Posts Tagged Depression

[Images] 137 Artists Try To Show What Depression Looks Like And Some Results Will Make Your Skin Crawl

Living with depression is hard, but it is treatable, so if you think that you might be suffering from it or spot the first depression symptoms with your relative or a friend, don’t ignore it. Get help.

#1 Brain Sick

Brain Sick

Robert Carter, Final score: 156points

#2 Mind Devour

Mind Devour

The painting describes a person with psychological problems such as schizophrenia, insanity, depression or other mental problems. His endless screaming makes his own mind eat him up. I have periods in my life where I feel like this. I wanted to make an illustration of my thoughts and my pain within.

Sebmaestro, Final score:148points

MORE —-> 137 Artists Try To Show What Depression Looks Like And Some Results Will Make Your Skin Crawl | Bored Panda

, , , ,

Leave a comment

[WEB SITE] TBI and PTSD: Navigating the Perfect Storm – BrainLine

Marilyn Lash, MSW, Brain Injury Journey magazine
TBI and PTSD: Navigating the Perfect Storm

So often people talk about the effects of traumatic brain injury or the consequences of post-traumatic stress disorder as separate conditions — which they are. But for the person who is living with the dual diagnosis of TBI and PTSD, it can be hard to separate them.

Just as meteorologists predict “the perfect storm” when unusual and unprecedented conditions move in to create catastrophic atmospheric events, so can the combination of PTSD and TBI be overpowering and destructive for all in its path. The person with TBI and PTSD is living in a state unlike anything previously experienced. For the family, home is no longer the safe haven but an unfamiliar front with unpredictable and sometimes frightening currents and events.

While awareness of PTSD has greatly increased with recently returning service members and veterans, it is not new and nor limited to combat. Anyone — children, adolescents, adults, elderly — who is exposed to a life-threatening trauma can develop PTSD. Car crashes, shootings, floods, fires, assaults, or kidnapping can happen to anyone anywhere. But the rate of PTSD after brain injury is much higher in veterans than civilians due to their multiple and prolonged exposure to combat. According to O’Connor and Drebing, it is estimated that up to 35% of returning veterans with mild brain injury also have PTSD.

What’s unique about PTSD?

Symptoms of PTSD include:

  • Unwanted and repeated memories of the life-threatening event
  • Flashbacks where the event is relived and person temporarily loses touch with reality
  • Avoidance of people, places, sights, or sounds that are reminders
  • Feelings of detachment from people, even family, and emotional numbness
  • Shame about what happened and was done
  • Survivor guilt with loss of friends or comrades
  • Hypervigilance or constant alertness for threats.

Individuals with PTSD are at increased risk for depression, physical injuries, substance abuse, and sleep problems, which in turn can affect thoughts and actions. These risk factors also occur with brain injury.

PTSD is a mental disorder, but the associated stress can cause physical damage. TBI is a neurological disorder caused by trauma to the brain. It can cause a wide range of impairments and changes in physical abilities, thinking and learning, vision, hearing, smell, taste, social skills, behaviors, and communication. The brain is so complex, the possible effects of a traumatic injury are extensive and different for each person.

When PTSD and TBI coexist, it’s often difficult to sort out what’s going on. Changes in cognition such as memory and concentration, depression, anxiety, insomnia, and fatigue are common with both diagnoses. One basically feeds and reinforces the other, so it’s a complicated mix — it’s the perfect storm. It may help to consider and compare changes commonly seen with TBI and PTSD.

Memory

TBI: A period of amnesia for what went on just before (retrograde amnesia) or after (anterograde amnesia) the injury occurred is common. The length of time (minutes, hours, days, or weeks) of amnesia is an indicator of the severity of the brain injury. For example, the person may have no memory of what happened just before or after the car crash or IED explosion.

PTSD: In contrast, the person with PTSD is plagued and often haunted by unwanted and continuing intrusive thoughts and memories of what happened. The memories keep coming at any time of day or night in such excruciating detail that the person relives the trauma over and over again.

Sleep

TBI: Sleep disorders are very common after brain injury. Whether it is trouble falling asleep, staying asleep, or waking early, normal sleep patterns are disrupted, making it hard to get the restorative rest of sleep so badly needed.

PTSD: The mental state of hypervigilance interferes with slowing the body and mind down for sleep. Nightmares are so common with PTSD that many individuals dread going to bed and spend long nights watching TV or lying on the couch to avoid the night’s terrors. Waking up with night sweats so drenching that sheets and clothing are soaked. Flashbacks so powerful that bed partners have been struck or strangled while sleep battles waged.

Isolation

TBI: Many survivors of TBI recall the early support and visits of friends, relatives, and coworkers who gradually visited or called less often over time. Loss of friends and coworkers leads to social isolation, one of the most common long-term consequences of TBI.

PTSD: The isolation with PTSD is different as it is self-imposed. For many it is simply too hard to interact with people. The feeling of exposure outside the safe confines of the house is simply too great. The person may avoid leaving the house as a way of containing stimuli and limiting exposure to possible triggers of memories. As a result, the individual’s world becomes smaller and smaller.

Emotions

TBI: When the areas of the brain that control emotions are damaged, the survivor of a TBI may have what is called “emotional lability.” This means that emotions are unpredictable and swing from one extreme to the other. The person may unexpectedly burst into tears or laughter for no apparent reason. This can give the mistaken impression that the person is mentally ill or unstable.

PTSD: Emotional numbness and deadened feelings are a major symptom of PTSD. It’s hard for the person to feel emotions or to find any joy in life. This emotional shutdown creates distance and conflicts with spouses, partners and children. It is a major cause of loss of intimacy with spouses.

Fatigue

TBI: Cognitive fatigue is a hallmark of brain injury. Thinking and learning are simply harder. This cognitive fatigue feels “like hitting the wall,” and everything becomes more challenging. Building rest periods or naps into a daily routine helps prevent cognitive fatigue and restore alertness.

PTSD: The cascading effects of PTSD symptoms make it so difficult to get a decent night’s sleep that fatigue often becomes a constant companion spilling over into many areas. The fatigue is physical, cognitive, and emotional. Feeling wrung out, tempers shorten, frustration mounts, concentration lessens, and behaviors escalate.

Depression

TBI: Depression is the most common psychiatric diagnosis after brain injury; the rate is close to 50%. Depression can affect every aspect of life. While people with more severe brain injuries have higher rates of depression, those with mild brain injuries have higher rates of depression than persons without brain injuries.

PTSD: Depression is the second most common diagnosis after PTSD in OEF and OIF veterans. It is very treatable with mental health therapy and/or medication, but veterans in particular often avoid or delay treatment due to the stigma of mental health care.

Anxiety

TBI: Rather than appearing anxious, the person acts as if nothing matters. Passive behavior can look like laziness or “doing nothing all day,” but in fact it is an initiation problem, not an attitude. Brain injury can affect the ability to initiate or start an activity; the person needs cues, prompts, and structure to get started.

PTSD: Anxiety can rise to such levels that the person cannot contain it and becomes overwhelmed by feelings of panic and stress. It may be prompted by a specific event, such as being left alone, or it can occur for no apparent reason, but the enveloping wave of anxiety makes it difficult to think, reason or act clearly.

Talking about the Trauma

TBI: The person may retell an experience repetitively in excruciating detail to anyone who will listen. Such repetition may be symptomatic of a cognitive communication disorder, but it may also be due to a memory impairment. Events and stories are repeated endlessly to the frustration and exasperation of caregivers, friends, and families who have heard it all before.

PTSD: Avoidance and reluctance to talk about the trauma of what was seen and done is a classic symptom of PTSD, especially among combat veterans.

Anger

TBI: Damage to the frontal lobes of the brain can cause more volatile behavior. The person may be more irritable and anger more easily, especially when overloaded or frustrated. Arguments can escalate quickly, and attempts to reason or calm the person are often not effective.

PTSD: Domestic violence is a pattern of controlling abusive behavior. PTSD does not cause domestic violence, but it can increase physical aggression against partners. Weapons or guns in the home increase the risks for family members. Any spouse or partner who feels fearful or threatened should have an emergency safety plan for protection.

Substance Abuse

TBI: The effects of alcohol are magnified after a brain injury. Drinking alcohol increases the risks of seizures, slows reactions, affects cognition, alters judgment, interacts with medications, and increases the risk for another brain injury. The only safe amount of alcohol after a brain injury is none.

