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Two Ways To Look At The Causes Of Depression

Photo Courtesy Of: freedigitalphotos.net/ by David Castillo

Photo Courtesy Of: freedigitalphotos.net/ by David Castillo

We know a lot about how depression works, and we know a little–though not as much as we’d like–about how to treat it. However, we still don’t know what causes depression, and there are many strong disagreements in the medical and research communities as to where depression comes from, or even how to classify and think about therapy.

Psychology Today is a great resource for different perspectives on mental illness; many of their contributors write blogs about a specific perspective or aspect of an illness. This post is based on blog posts by Christopher Bergland, who writes a blog about the connection between mental health; Emily Deans MD, who writes from the perspective of an evolutionary psychologist; and Gregg Henriques, Ph.D., whose blog wants to create “a unified approach to psychology and philosophy.”

Mr. Bergland and Dr. Deans approach depression as a disease, located in the body; Professor Henriques looks at depression of a symptom of larger philosophical problems in the sufferers’ life. These approaches aren’t mutually exclusive, and neither of them is a definitive “solution” to the problem of the causes of depression, but they may provide complementary ways of thinking about the illness.

Depression in the Body

The popular idea that depression is caused by a “chemical imbalance in the brain” is very vague, and creates a false impression. Many people are led to think that antidepressant medications “re-balance” the brain in the same way that a vitamin supplement resolves a vitamin deficiency. The truth is much more complicated.

At the same time, the biology of the brain is definitely involved in the way depression affects people. You’ve probably seen images showing how a depressed brain looks different than a healthy brain–the healthy brain is “lit up” while the diseased brain is “dark.” Some parts of the brain actually shrink in size as depression progresses–and are restored when depression ends.

Research increasingly suggests that inflammation–the way our bodies respond when we get a cold, or are exposed to something we’re allergic to, or get a burn. This can happen at a low level throughout our entire bodies or even in the tissue of the brain.

The chemistry of our bodies can influence inflammation, and can also be influenced by our lifestyle choices. Both Mr. Bergland and Dr. Deans implicate a chemical called kynurenine in the inflammation that causes depression, and suggest different ways to fight it. Mr. Bergland points out that exercise converts kynurenine into kynurenic acid, and so regular exercise can reduce inflammation. This is one reason why exercise is a helpful treatment for depression.

Dr. Deans talks about reducing inflammation through diet, by changing your fat intake. Many people cut fat out of their diet for the wrong reasons–a high-fat diet generally doesn’t lead to weight gain–but eating healthier fats may make a difference. “Omega-3” fatty acids–mostly found in fish–reduce inflammation, while “Omega-6” fatty acids–found in vegetable oil and many other fat sources–can increase inflammation. Fish oil supplements are safe for most people and can be found in many supermarkets and pharmacies.

Depression as a Behavioral Response

Professor Gregg Henriques has a very different view of depression; he isn’t convinced by these neurochemical viewpoints. In what he calls the “Behavioral Shutdown” theory of depression, he says that people are generally depressed because their lives aren’t going the way they like.

In the Behavioral Shutdown model, depression is an immune response from the brain that spins out of control and proves unhelpful in our modern environment. Think of a bear that hibernates for the winter. The bear hibernates because its body knows that it wouldn’t be effective to forage for food during winter. If the bear was out and about, it would lose heat very quickly and fail to find food, so it might as well stay in and wait until spring.

Similarly, you can think of depression as being triggered by a sort of “emotional winter”–a time when the brain finds that it isn’t being rewarded enough for the effort it’s putting in. Sometimes, these triggers are obvious. Very poor people, and women in abusive relationships, are susceptible to depression because they suffer under immense emotional burdens and often aren’t receiving any emotional rewards in return. But it can also be more subtle, like a period of increased stress at work, or a time when you feel more distant with your established emotional connections (as when children leave their families and friends to go to college). In either case, the brain reacts by creating a state that discourages sufferers from seeking out emotional attachments or pleasure. Depression primes you to avoid situations where you could fail, embarrass yourself, or just expend a lot of energy for no reward.

