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.

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Jan
08
2022

Sleep Training to Prevent Insomnia and Depression

A new study describes that sleep training to prevent insomnia and depression is desirable. Notably, the study published in JAMA Psychiatry took 291 people age 60 years and older and followed them for three years. In this case half the participants received treatment with sleep training, the other half treatment with cognitive behavioral therapy. The other half was the control who received sleep education therapy from a public health educator. It is important to realize that both groups received 120 minutes weekly group sessions for two months. That is to say, following training of 2 months the subjects were followed for 36 months. It must be remembered that they completed monthly questionnaires to monitor for depression and insomnia. At the end of the study almost 1/3 of the cognitive behavioral group still were free of insomnia.

The control group who received sleep education therapy initially showed no longer any

improvement. In other words, the initial progress did not last with sleep education only. The study was also published in CNN.

Results about rates of depression

Those subjects of the cognitive behavioral therapy group who had a sustained remission of their insomnia disorder had a rate of 82.6% less depression. This was in comparison to the subjects who did not sustain their treatment against insomnia. Dr. Pim Cuijpers commented that the results of the study show “a completely new and innovative way” of tackling the growing problem of depression. Dr. Cuijpers is a professor of Clinical Psychology at the Free University of Amsterdam.

A brief background about depression in older patients

Depression is common in people above the age of 60. About 30-50% of this age group develop depression. Part of this could be that older people often do not get enough sleep as middle-age or younger adults do. Melatonin production declines with older age and this may play a role in insomnia of older people. On the other hand, one of the major symptoms of depression is a lack of sleep. It seems that a lack of REM sleep, the deep sleep that makes us dream, is responsible for both troubles, sleeping (insomnia) and depression.

Cognitive behavioral therapy administered by a therapist is effective for insomnia

It is important that a therapist administers the cognitive behavioral therapy. There are recordings available online that provide cognitive therapy, but they are not individualised. Dr. Irwin said: “That’s why CBT-I is so effective in person, because the therapist is helping that individual navigate and negotiate with themselves — and it can be really hard work,” Irwin added. “I believe that’s also why CBT-I apps or online tools often don’t work — people get frustrated, disappointed or angry at themselves, and they basically stop the work.”

The rationale for cognitive behavioral therapy (CBT)

CBT for insomnia has five components: Stimulus control, sleep restriction, sleep hygiene, relaxation and cognitive behavioral therapy. Researchers gave the program the name CBT-I. Sleep hygiene and relaxation involve these sleeping habits: going to bed at the same time every day, eliminating noise and blue light from electronic devices. Also, you want to keep your bedroom cool, take warm baths and do yoga for relaxation.

Stimulus control and sleep restriction

Stimulus control involves getting out of bed, if you can’t sleep. Dr. Irvin said: “Most people stay in bed, fretting about not falling asleep, which then turns the bed into a negative space. Instead, people are taught to get up after 10 minutes of tossing and turning, do quiet, non-stimulating activities, and not to come back to bed until they are sleepy.” Sleep restriction means that a person lies in bed only to sleep plus 30 minutes. It is a way to make people with insomnia get out of bed instead of lying there awake.

Cognitive behavioral therapy

Cognitive behavioral therapy disrupts irrational thoughts and beliefs about sleep. Patients with insomnia often think “I can never sleep” or “I might die if I don’t sleep tonight.” A therapist has training to help the patient find a way back to a more realistic mindset. Eventually the patient accepts the bed as a welcoming place.

Cognitive behavioral therapy is effective in preventing depression

Dr. Irwin pointed out that chronic insomnia often leads to depression. A dangerous consequence of depression can be preoccupation with suicide. A certain percentage of patients with depression in any age group want to kill themselves. This is where cognitive behavioral therapy can intervene and make a huge difference. As mentioned earlier almost 1/3 of patients who received cognitive behavioral therapy for two months retained their normal sleep pattern. It was among this group that 82.6% had no depression compared to a control group. These are very important statistics. Dr. Irwin said: “We have shown that we can actually target insomnia with cognitive behavior therapy and prevent depression from occurring”.

