Posts Tagged Depression

[TED Talks] 5 Must watch TED Talks About Depression

Hello, my name is Faith and I’ve been managing depression and anxiety for as long as I can remember. I started this blog to share my tips and tricks and help other bad ass babes kick ass on their mental health journey. I have an online support group you can join for free here. If you need help finding a mental health care provider call 1-800-662-HELP (4357) or visit BetterHelp to talk to a certified therapist online at an affordable price.

This post contains affiliate links, you can read my full disclosure policy here.

I went down the rabbit hole of TED talks again and I thought I would share these awesome TED talks about depression. These aren’t all uplifting but sometimes you need to hear some realness. Positivety kind of feels like a big pile of garbage when you’re depressed anyways (if you’ve ever tried to watch a motivational talk when you’re depressed you probably know what I’m talking about). If you’re depressed and looking for resources checkout my articles on depression and download my free mental health planner.

David Burns talks about using cognitive therapy to treat his depressed patients. He helps his clients to change how they think in order to change how they feel.

Kevin Breel talks about breaking the stigma of depression. If you are feeling depressed and feel like you are along trust me you’re not. There are lots of us out here struggling with depression. I have a mental health support group on Facebookthat you can join if you are looking to connect with other people who are struggling with mental health.

Zindel Segal has been treating his depressed clients by teaching them to appreciate the present moment. Try out the techniques in his talk and see if you think they can help you.

I love her story about communicating with her 2 year old in a positive way. She started trying to practice unconditional positive regard with her kids and then started trying to practice giving unconditional positive regard on herself.

Here’s a kids TED talk from a girl that was hospitalized from depression and anxiety.

Thanks for checking out my post. If you’re looking for more motivation checkout my post of bad ass commencement speeches. I have a ton of mental health resources on my site that I hope you’ll checkout like my free mental health planner or my posts related to anxiety and depression.

 

via TED Talks About Depression – Radical Transformation Project

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[WEB SITE] Coping With Emotional Changes After Stroke for Families

Coping With Emotional Changes After Stroke-blog

As a stroke survivor, you can face major life changes. In the aftermath of a stroke, you may experience a sense of loss that is rooted in the feeling that you’ve lost the life you had before your stroke, or your independence. These strong emotional reactions take a toll.

It is normal to experience emotions ranging from frustration, anxiety, and depression to a sense of grief, or even guilt, anger, and denial after such a monumental change. Realizing that these emotions are normal, and that you are not alone in experiencing them, is an important step to acknowledging and coping with them in a healthy way. By doing this, you avoid becoming overwhelmed, thus avoiding further difficulties during your recovery.

Reasons for Emotional Changes After a Stroke

Young Man At Balcony In Depression Suffering Emotional Crisis And Grief

A stroke causes physical damage to your brain. Feeling or behaving differently after a stroke may be connected to the area of your brain that was damaged. If the area of your brain that controls personality or emotion is affected, you may be susceptible to changes in your emotional response or everyday behavior. Strokes may also cause emotional distress due to the suddenness of their occurrence. As with any traumatic life experience, it may take time for you to accept and adapt to the emotional trauma of having experienced a stroke.

Emotional Changes a Stroke Might Cause

PseudoBulbar Affect

crying

Sometimes referred to as “reflex crying,” “emotional lability,” or “labile mood,” Pseudobulbar Affect (PBA) is a symptom of damage to the area of the brain that controls expression of emotions. Characteristics of the disorder include rapid changes in mood, such as suddenly bursting into tears and stopping just as suddenly, or even beginning to laugh at inappropriate times.

Depression

depressed

If you are feeling sad, hopeless, or helpless after having suffered a stroke, you may be experiencing depression. Other symptoms of depression may include irritability or changes to your eating and sleeping habits. Talk to your doctor if you are experiencing any of these symptoms, as it may be necessary to treat with prescription antidepressants or therapy to avoid it becoming a road block to your recovery.

Anxiety

anxiety

Anxiety is quite common after a stroke. You may have feelings of uneasiness or fears about your health; this is normal and healthy. However, if your anxiety does not subside in time and you feel overwhelmed, you may be dealing with an anxiety disorder, which requires help from your doctor or a mental health professional.

Medical staff will perform an informal evaluation to check for anxiety while you are in the hospital. Often, this involves a quick discussion with hospital staff, during which they will ask you if you have any worries or fears about your health. This evaluation may also involve hospital staff asking your family members if they have noticed a change in your mood or behavior. It is important that you are kept in the loop about any issues that may present themselves, and that you are provided with as much information about your health and treatment options as possible.

Symptoms of anxiety to watch for may include irritability or trouble concentrating. You may also experience trouble sleeping due to your mind racing about your health. Sometimes, you can become tired easily, even if well rested.

Physical symptoms may also present themselves. These symptoms include a racing heart and restlessness and are often coupled with a sense of overwhelming worry or dread. If you find yourself avoiding your normal activities, such as grocery shopping, visiting friends, going for walks, or spending a large portion of your day dwelling on things you are worried about, you may have an anxiety disorder. Your doctor can recommend that you visit a psychologist to help cope with and eventually overcome anxiety.

Other Emotional Reactions

You may experience a range of other emotional reactions after a stroke, including anger and frustration. Additional symptoms may be a sense of apathy or a lack of motivation to accomplish things you typically enjoy.

Coping With Changing Emotions

Physician Ready To Examine Patient And Help

There are many ways to treat the emotional changes associated with a stroke. The first step is discussing how you feel, as well as any concerns you may have about your health with your doctor. One treatment option is counseling, which involves speaking about your distressing thoughts and feelings with a mental health professional or therapist. Simply talking about the way you are feeling can be helpful when coping with overwhelming emotions after experiencing a traumatic event such as a stroke.

