it, saying to my self that – it’s just caffeine, it’s not like I do illegal stimulant drugs. Shrooms helped me accept that brain biochemistry doesn’t care about the legal status of caffeine. I had to accept that even though being completely legal and sold everywhere, I do get mood crashes from caffeine as I would from cocaine (which I tried a long time ago in high school). I can have a few cups of tea in a day, but I do like to drink several in a row, I also like coffee and yerba mate. I have been observing my symptoms for a while and I do notice that I get dysphoric later on in the day if I have coffee or yerba mate in the morning, especially on an empty stomach. I also get more paranoid about being alone, not having any friends (even though I do have several good friends), etc. I knew this for a while, just shrooms helped me accept that I really should do something about the caffeine addiction as it really negatively impacts my mood and sense of self.

I don’t think I need to completely give up tea, but I did have to quit coffee and yerba mate, which actually did help me to have a more even mood throughout the day. I also have been taking CBD oil that I made at home, I think that also helps with anxiety and mood swings. I will still have a few cups of black tea, which I love, but I need to limit myself at only three-four cups of tea per day, not very strong.

This realization might seem not very important, maybe some people expect some enlightenment or spiritual experiences from shrooms, but whenever I do shrooms I actually feel very logical and I am able to see myself from a side. I was able to analyze the correlation between my caffeine consumption and my BPD symptoms in a more unbiased way and this is actually an important realization for me, as BPD symptoms really worsen my quality of life, so if something like reducing caffeine can help – it’s not a breakthrough for humanity, but a big improvement for me. And also hoping to help anyone else reading it affected by BPD – I do believe caffeine might worsen psychiatric symptoms for some individuals.

Observations on calcium and PMS/PMDD symptoms. Observaciónes sobre calcio y síntomas de SPM/TDPM.

After several visits to the doctor, I finally received references for hormone blood tests. I definitely do not regret spending time on doctor visits and laboratory tests, because it was really interesting to observe hormonal fluctuations throughout the cycle. The results clearly showed that my progesterone level quickly rises during the luteal phase, close to 50 nmol/l. One day/several days before menstruation, my progesterone drops to 1.8 nmol / l. At the peak, my progesterone was close to the top threshold. The level was not exactly abnormal, but research indicates that some women react negatively to changes in hormone levels.

Premenstrual dysphoric disorder (PMDD)  – a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. The exact cause of PMDD is not known. It may be an abnormal reaction to normal hormone changes that happen with each menstrual cycle. The hormone changes can cause a serotonin deficiency.

What is premenstrual dysphoric disorder (PMDD)?

I also came across an article in the Journal of Clinical Endocrinology & Metabolism, which states that there may be cyclical changes in calcium metabolism during the menstrual cycle in women with PMDD. Interesting points from the article:

  • Irritability, anxiety, and mania have been associated with hypocalcemia, whereas increased calcium concentrations have been noted in some patients with depression.
  • Three separate investigations have demonstrated that the dysphoria, anxiety, depression, and somatic symptoms of PMS all respond favorably to either increased dietary calcium intake or daily calcium supplementation
  • Increased calcium intake proved to benefit significantly all four major categories of PMS symptoms (negative affective symptoms, water retention symptoms, food cravings, and pain symptoms).
  • When compared with asymptomatic women, women with PMS were shown to have exaggerated fluctuations of the calcium-regulating hormones across the menstrual cycle with evidence of vitamin D deficiency and secondary hyperparathyroidism.

For the authors’ study – a total of 129 women completed the timed biochemical and hormone evaluation with 115 (68 PMDD and 47 controls) providing hormone data meeting criteria for analysis. Results – Although the screening baseline 24-h urine calcium was not found to be significantly different between the groups, the random urine calcium collections during hormonal sampling were significantly lower in the PMDD group compared with controls.

In the PMDD group, total serum calcium was found to be significantly lower at 3 points: at follicular phase 1 (menses) (9.17 ± 0.55 mg/dl, P < 0.001) compared with later phases 2, 3, and 4; at midcycle phase 3 (9.25 ± 0.55 mg/dl) compared with phase 2 (9.33 ± 0.58 mg/dl, P = 0.036); and during late luteal phase 5 (9.18 ± 0.73 mg/dl) compared with phase 4 (9.27 ± 0.55 mg/dl, P = 0.018). Ionized calcium did not fluctuate as dramatically as did total calcium, but a large difference was noted between early phases 1 and 2 of the menstrual cycle again with phase 1 having the lowest ionized calcium concentration (1.166 ± 0.072 vs. 1.175 ± 0.073 mmol/liter, P = 0.069). Intact PTH peaked in follicular phase 2 (56.9 ± 35.3 pg/ml) following the decline in serum calcium during phases 1 and 5. Follicular phase intact PTH was significantly higher than luteal phase concentrations and reached its nadir in luteal phase 4 (50.9 ± 34.4 pg/ml, P < 0.01). In conjunction with the follicular phase rise in intact PTH, serum pH was lower in the follicular phase 1 and 2 compared with midcycle phase 3 and luteal phase 4 (phase 1, 7.36 ± 0.004 vs. phase 3, 7.37 ± 0.023; P = 0.015; data not shown). The concentration of 1,25(OH)2D declined precipitously in luteal phase 4 and was significantly lower compared with all earlier phases (phase 4, 45.0 ± 27.5 vs. phase 3, 49.6 ± 27.5 pg/ml; P = 0.006). Urine calcium and 25OHD concentrations did not appear to vary between individual phases in the PMDD group.