Sleep Training to Prevent Insomnia and Depression


Sleep Training to Prevent Insomnia and Depression

Conclusion

A new study in JAMA Psychiatry describes that sleep training to prevent insomnia and depression is feasible. Sleep researchers used cognitive behavioral therapy sessions for two months on subjects who suffered from insomnia. The treatment group had profound effects with respect to improving insomnia and depression. Almost 1/3 of subjects treated with cognitive behavioral therapy returned to a normal sleeping pattern. And this subgroup of patients had 82.6% less depression. The lead author, Dr. Irwin thinks that cognitive behavioral therapy could become the new way of how to treat and prevent depression.

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.

Aug
25
2018

The Downside Of Living To 100

A review article has examined longevity and reviewed the downside of living to 100. In their 80’s about 10% of the population live in nursing homes, but among centenarians 55% are residing in nursing homes. They are often very lonely, as their social circles have shrunk as they aged.

Common diseases of older people

Osteoarthritis makes it difficult for people to get around, it causes chronic pain and it can also be the reason for falls. In 1990 there were 213.4 cases of osteoarthritis per 100,000. 26 years later, in 2016 there were 232.1 cases of osteoarthritis per 100,000 people.

Chronic obstructive pulmonary disease (COPD) has been falling, because less people smoke cigarettes now. Statistics show 1667 cases of COPD per 100,000 in 1990, but only 945 cases of COPD per 100,000 in 2016.

Diarrhea and common infections have dropped sharply from 8951 per 100,000 in 1990 to 3276 per 100,000 in 2016.

What other common diseases do older people get?

There are a number of common diseases that affect the elderly.

Osteoarthritis

Osteoarthritis of the hips and the knees are common, but it can affect every joint in the body. In the end stage knee replacements or hip replacements may be necessary. But before a total knee replacement or total hip replacement can even come into consideration, the person’s heart needs a thorough checkup to ensure that it is safe for the patient to undergo surgery under a general anesthetic.

Heart disease

Older people often have heart disease.

When coronary arteries are narrowed, heart attacks occur. Cardiologists can place stents, so that previously narrowed coronary arteries receive normal blood flow. Following such a procedure the patient may live for another 10 to 15 years.

There are also heart valve calcifications. The aortic valve is particularly endangered. A heart surgeon may be able to replace a diseased aortic valve by a porcine valve.

The nervous system of the heart transmits electrical signals from the sinus node to the muscle fibers, which can get diseased. Heart rhythm problems may necessitate the insertion of a pacemaker.

Finally, the heart may enlarge, but pump less blood than before. This condition is congestive heart failure. The 5-year survival for this condition is only 50.4%. Unfortunately there is very little the doctor can do for patients like this.

Cancer

The older we get, the more DNA mutations we accumulate. At one point cancer develops. If the diagnosis happens at an early stage there is a good chance that surgery can remove a cancerous growth, and the patient survives. But there are cancers that are notoriously difficult to recognize in the early stages. These are: cancer of the pancreas, kidney cancer, stomach cancer and certain types of leukemias.

Respiratory diseases

Those who smoked earlier in life may develop chronic obstructive pulmonary disease (COPD). It is a chronically disabling lung disorder. Often these individuals have to carry an oxygen tank with them wherever they go. The 5-year survival rate for people with COPD is 40 to 70%.

Osteoporosis

Osteoporosis is a disease where the bone is brittle. Spontaneous bone fractures can occur at the wrists, the upper thigh bone (femoral fractures) or in the vertebral bones. Women in menopause are hormone deficient and this contributes to calcium depletion of the bones. Lately research has shown that vitamin K2 and vitamin D3 are necessary for a normal calcium metabolism. Briefly, 200 micrograms of vitamin K2 and 5000 IU of vitamin D3 every day are the necessary dosage that the body can absorb calcium from the gut, eliminate it from the blood vessels and deposit it into the bone. Calcium is present in milk products and milk. If a person does not consume enough milk products a supplement of 1000 mg of calcium daily does make sense.

Alzheimer’s

The older we get, the more likely it is an onset of Alzheimer’s or dementia. Between the ages of 90 to 94 there is a yearly increase of Alzheimer’s of 12.7% per year. The group from age 95 to 99 years has a yearly increase of Alzheimer’s of 21.2% per year. Persons aged 100 years and older have an increase of Alzheimer’s by 40.7% per year. What this means is that essentially there is a doubling of Alzheimer’s every 5.5 years. We do not have all of the answers why this is happening and why Alzheimer’s develops. But we do know that diabetics are more likely to develop Alzheimer’s. High blood sugar levels and high insulin levels seem to lead to the precipitation of the tau protein in the brain, which causes Alzheimer’s.