This doesn’t mean that people shouldn’t ever be treated for depression using medication, according to Professor Henriques–but it suggests that you and your mental health professional shouldn’t be looking at your brain at the root cause of the problem. Instead, you should try and decrease your emotional work/reward ratio to convince your brain to wake up again. This isn’t too different from Behavioral Activation Therapy, in that it depends on your ability to make a change in your life, even if your brain is telling you not to. Seek out positive relationships and gratifying hobbies, and seek to remove sources of stress that you don’t need. If you want to get past the winter, look for an emotional spring.

Do you or a loved one suffer from depression? See if you qualify for Lincoln’s clinical research study on depression today!

Understanding the Different Types of Migraine

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About 18% of women, and 6% of men, suffer from migraine. This illness is more common than diabetes and asthma combined, and comes in many different, complex forms. Just as we did with the types of Bipolar Disorder last week, we hope to give an overview of the ways in which migraines can present themselves.

As with the Bipolar post, this is not meant as a diagnostic tool. If you are suffering from symptoms that you believe to be migraines, talk to your doctor.

There are two “main” categories of migraine: with aura and without aura. An “aura” is a set of symptoms that starts shortly before the migraine, and lasts until the migraine begins or a little afterwards. These symptoms can include visual disturbances, numbness, weakness, nausea, tingling, or confusion.

Migraines themselves, as well as the headaches, can include a variety of symptoms including nausea, blurred vision, confusion, and fatigue.

However, there is another, more rare type of migraine called migraine without headache, in which these other symptoms  are present without the headache. The most common symptoms of a migraine without headache are disturbances in vision and nausea, which can lead to vomiting. However, there are many symptoms and experiences–located all over the body–that may technically be the result of migraines, even if you don’t feel any headaches.

chronic migraine can be diagnosed if you experience migraine symptoms for more than 15 days every month for three months. Chronic migraine is often debilitating and is most commonly treated with preventative medication.

Sources: MigraineAgain, Migraine Research Foundation

Do you or a loved one suffer from Migraine? See if you may qualify for Lincoln Research’s study on Migraine today!

Understanding the Different Types of Bipolar Disorder

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Like many mental illnesses, Bipolar Disorder gets talked about a lot by people who don’t really know what it means. Moody or inconsistent people are often slandered as “bipolar,” and energetic and eccentric people are characterized as “manic” (or, to use an outdated term, “maniacs”). Although these usages are usually flippant and not meant as diagnoses, they speak to a widespread understanding over what Bipolar Disorder actually is and how it manifests. We thought we’d clear up the air by explaining the types of the disorder.

This article is not meant as a diagnostic tool. Similarly, unless you’re a mental health professional, it’s not your job or duty to diagnose the people around you based on their behavior that you can see. If you’re experiencing psychological symptoms that are interfering with your life, describe these symptoms to your doctor or (if you have access to one) a mental health professional.

Bipolar I Disorder

The two “poles” of Bipolar Disorders are mania and depression. Depressive episodes manifest just as they would in Major Depressive Disorder, meaning they can last for days, months, or even years. Typically, someone with Bipolar Disorder spends much more time depressed than manic.

The manic episodes required for a diagnosis of Bipolar I are dramatic and dangerous–not dangerous to others except in rare cases, but often dangerous to one’s self. People suffering from mania are often drawn to dangerous decisions such as drug use, risky sexual practices, and criminal activity. It can be difficult to think through one’s actions or sort through one’s thoughts while in this state. Many people with Bipolar I require hospitalization for mania.

Bipolar I can also include “mixed” episodes–episodes with both manic and depressive symptoms, or rapidly altering between the two. However, normally the switch between the “poles” occurs over the course of weeks or months.

Bipolar II Disorder

Bipolar II is less extreme than Bipolar I. The depressive symptoms are the same, but instead of a full manic episode, sufferers from Bipolar II experience lesser symptoms, known as “hypomanic” symptoms.

A friend of mine has described hypomania as “feeling good, but in a bad way.” Hypomanic symptoms can include:

  • Difficulty concentrating
  • Talking excessively, or talking or thinking more quickly than usual
  • Increased interest in sex or other pleasurable activities
  • Irritability
  • Increased energy, difficulty sleeping or a lack of desire to sleep

These symptoms can qualify as hypomania when they last for four or more days and feel strange, upsetting, or make the sufferer feel like he “isn’t himself.”

