Nov
05
2022

Poetry Helps Anxiety and Depression

Recently CNN published an article that stated that poetry helps anxiety and depression. Notably, poetry helps to cope with loss, fear, a marital break-up and helps during loneliness like a quarantine for Covid-19. Certainly, it is because of this that two authors, David Haosen Xiang and Alisha Moon Yi wrote this 2020 review about poetry’s healing power throughout the pandemic. It is important to realize that they conducted poetry classes at Harvard Medical School and Harvard College. In doing this they observed various health benefits from writing, reading and listening to poetry. Indeed, they saw that poetry combatted stress and depression and reduced postsurgical pain. In addition, poetry improved mood, work performance and memory.

Poetry helped hospitalized children

Another key point, a 2021 study involving 44 hospitalized children measured the effects of poetry on fear, sadness, anger, worry and fatigue.  By all means, all of these parameters were reduced when the children were reading, writing or listening to poetry. However, one exception was pain in this group of children, which was unaffected by poetry.

Details of the statistical results

To clarify, here are the results of this study in more detail. A statistically significant reduction of symptoms requires a p value of 5% or less. The 44 hospitalized children had a fear reduction with a p value of 2.1%. Exposure to poetry reduced sadness with a p value of 0.4%, anger with 3.9%, worry with 4.1%, and fatigue with 0.1%. As indicated already the only exception was pain reduction, which had a p value of 9.1% meaning that it was not statistically significant. Poetry has the ability to provide comfort and boost your mood when you are exposed to stress, trauma and grief.

Emotional responses elicited by hearing poetry

Poetry can also elicit peak emotional responses. In a study from 2017, researchers examined psychophysiological responses of 27 people. They measured how many people experienced chills or goosebumps when they listened to poetry read aloud. The researchers concluded that physical responses are connect to the rewards-sensing area of the brain.

Pleasure inducing activities can stimulate the reward areas of the brain

The pleasure center consists of the nucleus accumbens, the amygdala and the hippocampus. Together they contain dopamine neurons that communicate with the grey matter nerve cells in the prefrontal cortex. I have discussed this elsewhere in more detail. A pleasurable meal, sex, winning a video game, listening to music, earning money and reading a funny cartoon can all cause dopamine release that the person perceives as pleasure. But so can drugs, smoking cigarettes, drinking alcohol and taking street drugs.

Dr. Amen’s SPECT scans

Dr. Amen is a psychiatrist who specializes in SPECT scan technology. SPECT stands for Single Photon Emission Computerized Tomography. This is summarized in this review. Briefly, a SPECT scan shows where most of the blood flow occurs in the brain. People who abuse drugs or nicotine develop areas that have a lack of perfusion. It looks like holes in the brain as depicted under point 5 of the above link, which can create abnormal thinking patterns. Fortunately, with drug rehabilitation the brain pattern can normalize again.

Discussion of why poetry helps anxiety and depression

It is the excitement of the pleasure centers in the brain that relieves anxiety and depression. It seems to not matter whether we listen to poetry read aloud, read it or create it. But a pleasurable meal, sex, winning a video game, listening to music, earning money and reading a funny cartoon can also release dopamine in the pleasure centres of our brain. Repeated stimulation of the pleasure centers from exposure to poetry seems to be what gives us relief from anxiety and depression.

Xiang and Yi who observed students writing, reading and listening to poetry at Harvard Medical School and Harvard College said: “Whether it is coping with pain, dealing with stressful situations, or coming to terms with uncertainty, poetry can benefit a patient’s well-being, confidence, emotional stability, and quality of life.”

Poetry Helps Anxiety and Depression

Poetry Helps Anxiety and Depression

Conclusion

Newer research showed that poetry helps anxiety and depression. This is true in university and college students as well as in hospitalized children. One study concluded that poetry seems to activate the rewards-sensing area of the brain. Other studies showed that it is the nucleus accumbens, the amygdala and the hippocampus, which form the pleasure centers in the brain. The psychiatrist Dr. Daniel Amen did detailed studies with SPECT scans where brain changes are made visible. Brain SPECT scans have a similar appearance in people exposed to writing, reading and listening to poetry as people who had a pleasurable meal, sex, were winning a video game, listening to music, earning money or reading a funny cartoon. The common denominator is the release of dopamine from the pleasure centres of the brain.

Oct
25
2022

Overcoming Grief after a Loss

This article is about overcoming grief after a loss. During the Covid epidemic many people died, which caused a lot of grief among their loved ones. Unresolved grief can cause anxiety and depression. Whenever you have lost a loved one, counseling can help you to continue the grieving process.

Claire Bidwell Smith is an author of several books and has a master’s degree of clinical psychology from Antioch University in Los Angeles. She published the book “Anxiety-the missing stage of grief” (Hachette Books, 2018). In it she explores the stages of grief and notices that anxiety is very much part of the grieving process. However, this point is often overlooked by mainstream psychologists. Claire Bidwell Smith offers strategies to deal with the loss of a loved one and overcome the anxieties that people often feel as well. Here is a write-up from CNN where Claire Bidwell Smith was interviewed.

Anxiety is a powerful emotion

Anxiety can be very powerful, but it is often mistaken for a physical problem. As a result, people present at the emergency room of a hospital for various symptoms of pain and a myriad of other complaints. After expensive tests the doctor finds no physical abnormality and the diagnosis is anxiety or panic attack. Smith said that 70% of her referrals went to the hospital first and were diagnosed as panic attacks. Patients have a hard time to understand that their anxiety is a direct result of their grieving process.

Relationship between grief and anxiety

CNN asked Smith how grief and anxiety are related. She answered that a sudden death from an infection like Covid makes you realize that we are not safe and are not in control. Everything in your life changes and emotional upheaval is much bigger than ever imagined. Grief, which consists of emotions that accompany a loss of life can force you to kneel down emotionally speaking. This process feeds anxiety. People who grieve the loss of a loved one get anxious about their own health and about the safety of other loved ones. They may not even realize that what they are experiencing is anxiety or that this is related to the grieving process.

Anxiety

Anxiety is a condition that presents with fears and worries. This can present with many different body symptoms. The patient may experience chest pains and think it is a heart attack. But tests are normal and the physician calls it anxiety. Similarly, anxiety can present as stomach aches, headaches or insomnia.

What coping strategies are available?

There are many support groups to help people with anxiety; in addition, grief therapists can help with individual counseling. It may be difficult to motivate the patient to make use of these services. Since Covid you can have access to virtual anxiety support services. It is important that people seek counseling support, as otherwise they get stuck in their anger or guilt. Unfortunately, many people give up and end up in substance abuse. They develop relationship problems and get into trouble at work or in school. So, not seeking support only backfires. Get yourself on a waiting list for a counselor! Work through your grief and you will feel better.

What is your advice to people who resist a formal mental health treatment?

Smith mentioned that there are a lot of self-guided online courses. Also, reading books and articles about grieving are useful, because you get on with your grieving process. Social media is another source for information about the grieving process. It helps you to understand what other people with the same problem experienced and how they overcame it. Having said this, people can develop a full-blown anxiety disorder or clinical depression. In this case they require an assessment by a psychiatrist.

What is the role of meditation and mindfulness in healing anxiety?

Smith pointed out that when we grieve and when we are anxious, we spend time in the past or we worry about the future. Meditation and mindfulness bring our awareness to the present moment. Meditation helps us to focus on our own thoughts. It helps us also to detach from negative thoughts or irrational fears.

