Author Archives: RichardB

Types of Depression

24 Wednesday May 2023

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Whether you’re a college student in the middle of a major slump, a new mom who can’t pinpoint why she’s feeling so glum, or a retiree grieving over the loss of a loved one, that question isn’t an easy one to answer.

But there’s one thing for sure: “It is much more than just a sad mood,” said Angelos Halaris, MD, a professor of psychiatry and medical director of adult psychiatry at the Loyola University Medical Center in Chicago. Symptoms may include everything from hopelessness and fatigue to physical pain. And just as symptoms vary from person to person, so do the actual diagnoses. The word depression is actually just an umbrella term for a number of different forms, from major depression to atypical depression to dysthymia.

The most common form of depression? Major depression. In fact, about 7 percent of the adult U.S. population has this debilitating mental health condition at any given time, according to the National Institute of Mental Health (NIMH).

If you’re experiencing major depression, you may feel and see symptoms of extreme sadness, hopelessness, lack of energy, irritability, trouble concentrating, changes in sleep or eating habits, feelings of guilt, physical pain, and thoughts of death or suicide — and for an official diagnosis, your symptoms must last for more than two weeks. In some instances, a person might only experience one episode of major depression, but the condition tends to recur throughout a person’s life.

The best treatment is usually with antidepressant medications, explained Dr. Halaris, but talk therapy may also be used to treat depression. And there’s good news: An estimated 80 to 90 percent of people with major depression respond well to treatment.

About 2 percent of the American population has a form of depression that’s less severe than major depression but is still very real — dysthymia.

Dysthymia is a type of depression that causes a low mood over a long period of time — perhaps for a year or more, explained Halaris. “People can function adequately, but not optimally.” Symptoms include sadness, trouble concentrating, fatigue, and changes in sleep habits and appetite.

This depression usually responds better to talk therapy than to medications, though some studies suggest that combining medication with talk therapy may lead to the greatest improvement. People with dysthymia may also be at risk for episodes of major depression.

A whopping 85 percent of new moms feel some sadness after their baby is born — but for up to 16 percent of women, that sadness is serious enough to be diagnosable.

Postpartum depression is characterized by feelings of extreme sadness, fatigue, loneliness, hopelessness, suicidal thoughts, fears about hurting the baby, and feelings of disconnect from the child. It can occur anywhere from weeks to months after childbirth, and Halaris explained it most always develops within a year after a woman has given birth.

“It needs prompt and experienced medical care,” he said — and that may include a combination of talk and drug therapy.

Would you prefer to hibernate during the winter than face those cold, dreary days? Do you tend to gain weight, feel blue, and withdraw socially during the season?

You could be one of 4 to 6 percent of people in the United States estimated to have seasonal affective disorder, or SAD. Though many people find themselves in winter funks, SAD is characterized by symptoms of anxiety, increased irritability, daytime fatigue, and weight gain. This form of depression typically occurs in winter climates, likely due to the lessening of natural sunlight. “We don’t really know why some people are more sensitive to this reduction in light,” said Halaris. “But symptoms are usually mild, though they can be severe.”

This depression usually starts in early winter and lifts in the spring, and it can be treated with light therapy or artificial light treatment.

Despite its name, atypical depression is not unusual. In fact, it may be one of the most common types of depression — and some doctors even believe it is underdiagnosed.

“This type of depression is less well understood than major depression,” explained Halaris. Unlike major depression, a common sign of atypical depression is a sense of heaviness in the arms and legs — like a form of paralysis. However, a study published in the Archives of General Psychiatry (now known as JAMA Psychiatry) found that oversleeping and overeating are the two most important symptoms for diagnosing atypical depression. People with the condition may also gain weight, be irritable, and have relationship problems.

Some studies show that talk therapy works well to treat this kind of depression.

Psychosis — a mental state characterized by false beliefs, known as delusions, or false sights or sounds, known as hallucinations — doesn’t typically get associated with depression. But according to the National Alliance on Mental Illness, about 20 percent of people with depression have episodes so severe that they see or hear things that are not there.

“People with this psychotic depression may become catatonic, not speak, or not leave their bed,” explained Halaris. Treatment may require a combination of antidepressant and antipsychotic medications. A review of 10 studies concluded that it may be best to start with an antidepressant drug alone and then add an antipsychotic drug if needed. Another review, however, found the combination of medications was more effective than either drug alone in treating psychotic depression.

If your periods of extreme lows are followed by periods of extreme highs, you could have bipolar disorder (sometimes called manic depressive disorder because symptoms can alternate between mania and depression).