Your doctor may also prescribe antidepressants or anti-anxiety medication to help you deal with the emotions involved with a stroke. While they are not a cure-all for emotional troubles, antidepressants change the levels of certain chemicals in your brain, alleviating the symptoms of depression and anxiety, lifting your mood, and making life feel more bearable while you’re recovering. It is important to stay in contact with your doctor if you decide to take medication, as it will not be effective for everyone and may have unpleasant side effects.

Seek Support or Professional Advice

A stroke can come on suddenly and have a monumental effect on your life. For this reason, it is common for many patients to struggle with emotional side effects following a stroke. You may suffer damage to the section of your brain that affects emotions, causing a change in personality or emotional expression known as Pseudobulbar Affect. You may also experience symptoms of anxiety or depression, along with feelings of anger, frustration, or uncharacteristic apathy.

It is important to discuss your emotional concerns with your doctor. You may need a prescription for antidepressants or anti-anxiety medication, or a recommendation to see a mental health professional who can help you form healthy coping mechanisms.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

via Coping With Emotional Changes After Stroke for Families

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[WEB SITE] Dopamine deficiency: Symptoms, causes, and treatment

    1. Symptoms
    2. Causes
    3. Diagnosis
    4. Treatment
    5. Dopamine vs. serotonin
    6. Outlook

 

 

Dopamine is a chemical found naturally in the human body. It is a neurotransmitter, meaning it sends signals from the body to the brain.

Dopamine plays a part in controlling the movements a person makes, as well as their emotional responses. The right balance of dopamine is vital for both physical and mental wellbeing.

Vital brain functions that affect mood, sleep, memory, learning, concentration, and motor control are influenced by the levels of dopamine in a person’s body. A dopamine deficiency may be related to certain medical conditions, including depression and Parkinson’s disease.

A dopamine deficiency can be due to a drop in the amount of dopamine made by the body or a problem with the receptors in the brain.

Symptoms

 

Sad and depressed woman with low dopamine levels. alone in thought.

A dopamine deficiency is associated with depression, but researchers are still investigating this complex link.

 

The symptoms of a dopamine deficiency depend on the underlying cause. For example, a person with Parkinson’s disease will experience very different symptoms from someone with low dopamine levels due to drug use.

Some signs and symptoms of conditions related to a dopamine deficiency include:

  • muscle cramps, spasms, or tremors
  • aches and pains
  • stiffness in the muscles
  • loss of balance
  • constipation
  • difficulty eating and swallowing
  • weight loss or weight gain
  • gastroesophageal reflux disease (GERD)
  • frequent pneumonia
  • trouble sleeping or disturbed sleep
  • low energy
  • an inability to focus
  • moving or speaking more slowly than usual
  • feeling fatigued
  • feeling demotivated
  • feeling inexplicably sad or tearful
  • mood swings
  • feeling hopeless
  • having low self-esteem
  • feeling guilt-ridden
  • feeling anxious
  • suicidal thoughts or thoughts of self-harm
  • low sex drive
  • hallucinations
  • delusions
  • lack of insight or self-awareness

Causes

 

Dopamine model 3D render.

 Dopamine deficiency may be influenced by a number of factors. Existing conditions, drug abuse, and an unhealthy diet may all be factors.

 

Low dopamine is linked to numerous mental health disorders but does not directly cause these conditions.

The most common conditions linked to a dopamine deficiency include:

In Parkinson’s disease, there is a loss of the nerve cells in a specific part of the brain and loss of dopamine in the same area.

It is also thought that drug abuse can affect dopamine levels. Studies have shown that repeated drug use could alter the thresholds required for dopamine cell activation and signaling.

Damage caused by drug abuse means these thresholds are higher and therefore it is more difficult for a person to experience the positive effects of dopamine. Drug abusers have also been shown to have significant decreases in dopamine D2 receptors and dopamine release.

Diets high in sugar and saturated fats can suppress dopamine, and a lack of protein in a person’s diet could mean they do not have enough l-tyrosine, which is an amino acid that helps to build dopamine in the body.

Some studies have found that people who are obese are more likely to be dopamine deficient too.

Diagnosis

There is no reliable way to measure levels of dopamine in a person. However, a doctor may look at a person’s symptoms, lifestyle factors, and medical history to determine if they have a condition related to low levels of dopamine.

Treatment

 

Omega-3 fatty acid supplements.

Omega-3 fatty acid supplements may help to boost dopamine levels naturally.

 

 Treatment of dopamine deficiency depends on whether an underlying cause can be found.

If a person is diagnosed with a mental health condition, such as depression or schizophrenia, a doctor may prescribe medications to help with the symptoms. These drugs may include anti-depressants and mood stabilizers.

Ropinirole and pramipexole can boost dopamine levels and are often prescribed to treat Parkinson’s disease. Levodopa is usually prescribed when Parkinson’s is first diagnosed.

Other treatments for a dopamine deficiency may include:

  • counseling
  • changes in diet and lifestyle
  • physical therapy for muscle stiffness and movement problems

Supplements to boost levels of vitamin Dmagnesium, and omega-3 essential fatty acids may also help to raise dopamine levels, but there needs to be more research into whether this is effective.

Activities that make a person feel happy and relaxed are also thought to increase dopamine levels. These may include exercise, therapeutic massage, and meditation.

Dopamine vs. serotonin

Dopamine and serotonin are both naturally occurring chemicals in the body that have roles in a person’s mood and wellbeing.

Serotonin influences a person’s mood and emotions, as well as sleep patterns, appetite, body temperature, and hormonal activity, such as the menstrual cycle.

Some researchers believe that low levels of serotonin contribute to depression. The relationship between serotonin and depression and other mood disorders is complex and unlikely to be caused by a serotonin imbalance alone.

Additionally, dopamine affects how a person’s moves, but there is no clear link to the role of serotonin in movement.

Outlook

Dopamine deficiency can have a significant impact on a person’s quality of life, affecting them both physically and mentally. Many mental health disorders are linked to low levels of dopamine. Other medical conditions, including Parkinson’s disease, have also been linked to low dopamine.