PTSD: Using alcohol and drugs to self-medicate is dangerous. Military veterans drink more heavily and binge drink more often than civilian peers. Alcohol and drugs are being used often by veterans to cope with and dull symptoms of PTSD and depression, but in fact create further problems with memory, thinking, and behavior.

Suicide

TBI: Suicide is unusual in civilians with TBI.

PTSD: Rates of suicide have risen among veterans of OEF and OIF. Contributing factors include difficult and dangerous nature of operations; long deployments and multiple redeployments; combat exposure; and diagnoses of traumatic brain injury, chronic pain, post-traumatic stress disorder, and depression; poor continuity of mental health care; and strain on marital and family relationships. Veterans use guns to commit suicide more frequently than civilians.

Summary

There is no easy “either/or” when it comes to describing the impact of TBI and PTSD. While each diagnosis has distinguishing characteristics, there is an enormous overlap and interplay among the symptoms. Navigating this “perfect storm” is challenging for the survivors, the family, the caregivers, and the treatment team. By pursuing the quest for effective treatment by experienced clinicians, gathering accurate information, and enlisting the support of peers and family, it is possible to chart a course through the troubled waters to a safe haven.

References:

O’Connor, M. & Drebing, C. (2011). Veterans and Brain Injury. In Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers, Eds. Fraser, Johnson & Bell. Youngsville, NC: Lash & Associates Publishing/Training, Inc.

Ehde, D. & Fann, J. (2011). Managing Depression, Anxiety, and Emotional Challenges. In Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers, Eds. Fraser, Johnson & Bell. Youngsville, NC: Lash & Associates Publishing/Training, Inc.

Posted on BrainLine March 7, 2013. Reviewed July 26, 2018.

 

via TBI and PTSD: Navigating the Perfect Storm | BrainLine

, , , , , , , , , , , ,

Leave a comment

[WEB PAGE] Video games help people with disabilities find friends and transcend real-world limitations – The Washington Post

By  Hawken Miller Oct. 14, 2019

When Jackson Reece lost his arms and legs to sepsis after already being paralyzed, he thought his life was over. It was video games that brought him back.

“I don’t think about being disabled when I’m in my gaming setup and talking to everyone,” Reece, 33, said. “Just Jackson ‘pitbullreece,’ just sitting here playing, and that’s what makes me me.”

In the United States, one in four people have a disability, according to Centers for Disease Control and Prevention. Gaming allows many of them to do things in a virtual space they could only dream of in reality. It also helps them connect and overcome social anxiety and feelings of depression.

“It’s my escape,” said Brian “Wheely” McDonald, 31, who has arthrogryposis, causing the normally elastic tendons in his hands to stiffen. “I’m not disabled in video games. I have people telling me all the time how amazing I am at games.”

Brian McDonald, who is in a wheelchair because of arthrogryposis, uses his keyboard and mouse to play video games. (Courtesy photo)

Brian McDonald, who is in a wheelchair because of arthrogryposis, uses his keyboard and mouse to play video games. (Courtesy photo)

Mark Barlet, founder of Able Gamers Charity, which helps those with disabilities connect to video games through adaptive technology, said that like with many able-bodied individuals, video games can help those with disabilities forget what they can’t do.

“The trappings, the scary parts of disability, don’t define and don’t have to define you [in video games], and that’s really breathtaking,” Barlet said.

It’s proven that social interaction, now readily available through online connectivity in video games, leads to better health outcomes. Researchers at the Health Resources and Services Administration compared social isolation to smoking 15 cigarettes every day. A review by Bert N. Uchino, chair of University of Utah’s psychology department, in the Journal of Behavioral Medicine pointed to studies that link a lack of social support to higher mortality rates.

Reece and McDonald are both part of a group called Detroit Gamers, a streaming community that includes people from all over the country with varying abilities. The group was started by Rocky Stoutenburgh, 31, or “RockyNoHands” to those who watch his stream.

“We all make sure we support each other and view each other, post each other,” Stountenburgh said.

Mega-streamer Michael “Shroud” Grzesiek, who has nearly 7 million followers on Twitch, watched Stountenburgh play PlayerUnkown’s Battlegrounds, a realistic, last-person/team-standing battle royale game, on his channel in 2017. The Shroud reaction video is how McDonald and many others discovered Stoutenburgh, who now has 51,000 followers on Twitch.

Streaming is a way to not only help social interaction, but also inspire others to move past their own difficulties, according to McDonald and others interviewed for the story.

“My stream is not designed for sympathy, and don’t let a disability stop you from doing what you want to do,” McDonald said. “Don’t feel bad for me. I want you to come watch my awesome gameplay instead.”

Stoutenburgh and Reece both use a device called a QuadStick, a joystick they can control with their mouths and breathing tubes for up to 32 different inputs. Guinness World Records recognized Stoutenburgh for the most Fortnite victories with a QuadStick.

Fred Davison took over designing and producing the QuadStick in 2012 after reading a syndicated story in the local paper about the inventor Ken Yankelevitz, who at that time was in his mid-70s and looking for a succession plan. Davison, recently retired from Cisco, thought he could use his skills in hardware and software to improve the device.

“This is a whole other level of satisfaction and tremendous reward with the things people say to me,” Davison said. “I wish I would have come across this a lot earlier.”

Davison worked with quadriplegic Matt Victor, who sustained a spinal injury in 1985 when he was 8, to perfect the device. Victor, 42, has played video games since the Atari, when there was a stick he controlled with his chin and a single button. Now, with improved technology and the QuadStick, he can play more complicated games and meet new people.

“It really opens up a lot of doors of making new friends and having some form of entertainment in your life,” Victor said. “Its opened up a whole world to me. It literally changed my life.”

Community is an important part of online gaming and has helped many with disabilities find lasting friends.

“If they can play a video game with their friends at a good level, then that helps them interact and breaks down the barrier and isolation that their circumstances place them in,” Davison said.

Jackson Reece sets up his live stream in his home in Waynesville, North Carolina. (Courtesy photo)

Jackson Reece sets up his live stream in his home in Waynesville, North Carolina. (Courtesy photo)

Reece, who lives in Waynesville, North Carolina, met one of his best friends while playing Call of Duty 4: Modern Warfare. Andrew “abigsillygoose” Gray towers over Reece with an intimidating 6-foot-5, 300-pound frame. The first time they met, Gray snuck up and wrapped his arms around Reece in a hug.

“Games and the love of a title becomes that shared experience that bridges the gap between someone profoundly disabled and not,” Barlet said.

Gray and Reece had plenty of online adventures, too. Drew helped Reece get his first nuke in Black Ops 2, a moment of gaming mastery that requires a 25-kill streak. Gray covered Reece’s back while he unleashed mayhem on the battlefield.

Their exploits have not all been in a virtual world either. The two attended Carolina Panthers training camp, meeting the NFL team’s players and grabbing autographs from Luke Kuechly, Torrey Smith and Graham Gano. The Panthers social media managers know Reece by name and often respond to his comments on Facebook.

Back when Reece lost his arms and legs he said he was “anti-social and afraid to go out in public.” Now, with streaming and video games, he says he’s put himself out there again and feels like his normal self when interacting with others.

“Gaming helped me get to coping [with] being social again,” Reece said.

 

via Video games help people with disabilities find friends and transcend real-world limitations – The Washington Post

, , , ,

Leave a comment

[WEB PAGE] 15 Incredible Natural Remedies for Anxiety and Depression

At some point in our lives we all end up going through anxiety and depression. While these feelings are normal and affect a majority of people, it’s never fun to feel blue or anxious. Many times, people dealing with depression and anxiety will turn to prescription drugs to help them with these feelings, yet natural remedies for anxiety and depression can help too.

As an advocate for mental health and wellness, as well as natural remedies, I have researched thoroughly to share the natural and safe ways to help anxiety and depression.

 

Causes

Anxiety and depression are often seen hand in hand since many individuals with anxiety often have depression too. These feelings can be caused by a wide range of environmental and/or personal triggers. For some, there is no true cause to feeling anxious or depressed, yet for others there are more clear causes and sometimes a combination of causes will lead to anxiety and depression.