Imagination as another powerful tool

Smith explained as an example that she was not there when her mother died in the hospital. When she is overcome by negative emotions regarding this memory, she envisions herself crawling into the hospital bed with her dying mother, holding her and saying good bye to her. Smith admitted that it took her about 5 years before she was ready to do these imagination experiments. By using this imagining tool your present focus is on the now away from negative emotions of the past or fears what the future may hold.

Stories help to reduce grief

How we handled a painful story from the past determines how it influences our daily thinking. Often people do not know how to handle such a story and they tend to suppress it. But psychologists found that it is much healthier to deal with these stories and reframe them. When people find a way how to explore their story, they can reframe it and remove the negative feelings that had an association with it in the past. Healing comes from therapy, from counseling, online grief forums and support groups. There are also grief writing classes where you can rewrite your story experiencing how the past memories become less powerful and the future is brighter.

Stay connected with your lost loved one

It used to be taught that the best therapy would be to “letting go and moving on”. But now psychologists think it is better to move forward with the person you have lost. Specifically, what this means is that it is OK to have an inner talk with the person you lost. Smith added: “For example, pondering: What advice would my dad give me about this job offer? What would my mom think of my new boyfriend?”

The crux of grief work is making meaning out of loss

CNN asked Claire Bidwell Smith whether she quoted Hope Edelman who authored the book “The After Grief”. Hope Edelman said in this book that the “crux of grief work is making meaning out of loss”. Smith’s reply was that this stage develops naturally. But she cautioned that guilt, regret and anger are standing in the way of our ability to make meaning. They have to be dealt with first. This is why counseling, grief work and overcoming guilt and anger are so important.

Overcoming Grief after a Loss

Overcoming Grief after a Loss

Conclusion

When we lose a loved one or lose our job, we experience a grief reaction. There are powerful negative feelings like anger, guilt and other feelings that make it difficult to overcome our grief. Claire Bidwell Smith is an author of several books and has a master’s degree of clinical psychology from Antioch University in Los Angeles. She was interviewed by CNN regarding her work and her latest book “Anxiety-the missing stage of grief” (Hachette Books, 2018).

Anxiety is an important aspect of grieving

In the interview she explained that anxiety is an important aspect of grieving. But many people go to the emergency room of a hospital, because they think the symptoms, they feel are physical. It is the emergency physician who tells them after several tests that they have anxiety and they need to seek a counselor. After a few months of counseling grieving persons usually feel a lot better. They are now accepting what happened in the past and hope for a better future.

Sep
24
2022

When is Someone at Risk for Suicide?

We are asking ourselves: When is someone at risk for suicide? This year’s National Suicide Week was from Sept. 4 through 10, 2022. Every day of each year it is important to be aware of signs and symptoms of impending suicide. However, the purpose of the yearly National Suicide Week is to really bring it to everyone’s attention how common deaths by suicides are. We all can contribute to improve the situation by increasing our awareness.

Some suicide statistics

In the US alone nearly 46,000 persons died by suicide in 2020. This means that there is one death by suicide every 11 minutes. In 2020 nearly 800,000 died by suicide worldwide. About 1.2 million attempted it. The hope is that the public will learn through education to recognize the signs of an impending suicide. This way the suicidal person can get counselling and hopefully not commit suicide.

Abnormal behaviors to watch out for  

People who are getting suicidal may practice with guns, overdosing with pills or handle potentially lethal items. Other behavioral red flags could be giving away cherished items. The suicidal person may sleep too much or not enough. Isolation or withdrawal may be another pointer in a previously sociable person that he or she is becoming suicidal. Revenge thinking, reckless driving, agitation can all be pointers as well that the person is preparing for suicide. Justin Baker is the clinical director of The Suicide and Trauma Reduction Initiative for Veterans at The Ohio State University Wexner Medical Center. He said: ”A lot of times people need to kind of work up to that actual making an attempt because it’s a biologic thing you have to go against, your own survival”.

Watch what people say

When people become suicidal their words often indicate what they want to do. It is a warning sign, if someone is talking about wanting to die, by suicide or otherwise. Some people state that they feel like they have no reason to live. This is an alarm signal that they may be suicidal. Some people say that they feel like they are a burden for the people living around them. Other problematic statements are: “You don’t need me for this anymore” or “I feel like it’d be better if I just wasn’t here.” Someone uttering statements like these should get counseling. This allows them to vent their feelings and to reassess their situation.

Suicide risk factors

Hopelessness: People may express that they feel the future won’t be any better. Or they do not see a way out of the pain that they are in.

Obsession with death and dying: Some people ruminate about dying and they develop a plan what they may want to do to themselves.  

Extreme mood swings: When somebody who usually is depressed and stressed behaves calm or cheery, this is an alarm sign that the person may be suicidal. They may have struggled with their decision to kill themselves, but when they accepted that this is what they want to do it calms their mind.

Past trauma: Abuse, trauma and neglect in the past are risk factors for suicide in the future.

Drug abuse: substance abuse predisposes a person towards being suicidal later on in life.

More suicide risk factors

Severe chronic illness with chronic pain: when a person has a chronic illness, and it is difficult to treat, people lose hope and they feel trapped. At this point suicide appears to be an option.

Mental disorders: people with schizophrenia, anxiety, depression or personality disorders are at a higher risk to turn suicidal. This is particularly so when they did not receive treatment and their mental condition deteriorates.

Family history, other factors and teen suicides

Family history of suicide: when there is a family history of suicide or a personal history of failed attempt of suicides the risk of suicide is much bigger than in the general population.

Other factors: There are many more factors that all can have a bearing on the risk for suicide. Financial loss and loss of a job are examples, but also prolonged stress from bullying or harassment. Divorce, breakup of a relationship, insufficient social support and many other negative emotions can contribute to a risk for suicide as well. A lot depends on the emotional make-up and the resilience of a person.

Teens: Teens are particularly vulnerable to commit suicide. It is important to listen to the teen in trouble and to arrange for counseling and support. More on teen suicide here.

What to do when faced with a person who contemplates suicide?

There are several crisis phones that are important to remember. In 2019 congress in the US has proposed to establish crisis lines with a simple 3-digit number: 988. But not all states have this number activated yet. The national crisis line in the US is: 1-800-273-TALK (1-800-273-8255).

In Canada the crisis hotline is: 1-833-456-4566.

There are counselors who have experience in listening to people in distress and talk to them.

When a person wants to commit suicide call 911. Sometimes a person in mental distress needs to be hospitalized and treated by a psychiatrist. Some people may benefit from electroconvulsive therapy, others from antidepressants. Cognitive therapy and behavioral therapy have a place as well in treating depressed patients. Close follow-up is important to prevent a relapse.

When is Someone at Risk for Suicide?

When is Someone at Risk for Suicide?

Conclusion

This year’s National Suicide Week was from Sept. 4 through 10, 2022. In the US alone nearly 46,000 persons died by suicide in 2020, nearly 800,000 died by suicide worldwide. It is important to recognize the signs of impending suicide. There are several high-risk factors that point to impending suicide, such as hopelessness, obsession with death and dying and extreme mood swings. There are certain constellations that are associated with a high risk for suicide: a history of a mental disorder, a break-up of a relationship, a severe illness with chronic pain and others. It is important to get the person at risk to a counselor or psychiatrist.