There is limited evidence that diet and lifestyle can affect the levels of dopamine a person creates and transmits in their body. Certain medications and some therapies may help relieve symptoms, but a person should always speak to a doctor first if they are concerned about their dopamine levels.

 

via Dopamine deficiency: Symptoms, causes, and treatment

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[WEB PAGE] Excitatory magnetic brain stimulation reduces emotional arousal to fearful faces, study shows

February 6, 2018

A new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging looks at the modulation of emotion in the brain

A new study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging reports that processing of negative emotion can be strengthened or weakened by tuning the excitability of the right frontal part of the brain.

Using magnetic stimulation outside the brain, a technique called repetitive transcranial magnetic stimulation (rTMS), researchers at University of Münster, Germany, show that, despite the use of inhibitory stimulation currently used to treat depression, excitatory stimulation better reduced a person’s response to fearful images.

The findings provide the first support for an idea that clinicians use to guide treatment in depression, but has never been verified in a lab. “This study confirms that modulating the frontal region of the brain, in the right hemisphere, directly effects the regulation of processing of emotional information in the brain in a ‘top-down’ manner,” said Cameron Carter, M.D., Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, referring to the function of this region as a control center for the emotion-generating structures of the brain. “These results highlight and expand the scope of the potential therapeutic applications of rTMS,” said Dr. Carter.

In depression, processing of emotion is disrupted in the frontal region of both the left and right brain hemispheres (known as the dorsolateral prefrontal cortices, dlPFC). The disruptions are thought to be at the root of increased negative emotion and diminished positive emotion in the disorder. Reducing excitability of the right dlPFC using inhibitory magnetic stimulation has been shown to have antidepressant effects, even though it’s based on an idea-that this might reduce processing of negative emotion in depression-that has yet to be fully tested in humans.

Co-first authors Swantje Notzon, M.D., and Christian Steinberg, Ph.D, and colleagues divided 41 healthy participants into two groups to compare the effects of a single-session of excitatory or inhibitory magnetic stimulation of the right dlPFC. They performed rTMS while the participants viewed images of fearful faces to evoke negative emotion, or neutral faces for a comparison.

Excitatory and inhibitory rTMS had opposite effects-excitatory reduced visual sensory processing of fearful faces, whereas inhibitory increased visual sensory processing. Similarly, excitatory rTMS reduced participants’ reaction times to respond to fearful faces and reduced feelings of emotional arousal to fearful faces, which were both increased by inhibitory rTMS.

Although the study was limited to healthy participants, senior author Markus Junghöfer, Ph.D., notes that “…these results should encourage more research on the mechanisms of excitatory and inhibitory magnetic stimulation of the right dlPFC in the treatment of depression.”

 

via Excitatory magnetic brain stimulation reduces emotional arousal to fearful faces, study shows

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[WEB SITE] How Doctors Are Using Brain Imaging to Treat Depression

Typically, depression is diagnosed based on what a patient describes about their emotional and mental state. People who suffer from depression often state that they’re sad more often than not and that things they used to enjoy are no longer enjoyable.

The biggest hurdle in diagnosing depression is overcoming the stigma and embarrassment of possibly having a mental health disorder. It’s hard to talk about such raw, emotional, and personal details. Another issue is the fact that depression manifests itself in different ways. Some patients stop eating, others gain weight and suffer from anxiety. There’s no one-size-fits-all when it comes to depression symptoms.

While there aren’t many biological indicators that can be used to diagnose someone with depression, brain imaging has proven to be useful in diagnosing and helping to shape a treatment plan.

What Does Brain Imaging Show?

A recent study that was published in Nature Medicine discuss biological markers that can be used to distinguish different types of depression. To get a better look at the brain, functional magnetic resonance imaging was used to measure the connection strength between the brain and neural circuits. From these images researchers were able to pinpoint four types of depression.

While further research is needed to confirm initial findings, the potential of using biological indicators paves the way for clearer diagnoses and more personalized and effective therapies that treat the brain.

Based on the research, it was observed that certain patients experienced higher levels of fatigue while others discussed a lack of pleasure. In the future there is hope that certain treatment types can be matched to a type of depression. For example, those who report a lack of pleasure may benefit from a treatment known as transcranial magnetic stimulation (TMS). Because TMS uses a magnet to create small electric currents in the brain, the under-functioning reasons can be restored through TMS therapy.

The Next Steps

Though several studies have been conducted to compare depressed brains to those who don’t have the condition, it will take some time before brain imaging becomes a fool-proof way of diagnosing depression. Doctors and researchers will need to find common ground and patterns between the various types of depression so there is one unified method of determining if a patient has depression and the type.

In the future, it’s hoped that brain imaging can not only be used to diagnose depression but also to:

  • Determine treatment options
  • Determine the success rate of treatment
  • Understand other mental health disorders
  • Diagnose other conditions that may impact depression symptoms

While there is still a way to go in using brain imaging to diagnose and treat depression, the future is bright in this health arena.

Treatment Options

There are several forms of brain treatment that can be used to treat depression. The top two options include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

Electroconvulsive Therapy (ECT)

The use of ECT dates back hundreds of years. In fact, ECT is the most commonly used brain treatment for those who suffer from depression. When undergoing ECT treatment, an electric current is formed in the brain that creates a spurt of energy. This causes the patient to have a seizure. Though seizures can be quite scary to experience and even scarier to watch, patients are given anesthesia and a muscle relaxant to avoid the convulsions that are often seen in someone who is having a seizure.

The biggest drawback to ECT is memory loss. Patients often have a hard time remembering past memories so doctors encourage people to create new memories to get that functionality in the brain back up and running.

Transcranial Magnetic Stimulation (TMS)

While electroconvulsive therapy (ECT) is often the go-to procedure for those with severe, long-term, or treatment resistant depression, TMS has proven to be an effective brain treatment for depression. As we better understand how depression impacts regions of the brain, especially the prefrontal cortex, doctors will be able to pinpoint which treatment of combination thereof will produce the best results for a patient.