Depression and anxiety can be caused by the following:

  • Genetic makeup
  • Experiencing a traumatic event
  • Stress
  • Health conditions (including but not limited to cancer, chronic pain, etc.)
  • Greif
  • Changes in your personal like (divorce, loss of a job, moving,)
  • Substance abuse

While there are many different causes to anxiety and depression, you need to remember, having these feelings is not anyone’s fault or a flaw in your own character. Sometimes there does not have to be a ‘reason’ for feeling anxious or depressed. It just happens. But the good news is, if you can recognize the signs and symptoms, you can begin to use herbal remedies to help you improve.

Signs and Symptoms

Everyone who suffers from anxiety and depression will exhibit different signs and/or symptoms. It all depends on your chemical makeup in your brain. To give you an idea of how anxiety and depression can affect individuals, here is a list of the most common signs and symptoms of depression.

  • Excessive tiredness or sleeping
  • Insomnia
  • Panic attacks
  • Sweating
  • Shallow and rapid breathing
  • Tension
  • Feeling nervous
  • Shortness of breath or trouble breathing
  • Feelings of despair or loneliness
  • Changes in your eating habits- either too much or too little
  • Inability to relax
  • Feeling cranky or moody
  • Constant feelings of worthlessness or sadness
  • Difficulty with decision making, memory, or concentration
  • Constant irrational fears or worryConstant irrational fears or worry
  • Rapid heartbeat
  • Headaches
  • Abdominal pain
  • Hot flashes
  • Loss of interests, hobbies, or social life
  • Anti-social behavior

Although these are just a few symptoms of anxiety and depression, everyone experiences anxiety and depression in different ways. Signs and symptoms of depression in women and men will vary so it is important to speak to a professional if you are feeling anxiety and depression.

Treatments​

After discussing with a professional, they will be able to diagnose your anxiety and depression. From there the signs and symptoms of depression in men and women can be improved with the help of these herbal remedies.

If you are interested to treat your depression, anxiety and panic attacks with natural remedies, these 15 home remedies for anxiety and depression can surely help you beat the blues and find your calm.

15 Incredible Natural Remedies for Anxiety and Depression

1. Drinking Chamomile Tea

Depression and anxiety will go hand in hand with sleeping problems. Yet drinking a cup of hot chamomile tea can help you relax and get to sleep when you need it. This is due to the flavonoids that are present in the tea. It is a naturally occurring chemical in the plants that induce relaxation. Richard from InsideBedroom Blog has written about the tips to get better sleep which also has mention about drinking tea.

Chamomile Tea

Required Ingredients:

  • 1 cup boiling water
  • 2 tbsp of dried chamomile or just 1 teabag
  • Dash of honey

Process:

  • Boil the water and pour it over the tea.
  • Steep for 5 minutes if loose tea. Steep for 15 minutes if using a teabag.
  • Strain the tea or remove the teabag.
  • Add the honey.
  • Drink 30 minutes before bed or when you need to relax.

2. Practice Meditation

meditation

Practicing daily meditation will help to improve the signs of depression in women and men. Taking even just 15 minutes to calm your mind and simply breathe will do wonders to help you cope, prevent, and calm your anxiety and depression.

Required Ingredients:

  • A calm, quiet space
  • Comfortable clothing
  • Time

 

Process:

  • Put on some comfortable clothing and find a calm, quiet place.
  • Turn off your phone, close your blinds, and take other measures as needed to prevent interruptions.
  • Regulate your breathing and attempt to release your thoughts.
  • Breathe deeply with a clear mind for at least 15 minutes.
  • Repeat daily.

3. Get Back to Nature

walking in countryside

Getting yourself back to nature is a great way to ground yourself and release your feelings of anxiety and depression. Spending time outside and breathing the fresh air and taking in the sunlight will certainly improve your mood and help you release your anxious feelings.

Required Ingredients:

  • Natural park, forest, or path
  • Time

 

Process:

  • Go to a place where you can experience nature.
  • Spend at least 30 minutes walking around, or just being outside in the open.
  • Repeat as often as needed.

4. Eat Your Breakfast

breakfast

Starting your day right by eating a well-balanced meal will help you through the entire day. Not only will you be giving your mind and body energy to face the day, eating a healthy breakfast will improve your mood.

Required Ingredients:

  • A variety of healthy foods

Process:

  • Set your alarm and wake up at a scheduled time each day.
  • Make yourself a breakfast of healthy and wholesome foods.
  • Eat breakfast daily.

5. Inhaling Lavender

lavender-products

Lavender is well-known for its calming and soothing effects. The aroma of lavender is actually considered an emotional ant-inflammatory. Inhaling fresh lavender or lavender oil will give you a sense of calm and relaxation which will help improve anxiety and panic attacks.

Required Ingredients:

  • Essential oil of lavender or fresh lavender

Process:

  • Place a few drops of essential oil of lavender on your wrists and behind your ears and inhale deeply.
  • If you are using fresh lavender, fill your home with a few bouquets so you can continuously breathe in their calming scent.
  • Breathe in fresh lavender whenever you begin to feel anxiety and depression.

6. Avoid Coffee

a cup of cofee

While coffee is a great kick start to your day, it is not so great for those with anxiety and depression. The stimulation from coffee can enhance your feelings of anxiety and depression and even trigger them.

Required Ingredients:

Process:

  • Avoid drinking coffee (and other caffeinated drinks) for a couple of days.
  • If you truly need a coffee, switch to decaf.
  • Avoid coffee and caffeine for as long as you need to prevent triggers of anxiety and depression.

7. Supplement St. John’s Wart

Credit: WebMD

A very popular home remedy for anxiety and depression is the herb St. John’s Wart. This is because of the hypercin that is one of its main components. The hypercin will affect the various neurotransmitters in a similar manner to prescription drugs for depression and anxiety.

Required Ingredients:

  • A high quality capsule of St. John’s Wart

Process:

  • Take 300 milligrams of the St. John’s Wart 3 times each day.
  • Repeat for at least one week.

Notes:

The hypercin in the St. John’s Wart can sometimes interact with other drugs. Be sure to speak to your doctor before you start this home remedy for anxiety and depression.


8. Increase Your B Vitamin Intake

Vitamin B

Increasing your B Vitamins will help your brain produce more serotonin, epinephrine, and dopamine, thus resulting in an improved mood.

Required Ingredients:

  • Vitamin B capsules
  • Foods that contain high amounts of Vitamin B (fish, shellfish, cheese, spinach, turkey, and bell peppers to name a few)

Process:

  • Eat more foods that contain Vitamin B naturally.
  • Take 300 milligrams of vitamin B capsules each day if you do not eat the foods that naturally contain Vitamin B.
  • Make this a part of your regular diet.

9. Increase Your Magnesium Intake

Magnesium

Magnesium is a very important part of a balanced diet. Without a proper level of magnesium, we cannot keep the chemicals within our brain stable, regulate our heartbeats, or synthesize our RNA and DNA.

Required Ingredients:

  • Incorporate foods such as spinach, bananas, dry almonds, and/or soy milk.
  • If you do not enjoy these foods, magnesium capsules will suffice.

Process:

  • Intake magnesium rich foods or a magnesium capsule each day for a highly functioning body and mind.
  • Make magnesium a part of your daily diet.

10. Get Some Exercise

Exercise

Exercise is a fundamental part of maintaining a good mood and a relaxed mind. Exercise will release endorphins which will make you feel good and feel happy.

Required Ingredients:

Process:

  • Take a minimum of 15 minutes each day to exercise.
  • Repeat daily and make it a part of your regular schedule. Not only will you feel better mentally, you will feel better physically.

 


11. Utilize Light Therapy

light therapy

Light therapy is great to do if you happen to have seasonal affective disorder. Your mood drops in the winter months due to the limited sunlight, but light therapy can also help with depression. This is because the light will help activate the circadian pacemaker in the brain which will help to regulate your sleep cycles.

Required Ingredients:

  • Bright light made for SAD and depression
  • timer

Process:

  • Turn on the light and shine it on you (not directly in your face though)
  • Set a timer for 10 minutes.
  • Repeat a few times per day after the sun has set.

 


12. Intake Pumpkin Seeds

pumpkin seeds

Pumpkin seeds will contain healthy fats as well as magnesium- both will help to lighten your mood. In addition, pumpkin seeds contain L-tryptophan which is an amino acid that helps your brain produce serotonin.

Required Ingredients:

  • One cup of cooked or raw pumpkin seeds

 

Process:

  • Eat one cup of the raw or cooked pumpkin seeds once per day.
  • Repeat daily while you are struggling with depression.