Treatment intervention for suicidal person

By talking it out, the pain of suffering gets eased. If there is an underlying depression it can be treated with various treatment modalities. Cognitive behavior therapy may help to change the negative thought patterns. It is important to intervene early. Close follow-up to prevent a relapse is also important.

Sep
19
2021

World Suicide Prevention Day is on September 10

A CNN article points out that world suicide prevention day is on September 10.

Some statistics regarding suicides

According to the WHO more than 700,000 People die from suicide every year.

In the US suicide rates have risen between 1999 and 2018. President Joe Biden stated: “In 2019, suicide was the 10th leading cause of death in the United States, and the second leading cause of death for young people between the ages of 10 and 34.”

This was further underlined by a study from the CDC. It pointed out the emergency room visits started to climb in May 2020 for attempted suicide in youth. The CDC stated: “The mean weekly number of these visits was 26.2% higher during summer 2020 and 50.6% higher during winter 2021 compared with the corresponding periods in 2019”.

Triggering factors that make people commit suicide

Suicidal thoughts start when a vulnerable person encounters stressful events. The life situation can become so painful that in their way of thinking suicide is the only way to stop the pain. There are huge differences of opinions: what may be meaningless to one person, may feel devastating to another.

Common triggering factors are as follows.

  • Illness and physical discomfort
  • Conflicts with family or friends
  • Illness of family members
  • Death of family member or friend
  • Loneliness

In a study 50% expressed two of these 5 triggers, 37.5% expressed one of the 5 triggers. 12.5% expressed three of the 5 triggers.

With the Covid-19 epidemic there are new pressures on people. They cannot freely move around or travel. He/she may have lost a friend or relative to Covid. And people may be anxious about their own survival. I described this here before.

Biochemical changes in the brain with depression

In the past low serotonin levels in the brain were thought to be the main cause of depression. But researchers realized later those medications that increased serotonin levels did not always help depression. They found that dopamine and norepinephrine are also important brain transmitters that play a role in depression. When dopamine levels are low, depression occurs. Similarly, when norepinephrine is low, the patient can develop depression. On the other hand, in bipolar disorder the brain produces too much norepinephrine, which causes manic episodes. https://www.verywellmind.com/the-chemistry-of-depression-1065137 The physician needs to take a thorough history and note from that which brain transmitter system would be mainly affected. This helps the physician later to decide which antidepressant to choose from to rebalance the brain transmitters.

How to detect stress signals

There are a number of risk factors, which the CDC has outlined, for which the health professional or a family member wants to look in order to assess the suicide risk.

Does the patient have a history?

People with a mood or anxiety disorder, or with an alcohol or substance abuse disorder are at a higher risk of developing depression and suicide.

Did the person experience a loss?

A loss can be a death in the family, a loss of a job or the loss of an important person in a relationship. This is particularly bad when there is social isolation and a lack of support. With Covid-19 millions of people have suffered the loss of a job, social isolation and having to quarantine.

Is it easy for the distressed person to get a gun?

Firearms are a common means for people to kill themselves. When there is easy access to a gun, there is a high probability that the person uses it in times of distress.

History of previous suicide attempt

When a person attempted to commit suicide, but failed, there is a higher risk for them to repeat a suicide attempt and succeed. Also, there is a copycat phenomenon when the news comes out that a famous personality committed suicide. For instance, when the comedian Robin Williams committed suicide in 2014 there was a 10% rise in suicides in the following months all over the US.

Belief system that honours personal sacrifice

Some religious or cultural groups consider suicide a noble solution to a personal dilemma.

A person from this background is at a much higher risk to commit suicide.

Warning signs of pending suicide attempt

There are a number warning signs that point to a higher risk of possibly planning suicide.

  • A person may talk about wanting to die or kill themselves.
  • Searching online for ways to kill oneself or buying a gun.
  • Feeling trapped or feeling unbearable pain.
  • Talking about feeling hopeless and having no reason to live.
  • Stating that they feel they are a burden to others.
  • Drinking more alcohol and using more drugs.
  • Acting agitated or anxious. Reckless behavior.
  • A person withdrawing or isolating themselves.
  • A person sleeping too much or too little.
  • Extreme mood swings.
  • Talking about seeking revenge or showing rage.

These are all red flags that should alarm you to ask for help. Not all of these alarm signs are present all the time with people who are considering to attempt suicide. When you have suicidal thoughts in the US, call the National Suicide Prevention Lifeline at 800-273-8255. For Spanish crisis support call: 888-628-9454.

World Suicide Prevention Day is on September 10

World Suicide Prevention Day is on September 10

Conclusion

World suicide prevention day is on September 10. This reminds us every year that suicide is a colossal problem of society. Stress, loss of health, losing a loved one, a broken marriage and financial loss can all contribute to depression. If patients with mental distress do not receive timely intervention and treatment, the life situation can become so painful that in the patient’s way of thinking suicide is the only way to stop the pain. The key is for the loved ones in the circle of friends to pay attention to the warning signs and bring the suicidal person to the attention of the psychiatric health professionals. Sometimes an in-patient admission to a psychiatric facility may be required to interrupt the negative thinking pattern. Ignoring the warning signs can have devastating consequences. Prevention is the only way to avoid suicide.

Jun
26
2021

Being A Morning Person Can Prevent Depression

A British study concluded that being a morning person can prevent depression. It was reviewed also in CNN. The study used sleep data from 85,000 UK participants in the Great Britain Biobank Study. They wore wrist activity monitors that provided sleep data. Researchers compared the sleep data with the self-reported mood changes. They found that if the sleep pattern is misaligned with the circadian rhythm, those who are night owls are at a higher risk of developing mood disorders. The controls were those who were morning persons. They were not affected by the misalignment effect.

Normal sleep pattern

Natural sleep habit or the circadian rhythm starts between 10 PM and 11 PM and continues for 7 to 8 hours. Your hormones are replenished during your sleep. This helps your body’s hormones and the immune system to restore itself overnight.

“The health problems associated with being a night owl are likely a result of being a night owl living in a morning person’s world, which leads to disruption in their body’s circadian rhythms”. This is what sleep specialist Kristen Knutson said. She is an associate professor of neurology and preventive medicine at Northwestern University Feinberg School of Medicine.

Reclaim your natural sleep habit

The key is to learn to live within your circadian rhythm pattern. Caffeine is a powerful stimulant and will stop you from falling asleep. For this reason, it is best to avoid caffeine-containing beverages. If you cannot live without your favourite cup of java, switch to the decaffeinated version. Stop using LED lights (from TV, computers, tablets or smartphones) 2 hours prior to your bedtime. Use dark curtains and enjoy a comfortable bed. Maybe read that thriller, earlier in the day instead of making it your bedtime story. And do yourself a favour: you do not need the eleven o’clock news on TV!  They will probably stop you from falling asleep. Go to sleep between 10PM and 11PM.

Children can have problems with sleep disturbances and depression

Another study published March 22, 2021 in the Jama Network showed that depression had an association with sleep disturbances in youth and children.

A meta-analysis of 16 publications looked at depression and disturbed sleep. It showed that depression was 1.5-fold higher in sleep disturbed youths/children compared to controls with a normal sleep pattern.

Other studies re. being a morning person can prevent depression

Another study with Dr. Knutson as the lead author appeared in 2018. The authors found that various health conditions, mood disorders and mortality were on the increase the more the sleep rhythm deviated from the circadian rhythm. Morning persons were protected from this effect. But night shift workers and night owls were at a higher risk of disease. Specifically, they found the following associations for evening types.