TMS is beneficial in that it is safe, non-invasive, has minimal side effects, and is designed to target and restore those abnormal connections in the brain. Unlike ECT and other forms of brain treatment options, TMS typically produces minimal to no side effects. Some patients have complained of headache and scalp discomfort but nothing as serious as the memory loss that is often found in those who undergo ECT.

Conclusion

As it stands physical symptoms are the best indicators of whether or not someone has depression. But, with the continued research of using brain imaging to diagnose and determine treatment brings new hope and ideas into the mental health realm.

via How Doctors Are Using Brain Imaging to Treat Depression

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[VIDEO] NeuroStar TMS Therapy – The Complete Clinical Solution for Depression – YouTube

NeuroStar TMS Therapy is an FDA-cleared safe and effective non-drug depression treatment for patients who are not satisfied with the results of standard drug therapy. This novel treatment option provides benefits without the side effects often associated with antidepressant medication. NeuroStar TMS Therapy is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode. The most common side effect is pain or discomfort at or near the treatment site. These events are transient; they occur during the TMS treatment course and do not occur for most patients after the first week of treatment. There is a rare risk of seizure associated with the use of NeuroStar TMS (less than 0.1% per patient).

via NeuroStar TMS Therapy – The Complete Clinical Solution for Depression – YouTube

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[BLOG POST] Tryptophan in Mood, Anxiety, and Depression

 

Deficiency of monoamines, such as dopamine, epinephrine, and serotonin, is the most widely accepted theory explaining mood disorders. Among these neuromediators, serotonin deficiency is considered as most significant in relation to anxiety and depression. This theory has been proven by the effectiveness of drugs that help to increase monoamines levels in the brain, although research in this direction has been hampered by the limitations of present-day technology in measuring the levels of specific monoamines and their properties. However, studies do indicate that their deficiency plays a role in individuals prone to mood swings.

Tryptophan as precursor for serotonin

Tryptophan is one of the essential amino acids. It can’t be produced by our body and has to come through food products rich in proteins. It is required for both anabolic processes and production of various hormones. Tryptophan is a chemical precursor for the synthesis of the neurotransmitter serotonin. This means that the amount of serotonin produced in our body is dependent on the dietary intake of tryptophan. Since serotonin is related to mood regulation, it is entirely possible that tryptophan deficits may have a negative effect on our mood state. On the other hand, its supplementation may be helpful in disorders like anxiety or depression. Multiple investigations seem to support the idea that decreased levels of tryptophan lead to a reduction in serotonin and changes in mood. Some studies have indicated that higher intake of tryptophan may improve social interactions by improving mood and decreasing aggression and dominant behavior.

Serotonin in mood and cognition

Serotonin is important for both mood regulation and regulation of cognitive functions like learning and memory. The effect of monoamine inhibitors called serotonin reuptake inhibitors in various disorders of mood supports this theory. However, it is important to keep in mind that antidepressants are only partially effective in treating mood disorders since monoamine deficits are just one of the factors influencing mood. Most of the serotonin in our body is produced outside the brain, indicating that this compound has a much broader role in our normal physiology. It is possible that many functions of serotonin are still not understood.

Tryptophan depletion and mood regulation

To understand the role of serotonin, and more specifically tryptophan, many tryptophan-depletion studies have been done in recent times. In one simple crossover study, 25 healthy adults were studied for mood changes like anxiety and depression after consuming either a high tryptophan diet or a low tryptophan diet for four days. Tryptophan consumption seems to affect mood even in such a short interval. The study showed that those on a high tryptophan diet had much better mood as compared to those on a low tryptophan diet, although the negative effects of a low tryptophan diet were less pronounced. If such a quick and straightforward analysis can show the difference, it is entirely possible that long-term low tryptophan consumption or depletion may have much graver consequences for mental health.

Tryptophan and gut-brain axis

When we talk about the gut-brain axis we are not just discussing the digestive role of the gut and its effect on overall health, something that has been well known for many years. Our digestive system is also involved in neuro-hormonal signaling, through which it can have an impact on brain functioning. Recently, the influence of gut health on the brain has been the subject of many studies and for good reason. Our gut has more nerve cells than our spine, and it produces many hormones that have various implications for health. Further, it is now well understood that the neural relationship between the gut and brain is dual-sided, and there are more nerve fibers sending information from the gut to the brain rather than from the brain to the gut. Thus, due to the effect of nerves, hormones, and other neurologically active compounds, the gut plays a prominent role in mental wellbeing. Even small changes in the gut could directly affect our behavior. Gut microbiota and their relationship to mood have also recently received lots of attention.

When it comes to tryptophan, the digestive system is not solely involved in its absorption or metabolism. Now it is well-established that serotonin is mostly produced in the gut rather than in the brain, further strengthening the theory of gut-brain interrelation. This theory explains the mood alterations in irritable bowel syndrome (IBS). Further, the development of IBS has been shown to be connected to tryptophan depletion.

The studies show that tryptophan depletion, due to its relationship with serotonin, is undoubtedly one of the most essential elements to consider when analyzing altered mood and cognition. Low serotonin could generally cause a state of lowered mood, impaired cognition, poor working memory, and lower reasoning. Conversely, high tryptophan supplementation could have a positive effect on mood, memory, energy level, and emotional processing.

Low dietary consumption of tryptophan could be one of the elements leading to chronic conditions like depression and anxiety. Bowel conditions like IBS that disturb tryptophan metabolism and alter serotonin levels may also modify our behavior and feelings.

The search for effective therapeutic approaches to the treatment of mood disorders, anxiety, and depression has gained lots of attention in the last few decades. Understanding the role of tryptophan may open up new possibilities for managing mood and cognition problems. It is quite possible that a high tryptophan diet may not only help to prevent mood disorders but also increase the effectiveness of existing drug therapies.