 


13. Face the Fear

face the fear

If something is making you feel afraid, face the fear. This can help you understand your anxiety since most anxiety stems from the uncertain. Exposure therapy or facing your fears will help you learn how to live your life with uncertainty and risk.

Required Ingredients:

  • Time
  • Exposure to your fears and uncertainties

Process:

  • Take it slow and set aside some time to face the fears or what is causing your anxiety.
  • Repeat as often as needed until the fears or causes of anxiety are no longer there.

Notes:

Speaking to a therapist or friends and family for support will help you through this process.


14. Partake in Laughter

laughter

They always say, laughter is the best medicine. And it’s true! Cultivating a good sense of humor, even if you do a fake laugh, will boost your mood and your dopamine production.

Required Ingredients:

  • Humorous movie
  • Funny jokes or people

 

Process:

  • Spend time indulging in something humorous and laugh.
  • Take time each week to find laughter.

 


15. Administer Lemon Balm

lemonpalm

Lemon balm is an herbal remedy that can help reduce your stress and anxiety, as well as help you with your sleep. Lemon balm extract can be found in a tincture, capsule, or tea form. No matter which form you choose to use, start with the smallest dosing schedule and be sure to follow the directions and soon you will be feeling less anxious and more calm.

Required Ingredients:

  • Lemon balm extract

 

Process:

  • Take the smallest dose of lemon balm extract and follow the directions closely.
  • Repeat daily as needed.

 

Notes:

It is important to follow the directions accordingly because taking too much can actually make you feel much more anxious.


How to Prevent Anxiety and Depression

Battling anxiety and depression is not easy. However, if you make effort to take certain measures in your day to day life, you will certainly notice an improvement in these conditions. Along with the help of natural remedies for anxiety and depression, the following methods can be used to help you manage and cope with these issues.

  • Exercise daily, for at least 20-30 minutes.
  • Keep a journal and write in it each day.
  • Make sure you get plenty of sleep. ​SleepAdvisor.org got some advice for ​​reducing anxiety before bed.
  • The Quality of sleep matters as much as the quantity.” Check out this article on how to get a higher quality of sleep.
  • Limit alcohol and caffeine.
  • Learn and understand what triggers your anxiety and depression.
  • Get support from friends and family.
  • Keep a positive attitude.
  • Get involved with a volunteer organization.
  • Accept and understand that you cannot control everything.
  • Get your daily dose of sunshine.
  • Learn more about anxiety and depression by reading articles.
  • Do things that will make you feel good- even if you don’t feel like doing them.

As an advocate for mental health and wellness, I hope you have enjoyed this article. If you found something in this article useful for signs of depression in men and women, or anxiety and panic attacks, please comment to let me know! Or if you would like to share the 15 incredible home remedies for anxiety and depression, please do!

 

via 15 Incredible Natural Remedies for Anxiety and Depression – eHome Remedies

, ,

Leave a comment

[WEB SITE] AI helps identify patients in need of advanced care for depression

Depression is a worldwide health predicament, affecting more than 300 million adults. It is considered the leading cause of disability and contributor to the overall global burden of disease. Detecting people in need of advanced depression care is crucial.

Now, a team of researchers at the Regenstrief Institute found a way to help clinicians detect and identify patients in need of advanced care for depression. The new method, which uses machine learning or artificial intelligence (AI), can help reduce the number of people who experience depressive symptoms that could potentially lead to suicide.

The World Health Organization (WHO) reports that close to 800,000 people die due to suicide each year, making it the leading cause of death among people between the ages of 15 and 29 years old.

Major depression is one of the most common mental illness worldwide. In the United States, an estimated 17.3 million adults had at least one major depressive episode, accounting to about 7.1 percent of all adults in the country.

Image Credit: Zapp2Photo / Shutterstock

Image Credit: Zapp2Photo / Shutterstock

Predicting patients who need treatment

The study, which was published in the Journal of Medical Internet Research, unveils a new way to determine patients who might need advanced care for depression. The decision model can predict who might need more treatment than what the primary care provider can offer.

Since some forms of depression are far more severe and need advanced care by certified medical health providers, knowing who is at risk is essential. But identifying these patients is very challenging. In line with this, the researchers formulated a method that scrutinizes a comprehensive range of patient-level diagnostic, behavioral, and demographic data, including past clinic visit history from a statewide health information.

Using the data, health care providers can now build a technique on properly predicting patients in need of advanced care. The machine learning algorithm combined both behavioral and clinical data from the statewide health information exchange, called the Indiana Network for Patient Care.

“Our goal was to build reproducible models that fit into clinical workflows,” Dr. Suranga N. Kasthurirathne, a research scientist at Regenstrief Institute, and study author said.

“This algorithm is unique because it provides actionable information to clinicians, helping them to identify which patients may be more at risk for adverse events from depression,” he added.

The researchers used the new model to train random forest decision models that can predict if there’s a need for advanced care among the overall patient population and those at higher risk of depression-related adverse events.

It’s important to consider making models that can fit different patient populations. This way, the health care provider has the option to choose the best screening approach he or she needs.

“We demonstrated the ability to predict the need for advanced care for depression across various patient populations with considerable predictive performance. These efforts can easily be integrated into existing hospital workflows,” the investigators wrote in the paper.

Identifying patients in need of advanced care is important

With the high number of people who have depression, one of the most important things to do is determine who are at a higher risk of potential adverse effects, including suicide.

Depression has different types, depending on the level of risk involved. For instance, people with mild depression forms may not need assistance and can recover faster. On the other hand, those who have severe depression may require advanced care aside from what primary care providers can offer.

They may need to undergo treatment such as medications and therapies to improve their condition. Hence, the new method can act like a preventive measure to reduce the incidence of adverse events related to the condition such as suicide.

More importantly, training health care teams to successfully identify patients with severe depression can help resolve the problem. With the proper application of the novel technique, many people with depression can be treated accordingly, reducing serious complications.

Depression signs and symptoms

Health care providers need to properly identify patients with depression. The common signs and symptoms of depression include feelings of hopelessness and helplessness, loss of interest in daily activities, sleep changes, irritability, anger, appetite changes, weight changes, self-loathing, loss of energy, problems in concentrating, reckless behavior, memory problems, and unexplained pains and aches.


Journal reference:

Suranga N Kasthurirathne, Paul G Biondich, Shaun J Grannis, Saptarshi Purkayastha, Joshua R Vest, Josette F Jones. (2019). Identification of Patients in Need of Advanced Care for Depression Using Data Extracted From a Statewide Health Information Exchange: A Machine Learning Approach. Journal of Medical Internet Research. https://www.jmir.org/2019/7/e13809/


via AI helps identify patients in need of advanced care for depression

, , , , , , , , ,

Leave a comment

[WEB PAGE] 10 ways to cope with depression after brain injury

10 ways to cope with depression after brain injury

We’ve put together some top tips to help cope with depression

Depression is common among brain injury survivors, with half of all survivors experiencing it in the first year following their injury.

It can also develop as the person starts to understand the full impact of their injury, and can lead to feelings of hopelessness and altered self-esteem and identity as the survivor reflects over the changes that they are facing, and may continue to face in the future.

With expert support from Dr Elizabeth Kent and Dr Cliodhna Carroll, from Kent Clinical Neuropsychology Service, and with feedback from brain injury survivors, we’ve put together some top tips to help cope with depression.

More detailed information can be found on our factsheet Depression after brain injury.

The information provided here is not intended to replace medical advice, so if you are experiencing symptoms of depression always speak to your GP or other healthcare professional.

Top tips

man with head in hands

Talk

Try to talk to your family or friends about how you’re feeling and why you may appear to be distant. If you find it difficult to speak about how you feel, try to find other ways of communicating such as writing a letter. Consider talking to your employer about depression if you feel that it’s affecting your work performance.

Avoid isolation

Try to avoid becoming socially isolated. It’s important to spend at least some time socialising with people on a face-to-face basis. If you struggle in crowds, try to arrange meeting a friend at a quiet location. Alternatively, consider finding a local support or activity group that you can attend, such as a local Headway group or branch.

Engage

Engage in activities that you enjoy doing, such as listening to uplifting music, creating art or reading a book. Research indicates that these activities can be useful ways of coping with depression. And don’t be afraid to try something new!

Educate yourself

Educate yourself on the effects of brain injury. Understanding your injury may be the first step towards accepting it, which might help with managing depression. The Headway website is a good place to start.

