September 19, 2022

By Don Sapatkin

Good Monday morning, MindSite news readers! Are you embarrassed by a recent bout of oversharing? We have a story that may help. Atypical depression in women turns out to be, well, typical. California Gov. Gavin Newsom signs two controversial bills related to mental health into law. Plus: Think twice – at least – about using cannabis while pregnant. Read those stories and more in today’s Daily.

How to nurse a vulnerability hangover

via Twitter

If you’re feeling anxiety, shame and regret after saying something a bit too personal on last night’s date or at the office, you may be suffering from a non-diagnosable but easily identifiable condition, the New York Times reports. The good news? “It’s probably just fine.”

The catchy term “vulnerability hangover” was coined by Brené Brown, a research professor and best-selling author who studies human connection at the University of Houston. As humans, we have competing needs “to build connection with other people by being our real selves, but also to conform to social norms, like not sharing too much,” says Emma Seppala, science director of the Center for Compassion and Altruism Research and Education at Stanford University. And simultaneously balancing the need for intimacy with fears of judgment or rejection can be tricky.

So, how do you prevent an uncomfortable vulnerability hangover from becoming debilitating?  According to the Times article, you should put it into perspective: Others probably aren’t thinking about your oversharing as much as you are, a phenomenon called “the beautiful mess effect.” Know that you may have helped someone: studies show that vulnerability can increase closeness and build trust. Also, reframe it as a learning experience: Curiosity (why did I share that?) is better than self-flagellation. Consider making a plan for next time: Talking about ourselves feels good, but rusty pandemic social skills and impaired judgment from alcohol can take connection cravings too far. The bottom line: Be aware of what you do not want to share.

Still, don’t let a vulnerability hangover scare you away from intimacy. More vulnerability often means better communication. Being comfortable with vulnerability’s aftereffects, Seppala said, “requires courage initially, but then it’s like this muscle you build.”

Atypical depression in women may be more common than we think

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Despite the name, “atypical depression” actually is common in women but often is misdiagnosed, psychiatrist Mark Rego writes in a Psychology Today blog. Misunderstood symptoms lead to delays in treatment, especially among young women and adolescents, he says: “Atypical depression is important to recognize as it is commonly what is wrong with the ‘troubled teenage girl.’” 

Atypical depression – also known as “depression with atypical features” – affects an estimated 18% to 36% of people with depressive disorder. It is far more likely to occur in women than men, typically begins at an earlier age (teens and 20s) and lasts longer than typical depression. Rego, an assistant clinical professor at the Yale School of Medicine and author of Frontal Fatigue, traces the first description of the condition back to 400 B.C., when depressive symptoms were known as melancholia. The psychiatric profession still describes someone who barely moves or shows pleasure and appears flat, worried and unhappy as having melancholia, or serious typical depression. What they don’t show is reactivity.

In atypical depression, on the other hand, reactivity is not only present but sometimes amplified. A young woman may laugh at jokes but react to a perceived rejection or insult – emphasis on perceived – with an explosive emotional response, a symptom of  a condition called rejection sensitivity, which leads to negative feelings (“sad, angry, blah”) and can cause constant conflict with others, Rego explains. Quick, dramatic changes in moods, sometimes result in misdiagnoses of borderline personality, bipolar disorder, other personality disorders or the labels “difficult” or “manipulative,” according to Rego. People with atypical depression may sometimes eat and sleep less rather than more. Very high anxiety is common.

Rego says people with atypical depression may be helped by medications not normally used for depression. Therapy around interpersonal relationships and the handling of strong emotions is valuable, once a patient’s mood is more stable. “Treatment of atypical depression may not right the listing course of a young woman’s life in every case,” he says. “But it usually makes change possible where before it was unapproachable.”