References

Delgado, P. L. (2000) Depression: the case for a monoamine deficiency. The Journal of Clinical Psychiatry61 Suppl 6, 7–11. PMID: 10775018

Jenkins, T. A., Nguyen, J. C. D., Polglaze, K. E., & Bertrand, P. P. (2016) Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients8(1). doi: 10.3390/nu8010056

Lindseth, G., Helland, B., & Caspers, J. (2015). The Effects of Dietary Tryptophan on Affective Disorders. Archives of Psychiatric Nursing29(2), 102–107. doi: 10.1016/j.apnu.2014.11.008

Young, S. N., & Leyton, M. (2002) The role of serotonin in human mood and social interaction. Insight from altered tryptophan levels. Pharmacology, Biochemistry, and Behavior71(4), 857–865. PMID: 11888576

Young, S. N., Smith, S. E., Pihl, R. O., & Ervin, F. R. (1985) Tryptophan depletion causes a rapid lowering of mood in normal males. Psychopharmacology87(2), 173–177. doi: 10.1007/BF00431803

Image via freeGraphicToday/Pixabay.

via Tryptophan in Mood, Anxiety, and Depression | Brain Blogger

 

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[Abstract] The assessment of psychological factors on upper extremity disability: A scoping review

Abstract

Introduction

The primary purpose of this scoping review was to describe the nature and extent of the published research that assesses the relationship between psychological features and patient-reported outcome following surgery or rehabilitation of upper extremity disease or injury.

Methods

Twenty-two included studies were examined for quantitative study design, outcome measure, inclusion/exclusion criteria, follow-up and recruitment strategy. Patient population and psychological assessment tools were examined for validity.

Results

Twenty-two studies met the inclusion criteria for this study. Only 7 of the 22 studies were longitudinal and the rest were cross sectional studies. Depression was the most common psychological status of interest and was included in 17 studies. Pain catastrophizing was the psychological status of interest in 5 of the studies. Four studies considered anxiety, 3 considered pain anxiety, 3 considered distress, 2 considered coping, 2 considered catastrophic thinking, and 2 considered fear avoidance beliefs.

Discussion

The majority of studies in this review were cross-sectional studies. Cross-sectional studies may not provide conclusive information about cause-and-effect relationships. This review encourages clinicians to be mindful of the psychological implications found in rehabilitation of individuals with upper extremity disease or injury along with being cognizant of choosing appropriate measurement tools that best represent each patient’s characteristics and diagnoses.

Conclusions

The nature of the research addressing psychological factors affecting outcomes after hand injury focus on negative traits and have limited strength to suggest causation as most have used cross-sectional designs. Stronger longitudinal designs and consideration of positive traits are needed in future studies.

via The assessment of psychological factors on upper extremity disability: A scoping review – Journal of Hand Therapy

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[WEB SITE] ‘After, I feel ecstatic and emotional’: could virtual reality replace therapy? – The Guardian

If you’ve got acrophobia, paranoia, fear of flying, PTSD, even depression, software could soon be the solution

Virtual reality is the great hope for many mental health professionals.

 Illustration: Leonard Beard for the Guardian

Leslie Channell admits he’s not a typical case for treatment. Channell, known to everybody as Chann, is a registered pilot who served 24 years in the army working on Apache helicopters. Chann also happens to be scared of heights. He doesn’t mind flying planes or sitting on the side of the Apache with the door open; he’s just terrified of going up two or three floors of a building or driving over a bridge.

Chann is nervous; his speech is fast. He says he’s sweating. We meet at a trendy startup in Oxford, where he is about to undergo virtual-reality therapy for his phobia (although the term “virtual-reality” therapy is controversial: some say the VR is just a tool for the therapy; others argue that the virtual reality is the therapy itself). Psychologists are now trialling VR for all kinds of conditions, from phobias to pain management to post-traumatic stress disorder (PTSD).

There are two other people in the room. Cognitive-behavioural therapist Polly Haselton sits behind a curved computer screen watching Chann, occasionally asking questions. Daniel Freeman, professor of clinical psychology at the University of Oxford and one of the world’s pioneers in this field, watches Chann’s every movement. Freeman explains there are three common fears of heights: that you will fall; that what you are standing on will give way; or that you will jump, which is known as “the call of the void”. Chann’s fear is of falling.

A view of the virtual-reality therapy programme that guides patients through their fear of heights.

 The virtual reality therapy programme that guides patients through their fear of heights

A view of the virtual-reality therapy programme that guides patients through their fear of heights.

Photographs: Nowican/Oxford VR

He straps on his virtual-reality headset (also known as a head-mounted display, or HMD). Inside the headset, he will find himself fully immersed in a three-dimensional world. Today, he is going to level four of a 10-storey building in New York to rescue a kitten stranded on a branch of an indoor tree.

Chann has to use a lever to push himself on to a small platform towards the cat. He is a stocky, tough-looking man in his late 50s. But he’s not looking tough any more. His voice is rising, and he’s shaking. He edges forward along the virtual branch. In real life, his feet also move gingerly – then come to a sudden stop. His breathing becomes louder and more staccato.

“You’re doing really well,” Haselton says.

“You don’t know how difficult this is,” Chann pants. “Come here, cat.” Then he stops. “Nah, can’t get it. Aaaagh. No! Gotta come back.”

He starts again, cautiously edging forward. “Yes. Yes. Yes! No, stop Chann. Yes! Yes!” His yeses are urgent, desperate. He makes a grab for the kitten, and returns it to virtual safety.

Task complete. He takes his headset off, talking even faster. “My anxiety levels were way high. Super high.”

“We’re talking nine out of 10, 10 out of 10?” Freeman asks calmly.

“Yeah. I really didn’t want to be there. I had to think I was in a room in Oxford. ‘You’re not here, it’s all OK, do it.’”