Diabetes

When diabetes is not well controlled, there is accelerated hardening of the arteries. This can cause heart attacks and strokes. Longstanding diabetes can affect the kidneys (diabetic nephropathy, kidney damage) and can lead to hardening of the leg arteries. Often the only treatment left is a below knee amputation. Blindness from uncontrolled diabetes is common and pain from diabetic neuropathy as well.

Diabetics have an average life expectancy of 77 to 81 years. However, if they pay attention to their blood sugars and manage their diabetes closely they can live past the age of 85.

Falls and balance problems

As people age, their balance organ is not functioning as well. Also, people with high blood pressure medication may have postural hypotensive episodes that can lead to falls.

There may be a lack of cognitive functioning and misjudging of steps, ledges and irregularities in the floor. When a person has brittle bones from osteoporosis and they fall, a hip fracture is very common. At a higher age surgery for a hip fracture is dangerous. It can have a mortality of 50%.

Obesity

A person with obesity has a life expectancy that is 10 years less than a person without obesity. The reason for this is that with obesity This is so, because the risk of heart attacks, strokes, cancer, arthritis and diabetes is increased.

Depression

Older people often get depressed. It even has its own name: involutional depression. People can get into a state of mind, where they think negatively. Depressed people feel that they have nothing to live for. They lost friends; they are shut in because they can’t drive a car any more. This type of depression needs treatment by a psychologist or psychiatrist. The danger of leaving depression untreated is that the person may get suicidal. In older people depression is often precipitated by physical health problems.

Oral health

When teeth are not looked after, gingivitis and periodontitis can develop. Infected gums can shed bacteria into the blood and this can affect the heart valves. Endocarditis, the infection of heart valves, is a cardiological emergency. Prolonged antibiotic therapy is necessary to overcome this condition.

Poverty

Poverty has real consequences. The aging person may not have access to the optimal medical care facility because of a lack of funds. But even at a younger age there is evidence that people are healthier when they are wealthier.

Shingles

Older people often get shingles, even if they had chickenpox or shingles as a child. This is evidence that the immune system is getting weaker. Shingles in an older person should alarm the treating physician that there could be an underlying cancer. Due to that knowledge a cancer-screening tests should be part of the medical exam. In addition, a varicella vaccine should be offered to the patient to build up immunity.

The Downside Of Living To 100

The Downside Of Living To 100

Conclusion

Living to 100 is often glorified in the press. Maybe you have seen a 90-year old jogger completing a marathon, or you saw an 85-year old couple ballroom dancing. But what they don’t show you is what I summarized here, the less glamorous things about living to 100. You may get a heart attack or a stroke. Osteoarthritis may affect you how you walk. Congestive heart failure may make you get short of breath when you walk upstairs. Then there are various cancer types that are difficult to diagnose early.

If you have smoked in the past, you may suffer from chronic obstructive pulmonary disease (COPD), which leaves you breathless.

Other illnesses

Osteoporosis can lead to spontaneous fractures. Because the bone has a lack of calcium, this is difficult to treat and takes a long time to heal.

Alzheimer’s is ever so much more common when you approach the year 100. There are other medical conditions you can get: obesity, diabetes and depression. When you get shingles for the second time, it may mean that your immune system is getting weak and a cancer-screening test should be done.

There are some downsides when you approach the age of 100.

Know your risks and be vigilant

You may keep your physician busy checking out various age-related illnesses, but more importantly, get regular check-ups and tests. Any condition is easier to treat with an earlier diagnosis! The message for anybody reading this is very simple. Prevention through healthy living is something you can actively pursue. Keep your body and your mind busy. Enjoy time with friends and family instead of living a solitary existence. See the glass that is half full instead of viewing it as half empty. Stick to a healthy diet. Knowing all the risks is not a scare but a call to being vigilant. Knowledge is powerful and will help you to enjoy your golden years feeling well and happy.

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May
05
2018

The Benefits Of Drinking Green Tea

Chances are you heard about the benefits of drinking green tea to reduce heart disease. But the polyphenols of green tea also prevent cancer, depression and cognitive decline.