Symptoms of mania include high energy, excitement, racing thoughts, and poor judgment. “Symptoms may cycle between depression and mania a few times per year or much more rapidly,” Halaris said. “This disorder affects about 2 to 3 percent of the population and has one of the highest risks for suicide.” Bipolar disorder has four basic subtypes: bipolar I (characterized by at least one manic episode); bipolar II (characterized by hypomanic episodes — which are milder — along with depression); cyclothymic disorder; and other specified bipolar and related disorder.

People with bipolar disorder are typically treated with drugs called mood stabilizers.

Premenstrual dysphoric disorder, or PMDD, is a type of depression that affects women during the second half of their menstrual cycles. Symptoms include depression, anxiety, and mood swings. Unlike premenstrual syndrome (PMS), which affects up to 85 percent of women and has milder symptoms, PMDD affects about 5 percent of women and is much more severe.

“PMDD can be severe enough to affect a woman’s relationships and her ability to function normally when symptoms are active,” said Halaris. Treatment may include a combination of depression drugs as well as talk and nutrition therapies.

Also called adjustment disorder, situational depression is triggered by a stressful or life-changing event, such as job loss, the death of a loved one, trauma — even a bad breakup.

Situational depression is about three times more common than major depression, and medications are rarely needed — that’s because it tends to clear up over time once the event has ended. However, that doesn’t mean it should be ignored: Symptoms of situational depression may include excessive sadness, worry, or nervousness, and if they don’t go away, they may become warning signs of major depression.

Blue Star Families and Museums

20 Saturday May 2023

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Blue Star Museums is a partnership between the National Endowment for the Arts and Blue Star Families, in collaboration with the Department of Defense and museums across America, offering free admission to the nation’s active-duty military personnel and their families, including National Guard and Reserve. The 2023 Blue Star Museums program begins on Armed Forces Day, Saturday, May 20, 2023 and ends on Labor Day, Monday, September 4, 2023.

https://www.arts.gov/initiatives/blue-star-museums

Drugs and the Brain

17 Wednesday May 2023

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The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity—you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. In brief, the brain regulates your body’s basic functions; enables you to interpret and respond to everything you experience; and shapes your thoughts, emotions, and behavior.

The brain is made up of many parts that all work together as a team. Different parts of the brain are responsible for coordinating and performing specific functions. Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug abuse that marks addiction. Brain areas affected by drug abuse include:

  • The brain stem, which controls basic functions critical to life, such as heart rate, breathing, and sleeping.
  • The cerebral cortex, which is divided into areas that control specific functions. Different areas process information from our senses, enabling us to see, feel, hear, and taste. The front part of the cortex, the frontal cortex or forebrain, is the thinking center of the brain; it powers our ability to think, plan, solve problems, and make decisions.
  • The limbic system, which contains the brain’s reward circuit. It links together a number of brain structures that control and regulate our ability to feel pleasure. Feeling pleasure motivates us to repeat behaviors that are critical to our existence. The limbic system is activated by healthy, life-sustaining activities such as eating and socializing—but it is also activated by drugs of abuse. In addition, the limbic system is responsible for our perception of other emotions, both positive and negative, which explains the mood-altering properties of many drugs.

How do the parts of the brain communicate?

The brain is a communications center consisting of billions of neurons, or nerve cells. Networks of neurons pass messages back and forth among different structures within the brain, the spinal cord, and nerves in the rest of the body (the peripheral nervous system). These nerve networks coordinate and regulate everything we feel, think, and do.

  • Neuron to Neuron
    Each nerve cell in the brain sends and receives messages in the form of electrical and chemical signals. Once a cell receives and processes a message, it sends it on to other neurons.
  • Neurotransmitters – The Brain’s Chemical Messengers
    The messages are typically carried between neurons by chemicals called neurotransmitters.
  • Receptors – The Brain’s Chemical Receivers
    The neurotransmitter attaches to a specialized site on the receiving neuron called a receptor. A neurotransmitter and its receptor operate like a “key and lock,” an exquisitely specific mechanism that ensures that each receptor will forward the appropriate message only after interacting with the right kind of neurotransmitter.
  • Transporters – The Brain’s Chemical Recyclers
    Located on the neuron that releases the neurotransmitter, transporters recycle these neurotransmitters (that is, bring them back into the neuron that released them), thereby shutting off the signal between neurons.

To send a message, a brain cell (neuron) releases a chemical (neurotransmitter) into the space (synapse) between it and the next cell. The neurotransmitter crosses the synapse and attaches to proteins (receptors) on the receiving brain cell. This causes changes in the receiving cell—the message is delivered.

How do drugs work in the brain?