Gov. Newsom signs controversial bills on mandatory mental health treatment and social media transparency

Via Twitter

California Gov. Gavin Newsom signed a highly controversial bill that could force severely mentally ill people, many of them living on the streets, into care and treatment, ABC News reports. The first-of-its-kind law would allow family members, first responders and others to ask a judge in a new kind of court to draw up a mandatory treatment plan that could include medication, therapy and housing for up to two years, for people diagnosed with certain mental disorders. Those who refuse could be placed under a conservatorship and ordered to comply. The plan has a lot of moving parts, as the Los Angeles Times explains, and the key challenge will be implementation by counties.

Newsom proposed the Community Assistance, Recovery and Empowerment (CARE) Act in March, stunning some county officials and winning support from mental health advocates, families, business organizations and dozens of mayors while angering many civil liberties groups and organizations that work with homeless people, minority communities and people with disabilities. Opponents say the new program will violate people’s civil rights and that coercion is incompatible with the peer-based model that is essential to mental health recovery. (People dealing with alcohol and opioid addiction won’t qualify unless they have a diagnosed psychiatric disorder.) Criticism came from across the political spectrum but Senate Bill 1338 sailed through the legislature.

The governor also signed a controversial social media transparency bill that he said would protect state residents, especially children, from hate and disinformation spread through social media platforms, The Hill reported. Assembly Bill 587 requires the companies to publicly post their policies on hate speech, disinformation, harassment and extremism and to report data on enforcement. 

Use of cannabis during pregnancy is linked to more mental disorders in adolescence

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Prenatal cannabis exposure is associated with increased odds of behavioral health problems as children progress through early adolescence and “may lead to greater risk for psychiatric disorders and problematic substance use” in later adolescence, according to a research letter published in JAMA Pediatrics.

The new research builds on an earlier study that found worsening mental health outcomes in younger kids. “In this study, we followed up with this same group of children, who are now as old as 12, to ask whether anything has changed,” lead author David Baranger, a postdoctoral researcher at Washington University, told Medical News Today. “To our surprise, we found that children with prenatal cannabis exposure still had worse mental health outcomes. They included symptoms of depression, anxiety and other psychiatric conditions.”

Among the study limitations cited by the authors were potential underreporting of cannabis use during pregnancy and imprecise data on frequency, potency and timing. In an email exchange, Baranger also acknowledged other possible limitations, including the possibility that children whose mothers reported using cannabis during pregnancy grew up in families that were more dysfunctional or varied in other ways that could influence mental health compared to children whose mothers reported no cannabis use. In addition, more children may be harmed simply because cannabis use during pregnancy has increased dramatically in recent years along with general recreational use, according to Medical News Today.

In other news…..

Cognitive behavioral therapy is just as effective digitally as it is face-to-face for depression, according to a systematic review and meta-analysis of 106 studies in  Nature Digital Medicine, but only after adjusting for important confounding factors like additional human support, longer interventions and high adherence. (The raw data showed in-person therapy was much more effective.) “Our results emphasize the potential of digital CBT to be integrated as a valuable tool in specific clinical scenarios, including more severe presentations of major depression,” the authors cautiously conclude.

Americans ranked the health care system’s handling of mental health lower than every other category (70% said “not too well” or “not at all well”) except for prescription drug costs (74%) in an Associated Press/NORC poll and issue brief that was covered by the AP. The poll was mainly focused on long-term care, with a majority of the respondents saying that the costs should largely be covered by insurers (private, 60%; Medicare, 57%, Medicaid, 53%) vs. individuals (26%) and families (23%).

The military’s vast new electronic records system, launched in 2022 after years of pilots, testing, and congressional mandates and intended to streamline care for service members, dependents and veterans, is hurting recruiters (and causing lots of other problems), according to Task & Purpose, a news site for the military community. Among other things: Instead of speeding up enlistments by showing all a new recruit’s health records, including every broken bone and prescribed medication, the mandatory transparency is surfacing prescriptions for antidepressants and ADHD medications that are increasingly common among young people but still pose huge hurdles to joining the service.

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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Don SapatkinReporter

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...