Green tea lowers cardiovascular mortality

A study in the Chianti region of Tuscany, Italy consisted of 807 men and women aged 65 years and older. They had urine tests for metabolites of green tea in the beginning of the study. The study went on for 12 years. 274 participants died, which was 34% of the total study group. Tests measured the total urinary polyphenol (TUP) concentration in both groups, the survivors and the participants who died. Those participants whose TUP was in the highest tertile of the TUP values had the lowest all-cause mortality. And those participants whose TUP was in the lowest tertile had the highest all-cause mortality. 

High blood pressure and stroke

A Taiwanese study from 2004 examined the blood pressure of 1507 subjects. There were 711 men and 796 women with a recent diagnosis of  high blood pressure. The investigators looked at tea consumption (green tea and oolong tea) and blood pressure reduction. They found that those who drank 120 to 599 mL/day of green tea or oolong tea decreased their blood pressure by 46%. Those who drank more than 600 mL/day of green tea or oolong tea lowered their blood pressure by 65%.

Another meta-study involving 194,965 people and 4378 strokes found that there was a reduction of strokes with increasing tea consumption. Those who drank 3 or 4 cups of green tea or black tea per day were the experimental group. Researchers compared them  to the control group that drank less than one cup of tea per day. The experimental group had a 21% lower risk of getting a stroke than the control group.

Cancer prevention more with black tea than with green tea

A meta-analysis of 18 studies from China showed that green tea and black tea consumption was beneficial for prevention of cardiovascular disease and for cancer prevention. The highest consumption of green tea reduced cardiovascular mortality by 33%. The highest black tea consumption lowered mortality by 12%. Cancer mortality turned out to be different. Green tea did not produce a reduction in mortality, but black tea lowered it by 21%.

Another study, this one from Shanghai, China, points out that there are 15 polyphenols in green tea that likely work on different target areas of the body. They target 200 different genes in humans affecting diabetes, cancer, cardiovascular disease, neurodegenerative disease, muscular disease and inflammation.

Other cancers like prostate and breast cancer benefit from green tea

This study shows evidence that habitual green tea drinkers do prevent prostate cancer and breast cancer to a certain extent.

Another study investigates the effect of tea on health. One of the studies from the same authors have shown that the oxidative damage to cells from cigarette smoking can come out in a urine test. Those smokers who drank 4 cups of tea per day had a 31% decrease in their urinary biomarkers to indicate DNA damage. As DNA damage is often the first step in cancer development, these findings are important to note.

Cognitive effects of green tea consumption in dementia patients

A 2017 review of dietary supplements to improve cognitive impairment pointed out several supplements that will improve cognition. Green tea is one of them, but omega-3 fatty acids (EPA), and docosahexaenoic acid (DHA) are also useful supplements to restore neuronal functioning.

A 2017 study from Basel, Switzerland found that green tea improved memory, reduced anxiety and activated the working memory, which could be made visible on functional MRI scans. These researchers also pointed out that green tea has this effect as a whole, you cannot attribute it to a single constituent. Separate tests of  caffeine or L-Theanine  showed that the beneficial effect was smaller than when green tea as a whole was tested.

2016 study on severe Alzheimer’s patients

This 2016 Iranian study looked at 30 patients with severe Alzheimer’s disease. A baseline assessment was first, and 2 months after taking 4 green tea pills daily another assessment followed. A blood test measured the oxidative stress before and after, so was the antioxidant level from the green tea. The oxidative stress test showed an improvement during the study. The antioxidant level in the blood was higher than before the start of the study. The cognitive function test improved only slightly.

A 2018 study from Singapore looked at the effect of drinking tea (black tea or green tea) regarding symptoms of anxiety or depression. In a group of 614 subjects who were elderly individuals, aged 60 years and above; 59% consumed tea for longer than 15 years. These tea-drinking people were significantly less depressed and significantly less anxious when they underwent psychological tests, compared to non-tea drinkers.

Depression and green tea consumption

There is a 2018 study from South Korea that looked at the link of beverages from 15 studies with depression. 347,691 participants were part  of  these 15 studies, and 20,572 cases of depression developed. Comparing a high consumption of tea or coffee to low consumption, the following statistics were the result: coffee consumption reduced depression by 27%, green tea consumption by 29%.