  • Evening types compared to morning types had a 1.94-fold risk of psychological disorders
  • The risk of diabetes was 1.30-fold for evening types
  • Neurological disorders had a 1.25-fold risk in evening types
  • Gastrointestinal/abdominal disorders occurred 1.23-fold more often in evening types
  • respiratory disorders were 1.22-fold more common in evening types
  • Evening types had a 10% increased risk of all-cause mortality

The researchers concluded that externally imposed timing of work and social activities has potentially serious health consequences.

Circadian misalignment responsible for disease

Dr. Knutson also said: “Circadian misalignment could also lead to inadequate sleep duration and quality, which could also impair mood and exacerbate mood disorders.”

In other words, circadian misalignment to circadian rhythm problems. This can cause mood disturbances, but eventually lead to the diseases listed above.

Evidence of health risks in night shifts workers

The medical literature is full of examples that the health of night shift workers is significantly affected by circadian misalignment. Here are a few examples.

1.Here is a random selection to illustrate the health risks of night shifts workers. A study from 2015 examined the sleep patterns of 315 shift nurses and health care workers in Iranian teaching hospitals. They found that 83.2% suffered from poor sleep and half of them had moderate to excessive sleepiness when they were awake.

2.This South Korean study examined 244 male workers, aged 20 to 39 in a manufacturing plant. Researchers compared blood tests from daytime workers to blood tests from night shift workers. They also obtained inflammatory markers like the C-reactive protein and leukocyte counts. Night shift workers had significantly higher values. The investigators concluded that shift workers have increased inflammatory markers. This is a sign of a higher risk of developing cardiovascular disease in the future.

Higher mortality and higher cancer risk in nighttime workers

3. A Swedish study found that white-collar shift workers had a 2.6-fold higher mortality over a control group of daytime white-collar workers.

4. Another study compared night workers in the age group of 45 to 54 with daytime workers and found a 1.47-fold higher mortality rate in the night shift workers.

5.In a study from China 25,377 participants were part of a study that investigated cancer risk in males with more than 20 years of night shift work. They had a 2.03-fold increased risk to develop cancer compared to males working day shifts. Women with night shift work in this study showed no effect with regard to cancer development.

Healthy telomeres with healthy sleep pattern

It is true that you can suffer multiple health problems, as all of your hormones depend on the resetting during your deepest sleep between 2AM and 4AM triggered by the nighttime melatonin response. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep.

One example of such a study comes from Milan, Italy. https://oem.bmj.com/content/75/Suppl_2/A480.1

In this 2018 study researchers compared 46 nurses who had worked in night shifts with 51 nurses working day shifts. Among the night shift workers breast cancer was common, but not among day workers.

Shortened telomeres, hypomethylation of BRC1 gene and p53 gene

In the night shift nurses from Milan there was hypomethylation of the breast cancer gene BRC1. There was also hypomethylation of the general cancer gene p53. At the same time significant telomere shortening occurred in night shift nurses who had worked night shifts for more than 15 years. This likely all worked together in causing night nurses to develop breast cancer more frequently.

Shortened telomeres mean a shortened life span. The reason for this is that people with shortened telomeres develop heart attacks, strokes and cancer. This is what shortens the life span. How do we avoid this risk? Go back to healthy sleep habits. As mentioned above it is best to start going to sleep between 10PM and 11PM and sleep for 7 to 8 hours. Night owls delay going to sleep by 2 to 3 hours.

Being A Morning Person Can Prevent Depression

Being A Morning Person Can Prevent Depression (click image to enlarge)

Conclusion

A publication in Molecular Psychiatry demonstrated that evening person (night owls) are more likely to develop depression. This is in comparison to morning persons. As discussed, other researchers showed that evening persons also can develop diabetes and neurological disorders. In addition, respiratory disorders and gastrointestinal disorders are more common in night owls as well. When it comes to mortality, evening persons have a 10% increase of mortality over morning persons. There is a large body of literature regarding diseases of night shift workers. Night Shift work is perhaps the most extreme example of a circadian misalignment. It leads to poor sleep, inflammation in the body, increased cancer risk and higher mortality compared to day shift workers.

Prevent telomere shortening

Even the telomeres get shortened in night owls and night shift workers. We can prevent problems like these by going to bed in time and sleeping according to our circadian rhythm. If you had a poor night’s sleep, make up for it with the help of an afternoon nap. Do not sleep all afternoon though; half an hour or one hour will be enough. Even a short, restful nap after coming home from work can restore your feeling of wellness.

Nov
28
2020

Mental Illness and Covid-19

A topic less discussed is mental illness and Covid-19. Covid-19 has been noticeably around us since March of 2020. With the various social distancing and quarantining methods people become more or less isolated emotionally. Social gatherings are outlawed depending on where you live. This helps to interrupt the spread of the virus, but it makes people feel more stressed as their relationships get interrupted.

Symptoms of stress

The CDC sums up that stress during a pandemic can cause the following:

  • Fear of your own health and the health of your loved ones
  • Loss of your job or financial support
  • Changes in eating habits
  • Changes in sleep pattern with lack in concentration
  • Increase in use of tobacco, alcohol or other substance consumption
  • Chronic health problems may deteriorate
  • Worsening of Mental health conditions

The more isolated we are, the more stress we feel. This undermines our stress coping mechanisms, makes us more anxious and more depressed.

Develop coping skills

Taking care of your family and friends may relieve your stress, but it needs to be balanced by taking care of yourself. Although you are physically isolated from others when you are in quarantine, you can stay in contact with others by phone or video chats. This makes you less lonely and isolated.

Take care of yourself. This includes eating well balanced meals, exercising regularly and getting enough sleep. Avoid the consumption of alcohol, tobacco and drugs. Share with a family member or friend how you feel. Maintain friendships through the phone, emails, social media and computer chats. This builds a strong support system for you.

Avoid too much exposure to news stories. Seeing negative stories about Covid-19 over and over again can be undermining, so take a break from the news media. Go for a walk. Take a nap.

Suicide

Sometimes depression can get out of control to the point of driving a person to the brink of suicide. In the US major depression is the leading cause of disability for ages 15-44.  At any given year 16.1 million American adults (about 6.7% of the U.S. population age 18 and older) suffer from major depression. 10.3% of Americans have thought about suicide. If you feel that way, do not act on this impulse. Call 1-800-799-4889. That is the National Suicide Prevention Lifeline & Chat.

Medical literature about the psychological impact of Covid-19

In a July 2020 publication the authors pointed out that Covid-19 infection is a significant psychological stressor. There is the fear of getting the virus and uncertainty about the future. Pre-existing anxiety and depression disorders get accelerated from the stress. In addition, mental disorders like schizophrenia with psychosis may worsen. This may require more antipsychotic medication to control it.

A Kaiser Family Foundation poll found in March 2020 that the Covid-19 pandemic has caused a major impact on US citizens. 45% of respondents said that the pandemic has affected their mental wellbeing significantly. If you are scared, depressed or anxious, you are tense and you have problems falling asleep, you are not alone. You can seek and receive help!

Prevention of mental disease from Covid-19

Here is some practical advice from the World Health Organization.