Chann is one of a dozen people currently testing this software. (Next month, the trial is being extended to 100 people.) Already, he says, it has made a difference to his life. “Yesterday, I went on a rollercoaster with my daughter. I had never gone on one before. Not the big ones, the smaller ones, but still…” He’s spent only around 20 minutes in the virtual world today, but he is exhausted. “I was worried about coming here, and I’ve done it, and I’m buzzing. Elated.” He pauses, trying to catch his breath. “But I know in my heart of hearts, if there was a real cat on level four, I would not be going out and getting it. Polly asked me, what if it was a little baby? That would change the dynamics.”

Freeman has been working with VR for 16 years. What he loves about this therapy is its simplicity. “There are very few conditions VR can’t help,” he says, “because, in the end, every mental health problem is about dealing with a problem in the real world, and VR can produce that troubling situation for you. It gives you a chance to coach people in other ways of responding. The people I see are anxious or depressed, or worried about people attacking them, and what they’ve done in their life is retreat from the world. With VR, you can get people to try stuff they haven’t done for years – go in lifts, to shopping malls, then they realise they can do it out in the real world.”

Acrophobia, or the fear of heights, is just the start, Freeman says. He has already developed VR programs that treat people with paranoia – for example, placing them in virtual libraries, lifts or on tube trains with strangers eyeballing them. In a Medical Research Council-funded study, he used VR with 30 patients to help them re-learn that they are safe around other people.

“The results were remarkable. From just 30 minutes in VR, there were large reductions in paranoia. Immediately afterwards, more than half the patients no longer had severe paranoia. Importantly, the benefits transferred to the real world. It wasn’t a definitive study. It was small and short-term, but the results do show great potential.” The program will initially be used in NHS mental health services with a staff member present, but Freeman believes that, ultimately, it could be available commercially.

Nearly two million people sought advice for mental health issues in 2015, according to the Health and Social Care Information Centre – up from 1.2 million in 2010. Meanwhile, the number of mental health nurses fell by nearly 15% from 45,384 in 2010 to 38,774 in July 2016, according to a written parliamentary answer from Philip Dunne, the health minister. The British Medical Association recently revealed that in 2016-17, 5,876 adult patients with mental health conditions were referred to another health trust for treatment, with some patients being sent 600 miles away to Scotland. Against this backdrop, virtual reality is the great hope for many mental health professionals. Some psychologists believe they are on the brink of a VR revolution. Then again, they were saying the same thing a quarter of a century ago.

Barbara Rothbaum’s office in Atlanta, Georgia, is closed due to the impending arrival of Hurricane Irma. In between electricity cuts, I manage to speak to her at her home. Rothbaum is a professor in psychiatry, a clinical psychologist at Emory University, and the founding mother of exposure therapy using virtual reality. “We published the very first study using VR to treat a psychological and psychiatric disorder back in 1995,” she tells me. Again, it was to treat acrophobia, and the results amazed Rothbaum. “Seven out of 10 people who got the virtual reality reported putting themselves in real-life height situations afterwards.” That was when they thought they were on to something big. “We used to say: ‘We’re on the cutting edge of the lunatic fringe.’ That was our line at the time.” She laughs.

After acrophobia, Rothbaum developed a VR program for fear of flying. This was even more effective, because traditional exposure therapy (paying for yourself and a therapist to travel on a plane) is time-consuming and expensive. “I can do all that in my 45- to 50-minute therapy session, with ultimate control. So if I know they’re not ready for turbulence, I can guarantee there won’t be turbulence.”

Rothbaum then went on to do pioneering work with Iraq and Afghanistan war veterans suffering from PTSD. Before VR, veterans were confined to imaginal therapy – basically, shutting your eyes and thinking yourself back to the original situation. But now Rothbaum could recreate it for them in a controlled environment. “With PTSD, especially in military folk, they are very avoidant emotionally. With VR, it’s harder to avoid, because it is such a potent stimulus.”

Early on in her VR career, a public-private partnership between Emory University and the Georgia Institute of Technology insisted Rothbaum and her colleagues form a corporation and patent their software. The result was a company, Virtually Better, that designs environments for fellow clinicians to use. “That is my conflict of interest,” Rothbaum says. Whoever she speaks to, she instantly declares it. Does it worry her that she is responsible for the research showing how effective her own VR products are? “It has done, over the years,” she says. “One of the ways I manage it is, I disclose, disclose, disclose.”

Rothbaum is not alone. VR therapy is a small, niche world. Read the scientific papers, and the same names crop up again and again. And most of these academics are now also running commercial companies. As traditional funds dry up for universities, people such as Rothbaum are increasingly reliant on business – often their own business – for support in their research.

As it happens, Rothbaum says, she lacked the cut-throat instincts to be a good businesswoman. “A criticism of Virtually Better was that it was run more like an academic department than a business. We knew how to write grants so we’d write small business grants and enjoy collaborating rather than competing. I thought it was an interesting way to do exposure therapy and wasn’t very mercenary about it.”

Has she ever used VR to treat her own fears? “No. My fear early on was that somebody was going to make a lot of money, and it wasn’t going to be us. Actually, that is probably still going to come true. But I’ve adapted to that; it’s all right.” She’s still not rich? “Oh no, not by a long shot, no.”

Despite research showing its efficacy, the VR therapy revolution did not take off in the 1990s or the noughties. This time around, though, it looks as if it might. Mel Slater, a professor of virtual environments, shows me why. We meet in the London HQ of Digital Catapult, a government initiative to promote the digital economy. Slater hands me the headset used in the virtual psychotherapy sessions he is developing. “The VR world burst open in 2013 when this Oculus Rift was released for a few hundred dollars, compared with the next credible headset of $50,000, and now all the big companies have gone into it.”

Slater talks quietly and, facially, has a touch of Woody Allen about him. Although primarily a computer scientist, he is now largely based in the psychology faculty at the University of Barcelona. Slater is one of the most-in-demand academics in the virtual world, with an endless list of titles, including professor of virtual environments at University College London, co-founder of the company Virtual Bodyworks, and immersive fellow at Digital Catapult. He also works with Daniel Freeman on treatments for persecutory delusions and acrophobia.