Bipolar Disorder with Rapid Cycling

A Bipolar Disorder is considered “rapid cycling” if involves four or more episodes (manic, hypomanic, or depressive) during a twelve-month period.

Cyclothymic Disorder

Cyclothymic disorder involves hypomanic episodes and mild depressive episodes that don’t meet the criteria for “full” depressive episodes, but more resemble Dysthymic Disorder.

Sources: WebMD, Depression and Bipolar Support Alliance

Do you or a loved one suffer from Bipolar Disorder? Lincoln Research is beginning a new study on Bipolar Disorder soon. Check our website for our current list of studies.

5 Ways to Fight Depressive Ruminations

Photo courtesy: flickr.com/ bing images

Photo courtesy: flickr.com/ bing images

Ruminations–dark, obsessive thoughts related to negative mood–are a crucial symptom of depression, and have the tendency to worsen depression. Depressed, ruminative people find that they aren’t really in control of their own thoughts, and can’t get these dark ideas out of their heads even when they aren’t rational. These patterns of thought, left unchecked, can turn into self-destructive or even suicidal ideation. Therese Borchard at EverydayHealth–who has personally suffered from ruminations–has shared five strategies for dealing with these thoughts.

1. Analyse the Thought: According to Byron Katie, if a thought is upsetting you, you should ask four questions (I’m paraphrasing here):

  1. Is this thought true?
  2. Am I absolutely sure that it’s true?
  3. How does this thought make me feel?
  4. How would I feel without this thought?

If you aren’t sure that the thought is true, then, as in mathematics, you can prove that it isn’t true by proving the opposite. If you’re bothered by the thought that you don’t deserve to be happy, try and come up with reasons why you do deserve to be happy. If you’re troubled by the thought that the world is a horrible place, make yourself think of reasons why the world is a wonderful place. Even if you don’t “overturn” the original thought, you can at least complicate it, thinking less in absolutes.

2. Use A Mantra. The purpose of a mantra is to center and refocus your thoughts around a single, often emotionally neutral, idea. It’s a brute-force way of clearing your mind and stopping complex, destructive thought patterns from gaining purchase. Your mantra should be personal to you, but think of the things that people instinctively say to battle panic and depression–things like “I’m okay.” In Finding Nemo, Dory and other characters respond to stressful situations by repeating “just keep swimming”–which can be read either as a mantra about perseverance, or about going with the flow.

3. Focus on Your Current Task. Life being what it is, most of us have things we’re supposed to be doing right now. Many of us think of that as a negative, but in the case of depression and rumination, simply approaching the tasks you have to do can be the best way of taking your mind off ruminative thoughts. Basic chores and some work tasks can be meditative once you get into them. If you don’t have anything you have to do–or anything you think you can reasonably get to in your current state–try to find a task that engages some part of your brain. Different things work for different people–knitting, doing Sudoku puzzles, writing a blog, reading, or just going for a walk.

4. Ask for help. You can’t always rely on your own brain to fix your own brain. Sometimes you need another brain to lend an assist. Talk your thoughts through with a friend, loved one, or mental health professional who’s in a better position to see things rationally or positively. Trust in the people around you, even if what they’re saying seems wrong at the time. Write down what they say and investigate it later. How or why is their perspective different from yours? A  good friend might not be able to fix everything, but will at least balance out the voice in your head.

5. Remember that you can’t always control these thoughts. Depression is an illness, and rumination is a symptom. There might be things you can do to alleviate it and make yourself feel better; however, blaming yourself for these thoughts, and obsessing over how you’re going to “beat” them, sometimes only makes the ruminations worse. When all else fails, put your rumination in the proper context. It’s something that’s going to make you suffer for a while and eventually subside. Treat yourself the way you would if any other part of you is sick, and ride it out.

Do you or a loved one suffer from depression? See if you qualify for Lincoln’s clinical research study on depression today!

Five Articles to Help You Understand the USA’s Heroin Epidemic

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This election cycle has made Americans more aware of what’s going on around them–a drug epidemic on the scale of the 1980s’ crack epidemic, driven by lower prices of heroin and a sharp rise in prescription opiate use.