Drugs are chemicals that affect the brain by tapping into its communication system and interfering with the way neurons normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure “fools” receptors and allows the drugs to attach onto and activate the neurons. Although these drugs mimic the brain’s own chemicals, they don’t activate neurons in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.

Other drugs, such as amphetamine or cocaine, can cause the neurons to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals. This disruption produces a greatly amplified message, ultimately disrupting communication channels.

How do drugs work in the brain to produce pleasure?

Most drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feelings of pleasure. When activated at normal levels, this system rewards our natural behaviors. Overstimulating the system with drugs, however, produces euphoric effects, which strongly reinforce the behavior of drug use—teaching the user to repeat it.

Most drugs of abuse target the brain’s reward system by flooding it with dopamine.

How does stimulation of the brain’s pleasure circuit teach us to keep taking drugs?

Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.

Why are drugs more addictive than natural rewards?

When some drugs of abuse are taken, they can release 2 to 10 times the amount of dopamine that natural rewards such as eating and sex do. In some cases, this occurs almost immediately (as when drugs are smoked or injected), and the effects can last much longer than those produced by natural rewards. The resulting effects on the brain’s pleasure circuit dwarf those produced by naturally rewarding behaviors. The effect of such a powerful reward strongly motivates people to take drugs again and again. This is why scientists sometimes say that drug abuse is something we learn to do very, very well.

Long-term drug abuse impairs brain functioning.

What happens to your brain if you keep taking drugs?

For the brain, the difference between normal rewards and drug rewards can be described as the difference between someone whispering into your ear and someone shouting into a microphone. Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals. As a result, dopamine’s impact on the reward circuit of the brain of someone who abuses drugs can become abnormally low, and that person’s ability to experience any pleasure is reduced.

This is why a person who abuses drugs eventually feels flat, lifeless, and depressed, and is unable to enjoy things that were previously pleasurable. Now, the person needs to keep taking drugs again and again just to try and bring his or her dopamine function back up to normal—which only makes the problem worse, like a vicious cycle. Also, the person will often need to take larger amounts of the drug to produce the familiar dopamine high—an effect known as tolerance.

Decreased Dopamine Transporters in a Methamphetamine Abuser

How does long-term drug taking affect brain circuits?

We know that the same sort of mechanisms involved in the development of tolerance can eventually lead to profound changes in neurons and brain circuits, with the potential to severely compromise the long-term health of the brain. For example, glutamate is another neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate for this change, which can cause impairment in cognitive function. Similarly, long-term drug abuse can trigger adaptations in habit or non-conscious memory systems. Conditioning is one example of this type of learning, in which cues in a person’s daily routine or environment become associated with the drug experience and can trigger uncontrollable cravings whenever the person is exposed to these cues, even if the drug itself is not available. This learned “reflex” is extremely durable and can affect a person who once used drugs even after many years of abstinence.

What other brain changes occur with abuse?

Chronic exposure to drugs of abuse disrupts the way critical brain structures interact to control and inhibit behaviors related to drug use. Just as continued abuse may lead to tolerance or the need for higher drug dosages to produce an effect, it may also lead to addiction, which can drive a user to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while producing intense impulses to take drugs.

How to Help Yourself if You Are Depressed

10 Wednesday May 2023

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Depressive disorders can make one feel exhausted, worthless, helpless, and hopeless. It is important to realize that these negative views are part of the depression and do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Engage in mild exercise. Go to a movie, a ballgame, or participate in religious, social, AA/NA meetings or other healthy activities.
  • Set realistic goals and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Expect your mood to improve gradually, not immediately.
  • Feeling better takes time. Often during treatment of depression, sleep and appetite will begin to improve before depressed mood lifts.
  • Postpone important decisions. Before deciding to make a significant transition–change jobs, get married or divorced–discuss it with others who know you well and have a more objective view of your situation.
  • Do not expect to ‘snap out of’ a depression. But do expect to feel a little better day-by-day.
  • Remember, positive thinking will replace the negative thinking as your depression responds to treatment.
  • Let your family and friends help you.

Abuse, Neglect and Addiction

03 Wednesday May 2023

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Somewhere south of a sunny childhood are emotional and physical abuse and neglect. There are four possible combinations: emotional abuse, emotional neglect, physical abuse, and physical neglect. If one or more of these describe your childhood, maybe you’ve worked hard to put all that stuff behind you — but a study in the journal Alcoholism: Clinical and Experimental Research shows it’s not that easy to keep your past in the past.

It may come as no surprise that people who were mistreated as children are more likely to struggle with addiction as adults. But exactly what kind of mistreatment you experienced can predict what kind of substance abuser you may become. Of course, having a bad childhood does not mean that you will abuse substances, and conversely there are plenty of folks who had wonderful childhoods and became substance abusers.

For better or for worse, you are shaped by your past. The kind of maltreatment you experienced as a child makes you more likely to lean in certain ways as an adult and how you may use alcohol in predictable patterns to attempt to bring yourself back into balance.

The study followed 314 young adults to discover exactly which unfortunate childhood experiences set people on the paths toward specific kinds of drinking. First the researchers asked about childhood maltreatment, personality and drinking, and then, five years later, they asked again, along with a measure of alcohol-related problems.

Which childhood experiences led to the development of alcohol-related problems as a young adult? Let’s look at each in turn:

1. Emotional Abuse

In this study, young adults who were emotionally abused as children were more likely to be depressed. These depressed people were, in turn, more likely to drink in order to feel better. Of all four types of maltreatment, emotional abuse was most likely to lead to people drinking during the week, and most likely to create alcohol-related problems like missing work or ending relationships.

2. Emotional Neglect

In this study, it was as if emotional neglect cut the head off young adults’ joy. These people weren’t any more likely to be depressed, but they were much less likely than others to be joyful, as if emotional neglect squeezed their positive adult emotions back toward the center. Perhaps because this group’s emotional experience wasn’t quite pushed into “negative” territory, they didn’t feel the need to compensate with alcohol and emotional neglect was the one form of maltreatment on this list that didn’t predict increased alcohol use.

3. Physical Abuse

The researchers call the result of physical abuse “positive emotionality and unconscientious disinhibition.” What this means is that people who were physically abused as children are more likely to be impulsive and seek rewards – they drink on weekends and have a hard time stopping. These people had alcohol-related problems related to massive over-consumption – not the consequences of day-in, day-out drinking, but the consequences of getting way too drunk in binges.

4. Physical Neglect

Like physical abuse, physical neglect made it difficult for people in this study to stop drinking; they had the same “unconscientious disinhibition,” or lack of personal control. But their reasons to start drinking were different. Physical neglect made people antisocial. One form of antisocial behavior was a cruel and sometimes self-destructive experience of drinking. Though physical neglect didn’t predict weekend drinking as strongly as did physical abuse, and it didn’t predict weekday drinking as strongly as did emotional abuse, physical neglect and its antisocial consequence predict both kinds of increased drinking – weekend and weekday…and maybe due to the combined effects, physical neglect leads to as many alcohol-related problems as the other versions of maltreatment.

As important as these specific results, is the idea that unresolved issues from your childhood influence why you drink, when you drink, and how much you drink as an adult. But each of these paths from a difficult childhood to adult alcohol problems pass through an important checkpoint, namely they pass through the person you become. It’s not that a traumatic childhood forces you to drink as an adult, it’s that left unexamined, a traumatic childhood can make you feel like you need to drink to get something you’re missing or get something you want as an adult.

One key function of treatment is working to uncover the unresolved experiences in your past that cause you to drink. Is there something in your past that makes you compensate with alcohol in the present? Only by working to resolve this past mistreatment can you truly move forward without feeling these needs, cravings, and compulsions to drink.

Stress management strategy #6

26 Wednesday Apr 2023

Posted by in Coping Skills, Handout, Stress

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Adopt a healthy lifestyle

Adopt a healthy lifestyle

You can increase your resistance to stress by strengthening your physical health. 

  • Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress. Make time for at least 30 minutes of exercise, three times per week. Nothing beats aerobic exercise for releasing pent-up stress and tension.
  • Eat a healthy diet. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.
  • Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.
  • Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.
  • Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.

There as many ways to reduce stress as there are stars. I use and recommend that people engage a variety of healthy coping and preemptive stress reducing techniques.

Stress Management Strategy #5

19 Wednesday Apr 2023

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Make time for fun and relaxation

Beyond a take-charge approach and a positive attitude, you can reduce stress in your life by nurturing yourself. If you regularly make time for fun and relaxation, you’ll be in a better place to handle life’s stressors when they inevitably come.

Don’t get so caught up in the hustle and bustle of life that you forget to take care of your own needs. Nurturing yourself is a necessity, not a luxury.

  • Set aside relaxation time. Include rest and relaxation in your daily schedule. Don’t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.
  • Connect with others. Spend time with positive people who enhance your life. A strong support system will buffer you from the negative effects of stress.
  • Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.
  • Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.

Learn the relaxation response

You can control your stress levels with relaxation techniques that evoke the body’s relaxation response, a state of restfulness that is the opposite of the stress response. Regularly practicing these techniques will build your physical and emotional resilience, heal your body, and boost your overall feelings of joy and equanimity.

There as many ways to reduce stress as there are stars. I use and recommend that people engage a variety of healthy coping and preemptive stress reducing techniques.