Exercise

Try to exercise for a few minutes every day. This may be difficult if you experience fatigue or have limited mobility. However, exercise is a proven method of improving low mood. Try to set yourself a routine, for example taking a short walk around the neighbourhood in the morning, or doing some gentle stretches for five minutes every afternoon.

balls with emotion faces

Seek support

Seek support from other services such as the Headway helpline or your local Headway support group or branch. There are also depression-specific support groups, where people can get peer support from others who are also affected by depression, although these tend to be non-brain injury specific.

Identify causes

Identify and seek help for specific issues in your life that may be causing or contributing to the depression, for example financial or relationship problems.

Speak to your doctor about your general health, including any potential hormonal imbalances that can arise after brain injury.

Make a ‘soothe box’

Consider putting together a ‘soothe box’. This is a box that contains personal items that may make you feel better and help you to cope when you are feeling depressed. You could put things in it such as photos or letters, or things that soothe your senses such as perfumes or soft fabrics.

Use wellbeing techniques

Consider wellbeing techniques such as mindfulness, yoga, meditation or other relaxation methods. Although there is limited research to prove their effectiveness, brain injury survivors often report benefiting from them. Speak to a therapist if you are considering trying any of these, as they may be able to guide you through learning how to effectively use them.

Be healthy

Maintain a healthy lifestyle. This involves enjoying a healthy diet, drinking plenty of water, avoiding alcohol and trying to ensure that you have a good night’s sleep.

Suicidal thoughts

Severe depression can cause some people to feel suicidal. This is characterised by extremely negative thoughts about oneself or the future, which can lead to the person thinking about or attempting to end their own life.

It is vital that anyone experiencing suicidal thoughts seeks help – however infrequently the thoughts occur and regardless of whether they intend to act on them.

Please, do not ignore these thoughts in the hope that they will go away.

Be honest and talk to your family or friends about how you’re feeling. Alternatively, you can speak confidentially to your GP.

You can also contact the Headway helpline on 0808 800 2244, or speak to Samaritans on its 24-hour support line 116 123.

If you are having recurring thoughts of suicide, ring NHS 111 or make an emergency appointment with your GP.

Further information

Explore the links below to access our resources on the psychological effects of brain injury.

If you would like to discuss this issue in more detail, please contact our national helpline on 0808 800 2244 or helpline@headway.org.uk.

 

via 10 ways to cope with depression after brain injury | Headway

, , , , , , , ,

Leave a comment

[REVIEW] Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls – Full Text

Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.

Background

Stroke is a common acute neurovascular disorder that causes disabling long-term limitations to daily living activities. The most common consequence of a stroke is motor deficit of variable degree,1 although nonmotor symptoms are also relevant and often equally disabling.2 To date, to the best of the authors’ knowledge, there is no validated treatment that is able to restore the impaired functions by a complete recovery of the damaged tissue. Indeed, stroke management basically consists of reducing the initial ischemia in the penumbra, preventing future complications, and promoting a functional recovery using physiotherapy, speech therapy, occupational therapy, and other conventional treatments.3,4

Ischemic damage is associated with significant metabolic and electrophysiological changes in cells and neural networks involved in the affected area. From a pure electrophysiological perspective, however, beyond the affected area, there is a local shift in the balance between the inhibition and excitation of both the affected and contralateral hemisphere, consisting of increased excitability and disinhibition (reduced activity of the inhibitory circuits).3,5 In addition, subcortical areas and spinal regions may be altered.3,5 In particular, the role of the uninjured hemisphere seems to be of utmost significance in post-stroke clinical and functional recovery.

Different theoretical models have been proposed to explain the adaptive response of the brain to acute vascular damage. According to the vicariation model, the activity of the unaffected hemisphere contributes to the functional recovery after a stroke through the replacement of the lost functions of the affected areas. The interhemispheric competition model considers the presence of mutual inhibition between the hemispheres, and the damage caused by a stroke disrupts this balance, thus producing a reduced inhibition of the unaffected hemisphere by the affected side. This results in increased inhibition of the affected hemisphere by the unaffected side. More recently, a new model, called bimodal balance recovery, has been proposed.3,5 It introduces the concept of a structural reserve, which describes the extent to which the nondamaged neural pathways contribute to the clinical recovery. The structural reserve determines the prevalence of the interhemispheric imbalance over vicariation. When the structural reserve is high, the interhemispheric competition model can predict the recovery better than the vicariation model, and vice versa.3

Repetitive transcranial magnetic stimulation

One of the proposed interventions to improve stroke recovery, by the induction of neuromodulation phenomena, is based on methods of noninvasive brain stimulation. Among them, transcranial magnetic stimulation (TMS) is a feasible and painless neurophysiological technique widely used for diagnostic, prognostic, research, and, when applied repetitively, therapeutic purposes.69 By electromagnetic induction, TMS generates sub or suprathreshold currents in the human cortex in vivo and in real time.10,11

The most common stimulation site is the primary motor cortex (M1), that generates motor evoked potentials (MEPs) recorded from the contralateral muscles through surface electromyography electrodes.11 The intensity of TMS, measured as a percentage of the maximal output of the stimulator, is tailored to each patient based on the motor threshold (MT) of excitability. Resting MT (rMT) is found when the target muscle is at rest, it is defined as the minimal intensity of M1 stimulation required to elicit an electromyography response with a peak-to-peak amplitude > 50 µV in at least 5 out of 10 consecutive trials.11 Alternatively TMS MTAT 2.0 software (http://www.clinicalresearcher.org/software.htm) is a free tool for TMS researchers and practitioners. It provides four adaptive methods based on threshold-tracking algorithms with the parameter estimation by sequential testing, using the maximum-likelihood strategy for estimating MTs. Active MT (aMT) is obtained during a tonic contraction of the target muscle at approximately 20% of the maximal muscular strength.11

The rMT is considered a basic parameter in providing the global excitation state of a central core of M1 neurons.11 Accordingly, rMT is increased by drugs blocking the voltage-gated sodium channels, where the same drugs may not have an effect on the gamma-aminobutyric acid (GABA)-ergic functions. In contrast, rMT is reduced by drugs increasing glutamatergic transmission not mediated by the N-methyl-D-aspartate (NMDA) receptors, suggesting that rMT reflects both neuronal membrane excitability and non-NMDA receptor glutamatergic neurotransmission.12 Finally, the MT increases, being often undetectable, when a substantial portion of M1 or the cortico-spinal tract is damaged (i.e. by stroke or motor neuron disease), and decreases when the motor pathway is hyperexcitable (such as epilepsy).13

Repetitive (rTMS) is a specific stimulation paradigm characterized by the administration of a sequence of consecutive stimuli on the same cortical region, at different frequencies and inter sequence intervals. As known, rTMS can transiently modulate the excitability of the stimulated cortex, with both local and remote effects outlasting the stimulation period. Conventional rTMS modalities include high-frequency (HF-rTMS) stimulation (>1 Hz) and low-frequency (LF-rTMS) stimulation (⩽1 Hz).11 High-frequency stimulation typically increases motor cortex excitability of the stimulated area, whereas low-frequency stimulation usually produces a decrease in excitability.14 The mechanisms by which rTMS modulates the brain are rather complex, although they seem to be related to the phenomena of long-term potentiation (LTP) and long-term depression (LTD).15

When applied after a stroke, rTMS should ideally be able to suppress the so called ‘maladaptive plasticity’16,17 or to enhance the adaptive plasticity during rehabilitation. These goals can be achieved by modulating the local cortical excitability or modifying connectivity within the neuronal networks.10

rTMS in stroke rehabilitation: an overview

According to the latest International Federation of Clinical Neurophysiology (IFCN) guidelines on the therapeutic use of rTMS,10 there is a possible effect of LF-rTMS of the contralesional motor cortex in post-acute motor stroke, and a probable effect in chronic motor stroke. An effect of HF-rTMS on the ipsilesional motor cortex in post-acute and chronic motor stroke is also possible.