The Benefits Of Drinking Green Tea

The Benefits Of Drinking Green Tea

Conclusion

Bioflavonoids are powerful antioxidants. But there are many more substances in green tea and coffee that are all beneficial for our health. One of the studies mentioned identified 15 polyphenols in green tea. But another study said that trying to identify one of the components as more active than the others would be a waste of time. They measured some of the factors by themselves and found that the overall effect was much smaller than green tea as a whole.

Other research has shown that the components of green tea activate several genes. This includes anti-inflammatory effects, prevention of heart attacks and strokes, lowering of blood pressure, anti-cancer effects, improvements of cognitive function, as well as improvement of depression and anxiety. As you can see the effect of green tea is diversified. Don’t hesitate to consume another cup of tea!

Mar
31
2018

Self-Love Is Important

You need to appreciate that self-love is important, if you want stable mental health and well-being. Before you can take care of people around you, you need to practice self-love first. You cannot give love, if you don’t love yourself first. We get so busy in working hard, wanting to achieve goals and then surpass ourselves. We want to be perfect. But this is not possible without first looking after our own needs: again, self-love is important to be able to reach the goals you want to achieve.

Perfectionism can be harmful

Most of us were grew up  in the Western society thinking that perfectionism would be good for us. After all, we achieve things; we criticize ourselves and improve it even more; so finally we end up with our dream goal. What is the downside of perfectionism?

Perfectionism often comes with chronic stress, which can shorten our life span. Perfectionism leads to diseases like irritable bowel syndrome, fibromyalgia, depression and eating disorders. Depression can have a serious complication, namely suicide attempts and actual suicide. Perfectionists also often suffer from anxiety disorders that can make life miserable. Chronic stress together with perfectionism can weaken the immune system, which in turn can cause infections and even autoimmune diseases.

Moving away from perfectionism

The United Nations passed a resolution in 2012 saying, “pursuit of happiness is a fundamental human goal.”

Psychologists also tell us that happiness is something we deserve to have; it is our right. A clinical psychologist in Vancouver, Canada, compares the inner critic of perfectionists to a “nasty adult beating the crap out of a tiny child”. We don’t have to beat ourselves up internally; it is not healthy for us. Don’t let the inner bully put yourself down for a minor thing that went wrong.

Start cultivating self-compassion. Self-compassion is not something that you have or do not have. According to psychologists self-compassion is something that you can learn.

The more you learn self-compassion, the less important perfectionism will be for you. You will still be productive and successful, but you will stop injuring yourself in the process.

Learning about self-compassion

Psychologists have researched how self-compassion can be developed. They even have invented an 8-week program that helps the client to build up self-compassion. These psychologists could measure a significant improvement of the level of self-compassion before taking the course and after completing it. According to Prof. Neff and associates there are three parts to self-compassion.

  • Self-kindness, which means treating yourself with understanding and forgiveness.
  • Recognition of one’s place in the shared humanity. This acknowledges that people are not perfect. It also means that personal experiences are part of the larger human experience.
  • Mindfulness, which means emotional balance and avoiding over identifying with painful emotions.

Listening to yourself

Dr. Kristin Neff has written a book that describes how to change your inner voice from a harsh voice to a softer, kinder internal voice. By becoming aware what your internal thoughts are, you can gradually change your internal talk. Profs. Neff and Germer have developed an 8-week course called “mindful self-compassion training”. In their own words “Self-compassion says, ‘Be kind to yourself in the midst of suffering and it will change.’ Mindfulness says, ‘Open to suffering with spacious awareness and it will change.'”

Part of the course is to learn how to deal with suffering when things go badly. In this case they recommend to their clients to repeat the following 3 phrases: “This is a moment of suffering,” “Suffering is a part of life,” and “May I be kind to myself.” This will take the sting away from the suffering and reduce the emotional pain.

Doubts about mindful self-compassion training?

You may have some doubts whether or not self-compassion training would work. But psychological tests regarding self-compassion ratings before and after the course have found a significant 43% difference. Similar compassion training can be found under this link.

These mindful exercises in self-compassion have been proven to down regulate the stress response. The hormones ACTH and cortisol in the blood were found to be much less in persons who had undergone self-compassion training. The training also was shown to increase heart rate variability, which is the body’s natural way to react to stress.

Not everybody is a good meditator. But apart from meditating there are other methods to recognize that self-love is important, as is self-compassion. You can write a letter to yourself, but pretend it comes from a close, loving friend. You could also write a letter that you pretend comes from you addressed to a person that you show compassion to.