  • Stay informed.
  • Have a daily routine. Get up and go to sleep at regular times. Eat healthy balanced meals. Exercise regularly. Have your work routine and also find time to rest. Do things that you enjoy.
  • Watch the news only to be informed, but limit news watching to a minimum. This will keep anxiety and depression in check.
  • Stay in contact with close friends by phone and computer technology.
  • Keep your alcohol consumption low. If you did not drink before at all, don’t start drinking in an attempt to deal with boredom, fear, anxiety or social isolation.
  • Take breaks from screen time. This reduces tension.
  • Video games: doing this may relax you for a short time. But longer video game activities can make you tense; you should balance this with the rest of your daily activities.
  • Social media. Use this for honest communication. Keep it brief. If you see misinformation, point out the truth.
  • Helping others: if you can, help others in the community with shopping or other chores.

Treatment for Mental disease from Covid-19

When you notice anxiety, depression or a flare-up of psychotic symptoms from schizophrenia, it is important to see your health professional right away. You may need some counselling. Others may need an antidepressant (for depression) or an adjustment to your antipsychotic medication. Some patients with milder depression or anxiety may benefit from cognitive/behavioral therapy. Most importantly, know that help is available! More info about cognitive therapy for suicide prevention.

Mental Illness and Covid-19

Mental Illness and Covid-19

Conclusion

Mental illness and Covid-19 is a huge topic. People definitely have experienced more anxiety and depression since the Covid-19 epidemic. This is because our lifestyle is suddenly restricted. We may have to go through a 14-day quarantine. But we also cannot participate in large gatherings with more than 50 people. Often, we have to wear masks in stores. In areas with high cases of Covid-19 there is also a severe restriction regarding with whom you can visit, leading to feelings of isolation. All of this can lead to mental illness. Essentially there are two ways of coping with this. First, we need to get a routine that makes us more resistant to mental illness. Secondly, if this fails, seek the advice of a health professional right away.

Seek mental illness treatment right away

When you catch mental illness early, it is much easier to treat. Milder cases of depression or anxiety may benefit from cognitive/behavioral therapy. More severe cases often require medication. In this outline I have discussed mental illness during the Covid-19 epidemic. I have not discussed the cases where people came down with Covid-19 coronavirus and got affected in their brain function from the virus. These cases need treatment by a neurologist and psychiatrist, and they are much more complicated.

Jan
11
2020

Centenarians Are Positive Thinkers

Dr. Thierry Hertoghe gave a presentation in Las Vegas on Dec. 14, 2019 where he stated that centenarians are positive thinkers. This was at the 27th Annual World Congress on Anti-Aging Medicine. The topic of his talk was “Positive Psychological Attitudes of Centenarians “.

Dr. Hertoghe is an endocrinologist in Belgium. Dr. Hertoghe took an interest in people above the age of 100. He felt that these people are special people with a very optimistic outlook on life. He went on to study the literature about this topic in detail and this is what this talk was about.

The oldest man, Gustav Gerneth died at 114 years 7 days in Germany (Oct. 22, 2019). The oldest female is Japan’s Kane Tanaka at 117 years (birthday Jan. 2,1903).

So, what is their secret to age that well? Here is what Dr. Hertoghe found out about centenarians.

Attributes of centenarians

Centenarians have a will to live. They adapt to changes; they have a sense of purpose, and they stay active. Other psychological features show that they have is a positive mood and they avoid stress and anxiety. Another important attribute is self-determination. They are very sociable, have close family ties, love their relationships and often have a strong religious faith. There is a connection between their basic values and beliefs and their spirituality. Centenarians insist on their freedom and they have a feeling of youth. Centenarians have their own centenarian spirit where they can feel young or old.

In the following I am reviewing the details that Dr. Hertoghe gave. He covered 13 subtopics regarding causes of longevity in centenarians.

The will to live

It takes courage to grow old and all centenarians have this. They say “Life is worth living”. They have a certain resiliency in a world that has an obsession about youth. Despite negative experiences they had to overcome they do not give up and they enjoy life as much as they can. A Finnish study examined 400 individuals aged 75-90 and followed them for 10 years. Group 1 who wished to live less than 5 years had a mortality rate of 68%. Group 2 wished to live for 5-10 years. They had a mortality of 45.6%. The last group, group 3 wanted to live more than 10 years. Their mortality was only 33.3%. Be careful what you wish for!

Adaptability

This describes the capacity to overcome adversity and your ability to adjust. In a study of 7400 Chinese centenarians’ resilience to changes was measured with psychometric psychological tests. The majority of subjects did not qualify for being resilient. Only 9% of male centenarians and 6% of female centenarians had the resiliency where they qualified for high adaptability. This high resilience group was associated with 2%-4% lower mortality risk. They had a 36%-55% higher odds of not developing cognitive impairment and they rated themselves as being in good health and having a “good life” satisfaction. These resilient centenarians had a 7%-12% higher probability of not developing a physical disability. Short-term health decline was not associated with these high resilient centenarians.

A sense of purpose

Centenarians can still contribute to society. Tao Porchon-Lynch turned 100 in 2014. She opened the Westchester Institute of Yoga in 1982 and is still practicing yoga. There are many ways how centenarians express a sense of purpose. Males often work in their old job, but only part-time. They may help with babysitting the great-grandchildren. Others do volunteer service. Still others may enrol in a university and study what they always wanted to do.

In a 2016 publication people older than 65 were followed between February 2011 and November 2014. Those who had neither hobbies or a purpose in life did not fare well. They had a risk of mortality of 2.08-fold compared to those with a sense of purpose. Dr. Hertoghe provided 9 more references regarding studies that showed the same finding.

Remaining active

If a centenarian remains active and moves about several hours per day, the body functions are preserved. Anna Mary Robertson Moses who was known by her nickname “Grandma Moses” took up painting at age 78. She died at age 101 in 1961.

Positive emotions

One study of 54 Ashkenazi Jewish older adults (aged 98-107) compared those with positive emotions to those with negative emotions. The researchers noted that a positive attitude about life allowed centenarians to live longer.

A study involving 2282 Mexican Americans aged 65 to 99 showed that positive affect scores were a predictor for the following. Subjects with a high positive affect had a 52% lower probability of becoming physically disabled. They were 36% less likely than the negative controls to lose their walking speed. In addition, they were 47% less likely to die during the two-year observation period than their negative controls.

Nurses’ Health Study and Veterans Affairs Normative Aging Study

Two studies, the Nurses’ Health Study (NHS) and men from the Veterans Affairs Normative Aging Study measured optimism. The researchers found that those with the highest optimism scores had a 1.5-fold higher probability in women and 1.7-fold in men to survive to age 85. This was compared to a control with the lowest optimism scores. Dr. Hertoghe provided 19 more studies that showed the effects of positive emotions regarding long term survival. For brevity reasons I will not dwell on them here.

Better stress management

Centenarians avoid excessive stress and attempt to relax instead.  It has been known since the ground-breaking work by Dr. Hans Selye that stress undermines longevity. By using relaxation methods intermittently one can reduce the stress response, which normalizes the excessive ACTH production in the pituitary gland and the concomitant cortisol production in the adrenal glands.

Self-determination

Long-living people have a strong willpower and are determined to succeed with what they want. They have a sense of self-worth and self-esteem. Centenarians have concerns for others, but they also have a healthy regard for themselves. Dr. Hertoghe provided 4 references to illustrate this, but for brevity reasons I will omit them here.

Social involvement

Centenarians have an active social life. They are involved with their family, with the community including often church communities. Sociability has a 2.3-fold higher probability of survival (mortality reduced by 57% due to sociability). Other studies confirmed this.