The potential role of rTMS in gross motor function recovery after a stroke has been assessed in a recent comprehensive systematic review of 70 studies by Dionisio and colleagues.18 The majority of the publications reviewed report a role of rTMS in improving motor function, although some randomized controlled trials (RCTs) were not able to confirm this result,1923 as shown by a recent large randomized, sham-controlled, clinical trial of navigated LF-rTMS.24 It has also been suggested that rTMS can specifically improve manual dexterity,10 which is defined as the ability to coordinate the fingers and efficiently manipulate objects, and is of crucial importance for daily living activities.25 Notably, most of the studies focused on motor impairment in the upper limbs, whereas limited data is available on the lower limbs.18 Walking and balance are frequently impaired in stroke patients and significantly affect the quality of life (QoL),26,27 and rTMS might represent a valid aid in the recovery of these functions.28,29 Spasticity is another common complication after a stroke, consisting of a velocity-dependent increase of muscular tone,30 and for which rTMS has been proposed as a rehabilitation tool.31

Dysphagia is highly common in stroke patients, it impairs the global clinical recovery, and predisposes to complications.32 It has been pointed out that rTMS targeting the M1 area representing the muscles involved in swallowing may contribute to the treatment of post-stroke dysphagia.33

Nonmotor deficit is also a relevant post-stroke disability that negatively impacts the QoL. Aphasia is a very common consequence of stroke, affecting approximately 30% of stroke survivors and significantly limiting rehabilitation.34 According to the IFCN guidelines, to date, there is no recommendation for LF-rTMS of the contralesional right inferior frontal gyrus (IFG). Similarly, no recommendation for HF-rTMS or intermittent theta burst stimulation (TBS) of the ipsilesional left IFG or dorsolateral prefrontal cortex (DLPFC) in Broca’s aphasia has been currently approved.10 The same is true for LF-rTMS of the right superior temporal gyrus in Wernicke’s aphasia.10

Neglect is the incapacity to respond to tactile or visual contralateral stimuli that are not caused by a sensory-motor deficit.35 Although hard to treat, rTMS has been proposed as a tool for neglect rehabilitation.36 However, the IFCN guidelines state that currently there is no recommendation for LF-rTMS of the contralesional left posterior parietal cortex, or for HF-rTMS of the ipsilesional right posterior parietal cortex.10 In a recent systematic review, most of the included studies supported the use of TMS for the rehabilitation of aphasia, dysphagia, and neglect, although the heterogeneity of stimulation protocols did not allow definitive conclusions to be drawn.37

Post-stroke depression is a relevant complication of cerebrovascular diseases.38 The role of rTMS in the management of major depressive disorders is well documented,39,40 and currently, rTMS is internationally approved and indicated for the treatment of major depression in adults with antidepressant medication resistance, and in those with a recurrent course of illness, or in cases of moderate-to-severe disease severity.39 In major depression disorders, according to the IFCN guidelines, there is a clear antidepressant effect of HF-rTMS over the left DLPFC, a probable antidepressant effect of LF-rTMS on the right DLPFC, and probably no differential antidepressant effect between right LF-rTMS and left HF-rTMS. Moreover, there is currently no recommendation for bilateral stimulation combining HF-rTMS of the left DLPFC and LF-rTMS of the right DLPFC. The mentioned guidelines also state that the antidepressant effect when stimulating DLPFC is probably additive, and possibly potentiating, to the efficacy of antidepressant drugs.10 However, no specific recommendation currently addresses the use of rTMS in post-stroke depression. Recently, rTMS has been proposed as a treatment option for the late-life depression associated with chronic subcortical ischemic vascular disease, the so called ‘vascular depression’.4144 Three studies tested rTMS efficacy in vascular depression (one was a follow-up study with citalopram). Although presenting positive findings, further trials should refine clinical and diagnostic criteria to assess its impact on antidepressant efficacy.45

Approximately 25–30% of stroke patients develop an immediate or delayed cognitive impairment or an overt picture of vascular dementia.46 There is evidence of an overall positive effect on cognitive function for both LF-rTMS47 and HF-rTMS,48 supported by studies on experimental models of vascular dementia.4952 Nonetheless, the few trials examining the effect on stroke-related cognitive deficit produced mixed results.5356 In particular, two studies found no effect on cognition when stimulating the left DLPFC at 1 Hz and 10 Hz,53,54 whereas a pilot study found a positive effect on the Stroop interference test with HF-rTMS over the left DLPFC in patients with vascular cognitive impairment without dementia.55 However, this finding was not replicated in a follow-up study.56 To summarize, rTMS can induce beneficial effects on specific cognitive domains, although data are limited and their clinical significance needs to be further validated. Major challenges exist in terms of appropriate patient selection and optimization of the stimulation protocols.57

Central post-stroke pain (CPSP) is the pain resulting from an ischemic lesion of the central nervous system.58 It represents a relatively common complication after a stroke, although it is often under-recognized and, therefore, undertreated.59 According to the IFCN guidelines for the use of rTMS in the treatment of neuropathic pain, there is a definite analgesic effect of HF-rTMS of contralateral M1 to the pain side, and LF-rTMS of contralateral M1 to the pain side is probably ineffective. In addition, there is currently no recommendation for cortical targets other than contralateral M1 to the pain side.10 Notably, rTMS might be effective in drug-resistant CPSP patients.58 A recent systematic review that included nine HF-rTMS studies suggested an effect on CPSP relief, but also underlined the insufficient quality of the studies considered.60

Study objective

In this article, we aim to provide an up-to-date overview of the most recent evidence on the efficacy of rTMS in the rehabilitation of stroke patients. Although several studies have been published, a conclusive statement supporting a systematic use of rTMS in the multifaceted clinical aspects of stroke rehabilitation is still lacking.

[…]

 

Continue —> Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls – Francesco Fisicaro, Giuseppe Lanza, Alfio Antonio Grasso, Giovanni Pennisi, Rita Bella, Walter Paulus, Manuela Pennisi, 2019

, , , , , , , , , , , , ,

Leave a comment

[WEB PAGE] Chemical imbalance in the brain: Myths and facts

Everything you need to know about chemical imbalances in the brain

Last reviewed 

A chemical imbalance in the brain occurs when a person has either too little or too much of certain neurotransmitters.

Neurotransmitters are the chemical messengers that pass information between nerve cells. Examples of neurotransmitters include serotonin, dopamine, and norepinephrine.

People sometimes call serotonin and dopamine the “happy hormones” because of the roles that they play in regulating mood and emotions.

A popular hypothesis is that mental health disorders, such as depression and anxiety, develop as a result of chemical imbalances in the brain.

While this theory may hold some truth, it runs the risk of oversimplifying mental illnesses. In reality, mood disorders and mental health illnesses are highly complex conditions that affect 46.6 million adults living in the United States alone.

In this article, we discuss conditions with links to chemical imbalances in the brain, myths surrounding this theory, possible treatment options, and when to see a doctor.

Myths

a man looking sad because he is experiencing a Chemical imbalance in the brain

Many factors may contribute to a person’s risk of mental illness.

Although chemical imbalances in the brain seem to have an association with mood disorders and mental health conditions, researchers have not proven that chemical imbalances are the initial cause of these conditions.

Other factors that contribute to mental health conditions include:

  • genetics and family history
  • life experiences, such as a history of physical, psychological, or emotional abuse
  • having a history of alcohol or illicit drug use
  • taking certain medications
  • psychosocial factors, such as external circumstances that lead to feelings of isolation and loneliness

While some studies have identified links between distinct chemical imbalances and specific mental health conditions, researchers do not know how people develop chemical imbalances in the first place.

Current biological testing also cannot reliably verify a mental health condition. Doctors do not, therefore, diagnose mental health conditions by testing for chemical imbalances in the brain. Instead, they make a diagnosis based on a person’s symptoms and the findings of a physical examination.

What conditions are linked to chemical imbalances?

Research has linked chemical imbalances to some mental health conditions, including:

Depression

Depression, also called clinical depression, is a mood disorder that affects many aspects of a person’s life, from their thoughts and feelings to their sleeping and eating habits.

Although some research links chemical imbalances in the brain to depression symptoms, scientists argue that this is not the whole picture.

For example, researchers point out that if depression were solely due to chemical imbalances, treatments that target neurotransmitters, such as selective serotonin reuptake inhibitors (SSRIs), should work faster.

The symptoms of depression vary widely among individuals, but they can include:

  • persistent feelings of sadness, hopelessness, anxiety, or apathy
  • persistent feelings of guilt, worthlessness, or pessimism
  • loss of interest in formerly enjoyable activities or hobbies
  • difficulty concentrating, making decisions, or remembering things
  • irritability
  • restlessness or hyperactivity
  • insomnia or sleeping too much
  • changes in appetite and weight
  • physical aches, cramps, or digestive problems
  • thoughts of suicide

It is possible to develop depression at any age, but symptoms usually begin when a person is in their teenage years or early 20s and 30s. Women are more likely than men to experience depression.