Cyclical Changes in Calcium Metabolism across the Menstrual Cycle in Women with Premenstrual Dysphoric Disorder

 

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Después varias visitas al doctor, finalmente recibí referencias para análisis de sangre de hormonas. Definitivamente no me arrepiento de pasar tiempo en las visitas al médico y las pruebas de laboratorio, porque fue realmente interesante observar las fluctuaciones hormonales a lo largo de ciclo. Los resultados mostraron claramente que mi nivel de progesterona sube rápidamente durante la fase lútea, cerca de 50 nmol / l. Un día/ varios días antes la menstruacion, mi progesterona baja a 1.8 nmol / l. En el pico, mi progesterona estaba cerca del umbral superior. El nivel no era exactamente anormal, pero la investigación indica que algunas mujeres reaccionan negativamente a los cambios en los niveles hormonales.

Trastorno disfórico premenstrual (TDPM): una forma mucho más grave de síndrome premenstrual (SPM). Puede afectar a mujeres en edad fértil. La causa exacta de TDPM no se conoce. Puede ser una reacción anormal a los cambios hormonales normales que ocurren con cada ciclo menstrual. Los cambios hormonales pueden causar una deficiencia de serotonina.

También me encontré con un artículo en el Journal of Clinical Endocrinology & Metabolism, que establece que puede haber cambios cíclicos en el metabolismo del calcio durante el ciclo menstrual en mujeres con TDPM. Puntos interesantes del artículo:

  • La irritabilidad, la ansiedad y la manía se han asociado con hipocalcemia, mientras que se han observado concentraciones elevadas de calcio en algunos pacientes con depresión.
  • Tres investigaciones separadas han demostrado que la disforia, la ansiedad, la depresión y los síntomas somáticos del síndrome premenstrual responden favorablemente al aumento de la ingesta de calcio en la dieta o a la suplementación diaria de calcio.
  • El aumento de la ingesta de calcio demostró beneficiar significativamente las cuatro categorías principales de síntomas de SPM (síntomas afectivos negativos, síntomas de retención de agua, antojos de alimentos y síntomas de dolor).
  • En comparación con las mujeres asintomáticas, las mujeres con síndrome premenstrual mostraron fluctuaciones exageradas de las hormonas reguladoras de calcio a lo largo del ciclo menstrual con evidencia de deficiencia de vitamina D e hiperparatiroidismo secundario.

Para el estudio de los autores, un total de 129 mujeres completaron la evaluación bioquímica y hormonal cronometrada con 115 (68 TDPM y 47 controles) que proporcionaron datos hormonales que cumplían los criterios para el análisis. Resultados: aunque no se encontró que el calcio basal en orina de 24 h para la detección sea significativamente diferente entre los grupos, las recolecciones aleatorias de calcio en orina durante el muestreo hormonal fueron significativamente más bajas en el grupo TDPM en comparación con los controles.

En el grupo TDPM, se encontró que el calcio sérico total era significativamente más bajo en 3 puntos: en la fase folicular 1 (menstruación) (9.17 ± 0.55 mg / dl, P <0.001) en comparación con las fases posteriores 2, 3 y 4; en la fase 3 del ciclo medio (9,25 ± 0,55 mg / dl) en comparación con la fase 2 (9,33 ± 0,58 mg / dl, P = 0,036); y durante la fase lútea tardía 5 (9,18 ± 0,73 mg / dl) en comparación con la fase 4 (9,27 ± 0,55 mg / dl, P = 0,018). El calcio ionizado no fluctuó tan dramáticamente como el calcio total, pero se observó una gran diferencia entre las fases tempranas 1 y 2 del ciclo menstrual nuevamente con la fase 1 con la concentración más baja de calcio ionizado (1.166 ± 0.072 vs. 1.175 ± 0.073 mmol / litro , P = 0,069). La PTH intacta alcanzó su punto máximo en la fase folicular 2 (56,9 ± 35,3 pg / ml) después de la disminución del calcio sérico durante las fases 1 y 5. La PTH intacta en la fase folicular fue significativamente mayor que las concentraciones de la fase lútea y alcanzó su punto más bajo en la fase lútea 4 (50,9 ± 34,4 pg / ml, P <0,01). Junto con el aumento de la fase folicular en la PTH intacta, el pH sérico fue menor en la fase folicular 1 y 2 en comparación con la fase 3 del ciclo medio y la fase lútea 4 (fase 1, 7.36 ± 0.004 vs. fase 3, 7.37 ± 0.023; P = 0.015 ; datos no mostrados). La concentración de 1,25 (OH) 2D disminuyó precipitadamente en la fase lútea 4 y fue significativamente menor en comparación con todas las fases anteriores (fase 4, 45.0 ± 27.5 vs. fase 3, 49.6 ± 27.5 pg / ml; P = 0.006). Las concentraciones de calcio en la orina y 25OHD no parecen variar entre las fases individuales en el grupo TDPM.