Practicing religion

Those who are centenarians were often raised in religious families. They developed a strong faith in God. A common theme among centenarians is that they trust in God and believe it is His will that they lived a long life. They also believe that eventually God will call them “home” when He is ready for them. Centenarians who practice religion have a strong belief in an afterlife, which sustains them to live and they accept death when it comes. In a 2017 study 18,370 participants aged 50 and older were interviewed in 2004 and followed for all-cause mortality to 2014. Regular church attendants had a mortality that was 40% less than those who did not attend. Dr. Hertoghe provided 20 more references that showed similar findings.

Spiritual involvement

Attributes of spiritual involvement are high ethical principles, resilience and hope that everything will turn out OK. Dr. Hertoghe cited from 7 different references that the average effect of spirituality leads to a 2- to 4-fold greater survival over 17 years.

A feeling of freedom

This makes centenarians less concerned what other people think of them. Dr. Helen Langner, a psychiatrist, still does a part-time psychiatric practice at age 100. She says about a feeling of freedom: “In old age, there’s often a sense of personal freedom because there is less pressure of a career or the responsibilities of work or raising a

family. It can and should be a time for people to do the things that are important to them and a time to enjoy. “

A feeling of youth

Many centenarians are young at heart. Even though they may look physically old, they don’t feel old in their heart.

What is the centenarian spirit?

When people are older than 100 years, they often have a mix of humor and eccentricity; they express emotions openly and they are happy people. They accept the death of spouses, siblings and significant others.

By the way, humor has a strong predictive survivor value. In a study that researchers conducted over 15 years, there was a clear positive effect of humor regarding mortality. A sense of humor reduced the all-cause mortality by 48%. In women humor lowered mortality regarding cardiovascular disease by 73%. Humor reduced death due to infections in women by 83%. Men had a non-significant reduction of all‐cause mortality by 12% and a significant lower mortality due to infections by 74%.

Dr. Hertoghe cited three more publications that showed the power of humor in reducing disease and disability.

Jeanne Louise Calment 

As an illustration for humor Dr. Hertoghe introduced Jeanne Louise Calment to the audience. She was a French woman who broke the record for being the oldest centenarian in the world.  Jeanne Calment died on August 4, 1997 at the age of 122 years and 164 days. She was asked by someone: “Why do you live so long?” She replied: “Because God has forgotten me…” Next question: “How do you consider your future life?” “Very, very short”. Last question:” What do you think of your wrinkles?” “The only wrinkle I have is the one I am sitting on”.

Centenarians Are Positive Thinkers

Centenarians Are Positive Thinkers

Conclusion

Centenarians have certain attributes that make them more resilient than others who die earlier. They have a will to live, an ability to adjust, a sense of purpose and they stay active. Their psychological make-up is such that they have a positive mood and they tend to avoid stress and anxiety. They have a sense of self-determination. They are very sociable, have close family ties, love relationships with people around them, and often have a strong religious faith. Their spirituality has a connection to their basic values and beliefs. Centenarians insist on their freedom and they have a feeling of youth. They have their own centenarian spirit where they can feel young or old. But they also have humor as documented above with the oldest woman that lived. She was 122 years and 164 days old when she died in 1997.

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Mar
09
2019

Live The Life That We Evolved For

A review article at CNN by a psychiatrist recommends that we live the life that we evolved for. Dr. Arash Javanbakht, an assistant professor of psychiatry at Wayne State University in Detroit, MI explains that man lived on this planet only since 200,000 years. But it takes about 1 million years for evolutionary changes to take place. As a result of this we tend to still behave in our lives the way we may have reacted 10,000 years ago. It is useful to think back of us being hunters and gatherers.

Anxiety, an ancient emotion

Anxiety, for instance, is an emotion that goes far back to 10,000 years ago when humans had to be part of the tribe. If an opposite tribe was fighting them chances were high that they could get killed. Even if your own tribe did no longer like you, there was a strong possibility that you were driven out or killed. This left us with an inheritance going back many millennia of anxiety. In modern life though it is the boss who does not like something you did. It could be a deadline for a school or college project that makes us anxious or some political news. The reasons have changed, but anxiety is still there!

Live the life that we evolved for: assess what we eat

Food was very scarce 10,000 years ago. When the tribe finally caught some prey, there was a feast where fatty food, meat, vegetables, fruit, nuts and seeds were eaten. Refined sugars were not available. You did not know when the next time would come where you had ample food. Today we still behave this way: we eat what we can and eat some more. The only problem is that there is no longer the pattern of famine orfeast. Instead there is easy access to the fridge with all kinds of food. We also have access to fast food places. And we drink sodas, eat candies and other sweets. Eventually we end up fat and fatigued.

Live the life that we evolved for: which way do we move?

Our ancestors had to run and walk many miles a day to find food. They may have been attacked by wild animals and had to flee. They also needed to chase a prey for food. Constant movement was the order of the day. What are we doing today? We did not evolve to step into a car and drive to work. We also did not evolve to sit at a desk from 9AM to 5PM. In the evening we sit in front of the TV or lie on a couch eating munchies and drinking beer.

Our modern life

It is no wonder that we gain weight, that our heart and lungs do not get conditioned, and that our muscles are a pile of mush. We need to think back what our bodies were built to do. Perhaps a long walk would be healthier than sitting all the time. Some of us do not mind to visit a gym daily and build an exercise routine into the day. This mimics the activities of the hunter/gatherers and is a lot better for our bodies.

Live the life that we evolved for: sleep problems

Many people today have problems to fall asleep. The sun had 100% control of the diurnal rhythm in the past. Now we have artificial lightning, blue light from TV’s, computer screens and iPhones. We are constantly getting stimulated. In addition, the stories we read or see on TV get us excited, so that the stress hormone, cortisol is released and melatonin, the sleeping hormone gets suppressed. Taken all this together, it is not really a wonder we have problems sleeping. Relaxation methods can help us to tone down before we go to sleep. You may want to meditate, do self-hypnosis, practice some yoga or just lie still and relax, clearing your mind, and more importantly switch the TV off and put the computer on “sleep”. Sleep for you comes easier this way.

Live the life that we evolved for: our fears

10,000 years ago fear was a normal part of our lives. There were predators you had to fear. There were tribal wars where you had to fight for your survival. You had to fear starvation. The fight/flight response was a reality. Compare this to our lives now. We may fear an exam, a meeting at work or agonize what to wear for a party. We have no real existential fears unless you live in a war zone. Many people may feel that they do not have enough fear in their lives, so they get drawn to horror and mystery stories, computer games, haunted houses etc. But this is fodder for anxiety!

Live the life that we evolved for: how to feel better

When we adopt a pet, let’s say a dog, we understand that it needs food, exercise, love and sleep. But when it comes to the human animal in us, we find it hard to understand that we need that too. In fact, we need to live the life that we evolved for. We need some form of exercise all the time, because that is what we were meant to do 10,000 years ago and our bodies are still built for that. When you walk the dog, you may make new friends or even a date. If you go to the gym, you realize that your muscles work better and begin to make your body fitter. You will also feel better about yourself. You appreciate that your mood is lifting, and you feel the increased energy and strength.

Dr. Arash Javanbakht said about the bottom line:

“If we treated our body the way responsible dog owners treated their dog, we would live a much happier life.”