Many different types of depression exist. These include:

The dramatic hormonal changes that take place after giving birth are among the factors that can increase a woman’s risk of developing postpartum depression. According to the National Institute of Mental Health, 10–15% of women experience postpartum depression.

Bipolar disorder

Bipolar disorder is a mood disorder that causes alternating periods of mania and depression. These periods can last anywhere from a few days to a few years.

Mania refers to a state of having abnormally high energy. A person experiencing a manic episode may exhibit the following characteristics:

  • feeling elated or euphoric
  • having unusually high levels of energy
  • participating in several activities at once
  • leaving tasks unfinished
  • talking extremely fast
  • being agitated or irritable
  • frequently coming into conflict with others
  • engaging in risky behavior, such as gambling or drinking excessive quantities of alcohol
  • a tendency to experience physical injuries

Severe episodes of mania or depression can cause psychotic symptoms, such as delusions and hallucinations.

People who have bipolar disorder can experience distinct changes in their mood and energy levels. They may have an increased risk of substance abuse and a higher incidence of certain medical conditions, such as:

The exact cause of bipolar disorder remains unknown. Researchers believe that changes in the dopamine receptors — resulting in altered dopamine levels in the brain — may contribute to the symptoms of bipolar disorder.

Anxiety

pensive woman

A person with an anxiety disorder may experience excessive worry.

However, people who have an anxiety disorder often experience persistent anxiety or excessive worry that worsens in response to stressful situations.

According to the authors of a 2015 review article, evidence from neuroscience research suggests that the gamma aminobutyric acid (GABA) neurotransmitter may play a crucial role in anxiety disorders.

The GABA neurotransmitter reduces neuronal activity in the amygdala, which is the part of the brain that stores and processes emotional information.

GABA is not the only neurotransmitter that anxiety disorders involve. Other neurotransmitters that may contribute to these disorders include:

  • serotonin
  • endocannabinoids
  • oxytocin
  • corticotropin-releasing hormone
  • opioid peptides
  • neuropeptide Y

Treatment

Doctors can prescribe a class of medications called psychotropics to rebalance the concentration of particular neurochemicals in the brain.

Doctors use these medications to treat a range of mental health conditions, including depression, anxiety, and bipolar disorder.

Examples of psychotropics include:

  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).
  • Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Pamelor).
  • Benzodiazepines, including clonazepam (Klonopin) and lorazepam (Ativan).

According to 2017 researchantidepressants improved symptoms in an estimated 40–60% of individuals with moderate-to-severe depression within 6–8 weeks.

While some people experience reduced symptoms within a few weeks, it can sometimes take months for others to feel the effects.

Different psychotropics have varying side effects. People can discuss the benefits and risks of these medications with their doctor.

The side effects of psychotropic medications can include:

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

When to see a doctor

man talking to doctor in her office both smiling

If a person experiences anxiety and mood changes every day for longer than 2 weeks, they should consider speaking to their doctor.

These symptoms should not cause alarm if they are mild and resolve within a few days.

However, people may wish to consider speaking with a doctor or trained mental health professional if they experience emotional, cognitive, or physical symptoms every day for more than 2 weeks.

Summary

Mental health is complex and multifaceted, and numerous factors can affect a person’s mental well-being.

Although chemical imbalances in the brain may not directly cause mental health disorders, medications that influence the concentration of neurotransmitters can sometimes provide symptom relief.

People who experience signs and symptoms of a mental health problem for more than 2 weeks may wish to speak to a doctor.

 

via Chemical imbalance in the brain: Myths and facts

, , , , , , ,

Leave a comment

[WEB PAGE] Identification and management of depression in people with epilepsy to save lives

Depression is the most common psychiatric comorbidity in people with epilepsy. Clinical studies have found that 20% to 30% of people with epilepsy have depression; the incidence may be as high as 50% to 55% in people visiting hospital epilepsy centers.

Untreated depression is associated with lower quality of life, poor treatment adherence, higher health care utilization and a risk for suicide up to 30 times higher than average.

Yet in most people with epilepsy, depression goes undetected. As an example, a Texas study conducted depression screening on 192 consecutive people visiting a high-volume epilepsy clinic. More than 1 in 4 people-;26%-;screened positive for depression and were subsequently diagnosed with depression. Of them, 65% had no previous history of the condition.

At the 33rd International Epilepsy Congress in Bangkok in June 2019, several sessions focused on psychiatric comorbidities in people with epilepsy and the crucial role of epileptologists in their identification and management.

Sometimes we think too much about the epileptology and not enough about comorbidities. There is individual clinician variation in this area. We must each recognize our own competency and know what we don’t know. Those are strongly influenced by our training, coworkers, culture, country and interests. But in the end, all clinicians must meet a minimum standard.”

Mike Kerr (UK), co-chair of a session on neuropsychiatric issues in epilepsy

This minimum standard was established by ILAE as part of its new epileptology curriculum. Domain 6 includes competencies and learning objectives about comorbidities, including the following:

6.1.1 Recognize psychiatric comorbidities, such as depression, anxiety, ADHD, psychosis and autism spectrum disorder

6.1.2 Appropriately manage or advise regarding psychiatric comorbidities

6.1.3 Adjust anti-seizure treatment as required by psychiatric comorbidities

However, the gap between knowledge and practice remains relatively wide. In a Bangkok session on psychological and psychiatric learning objectives in the ILAE curriculum, an informal survey found that most audience members did not conduct depression or suicidality screening in their clinics.

“Up to half of your patients will have depression and up to half will have anxiety,” said W. Curt LaFrance, Jr. (USA). “But almost no one in this session is using a depression screening tool.”

Generally, neurologists cite several reasons for not using screening tools or asking their patients about depression, including time constraints and the perception that screening is not their role. But physicians who manage the care of people with epilepsy are uniquely positioned to identify depression and initiate treatment that can improve quality of life and seizure control.

“It is part of our clinical responsibility as neurologists and epileptologists to take action in response to the high depression rates in people with epilepsy,” said Rosa Michaelis (Germany), co-chair of one of the sessions. “We should not expect other physicians to take over this task.”

Depression assessment: Individual variation

There’s no single “right” way for epileptologists to handle depression assessment and management, said Kerr. “Some people are multitaskers and will take on psychiatric management,” he said. “At the other end will be people who feel that none of it is their job. In the middle are the guiders, who keep epilepsy as a focus but also address the psychiatric issues.

Michaelis suggested that standardized screening is the most realistic strategy to increase detection rates. “We cannot rely on self-reported symptoms,” she said. Patients may not volunteer information about how they are feeling unless they are asked directly-;and even then, they may deny or downplay their symptoms, or physicians may misinterpret their complaints. Screening tools provide valuable information in only a few minutes; they also can be a gateway to conversations about depression and suicidality.

If the idea of establishing a formal screening program is overwhelming, Kerr suggested being alert to the possibility of depression in every patient and merely asking one question: “During the last month, have you felt down, depressed, or hopeless, or had little interest or pleasure in doing things?”

If the answer sounds at all like “Yes,” refer the patient to a mental health professional. Alternatively, he said, “If you feel competent in mental health assessment, consider using a validated measure” to get a better idea of the extent and severity of the patient’s issue.

For screening, Kerr and others in Bangkok recommended the Neurological Disorders and Depression Inventory in Epilepsy (NDDI-E), which is free for public use and available in more than a dozen languages. The NDDI-E consists of six short “feeling” statements:

  • Everything is a struggle
  • Nothing I do is right
  • Feel guilty
  • I’d be better off dead
  • Frustrated
  • Difficulty finding pleasure

For each statement, the person indicates how often they felt that way over the past two weeks. Points are given for each answer: always or often (4 points); sometimes (3); rarely (2); never (1).

A cutoff of 15 points is generally used to suggest depression, though cutoffs of 11 to 16 have been reported. According to Kerr, a cutoff score of 15 has 81% sensitivity and 90% specificity.

The Patient Health Questionnaire-9 (PHQ-9) or a shorter form, the PHQ-2, also can be administered.

The ILAE Commission on Psychiatry recommends annual screening, but many of the experts urged more frequent screening. They noted that because depression can be episodic, more frequent screening will better identify those patients in need of treatment. It also may improve patient-physician communication and trust.