Vitamins before antidepressants . Vitaminas antes de los antidepresivos.

Texto en español a continuación.

This post will not be against antidepressants. I only want to share my experiences, in case they might help someone. I found out the hard way that eating healthy and obtaining all the basic vitamins is necessary (but not sufficient) for mood stability and emotional regulation. Unfortunately not all doctors or psychiatrists check for vitamin and mineral deficiencies before prescribing antidepressants. There is a lot of research indicating that many vitamins and minerals are important for the functioning of neurotransmitters. So I am not stating ‘always vitamins instead of antidepressant’, but in my opinion as a patient, diet should always be reviewed first. Especially if you have any gastrointestinal problems, family history of gastrointestinal issues, or you live in a northern country. Also if you are vegan, vegetarian, or have any other food restrictions.

I have written in my previous posts about getting a diagnosis of autoimmune encephalitis, but let’s set that aside for now. I did end up being referred to a neurologist, but in this post I want to focus on my experience with psychiatrists. When I was referred to a psychiatrist by the emergency department, several blood tests were performed. Blood glucose level, iron level, thyroid stimulating hormone (TSH) test results were sent to the psychiatrist. Since these test results came back normal, right away the psychiatrist prescribed me mirtazapine.

Mirtazapine did not help my mood and I only gained weight on it and had trouble waking up in the morning. Therefore, my dissatisfaction with this approach is that several important blood tests were not prescribed. For example, I live in a northern country, therefore it is possible to be deficient in vitamin D. They also didn’t ask me about my diet, but a spicy diet can lead to deficiencies in B vitamins and omega 3 fatty acids. Additional point – my blood glucose was checked only once, it was not proven how I react to eating carbohydrates.

Later I discovered that I was deficient in vitamin D, that my blood sugar level would jump too high after eating refined carbohydrates, and I was not getting enough folic acid and calcium. By not performing the necessary laboratory tests, the doctor lost a lot of time and delayed my treatment. I was also taking unnecessary high doses of antidepressants, which were not helping.

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Esta publicación no será contra los antidepresivos. Solo quiero compartir mis experiencias, en caso de que puedan ayudar a alguien. Descubrí por las malas que comer sano y obtener todas las vitaminas básicas es necesario (pero no suficiente) para la estabilidad del estado de ánimo y la regulación emocional. Desafortunadamente, no todos los médicos o psiquiatras verifican las deficiencias de vitaminas y minerales antes de recetar antidepresivos. Hay mucha investigación que indica que muchas vitaminas y minerales son importantes para el funcionamiento de los neurotransmisores. Por lo tanto, no estoy diciendo “siempre vitaminas en lugar de antidepresivos”, pero en mi opinión como paciente, la dieta siempre debe revisarse primero. Especialmente si tiene problemas gastrointestinales, antecedentes familiares de problemas gastrointestinales o si vive en un país del norte. Además, si eres vegano, vegetariano o tienes otras restricciones alimenticias.

He escrito en mis publicaciones anteriores sobre el diagnóstico de encefalitis autoinmune, pero dejemos eso de lado por ahora. Terminé siendo referido a un neurólogo, pero en esta publicación quiero centrarme en mi experiencia con los psiquiatras. Cuando el departamento de emergencias me remitió a un psiquiatra, me realizaron varios análisis de sangre. Los resultados de las pruebas de nivel de glucosa en sangre, nivel de hierro y hormona estimulante de la tiroides (TSH) se enviaron al psiquiatra. Como los resultados de estas pruebas mostraron ser normales, de inmediato el psiquiatra me recetó mirtazapina.

Mirtazapine no ayudó mi humor y solo subí de peso, y tuve dificultad para despertar en las mañanas. Entonces, mi insatisfacción con este enfoque está que varios análisis de sangre importantes no fueron prescritas. Por example, vivo en un país del norte, por lo tanto está posible estar deficiente en vitamina D. También no me preguntaron sobre mi dieta, pero una dieta espicifica puede conducir a las deficiencias en vitaminas B y ácidos grasos omega 3.  Punto adicional – mi glucemia se comprobó solo una vez, no fue probado cómo reacciono al comer carbohidratos.

Mas tarde descubrí que era deficiente en vitamina D, que mi nivel de azúcar en la sangre saltaria demasiado alto después de comer carbohidratos refinados, además no estaba recibiendo suficiente ácido fólico y calcio. Al no realizar las pruebas de laboratorio necesarias, el doctor perdió mucho tiempo y retrasó mi tratamiento. Además estaba tomando dosis altas innecesarias de antidepresivos, que no estaban ayudando.