Like Rothbaum, Slater is one of the early 1990s pioneers. “Nobody told me virtual reality died, so I stayed with it.” He smiles.

And had it died? “No, but for a long time people said, ‘It’s not going anywhere because it’s too expensive.’ The equipment we used at UCL cost £1m. The equipment I have in Barcelona, when I set up there 10 years ago, was £100,000. Now I can do the same thing with £3,000.”

Slater says the human reaction still surprises him. “There is some level of the brain that doesn’t distinguish between reality and virtual reality. A typical example is, you see a precipice and you jump back and your heart starts racing. You react very fast because it’s the safe thing for the brain to do. All your autonomic system starts functioning, you get a very strong level of arousal, then you go, ‘I know it’s not real’. But it doesn’t matter, because you still can’t step forward near that precipice.”

Virtual reality therapy session

Simon Hattenstone explains his problems to Sigmund Freud…

 
Virtual reality therapy session

 …then analyses himself as Freud. Photographs: Event Lab, University of Barcelona, Spain

In some ways, he says, virtual reality beats reality because it enables you to experiment in ways you can’t, physically, in real life (for example, putting people in different bodies to experience what it is like to be a different gender or ethnicity) or in situations you would avoid.

“I was in one session where the guy had such a fear of public speaking that he told us about speaking at his daughter’s wedding, and we said, ‘How old is your daughter?’ and he said, ‘Three!’ So he spoke to a virtual audience. He said: ‘I can’t do this, I’m turning bright red, my voice is an octave higher.’ The psychologist later played it back to him and said: ‘Is your face red? No. Are you speaking an octave higher than normal? No.’ The psychologist did in one afternoon what would normally take 12 weeks.”

I have seen headlines suggesting that VR can cure depression. Surely that is an exaggeration? “Cure, I don’t know,” Slater says. “But we published a study last year where we reduced the level of depression among a cohort of people through a VR intervention not that dissimilar from what I’m going to show you today. Part of having depression is that you are overly self-critical and cannot give compassionate thoughts to yourself. So in the VR, you see a crying child. Beforehand, the therapist has given you a structure of things you should say to other people in order to give them compassion. So you say these things to the child who starts looking at you and stops crying. Then, in the next phase, you are that child, so you then see and hear your previous self giving you the compassionate speech. When we gave this to a group of moderately depressed people three times, the level of depression decreased.”

I put on my headset and sit in front of a screen. The program I’m trying, called VReflect-Me, is still being developed for people with anxiety issues and depression. It is based on the notion that, when advising friends, we are often kinder and more objective than when analysing ourselves.

First of all, an avatar is created of me. Then I embody that avatar. I am in a therapy session with a psychiatrist (in this case, Sigmund Freud) and I tell him my problems. In the next stage, I embody Freud. When my head moves, Freud’s head moves; when my hands move, his move; and when I’m ready, I advise myself in the form of Freud. (Slater says that Freud is a useful avatar, because you tend to adopt characteristics of your avatar; so, if he is wise, you become more wise.)

I tell Freud I have paranoid tendencies; generally, I think I’m incredibly boring with nothing to say and hate formal social situations (not the pub), because I fear my stupidity will be exposed. More specifically, I tell Freud, I have just read comments on social media about an interview I just wrote saying that I gave my subject an easy ride. I am full of self-loathing, and feel useless at my job.

Now I switch roles, and am Freud advising me. The first time I do it, I’m too self-conscious. Slater gently suggests that I was not fully immersed. I ask if I can do it again. This time, I go for it. It might not be the way Freud would have responded, but I listen to my problems and then tear into myself – rightly or wrongly, I make a good case for not being boring, stupid and a rubbish journalist. I verbalise everything and dismiss it as solipsistic nonsense. I then return to my own avatar. “Good points. Well made,” I say to Freud. And I mean it.

When I take off my headset and leave the virtual world, my breathing is fast and shallow – not unlike Chann’s after he’d been to the heights. I feel both ecstatic and emotional. Tearful, almost. Even if it doesn’t last, it’s been a useful exercise. I might say this kind of stuff to myself in my head, but it feels different when you say it out loud.

Slater is pleased with me. “Wow! You did amazing. You said, ‘You, you, you!’ which is great.” What he means is, I successfully got out of my head and into Freud’s. It strikes me as a powerful tool for therapists. There is no way I would have said what I said, as Freud, if I was simply talking to a real person.

But I can’t help thinking I’m a relatively safe case. What if I were more vulnerable? What, for example, if I suffered from the acrophobic’s call of the void, did the VR program, convinced myself I’d overcome my phobia, went to the nearest high-rise and jumped?

Dr Kate Anthony, an expert on the use of technology in therapy and a fellow of the British Association for Counselling & Psychotherapy, stresses that technology is there to be used alongside therapy, rather than instead of. “VR is a good opportunity for helping psychotherapists,” she says, “but we’re not at a stage yet where virtual reality is going to be able to replicate a human therapist.”

It’s all very well, she adds, having software to encourage you to talk and tackle your fears, but that will take you only so far. “The VR therapist can’t respond in any meaningful way, and without that meaningful response, I don’t think the client is going to progress.”

Once VR treatments have been proven to be effective, she says, she would like to see them available on prescription. What about making them commercially available? No, she says, it’s too risky. “If we’re talking about paranoia, for example, any of these situations can trigger the client. The trouble with something like that is it could bring up all sorts of issues. I would want to see it closely managed.”

Dr Michael Madary, a philosopher and technology ethicist, and his colleague Thomas Metzinger, have drawn up a code of conduct for the use of VR, some of which addresses its use in therapy. He thinks VR can have a positive impact, but that therapists must not blind themselves to the dangers. One particularly sensitive issue, Madary says, is data. Participants in studies know their data is confidential, but that could be very different if commercial companies invest in VR therapy purely for profit. “With motion tracking, particularly facial tracking, users are going to reveal a lot about themselves – about their mental state, about how they react to various stimuli – and that data can be collected and then used as a powerful bargaining tool.”

