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RichardbBrunner

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RichardbBrunner

Tag Archives: depression

Self-Care and #Depression

13 Tuesday Aug 2019

Posted by RichardB in Depression, Self-Care, Uncategorized

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depression, wellness

As a clinical psychologist, Mary Pipher, PhD, designed “healing packages” for her patients: activities, resources, and comforts to help them recover from trauma. Then, after Dr. Pipher’s book Reviving Ophelia became a runaway best-seller, she herself suffered from an episode of major depression and designed a healing package of her own. “The essence of my personal healing package,” she describes in her book Seeking Peace, “was to keep my life as simple and quiet as possible and to allow myself sensual and small pleasures.” She created a mini-retreat center in her home and modified the ancient ways of calming troubled nerves to fit her lifestyle. Pipher’s healing package looked like this:

She accessed the healing power of water by walking at Holmes Lake Dam, swimming at the university’s indoor pool, and reading The New Yorker magazine in the bathtub every morning.loneliness1.jpg

She cooked familiar foods, dishes that reminded her of home: jaternice, sweetbreads, and perch; and cornbread and pinto beans with ham hocks.

She unpacked her childhood teacup collection and displayed it near her computer desk to remind her of happy times and of people who loved her.

She reconnected with the natural world by walking many miles every week on the frozen prairie, watching the yellow aconites blossom in February and the daffodils and jonquils in March, following the cycles of the moon, and witnessing sunrises and sunsets.

She read biographies of heroes like Abe Lincoln, and read the poetry of Billy Collins, Robert Frost, Mary Oliver, and Ted Kooser.

She found role models for coping with adversity.

She limited her encounters with people and gave herself permission to skip holiday gatherings and postpone social obligations. She erased calendar engagements until she had three months of “white space” in her future.

She embraced her body through yoga and massage. She started to pay attention to tension in her neck and other cues from her body and let those signals teach her about herself.

msclip-030.jpgShe meditated every day.

These activities were exactly what she needed to emerge from the other side of depression. She writes:

After taking care of my body for several months, it began to take good care of me. My blood pressure improved and my heart problems disappeared. After a few months of my simple, relatively stress-free life and my healing package of activities, I felt my depression lifting. I enjoyed the return of positive emotions: contentment, joy, calmness and new sparks of curiosity and energy. I again felt a great tenderness toward others.

 

Psychiatrist James Gordon, MD, discusses similar healing packages in his best-selling book Unstuck. At the end of his first meetings with all of his patients, he will write out a “prescription of self-care,” which includes instructions on changing diet, advice about specific recommended meditations or exercises, and a list of supplements and herbs. “Among my recommendations, there are always actions, techniques, approaches, and attitudes that each person has told me — which she already knows — are helpful,” he explains. At the end of his introduction, he suggests each reader take some time to write out his or her own prescription. He supplies a form and everything.

Each person’s healing package is unique. Many people have benefited from more meditation and mindfulness exercises, psychotherapy sessions, and therapies like Eye Movement Desensitization and Reprocessing (EMDR) that help unclog the brain of painful memories. Some people do better with more physical exercise and nutritional changes. While mindfulness and meditation have certainly helped many become aware of my rumination patterns, the most profound changes in others recovery  have come from the bags of dark, green leafy vegetables, yoga, and breathing exercises.

It’s empowering to know that we don’t need a doctor or any mental health professional to design a healing package for us. We are perfectly capable of writing this prescription ourselves. Sometimes (not always), all it takes are a few simple tweaks to our lifestyle over a period of time to pull us out of a crippling depression or unrelenting anxiety.

Relaxation to Reduce Stress, Anxiety, & Depression

31 Wednesday Jul 2019

Posted by RichardB in Handout, Health, Meditation, mindfulness, Relaxation, Stress, Wellness

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depression, reduce, relaxation, Stress

Here is another handout that I often give to clients/patients. I should add that I do all of the ideas in my handouts. No point talking about something if you can walk it too.

The body’s natural relaxation response is a powerful antidote to stress. Relaxation techniques such as deep breathing, visualization, progressive muscle relaxation, meditation, and yoga can help you activate this relaxation response. When practiced regularly, these activities lead to a reduction in your everyday stress levels and a boost in your feelings of joy and serenity. What’s more, they also serve a protective quality by teaching you how to stay calm and collected in the face of life’s curveballs.

The relaxation response is not: The relaxation response is:
laying on the couch

sleeping

being lazy

a mentally active process that leaves the body relaxed

best done in an awake state

trainable and becomes more profound with practice

Starting a relaxation practice

A variety of relaxation techniques help you achieve the relaxation response. Those whose stress-busting benefits have been widely studied include deep breathing, progressive muscle relaxation, meditation, visualization, yoga, and tai chi. feelings-40

Learning the basics of these relaxation techniques isn’t difficult. But it takes practice to truly harness their stress-relieving power: daily practice, in fact. Most stress experts recommend setting aside at least 10 to 20 minutes a day for your relaxation practice. If you’d like to get even more stress relief, aim for 30 minutes to an hour.

Getting the most out of your relaxation practice

Set aside time in your daily schedule. The best way to start and maintain a relaxation practice is by incorporating it into your daily routine. Schedule a set time either once or twice a day for your practice. You may find that it’s easier to stick with your practice if you do it first thing in the morning, before other tasks and responsibilities get in the way.

Don’t practice when you’re sleepy. These techniques can relax you so much that they can make you very sleepy, especially if it’s close to bedtime. You will get the most out of these techniques if you practice when you’re fully awake and alert.

Choose a technique that appeals to you. There is no single relaxation technique that is best. When choosing a relaxation technique, consider your specific needs, preferences, and fitness level. The right relaxation technique is the one that resonates with you and fits your lifestyle.

Do you need alone time or social stimulation?

If you crave solitude, solo relaxation techniques such as meditation or progressive muscle relaxation will give you the power to quiet your mind and recharge your batteries. If you crave social interaction, a class setting will give you the stimulation and support you’re looking for. Practicing with others may also help you stay motivated.

The mindful way through depression

23 Tuesday Jul 2019

Posted by RichardB in Depression, mindfulness, youtube

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Serotonin deficiency may not be linked to depression

19 Friday Jul 2019

Posted by RichardB in brain, Depression, mental health, Neuroscience, Uncategorized

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brain, depression, Mental Health

Depression strikes some 35 million people worldwide, according to the World Health Organization, contributing to lowered quality of life as well as an increased risk of heart disease and suicide. Treatments typically include psychotherapy, support groups and education as well as psychiatric medications. SSRIs, or selective serotonin reuptake inhibitors, currently are the most commonly prescribed category of antidepressant drugs in the U.S., and have become a household name in treating depression.feelings-54.jpg

The action of these compounds is fairly familiar. SSRIs increase available levels of serotonin, sometimes referred to as the feel-good neurotransmitter, in our brains. Neurons communicate via neurotransmitters, chemicals which pass from one nerve cell to another. A transporter molecule recycles unused transmitter and carries it back to the pre-synaptic cell. For serotonin, that shuttle is called SERT (short for “serotonin transporter”). An SSRI binds to SERT and blocks its activity, allowing more serotonin to remain in the spaces between neurons. Yet, exactly how this biochemistry then works against depression remains a scientific mystery.

In fact, SSRIs fail to work for mild cases of depression, suggesting that regulating serotonin might be an indirect treatment only. “There’s really no evidence that depression is a serotonin-deficiency syndrome,” says Alan Gelenberg, a depression and psychiatric researcher at The Pennsylvania State University. “It’s like saying that a headache is an aspirin-deficiency syndrome.” SSRIs work insofar as they reduce the symptoms of depression, but “they’re pretty nonspecific,” he adds.

Now, research headed up by neuroscientists David Gurwitz and Noam Shomron of Tel Aviv University in Israel supports recent thinking that rather than a shortage of serotonin, a lack of synaptogenesis (the growth of new synapses, or nerve contacts) and neurogenesis (the generation and migration of new neurons) could cause depression. In this model lower serotonin levels would merely result when cells stopped making new connections among neurons or the brain stopped making new neurons. So, directly treating the cause of this diminished neuronal activity could prove to be a more effective therapy for depression than simply relying on drugs to increase serotonin levels.

Evidence for this line of thought came when their team found that cells in culture exposed to a 21-day course of the common SSRI paroxetine (Paxil is one of the brand names) expressed significantly more of the gene for an integrin protein called ITGB3 (integrin beta-3). Integrins are known to play a role in cell adhesion and connectivity and therefore are essential for synaptogenesis. The scientists think SSRIs might promote synaptogenesis and neurogenesis by turning on genes that make ITGB3 as well as other proteins that are involved in these processes. A microarray, which can house an entire genome on one laboratory slide, was used to pinpoint the involved genes. Of the 14 genes that showed increased activity in the paroxetine-treated cells, the gene that expresses ITGB3 showed the greatest increase in activity. That gene,ITGB3, is also crucial for the activity of SERT. Intriguingly, none of the 14 genes are related to serotonin signaling or metabolism, and, ITGB3 has never before been implicated in depression or an SSRI mode of action.

These results, published October 15 2013 in Translational Psychiatry, suggest that SSRIs do indeed work by blocking SERT. But, the bigger picture lies in the fact that in order to make up for the lull in SERT, more ITGB3 is produced, which then goes to work in bolstering synaptogenesis and neurogenesis, the true culprits behind depression. “There are many studies proposing that antidepressants act by promoting synaptogenesis and neurogenesis,” Gurwitz says. “Our work takes one big step on the road for validating such suggestions.”

 let-out-your-emotions_14-things-adults-can-learn-from-children.jpg

The research is weakened by its reliance on observations of cells in culture rather than in actual patients. The SSRI dose typically delivered to a patient’s brain is actually a fraction of what is swallowed in a pill. “Obvious next steps are showing that what we found here is indeed viewed in patients as well,” Shomron says.

The study turned up additional drug targets for treating depression—two microRNA molecules, miR-221 and miR-222. Essentially, microRNAs are small molecules that can turn a gene off by binding to it. The microarray results showed a significant decrease in the expression of miR-221 and miR-222, both of which are predicted to target ITGB3, when cells were exposed to paroxetine. So, a drug that could prevent those molecules from inhibiting the production of the ITGB3 protein would arguably enable the growth of more new neurons and synapses. And, if the neurogenesis and synaptogenesis hypothesis holds, a drug that specifically targeted miR-221 or miR-222 could bring sunnier days to those suffering from depression.

Types of Depression

29 Monday Apr 2019

Posted by RichardB in Depression, Uncategorized

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depression

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.21789-113979.jpg

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.5241352878_f53a343088.jpg

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 really 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.

The mindful way through depression

22 Monday Apr 2019

Posted by RichardB in Depression, mindfulness, YouTube

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Asanas that chase away the blues

10 Wednesday Apr 2019

Posted by RichardB in Research, Wellness, Yoga

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depression, yoga

Nice article from the Times of India, citing research using Yoga Asanas: Among the many clinical researches being conducted at Nimhans , one involved patients of an old-age home who were exposed to six months of yoga therapy. MRI scans taken before and after showed an increase in the size of the hippocampus, the brain’s memory index. “It wasdog1larger than before because the grey matter had increased. The results will be published in a scientific journal shortly ,” adds Gangadhar. The hippocampus is vulnerable to stress and atrophy is seen in patients of schizophrenia, post-traumatic stress disorder (PTSD) and severe depression. “Yoga acts as an antidepressant ,” he says. Read the entire article here.

Depression and the inflammatory process

27 Wednesday Mar 2019

Posted by RichardB in Depression, mental health, research, Uncategorized

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depression, inflammation, research

Most people feel down, tired and inactive when they’re injured or ill. This “sickness behavior” is caused by the activation of the body’s immune response. It’s the brain’s way of conserving energy so the body can heal.

This immune response can also occur in people with depression. This has prompted some researchers and clinicians to hypothesise that depression is actually a side effect of the inflammatory process.

But while there may be a connection between inflammation and depression, one doesn’t necessarily lead to the other. So it’s too simplistic to say depression is a physical, rather than a psychiatric, illness.

The inflammation hypothesis

University of California clinical psychologist and researcher George Slavich is one of the key recent proponents of depression as a physical illness. He hypothesises that social threats and adversity trigger the production of pro-inflammatory “cytokines”. These are messenger molecules of the immune system that play a critical role in orchestrating the host’s response to injury and infection.

This inflammatory process, Slavich argues, can initiate profound behavioral changes, including the induction of depression.5241352878_f53a343088.jpg

The idea that the activation of the immune response may trigger depression in some people is by no means a new one. Early descriptions of post-influenza depression appeared in the 19th century in the writings of English physician Daniel Tuke.

But it was not until the 1988 seminal paper, published by veterinarian Benjamin Hart, that the phenomenon of acute “sickness behavior” caught the interest of the scientific community.

Hart described his detailed observations of the “behavior of sick animals”. During acute infection, and in response to fever, the animals sought sleep, lost their appetite, showed a reduction in activity, grooming and social interactions, as well as showing signs of “depression”.

Just like the immune response itself, these changes reflect an evolved survival strategy that shifts priorities toward energy conservation and recovery.

Putting the theory into practice

Cytokine-induced sickness behavior has subsequently been studied as an example of communication between the immune system and the brain.

The behavioral changes during sickness resemble those associated with depression, so it didn’t take long for researchers to make a connection between the phenomenon of sickness behavior and mental disorders.

Such speculation was strengthened by research showing that depressive states can be experimentally induced by administering cytokines and other immunogenic agents (such as vaccines) that cause an inflammatory response.

Depression is frequently associated with inflammatory illnesses such as heart disease and rheumatoid arthritis. It’s also a side effect of treatment with cytokines to enhance the immune system.

Over recent decades, researchers have made progress in understanding how inflammation may impact on the activity of signalling pathways to and from the brain, as well as on the functioning of key neural systems involved in mood regulation.

But there’s not always a link

From the available evidence it’s clear, however, that not everyone who suffers from depression has evidence of inflammation. And not all people with high levels of inflammation develop depression.

brain-anatomy-colored.jpgTrajectories of depression depend on a complex interplay of a spectrum of additional risk and resilience factors, which may be present to varying degrees and in a different combination in any individual at different times. These factors include the person’s:

  • genetic vulnerabilities affecting the intensity of our inflammatory response
  • other medical conditions
  • acquired hyper-vigilance in the stress response systems due to early life trauma, current adversities, or physical stressors
  • coping strategies, including social support
  • health behaviors, such as sleep, diet and exercise.

Implications for treatment

In line with the notion that inflammation drives depression, some researchers have already trialled the effectiveness of anti-inflammatory therapy as a treatment for depression.

While some recipients (such as those with high levels of inflammation) showed benefit from the treatment, others without increased inflammation did not. This supports the general hypothesis.

However, in our desire to find more effective treatments for depression, we should not forget that the immune response, including inflammation, has a specific purpose. It protects us from infection, disease and injury.

Cytokines act at many different levels, and often in subtle ways, to fulfill their numerous roles in the orchestration of the immune response. Undermining their vital role could have negative consequences.

Mind versus body

The recent enthusiasm to embrace inflammation as the major culprit in psychiatric conditions ignores the reality that “depression” is not a single condition. Some depressive states, such as melancholia, are diseases; some are reactions to the environment; some are existential; and some normal.

Such separate states have differing contributions of biological, social and psychological causes. So any attempt to invoke a single all-explanatory “cause” should be rejected. Where living organisms are concerned it is almost never that simple.

In the end, we cannot escape the reality that changes must occur at the level of the brain, in regions responsible for mood regulation, for “depression” to be experienced.

 

Why We Need to Talk About Depression | Kevin Breel | TED Talks

12 Tuesday Feb 2019

Posted by RichardB in Depression, TedTalks, youtube

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depression, tedtalks

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