This is a problem that affects all of Rhode Islanders, and many people in and around Rhode Island are suffering, or know someone who’s suffering, from prescription opiate use. We think it’s important to stay informed on this issue, so we compiled a few articles showing different perspectives on the drug epidemic and what’s being done about it around the country and in the state.

  1. From the Atlantic, this article on the statistics behind the nationwide opioid and heroin epidemic;
  2. From the New York Times, this piece explaining the role of doctors in fostering (and combating) overuse of opioids;
  3. From the Providence Journal, an examination of the measures that Rhode Island is considering to combat overprescription;
  4. Also from the New York Times, a look at the effects of prescription limits, and the ways in which they fail some patients;
  5. And a sobering opinion piece from former R.I. Department of Health director Michael Fine on the realities of drug use in Rhode Island.

Do you suffer from opiate addiction? See if you may qualify for Lincoln’s clinical research study on opiate use today!

The Three Most Effective Forms of Therapy

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Therapy is not one-size-fits-all, and is a much more complicated science than most people think. Therapists and researchers are forever trying to nail down the best evidence-based strategies for helping clients better manage their illnesses. According to Dr. Cliff Lazarus at Psychology Today, three strategies have proven the most widely effective for dealing with common psychiatric conditions.

It’s worth noting that this is not a list of coping strategies, but methods of therapy–meaning that they’re things to work through in concert with a therapist. The most important factor for the efficacy of therapy is how strong a relationship you have with your therapist. Though some of these principles may be applied to coping mechanisms you can try by yourself, this article is specifically talking about things for therapists and clients to work on together.

1. For Depression: Behavioral Action Therapy

Behavioral Action Therapy (BAT) is a very simple concept. It can also be described with two aphorisms: “where your feet go, your head and heart will follow” and “fake it ’til you make it.” People who suffer from depression are often unmotivated to do the things they ordinarily enjoy, or even the things they need to do. BAT is all about overcoming that amotivation and carrying on your activities as you would otherwise.

This may seem like crass advice, but it’s not just about doing things because you have to. In the medium-to-long-term, engaging in these sorts of activities is known to have a reliable positive effect on depressed client. Depression reinforces itself by making sufferers want to withdraw and isolate themselves from the world around them. Staying socially active, keeping up hobbies, and getting outdoors help counter and eventually reverse this spiral of behavior.

2. For Anxiety: Exposure Therapy

Just as depression reinforces itself through withdrawal and isolation, anxiety reinforces itself through avoidance. Many people with anxiety disorders go far out of the way to avoid certain stimuli, and may miss out on important opportunities rather than risk an anxiety attack. Rather than helping the client cope, avoidant behaviors often only strengthen and reinforce the underlying anxieties.

However, exposing oneself to triggering stimuli can also make anxiety worse, or just lead to unnecessary suffering. The help of a therapist, and a controlled environment of exposure, creates a much more supportive and a more effective environment. Not all exposure treatments are direct–many anxious clients are put through “imaginal” exposure, visualizing and thinking through scenarios that cause anxiety.

3. For Social Challenges: Assertiveness Training

Social and interpersonal challenges can be connected to either anxiety or depression, but sometimes just need to be worked on on their own. In this arena, the most appropriate behaviors are also emotionally reinforcing. Assertiveness is about finding a line between passivity–awkwardness or difficulty expressing your own needs and opinions–and aggression, where your needs and opinions trump everybody else’s. An assertive person is able to say what they want to say without belaboring the point or belittling others.

Assertive behaviors cause self-confidence and a higher estimation of yourself. Whether or not you “get what you want” through these behaviors, you are likely to receive an emotional reward for yourself. Working through social situations with a therapist can prove very helpful, even if your problems aren’t connected with other symptoms such as depression or anxiety.

Do you or a loved one suffer from depression? See if you qualify for Lincoln’s clinical research study on depression today!

4 Inspiring Confessions from Recovering Addicts

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Addiction, like many mental illnesses, can be isolating. It’s often hard to find someone to talk to who you are certain will non-judgmentally understand what you’re going through. This is why many recovery programs, such as Alcoholics Anonymous, are focused on putting addicts in contact with one another and encouraging communication among that community.

The Internet is also a good resource for hearing from people who have had similar experiences. We’ve compiled a short list of articles and blog posts from recovering addicts, covering a wide variety of different experiences. All of these people have inspired us with their stories of hardship, the strength they exercised, and the courage they mustered to share their stories with the world.

  1. Rob Roberge, a writer suffering from addiction and Bipolar Disorder, shared his list of Seven Lies I Told Myself About My Addiction with Psychology Today.
  2. Ivana Grahovac, director of the nonprofit Transforming Youth Recovery, talked about recovery programs on college campuses for the Huffington Post.
  3. Stephanie Stark from the Atlantic interviews people from her hometown suffering from a heroin epidemic, focusing on the role social media can play in recovery.
  4. Chris Owen shares a glib, sometimes humorous take on his recovery with 9 Things I Don’t Miss About Alcohol Addiction.

There are many other voices out there, and support communities; these are just a few.

Do you suffer from opiate addiction? See if you may qualify for Lincoln’s clinical research study on opiate use today!

How Not to Let Facebook Get You Down

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Most people don’t really like Facebook. I check Facebook several times a day–occasionally this leads to a very productive conversation, but just as often, I have an actively unpleasant experience, usually in the form of a political argument that goes sour. Most of the time, I check my notifications, scroll through seven or eight posts, get bored, and flip over to something else.

Almost all of my friends complain about how barren Facebook is as a venue for social connection, entertainment, and information. I know many people who have deleted or suspended their Facebook accounts, although most of them eventually returned. This is supported by research. According to Amy Morin at PsychToday, studies have shown that Facebook in particular leads to sadness, and that only 9% of time spent on Facebook is social.

Advising people to get rid of Facebook probably isn’t useful advice. For many people, Facebook is still an important way to connect with people, to learn about events, and to keep up with your friends’ lives. But there are ways we can use Facebook differently so that it doesn’t have a negative effect on our mental health.

Make Facebook Less Passive

Passive consumption of information, especially a pseudorandom assortment of information, leads to reduced mood. I prefer social media platforms, like Twitter that give me a high level of control over what I see. I can choose to follow any number of accounts, and Twitter provides all of their tweets in chronological order, with only a few advertisements interspersed. The Twitter screen is also much less cluttered, and the sidebar content is easy to ignore. I follow friends, writers, comedians, and news sources, and if I’m not enjoying any of them, I unfollow them with no compunction.

It is much more difficult to actively control the flow of information on Facebook, for several reasons:

  1. By default, the Facebook data feed is controlled by an algorithm that decides what floats up to the top of your screen;
  2. Your feed is determined by your friends, and friendship on Facebook is often a mutual social obligation (contrast with, say, Twitter, where your decision to follow an account is independent of their decision to follow yours);
  3. Content produced by “pages” on Facebook–say, the page of a band you or a political candidate that you “Like”–is, by default, randomly shown to only a few of that page’s followers. Facebook expects that page to pay to “boost” their posts so that it shows up on your feed.
  4. At the same time, there’s a high density of sponsored and trending content that shows up whether you want it to or not.

Two of these problems can be easily solved.

On the Facebook homescreen, you can select between “top stories” and “most recent”–“most recent” gives you a chronological timeline. This will probably give you something closer to what you expect out of Facebook–updates both from people you know well and people you don’t know well, and from the page you Liked. “Top stories” tends to favor the content that people typically engage with, and trends towards political controversy and ideological extremism.

And, though you may feel obligated to be Friends with many people on Facebook who upset you, you don’t have to see the things you say. If you go to a person’s profile, you have the option to “Unfollow”–you’re still Friends with them, and they won’t know anything’s changed, but you won’t see any of their posts until you choose to “Follow” them again.

Don’t Compare Yourself To Your Friends

People on Facebook tend to present the best version of themselves and their lives to create the impression that they’re successful and happy. This makes everybody else feel envious and terrible. Remember that your friends’ Facebook feeds aren’t a real reflection of how your life is going–and that the way other people live doesn’t reflect upon your own life in any way.

For your own part, try not to use Facebook competitively. Resist the urge to photograph and upload every happy moment you spend with your friends and family. If you use Facebook to journal or blog, take some time to talk about the bad moments as well as the good ones.

Be Mindful of the Effect of Facebook

When you log into Facebook, it’s because some part of your brain expects that it will lift your mood–despite evidence to the contrary. Remaining mindful of the negative effects that Facebook can have can help fight off those same effects. Take stock of how much time you really want or need to spend on Facebook. And before clicking on Facebook, consider that there may be better, more active ways to spend your time.

Just Use Messenger

Messenger, the instant messaging arm of Facebook, has its own app and website. Unlike Facebook itself, Messenger is rather simple: it gives you access to all of your Facebook friends and allows you to contact them directly. Going directly to Messenger, without getting bogged down by all those ads and photos, might help you get closer to the stated purpose of Facebook–a way to stay connected with the people who have touched your life. Start a conversation with someone.

Do you or a loved one suffer from depression? See if you qualify for Lincoln’s clinical research study on depression today!

How to De-Stress During Your Vacations

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Most people spend at least some of their daily routine wishing they could take a break and get away. We treasure those few weeks of a year when we get to devote ourselves to relaxation and fun..

However, for those of us who are preconditioned to stress or anxiety, a change of scenery isn’t always enough. For some people, vacations only carry a marginal increase in mood, even before the added stresses of travel. To truly feel better, you need to change not only your circumstances and your routine, but also the way you think and react to your surroundings. An article on Psychology Today shares some tips that may be helpful.

The first thing to remember on a vacation is to leave your normal life–and especially your job–as far behind as possible. 91% of working Americans admitted to checking their work email while on vacation. Please remember that you don’t owe your employers anything when you’re off the clock. You do owe it to yourself to try and forget about work-related stress until you’re back in the office.

Email is only one example: technological interconnectivity makes a vacation a very different prospect than it was in the past. It might seem nearly impossible to “get away” when you’re carrying all your personal and professional relationships around in your phone. Similarly, if you’re trying to take a break from your daily routine, you’ll find a more insidious “daily routine” of smartphone use. Checking the same apps and websites every day might not be as stressful as your job, but it still locks you into a certain mindset and can distract you from the little joys of your vacation.

The most important thing going into a vacation is not to focus inward. Instead of just seeking your own pleasure, think about how you can help the people around you have a good time. Instead of sitting and waiting around for an emotional or physical reward, focus on how rewarding your present circumstances are. A vacation is an excellent time to practice gratitude and focus on the positive in your life.

With temperatures plummeting and snow on the way, think about getting away, if you have the chance. If you bring the right attitude into a vacation, you can come out feeling refreshed and ready to meet your life on new terms.

Do you or a loved one suffer from depression? See if you qualify for Lincoln’s clinical research study on depression today!

Nine Questions to Ask When Choosing a Therapist

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We tend to be very discriminating when we’re entering a relationship. It can take us choose our friends, our romantic partners, our schools, our employers or employees, or our pets. But in health care, and especially mental health care, we don’t often feel that we have choices. People who start therapy tend to blindly accept referrals or take the closest therapist to their home; they might not have met or spoken with their therapist until they start their first session.

You do, however, have options, especially if you live in a populous area. The best indicator of the success of therapy, according to Dr. Ryan Howes at EverydayHealth, is the strength of your relationship with your therapist. Before committing to a therapist, there are questions you should ask yourself, and questions you should ask your therapist.

Questions to ask yourself:

  • Could you imagine telling this therapist your most closely-held secret?
  • How long did it take you to relax around this therapist?
  • Did your conversation with this therapist feel natural, or was it awkward?
  • Did you leave the session feeling like you were able to say everything you wanted to say?
  • Did you understand your therapist’s response? Do you think it might be helpful?

Questions to ask a potential therapist:

  • “I’m having these problems… how will you help me?”
  • “What are your strengths as a therapist?”
  • “Have you ever been in therapy?”
  • “In our sessions, am I going to be setting the topic of discussion, or are you?”

If you don’t like the answers to these questions, look around for another therapist. Therapy can be difficult, but it doesn’t need to feel abstract and pointless–it should be a cooperative effort to improve your life in the short term as well as the long term.

Do you or a loved one suffer from depression? See if you qualify for Lincoln’s clinical research study on depression today!

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