Live The Life That We Evolved For

Live The Life That We Evolved For

Conclusion

It takes people 1 million years for evolutionary changes. We do not change our behavior fast. Dr. Arash Javanbakht, an assistant professor of psychiatry at Wayne State University in Detroit, MI compared our lives now with the lives of the hunters/gatherers in the past. People ate fatty food, meat, vegetables, fruit, nuts and seeds when a prey was hunted. But then there was an episode of fasting. People then had to walk and run all day long to catch some food again or they had to run to escape from a predator. Nowadays we use cars for transportation, use the elevator to get upstairs and walk from the table at home to the TV set. If we do not move enough and we eat the wrong foods, we do not turn fit but we turn fat.

Our modern lives

We also use LED lights from TV’s, computers, iPhones and tablets that interfere with our diurnal hormone rhythm. It is not about going back to sending smoke signals, but it is all about setting limits and when to stop and disengage from social media and the phone. Not setting limits is part of why we have problems to sleep. Stress can also be a factor of insomnia. Dr. Javanbakht says that we need to relearn how our bodies were built. We need proper nutrition without high-energy carbs. In addition we need regular exercise that will help us to relax and feel more energy. Anxieties will lift and we will feel better about ourselves.

Nov
03
2018

When you are sleepless

You are not alone when you are sleepless. Insomnia is a widespread problem in society.

Previous review of the topic of insomnia

I have reviewed the topic of insomnia before in a blog.

Briefly I pointed out that in some people there is a mutation of the gene that controls the circadian sleep rhythm. It is called the CRY1mutation. Some people have sleep disturbances from working night shifts. I mentioned the blue light of electronics that is produced by the TV screens or computer screens. The more you are exposed to it, the more it stimulates the brain to produce serotonin. This undermines the melatonin production, and as a result the person finds it extremely difficult to fall asleep. Children playing with i-phones, tablets or watching children’s programs on television can have sleep disturbances from the blue light. Blue has the frequency that over stimulates the brain and interferes with melatonin production. Drug and alcohol abuse can also interfere with the normal circadian sleep rhythm and cause insomnia.

Hormone factors of insomnia

For natural sleep to occur, we need melatonin which the pineal gland releases in the evening. It initiates and maintains sleep during the night. The natural opponent of melatonin is cortisol, the stress hormone, from the adrenal glands. Both hormones need to be in balance to allow you to sleep normally. Shortly before we wake up in the morning melatonin production goes down and cortisol production is up. Cortisol levels are low at night and high during the day. So it is cortisol that keeps us going throughout the day. But an excess of cortisol from chronic stress can also interfere with falling asleep and sleeping through the night.

Stress and insomnia

When we feel stressed, cortisol production goes way up. This has consequences regarding our sleep pattern. It can interfere with falling asleep, causes us to wake up from a deep sleep in the middle of the night and can give us problems falling asleep again. Chronic stress exposure leads to high cortisol production by the adrenal glands, which in turn will lower melatonin and cause sleep disturbances. Older people (above the age of 50) have very little melatonin production left, as there is an age-related decline of melatonin production. The melatonin production is highest in younger years and lowest in older age.

What to do when you are sleepless

There are several over-the-counter remedies, which in combination can be quite effective.

Melatonin for when you are sleepless

Melatonin (3 mg at bedtime) is a good start to see what it does for your sleeplessness. Taking a small amount of melatonin at bedtime we can re-establish the balance between cortisol and melatonin, which helps the circadian hormone rhythm and sleep pattern to come back. Some people wake up in the middle of the night and find it difficult to fall asleep again. If this happens at 3 AM, a good remedy at this time is to take another 3 mg of melatonin. Melatonin stays in the system for about 4 hours. Light during the day de-activates the effect, when light hits the retinas upon opening your eyes. You should not exceed 6 mg of total melatonin overnight. Otherwise it will interfere with the balance of cortisol and melatonin, lowering cortisol levels, which would rob you of energy during the day.

Phosphorylated serine (Seriphos)

A supplement that is freely available in the US (but not in Canada) consists of a simple amino acid. As this link shows (second item in the link) phosphorylated serine Seriphos) helps to down-regulate cortisol levels (lowering them). This means that melatonin gets the upper hand and you can sleep again.

The dosage for phosphorylated serine (Seriphos) varies from person to person, but will be in the range of 1000 mg to 3000 mg in the evening. After about 30 days the circadian rhythm may have recovered and you can stop the Seriphos. A one-day pause is required once a month for resetting the hormone receptors. Should you still have problems sleeping, you can continue with it for another month and pause again for a day. Seriphos has very few side effects.

Valerian root capsules

Another useful sleep aid is valerian root (as capsules). 500 mg to 1000 mg will help you to relax. It does not have the side effect of feeling groggy the next morning.

Other considerations when you are sleepless

Hormone problems like thyroid abnormalities (too much or too little thyroid hormones) are issues that your doctor has to investigate. Women in menopause often have sleep disturbances due to a lack of estrogen and progesterone. A knowledgeable healthcare professional is able to take care of that by prescribing bioidentical hormone creams.

When men approach andropause (the equivalent of menopause in women), they lose testosterone production. This can cause insomnia. The doctor can verify the hormone loss by a blood test. Replacement with either bioidentical testosterone cream or injections will rebalance testosterone levels. Insomnia may disappear. It is essential not to overdose testosterone, as this can also cause insomnia.

Sleep lab for when you are sleepless

When home remedies do not help, it may be time to check into one of the sleep labs to diagnose the kind of sleep disorder you are suffering from. Here is an overview what is happening there.

Essentially you get hooked up to monitors and are encouraged to just sleep as you would normally do. The physician in charge of the lab will later explain to you what the monitors showed, and tell you what type of sleep. According to the findings your doctor will recommend what measures are appropriate to remedy the situation.

Treatment for insomnia when over-the-counter remedies fail

Short acting benzodiazepams

When anxiety is not a problem, but only insomnia is (falling asleep or staying asleep) lorazepam 1 mg (Ativan) or temazepam 10 mg (Restoril) are shorter acting benzodiazepams that will help. It is not a permanent but a short “emergency break” for intermittent use, so that the GABA benzodiazepine receptors have time to recover. Otherwise, with continuous use tolerance would set in. This means higher and higher doses of the sleep medication would be necessary to achieve the same effect. Another non-benzodiazepine is Zolpidem 5 mg (Ambien). Even though this medication is not a benzodiazepine, it works on stimulating the same GABA benzodiazepine receptors.

Longer acting benzodiazepams combined with antidepressant Trazodone

For several years the combination of a small amount of the longer acting benzodiazepams, clonazepam (Rivotril) at 0.5 mg combined with a small amount of the anti-depressant trazodone (Oleptro or Desyrel) at 50 mg at bedtime has been has been in use quite successfully.

But there is a concern of drowsiness caused by Rivotril as this link shows.

Trazodone, which is an antidepressant has a sleep cycle restoring effect at low doses and has less side effects, because it is used at ¼ the dose for a full-blown depression. Males are often complaining that it reduces their sex drive, and it may cause erectile dysfunction.

Clonazepam side effects

Rivotril was originally in use to control epileptic seizures and anxiety. The combination therapy for sleep disorders uses Rivotril at ¼ of the regular dose. Although it is good as a sleep aid, it has a long half-life and stays in the system well into the next day. This may present as sleepiness and cause falls in elderly patients because of clouded attention. Replacement by one of the medium long acting benzodiazepams could be the solution. A drug pause for 1 day will help to reset the GABA benzodiazepine receptors and prevent tolerance from happening. Knowing all those effects and side effects it is wiser to reserve the use of these medication strictly when everything else has failed!