Though the ILAE consensus statement does not include a recommendation for anxiety screening, Kerr urged clinicians to screen for anxiety as well. The NDDI-E screens for both depression and anxiety; Kerr also recommended the GAD-2 or the ET7, short questionnaires that have been tested in people with epilepsy. Patients with positive screens can be referred to a mental health specialist or assessed further.

“All clinicians should aim to identify depression and anxiety,” Kerr said. “To be a level-2 epileptologist by ILAE standards, you will have to know how to do this.”

Antidepressants: Myth and reality

Psychotherapy and medication are common treatments for depression. Though few studies have focused on the effectiveness of psychotherapy for depression specifically in people with epilepsy, dozens of trials and several meta-analyses support the use of cognitive behavioral therapy (CBT).

Some medical professionals may avoid prescribing antidepressants to people with epilepsy because they believe these drugs decrease the seizure threshold. There is little scientific basis for this, say experts.

A 2017 study followed adults with epilepsy six months before and after the initiation of antidepressant therapy with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norephinephrine reuptake inhibitors (SNRIs). Though the study was relatively small (N=84), the findings showed that antidepressants did not increase seizure frequency. In fact, among patients having more than one seizure per month at baseline, 27.5% went on to have less than 1 per month, and 48% had at least a 50% reduction in frequency. Of the patients, 73% had a therapeutic response to the antidepressant; changes in seizure frequency were independent of therapeutic response.

Pediatric screening

Janelle Wagner (USA) and Avani Modi (USA) addressed the issue of screening for depression and anxiety in the pediatric epilepsy population as it relates to two learning objectives in the ILAE curriculum:

  • 2.5.1 – Recognize when to refer patients for a higher level of care (as it relates to psychiatric comorbidities)
  • 2.9.1 – Provide counseling specific to children with epilepsy and their parents, according to the epilepsy types

Children with epilepsy are at higher risk than other children for depression, anxiety and attention deficit disorder, said Kette Valente (Brazil). Among children with epilepsy, 1 in 4 has depression, 1 in 4 has anxiety, and between 15% and 27% consider committing suicide.

A 2015 ILAE survey found that 55% of pediatric neurologists screened for these comorbidities, compared with only 7% in 2005. However, 50% of clinicians did not feel comfortable with their knowledge of anxiety, and only 40% said that screening for and managing comorbidities were priorities.

Depressive symptoms in children can look different than in adults, said Modi. Low self-esteem, cognitive symptoms, and negative thinking are common. Irritability and disruptive behavior also may be concerns, she said. “What may be seen as a conduct problem is actually depression.”

Valente, Wagner, and Modi described multiple screening instruments that take between 10 and 30 minutes to complete. Valente noted, however, that the instruments are often completed by parents, who do not always reflect their child’s behavior accurately.

The NDDI-E-Y, the pediatric version of the NDDI-E, had a sensitivity of 79% and a specificity of 92% in a 2016 validation study. Like the NDDI-E, the youth version can alert providers to suicidal ideation and provide a platform to discuss it.

Valente suggested screening children at their first visit, and then at certain time points:

  • Every 6 months
  • When seizures worsen
  • After medication changes
  • After any type of complaint about mood or behavior, whether it comes from the child or a parent or teacher

“Screening is not perfect, but it must be done,” she said. “There is no reason not to do it.”

Suicidality – what to do?

Jakob Christensen (Denmark) warned congress attendees that suicide risk overall is increasing worldwide, and that people with epilepsy have triple the risk of a suicide attempt and at least double the risk of death by suicide, compared with the general population. People with psychiatric comorbidities, and those recently diagnosed with epilepsy, are at even greater risk.

A recent meta-analysis found a prevalence of suicidal ideation of 23.2% among people with epilepsy-;more than 7 times the prevalence in the general population. The pooled event rate of completed suicide in the meta-analysis was 0.5%, more than 30 times higher than the global estimated suicide rate (0.016%).

Screening can reveal suicidal thoughts or plans; on the NDDI-E, this can be seen on item 4, “I’d be better off dead”. A score of 3 or 4 on this item has been shown to identify suicidality with 84% sensitivity and 91% specificity.

Christensen recommended asking every patient about suicidal thoughts. “It can be as simple as saying, ‘Do you ever feel like life isn’t worth living?’ he said. Asking the question will not increase the risk of suicidality, he said. “People who have these thoughts are actually quite happy to have you ask the question. They often don’t realize that suicidality can be associated with epilepsy.”

If NDDI-E results indicate suicidality, Milena Gandy (Australia) outlined next steps:

  • Ask the patient if they’ve thought about harming themselves in the past week. If they say yes, ask for details. Ask if they’ve ever tried to kill themselves and if so, how and when.
  • If you feel they may be in imminent danger of harming themselves, ask if they can guarantee their safety until you see them again.
  • If they ask for immediate help or can’t guarantee their safety, you can call a suicide hotline for them, refer them to the emergency room (or escort them there yourself), or refer them to a crisis service.
  • If they are not in immediate crisis, refer them for mental health support if they don’t already have it. If they do have it, talk with them about making an urgent appointment.

The clock is ticking

Screening and conversations do take time. And while all physicians are pressed for time, “We need to think creatively about how we can do what’s possible” with screening, said Markus Reuber (UK). For example, ensure that any patient information (brochures, videos, other handouts) includes mention of mood disorders and anxiety as common comorbidities.

Reuber also noted that some offices and centers have epilepsy nurses or community health advocates who can talk about mental health, and mental health services, with patients. Providers must find creative ways to make time for these issues, he said, as they are a crucial part of epilepsy treatment.

“We can draw on experiences from other health conditions,” said Modi. “In cancer care, chronic pain and heart disease, referring to a psychologist is common practice. Yet there are still some perceptions in neurological disorders that psychological care isn’t as important. But improving mental health can improve medical care.”

 

via Identification and management of depression in people with epilepsy to save lives

, , , , ,

Leave a comment

[WEB SITE] Brains Tend to Work in Sync During Music Therapy, Study Suggests

Published on 

MusicTherapyDocUke

 

The brains of a patient and therapist become synchronized during a music therapy session, a breakthrough that could improve future interactions between patients and therapists, researchers suggest.

The research, published in the journal Frontiers in Psychology, was carried out by Professor Jorg Fachner and Dr Clemens Maidhof of Anglia Ruskin University (ARU).

In the study, they used a procedure called hyperscanning, which is designed to record activity in two brains at the same time, allowing them to better understand how people interact.

During the session documented in the study, classical music was played as the patient discussed a serious illness in her family. Both patient and therapist wore EEG (electroencephalogram) caps containing sensors, which capture electrical signals in the brain, and the session was recorded in sync with the EEG using video cameras, a media release from Anglia Ruskin University explains.

Music therapists work towards “moments of change,” where they make a meaningful connection with their patient. At one point during this study, the patient’s brain activity shifted suddenly from displaying deep negative feelings to a positive peak. Moments later, as the therapist realized the session was working, her scan displayed similar results. In subsequent interviews, both identified that as a moment when they felt the therapy was really working.

The researchers examined activity in the brain’s right and left frontal lobes where negative and positive emotions are processed, respectively. By analyzing hyperscanning data alongside video footage and a transcript of the session, the researchers were able to demonstrate that brain synchronization occurs, and also show what a patient-therapist “moment of change” looks like inside the brain.

“This study is a milestone in music therapy research,” says lead author Jorg Fachner, Professor of Music, Health and the Brain at Anglia Ruskin University (ARU), in the release.

“Music therapists report experiencing emotional changes and connections during therapy, and we’ve been able to confirm this using data from the brain.

“Music, used therapeutically, can improve well-being, and treat conditions including anxiety, depression, autism and dementia. Music therapists have had to rely on the patient’s response to judge whether this is working, but by using hyperscanning we can see exactly what is happening in the patient’s brain,” he continues.

“Hyperscanning can show the tiny, otherwise imperceptible, changes that take place during therapy. By highlighting the precise points where sessions have worked best, it could be particularly useful when treating patients for whom verbal communication is challenging. Our findings could also help to better understand emotional processing in other therapeutic interactions,” he concludes.

[Source(s): Anglia Ruskin University, Science Daily]

 

via Brains Tend to Work in Sync During Music Therapy, Study Suggests – Rehab Managment

, , , , , ,

1 Comment

%d bloggers like this: