Neglect of Contraceptive Depression

I recently found out that a distant cousin of mine is in psych hospital for severe depression. This is not totally out of the blue, but the psychiatrist apparently thinks it was at least partially caused by her combined oral contraceptive pill.

Our minds and our bodies are closely linked. Science is gradually providing fragments of stories about how closely linked they really are.

As the public conversation about mental health is growing, and we are not so scared of  revealing our own or our loved ones' suffering with mental illness, (thanks to the tireless individual campaigners and mental health organisations over the last 30 years). I have chatted with a number of people about this idea before posting it, and most had personal stories. My friends and colleagues talked about their bipolar or schitzophrenic siblings, their mother's postnatal depression, their own past mental breakdown, agoraphobia, trychotillomania (hair pulling), bulimia, paranoia, or basic depression, A websearch brings up a range of figures - most of them probably without much evidence - that somewhere around 30% to 50% of people will suffer diagnosable mental illness over their lifetime.

The physical effects of psychiatric medications are well known to those who take them, and to their loved ones. The link takes you to a book review. The story is appaling. I am going to read the book and look at Robert Whitaker's evidence and get back to you later maybe. But this post isn't about that.

Evidence is assembling about the relationship between prescription drugs and mental illness, that heart and cholesterol and NSAID medication can cause depression, anxiety, aggression, anorexia, memory loss, and a bunch of other things in about 1% of users.

Except did you notice this bit?
The MIND article says that the baldness medication Propecia can cause depression in 10% of users, via a suspected hormonal mechanism (suppression of testosterone).
 
Given that a websearch produces about a hundred thousand hits saying the combined oral contraceptive pill causes depression, plus forums full of heartbreaking stories,
Why did Scientific American not mention the pill? Are they worried that their readers might be sensitive to lady problems? Hardly. It's because there's a gaping chasm in the literature about psych effects ofCOCP for lady problems. Maybe a dozen, maybe twenty solid studies. After hunting very hard, I found three that I think are worth quoting.

Here's a paper from a 2009 pilot study from a psychiatrist at an Australian public hospital saying that depression is the most commonly cited reason for going off the pill, and depression related to contraceptive pill use is probably significant and there's not enough research and it should be investigated.
Here's a paper from a 2012 lit review by 4 people who seem not to have ever written anything else about gynecology, saying that despite not enough evidence and confounding variables, a few large studies say that women on the pill are probably not more depressed than those off the pill. And if you get depressed, you should stop taking it.
And another 2007 paper about a large number of women, written by clinical epidemiologists (folks who look very hard at stats about lots of sick people) saying that after removing confounding variables young Australian women on the pill aren't any more depressed than those not on the pill. And the longer you take the pill the less likely you are that you will be depressed.

Here are a few of the confounding variables

1) Women everywhere are more often diagnosed as depressed than men, apparently 23% against 11%. After women go through menopause it's 11% for both genders.
2) Some of that may be because of the menstrual cycle. There is a recently invented?discovered? psych illness called Premenstrual Dysphoric Disorder (PMDD) which basically means life sucks for the week or so before your period and you can't help but take it out on yourself & everyone else. A few pills have been marketed to dampen the hormonal oscillations and reduce PMDD. Lots of other things can help too. Pay particular attention to the diet & exercise notes because if it's supposed to be a serotonin depression mechanism, exercise is fabulous for lifting & maintaining serotonin.
3) It's not contraindicated for those already with depression or anxiety, ie women who are depressed anyway are prescribed the pill just as often as those who aren't. If a woman is already depressed when she starts the pill and she's still depressed on it - but differently depressed than she was before - how does the epidemiologist cope with the data? Remember that this can confound up to a quarter of subjects!
4) Women who get really depressed generally stop taking a pill, thus self-excluding themselves from any longitudinal studies. (What, are you going to tell a suffering woman that she should stay on it, make her & her family's life hell for the duration of a 5-year study just to give epidemiologists a statistically significant result?)

So anyway,
there's my distant cousin in the psych ward in some Perth hospital,
her 2 young kids are living at her mum's this week,
her fly-in fly-out husband is back at the mine for a fortnight,
and her psychiatrist has taken her off the combined oral contraceptive pill and substituted some juicy antidepressant. The gynecological issue she was taking it for is still around, if she can't be on the pill she may be looking at surgical sterilisation.


And Scholar only has a dozen mostly inconclusive studies since 2000.



If web-available stats on pill use are remotely accurate, about 100 million women are on the pill worldwide at any point in time. Up to a billion women may have tried it during their lives.
If 10% have mood disorders, anxiety, or depression, as a consequence of taking it (seems a reasonable guess given the testosterone-dropping hair medication above)
that's 10 million women!
some with stories like my cousin, some not so bad, some worse,
and one very fat profit margin for the usual pharmaceutical bad guys
And not enough research! 
Not enough attention!
Not enough public & scientific care for women's health!

Tonight I am a bit angry. Can you tell?

How to actually reduce your carbon footprint - Postpone big outputs

We make decisions about big infrequent emissions all the time. Taking an overseas holiday, pouring a large concrete slab, buying a new car. A simple - even banal - way to reduce emissions in a given time period is to not emit in that time period. In other words, to postpone a project and thus the big emission associated with it.

In "How Bad Are Bananas" Mike Berners-Lee proposes a 10-tonne annual CO2 'budget' per person. I think this is a good starting point for a sustainable first-world lifestyle, but will probably not be enough in the end.

Here are some examples of postponed emissions.

• A new car is more or less a 1-tonne embedded carbon purchase. If you wait another year before you upgrade your car, you postpone the carbon emission to manufacture not your car, but the one that replaces your new car in the sales yard.
• An overseas trip (from Australia) is more or less a 1-ton per capita emission. How about you go camping a couple of hours drive out of the city this year, and schedule that trip to Europe for next year or the year after. You will postpone that emission. 
• A concrete slab is, conveniently enough for counting, about a ton of CO2 per room. Putting your new house extension on posts instead of a slab, or hunting around for low CO2 emissions concrete (hey check out the Roman technology here!)
  The rest of the new room is about a ton as well. How about you let the kids share a bedroom for another year, and postpone the whole renovation. Or the new kitchen. Or the landscaping & new swimming pool. Renovating in timber is not simple because it's a carbon cost and a carbon sink.
  But if there are manufactured surfaces (like plaster) or manufactured appliances, you can bet on at least 1 tonne. 
• Professionally, can you encourage your company to get another year out of that large appliance for your corporation (the big printer, the server rack, the factory air conditioner, the big industrial pump/machinery thingo)? Can you persist in the existing premises for just one more year without designing a new purpose-built thing in a concrete industrial park?
• Can you get the fleet cars to be used for 4 years instead of 3?
• Can you think of any other 1-tonne CO2 expenditures which can be postponed without much fuss? You might surprise yourself.

Simple, obvious, and astoundingly easy (inaction is often very easy). Plus, it may have unexpected benefits for your personal or organisational financial outgoings as well.

Astronomy, mythology, and the art of teaching by telling progressively smaller lies.

I tell my kids stories at night. Sometimes they are good enough stories to re-tell here.
They can see the Milky Way at its most magnificent from their large, south-pointing, low-light-pollution 2nd-story windows. They ask about the stars.
"What's a star, Mum?"
"A star is just like a sun but a lot further away so it looks much smaller. And some stars aren't single suns, but a whole mass of suns a very very very long way away called a galaxy. And some are planets of our own solar system, reflecting the light of our own sun."
"How do you tell which one is which?"
"Well you have to learn about the skies. But if the star is in this section here (point to the bright spray of the Milky Way) it's probably a star. And if it's over there (south-west) it's probably a galaxy. And if it's really bright it might be a planet."
"Did people always know what stars were? When in history did they work it out?"
(precocious flippin' 5 yr old! *sigh*,)


Here starts the story, in grownup words this time.

The name Milky Way comes from Greek mythology, same as Galaxy comes from the same root as lactation.
Here is my favourite pre-Christian, (pre-Greek) creation story amalgum, from fragments of memory of mythology, which wouldn't hold up to any decent research but makes me smile anyway. (Come to think of it, maybe it's Hopi Indian. I'll look it up and edit this post.)

The Sky, the mother of everything, fell in love with the father Sun and they had children, the Earth, the Moon, (and the other inner planets, if you accept the assumption that this amalgum pre-Christian society had half-decent proto-astronomy)
She had so much milk for her child(ren) that it sprayed all over her dress, creating the Milky Way.
But the Sun and the Sky could not get along. The Sun was too bright, the Sky took up too much space.
Ultimately, they decided to split the care of their child Earth into Day and Night.
The Sky also helped her daughter the Earth deliver life, flowing out of the ground in a vast river and filling the land and the sea with all living things. (Can't remember which was the Earth's partner. It's not the Moon, he was her brother.)


So then a couple of weeks ago, we borrowed Carl Sagan's Cosmos ep 1&2.
There is a rather good section on the origins of life, at roughly 48 minutes.
Sagan stands next to a large glass bulb full of gases supposedly in abundance before plants evolved, took over and started messing with things.
Electrical arcs (simulating lightning) were generated through the chamber.
After an unspecified length of film on the cutting room floor, a fabulous brown sludge of proto-amino-acids started running down the walls of the chamber.
He put this forward as evidence that self-replicating organic molecules can appear on any planet with something close to the right atmosphere & a bit of atmospheric turbulence. I was convinced (enough to do a bit more reading & get more convinced, anyway).

Check out this very readable article on Google Scholar. It puts forward four theories from the body of literature for the origin of life and talks about their plausibility and likelihood. It's short but my version is shorter.

1. Exogenous, ie a "banana skin thrown from a passing spacecraft". Totally untestable, at least until we invent interstellar transport and go ask them if they dropped a banana skin on our planet about 4 Bn yrs ago.
2. Endogenous and atmospheric, from gases + electricity. like Urey & Miller demonstrated in 1953 and Sagan filmed in 1980, except that they might have gotten the primitive earth's atmosphere wrong, so on to the next theory
3. Endogenous, aquatic. Some magic around some funky hydrothermal vents, where clay or something protected the tiny volatile proto-proteins (lol) from boiling alive, or 
4. RNA from we don't know where. Possibly atmospheric. Proposed mechanism requires UV light.
   There is another one in the literature,
5. Meteorite bombardment literally vibrating some replicating organic molecules of life into existence. Also hard to test & probably not necessary since 2, 3, and 4 are quite plausible enough for me. Anyone got a spare planet to propel some meteors at, and we can see if you get a nice brown amino sludge?

It all sounds complicated, but truly, consider the endogenous theories alongside the miscellaneous mythology story above. I propose that the longer scientific language tells largely the same story, just a little differently.

• The Sky (atmosphere) interacted with the Sun (whose heat & light generated the required atmospheric turbulence, and also sent UV radiation if that turns out to be necessary) 
• and this interaction seeded RNA on earth (atmosphere, hydrothermal vent, who's pickin?)
• which then flooded simple replicating RNA from a few discrete places to fill the entire Earth, evolving into the life we know.
• The Sky had enough milk for all of her children, in fact her breasts were so full that they sprayed it right through the galaxy. (Sagan's film proposes highly probable extrasolar life, arising from similar mechanisms on other planets). 
• The stars in the sky are there to remind us that the Sky (both in terms of our Earth's atmosphere, and the whole galaxy & visible universe) is probably a very fecund place.

My two older kids loved that story. They told me I should write it down.
I hope you liked it too.

Sleep well, my invisible readers.
Lexskigator

Why I buy yarn - Energy Conversion (Part 1)

I don't really buy yarn.

I buy potential energy. I buy a tight little bundle of what might become something beautiful. I buy the promise of many hours of happy activity and a sense of satisfaction and achievement afterwords.

I buy energy storage. I store any extra optimism, imagination, and anticipation in my yarn. See, I know that sometime in the relatively near future I will be bogged down in mundanity, or stripped of enthusiasm, or curled up on the bed exhausted and about to lose the plot with many many hours to go before any backup arrives. I know that if I place the new yarn just there within view of my bed, I will be able to see it in my time of trial, and I will tap into that stored potential energy, re-ignite my imagination with what it might become, re-ignite my hope and my optimism and get enough energy to keep at it.

I buy a place to store love. There are many people who I love, but who I can't say that to - because of context, or history, or simply the limitations of the English language. So I knit something for them and give it to them and both of us know that its sole purpose is to say "You are important to me and I love you". A special ball of wool or alpaca earmarked for some specific person - or intended for some generic project but knowing that I'll probably give it away when it's made - is a ball of love.

I buy threads of connection between people in time. Knitting connects you to all those knitters in prehistory and history, dust and bones under the ground or sitting in suburban yarn and coffee shops or (like me) in front of the TV with a thread coming out of the coffeetable drawer, subcontinental slum workers finding time to work on a child's jumper after a 15 hour shift in a toxic environment, or an adult orphan crying from grief trying to concentrate on a garter-stitch scarf to take their mind off their mum's death. Everyone knows a knitter- their nan or aunt or their gay uncle Brent (hi Brent!). Knitting also teaches your fingers a skill and technique which your mind doesn't need to know. This skill was passed on orally, then stored in pattern books and old items, copied and re-invented again and again, now it's carefully filmed onto YouTube and discussed interminably on forums. I buy the necessary ingredients to connect with all those people in all those places and times, just by holding some sticks, moving my fingers, and waving a bit of string around.

I buy hope - for myself to be able to make something, and when it's done for me or someone else to love it.
I buy just a little bit of fear - that I will never be able to do the yarn justice. That it will languish on my shelf and be forgotten and eventually eaten by moths or taken to the tip by some callous and uncomprehending future daughter in law. That I will end up a crazy old lady with sausage-swollen legs living on beans, and a house full of clever home-storage-solutions embarrassingly stuffed with yarn. Maybe this is what stash anxiety is about. I have to be careful not to buy too much yarn.

I buy interpersonal energy in a compact, dense form. I aim to convert into other forms of energy - anticipation energy, work energy, finished energy, gift energy, generosity energy, gratitude energy, lasting and meaningful human energy. I don't buy it because it's yarn. I buy it because it's energy.