When you are sleepless

When you are sleepless

Conclusion

As I mentioned before, you are not alone when you are sleepless. Insomnia can present as having problems to fall asleep, but it may present in others as a problem in the middle of the night waking up and having problems going back to sleep again.

I described non-conventional methods to help you to sleep using melatonin, Seriphos and valerian root capsules. If this fails, a sleep lab investigation may be necessary to get to the bottom of your insomnia problem. Physicians often prescribe short acting benzodiazepams like lorazepam (Ativan) and temazepam 10 mg (Restoril).

Other possibilities to treat insomnia

There are other possibilities to treat insomnia, with a combination of a low-dose antidepressant (trazodone, brand name Oleptro in the US) and low-dose anti-seizure and anti-anxiety drug clonazepam (Klonopin or Rivotril). Anxiety can often be a big component in insomnia and this treats both. On the other hand, anxiety is a separate problem, which needs professional treatment. There can be side effects of sleepiness from clonazepam and men complain of a lack of sex drive and erectile dysfunction from trazodone. Help is available when you are sleepless. But you need professional help to work on the problem and find the solution.

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Oct
13
2018

Distribution Of Obesity In Women And Men Is Different

The distribution of obesity in women and men is different, when they gain weight on a low fat/high carb diet. The distribution of fat follows a pear shape in women due to fat accumulated around the hips. In males excessive fat accumulates around the waist, which gives them an apple shape appearance.

Researchers at the University of California, Riverside (UCR) have done experiments using a mouse model. They wanted to see what changes take place when obesity develops. Djurdjica Coss was the lead researcher of the study from the UCR School of Medicine.

The reason why this study was thought to be necessary

Many men and women have relatively normal weights until their mid 50’s. But when women approach menopause, they tend to accumulate fat in the thigh areas (pear-shape obesity). When their weight continues to rise, they also accumulate weight in the abdominal area. It is general knowledge that the fat in the abdominal region is metabolically more active producing inflammatory kinins.

Men above the age of 50 or 60 are also accumulating fat, but typically in the abdominal area right away. The name for this is apple-shape obesity. Unfortunately this is the fat we just discussed, metabolically active with inflammatory kinins. It is known to be the cause for heart attacks and strokes as it accelerates hardening of the arteries in the whole body. Dr. Coss found in doing experiments on mice that estrogen plays a major role in the development of obesity as discussed below.

The mouse experiments to study the development of obesity

The research team of Dr. Coss compared a group of mice that had their ovaries taken out. The ovaries in females are the main source of estrogens. They fed them a high-fat diet comparing their weight gain to that of male controls on the same diet. Obesity leads to a change in metabolism, called metabolic syndrome. This condition has an association with the production of inflammatory substances originating from the abdominal fat accumulation. Both male and female mice underwent a series of blood tests. They were also physically inspected. The female mice had the pear-type accumulation of fat, the males an apple-type fat accumulation.

More details about what obesity did to the experimental mice

In males there was a reduction of sperm count in the obese group as well as low muscle strength. In addition they were low in energy, had a lack of libido and their testosterone levels were low. The sperm number and the testosterone level had fallen to 50% of what they were when their weight was normal. This is what happens in human obese males as well. The inflammatory substances, that the abdominal fat creates, broke down the blood/brain barrier, and this affected the brain.

Among the female mice there was no neuroinflammation in the brain. There was no change in their hormones, which was quite a remarkable finding. This was a surprise and points out that beside estrogens there are other mechanisms to protect females from the effects of obesity.

Brain inflammation from obesity

Dr. Cross explained that in male mice the fat accumulation was of the apple-type. Female mice had the pear type fat accumulation. The fatty tissue in females did not release inflammatory kinins. On the other hand, the abdominal fat in the males released inflammatory kinins. These attracted macrophages, which is a cell type of the immune system. Activated macrophages now became aggressive and broke down the blood/brain barrier. This resulted in neuroinflammation of the brain. The brain normally is an immune protected site because of the blood/brain barrier. When this breaks down because of the action of inflammatory kinins from abdominal fat, the brain starts to develop memory loss like in Alzheimer’s disease.

Women before and after menopause

In females who still produce enough estrogen, fat from the pear type obesity distribution does not produce inflammatory kinins. This explains the relative protection of premenstrual women from heart attacks and neuroinflammation. But menopausal women start accumulating fat around the abdomen as well. At that point they can also develop inflammatory kinins and neuroinflammation. This is why the heart attack and stroke rate increases in postmenopausal women with apple-shape obesity.

Other studies supporting the effects of obesity in men and women 

Inflammatory substances in obese people affecting their brain

This publication shows that in a group of 141 neurologically healthy obese individuals the anti-inflammatory defense in the brain was weakened. Subsequently, various brain conditions developed because of the inflammatory substances affecting the brain.

How obesity affects your body functions

Obesity affects the body in various ways. It is particularly the apple type obesity that causes inflammatory substances circulating in the blood. A multitude of conditions can develop from this.

  • The cholesterol shows an increase of the bad LDL cholesterol and a reduction of the good HDL cholesterol.
  • The blood pressure rises. Without treatment high blood pressure can cause strokes.
  • Type-2 diabetes often develops because the insulin production cannot keep up with the demand. A second factor is a loss of insulin receptor sensitivity. As a result the insulin receptors of the body cells become resistant to insulin.
  • The gallbladder often develops stones, which may require gallbladder surgery.
  • Some cancers are increasing in frequency: endometrial cancer, breast, colon, kidney, gallbladder, and liver cancer.
  • Anxiety, depression and other mental disorders are more common, in part because of the neuro-inflammatory processes that I mentioned before.
  • Body pain and problems with physical functioning: obese people have more back pains, hip and knee pains from the extra weight. Slim people are less likely to have these problems. Obese people require more hip and knee replacement surgeries for end-stage arthritis than slim people.

Difference of metabolism in pear-shape versus apple-shape obesity

Back to the pear versus apple distribution of fatty tissue in obesity. diabetes, heart disease, high blood pressure and strokes as the apple type obesity. The difference in metabolism between the two is explained in detail here.

Distribution Of Obesity In Women And Men Is Different

Distribution Of Obesity In Women And Men Is Different

Conclusion

You may have heard that women tend to accumulate fat more around their hips, possibly because of hormonal factors. This is a pear-type fat distribution. In men who turn obese the fat accumulation follows an apple pattern. This type has a more aggressive metabolism in the fat tissue with inflammatory kinins accessing the blood circulation. It also affects the blood/brain barrier. Normally this barrier does not allow proteins to enter the brain. But when a person is obese, inflammatory kinins and proteins can enter the brain freely causing mental illnesses like depression and anxiety. Many obese people also develop type-2 diabetes leading to heart attacks and strokes.

Low fat diet from the 1980’s

The low fat diet of the 1980’s has caused a lot of obesity around the world. The problem is that merchants who provide low fat products have replaced fat with refined sugar. The liver converts refined sugar into fatty acids and triglycerides. These end up as fatty tissue. Given enough time this is causing obesity. Those who are obese need to cut out refined sugar in its many disguises. In addition they also need to cut down their starchy food intake. In the gut starchy foods break down into sugar.

When you cut out sugar and starchy foods, a person will typically lose 50 pounds in 3 months, at which point they have lost the label of “obesity”. They will also feel more energetic. The best advise for you is to maintain your weight loss with a Mediterranean diet. Research studies have shown that it is beneficial and anti-inflammatory.