He envisages a scenario where there is an advertisement flashed, or product placed, in the virtual world and the content creators collect the response of users to that ad based on the faces they make. “You can imagine seeing your avatar in a new jacket, for example. There will be a lot of powerful techniques that emerge in marketing, with widespread use of motion capture.”

Mel Slater accepts that virtual reality can be abused. But anything can, he says. “You can use a bread knife to cut bread or to stab someone, so any tool can be misused deliberately. This is why I think the applications in clinical psychology have to be led by people such as Daniel, who know the risks.”

Back in Oxford, Daniel Freeman is not so sure the programs need his presence to be effective. He is talking about his company Nowican, and anticipating the launch of its first product – Nowican Do Heights, the acrophobia program being trialled by Chann.

He hopes that the NHS and individual psychologists will invest in it, but believes its prime use will be for individuals seeking help. “We’re putting a virtual coach in there so you don’t need a therapist, and we’re also looking at better techniques than simple exposure.”

Is he in danger of doing himself out of a job? “No. We’re not saying it has to replace the therapist. Some people will want to talk to a therapist, and sometimes the complexity means you need a therapist. But the issue is, there aren’t enough therapists.” Freeman is hoping that, before long, we will be able to download this as an app on our smartphones.

In a world of diminishing NHS resources, Freeman regards it as a no-brainer: “I see people who have been waiting 20 years and not had a chance of seeing a therapist. The idea that we can give so many people the chance to access what the best therapists should be doing – that is really exciting.”

  • Watch the Guardian’s latest VR experience The Party, filmed from the perspective of a 16-year-old girl with autism, on our new Guardian VR app. You can download it from the Apple App Store and the Google Play Store, or watch it as a 360 video, along with other Guardian VR experiences, at theguardian.com/vr

via ‘After, I feel ecstatic and emotional’: could virtual reality replace therapy? | Technology | The Guardian

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[WEB SITE] Doctors Successfully ‘Rewire’ The Brain Of People With Depression.(Video)

Americans spend billions of dollars each year on antidepressants, but the National Institutes of Health estimates that those medications work for only 60 percent to 70 percent of people who take them. In addition, the number of people with depression has increased 18 percent since 2005, according to the World Health Organization, which this year launched a global campaign encouraging people to seek treatment.

The Semel Institute for Neuroscience and Human Behavior at UCLA is one of a handful of hospitals and clinics nationwide that offer a treatment that works in a fundamentally different way than drugs. The technique, transcranial magnetic stimulation, beams targeted magnetic pulses deep inside patients’ brains — an approach that has been likened to rewiring a computer.

TMS has been approved by the FDA for treating depression that doesn’t respond to medications, and UCLA researchers say it has been underused. But new equipment being rolled out this summer promises to make the treatment available to more people.

“We are actually changing how the brain circuits are arranged, how they talk to each other,” said Dr. Ian Cook, director of the UCLA Depression Research and Clinic Program. “The brain is an amazingly changeable organ. In fact, every time people learn something new, there are physical changes in the brain structure that can be detected.”

Nathalie DeGravel, 48, of Los Angeles had tried multiple medications and different types of therapy, not to mention many therapists, for her depression before she heard about magnetic stimulation. She discussed it with her psychiatrist earlier this year, and he readily referred her to UCLA.

Within a few weeks, she noticed relief from the back pain she had been experiencing; shortly thereafter, her depression began to subside. DeGravel says she can now react more “wisely” to life’s daily struggles, feels more resilient and is  able to do much more around the house. She even updated her resume to start looking for a job for the first time in years.

During TMS therapy, the patient sits in a reclining chair, much like one used in a dentist’s office, and a technician places a magnetic stimulator against the patient’s head in a predetermined location, based on calibrations from brain imaging.

Dr. Andrew Leuchter talks with a patient who is about to undergo transcranial magnetic stimulation, which treats depression by sending magnetic pulses to a specific area of the brain. Credit: UCLA

The stimulator sends a series of magnetic pulses into the brain. People who have undergone the treatment commonly report the sensation is like having someone tapping their head, and because of the clicking sound it makes, patients often wear earphones or earplugs during a session.

TMS therapy normally takes 30 minutes to an hour, and people typically receive the treatment several days a week for six weeks. But the newest generation of equipment could make treatments less time-consuming.

“There are new TMS devices recently approved by the FDA that will allow patients to achieve the benefits of the treatment in a much shorter period of time,” said Dr. Andrew Leuchter, director of the Semel Institute’s TMS clinical and research service. “For some patients, we will have the ability to decrease the length of a treatment session from 37.5 minutes down to 3 minutes, and to complete a whole course of TMS in two weeks.”

Leuchter said some studies have shown that TMS is even better than medication for the treatment of chronic depression. The approach, he says, is underutilized.

“We are used to thinking of psychiatric treatments mostly in terms of either talk therapies, psychotherapy or medications,” Leuchter said. “TMS is a revolutionary kind of treatment.”

Bob Holmes of Los Angeles is one of the 16 million Americans who report having a major depressive episode each year, and he has suffered from depression his entire life. He calls the TMS treatment he received at UCLA Health a lifesaver.

“What this did was sort of reawaken everything, and it provided that kind of jolt to get my brain to start to work again normally,” he said.

Doctors are also exploring whether the treatment could also be used for a variety of other conditions including schizophrenia, epilepsy, Parkinson’s disease and chronic pain.

“We’re still just beginning to scratch the surface of what this treatment might be able to do for patients with a variety of illnesses,” Leuchter said. “It’s completely noninvasive and is usually very well tolerated.”

via Doctors Successfully ‘Rewire’ The Brain Of People With Depression

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