Yoga to help you realize that self-love is important

Yoga is a great way to re-acquaint you with pleasures you experienced in childhood. Part of a yoga exercise can be “Mindful Eating”. You are simply refocusing your attention to the tastes that you may have taken for granted. Such a technique helps you to listen to yourself, become aware of your needs and train yourself in self-love and self-compassion. One of the top recommended Internet accessible yoga classes was this.

Self-love Is Important

Self-love Is Important

Conclusion

Perfectionism is widespread and is often taught in schools to be desirable. However, we become so good at this that it often turns into self-injurious behavior. We become harsh on ourselves and nothing is good enough to please us. And we expect perfection from people around us. We may even become abusive when they do not measure up to our expectations.

Dr. Kristin Neff has written a book that describes how to change your inner voice from a harsh voice to a softer, kinder internal voice. She also teaches an 8-week course at Harvard University how to develop self-compassion and self-love.

Mindful exercises in self-compassion

Mindful exercises in self-compassion have been proven to down regulate the stress response. It teaches you to deal with suffering when things go badly.

The bottom-line is to find your path away from perfectionism to a feeling of wholeness. And by achieving this we will free the negative energy of harsh and often unjustified criticism to give our best and succeed.

Nov
12
2016

Stress Drives Our Lives

Every year the American Psychological Association (APA) monitors the American public how stress drives our lives. This yearly report has been compiled since 2007. About 75% of the people questioned reported that they have experienced moderate to high stress over the past month.

Symptoms when stress drives our lives

What kind of symptoms can stress cause? It can cause sleep deprivation, anxiety, headaches and depression. But there can be more symptoms from any disease that stress may cause. The “Stress in America” report from February 2016 shows on page 5 that unhealthy life habits are used by low-income Americans to cope with stress. A bar graph shows that watching television or movies for more than 2 hours per day is common. Another way of coping is to surf the Internet more often, take more naps or sleep longer. Eating more, drinking alcoholic beverages and smoking more are other unhealthy ways to cope with stress.

As the stressed person gains extra weight and eventually becomes obese, there is a higher rate of diabetes that can develop with all of its complications.

Causes of stress in our lives

The “Stress in America” survey was based on 3,068 adults in the US who completed the survey during August 2015. 72% were stressed out about financial issues. 22% of these said that they were extremely stressed in the past month as a result of money concerns. Other common concerns were work, the economy, family responsibilities and concerns about personal health. Average stress levels among Americans decreased when compared to 2007. On a 10-point stress score respondents rated their stress at 4.9 in 2016 compared to 6.2 in 2007. But according to the American Psychological Association this is much higher than a stress rating of 3.7 considered to be a healthy level.

Stress affects people from all walks of life, workers, women, young adults, students and those with lower incomes.

“Stress is caused by the loss or threat of loss of the personal, social and material resources that are primary to us” Stevan Hobfoll, PhD, a clinical psychologist from Rush University Medical Center said. “So, threat to self, threat to self-esteem, threat to income, threat to employment and threat to our family or our health…” is what causes stress.

Stress drives our lives causing disease

When stress is too much for our system, we are starting to see pathology develop. “Stress is seldom the root cause of disease, but rather interacts with our genetics and our state of our bodies in ways that accelerate disease” professor Hobfoll says. The following are common diseases that can result from chronic stress.

Heart attacks and strokes

In a 2015 Lancet study 603,838 men and women who worked long hours were followed for a mean of about 8 years with respect to heart disease or strokes. All of the subjects were free of heart attacks and strokes when they entered into the study. There were a total of 13% more heart attacks in those who worked extra hours in comparison to those who worked 40 hours per week or less. With respect to strokes there were 33% more strokes in those who worked long hours. Researchers noted a dose-response curve for strokes in groups with various workloads. Compared to standard working hours there were 10% additional strokes for 41-48 working hours, 27% for 49-54 working hours and 33% for 55 or more working hours per week.

Stress drives our lives and causes substance abuse

In order to cope with stress many of us treat daily stress with alcohol. It makes you feel good subjectively, but it can raise your blood pressure causing heart attacks and strokes down the road. A low dose of alcohol may be healthy, but medium and high doses are detrimental to your health.

Next many people still smoke, although scientists have proven long time ago that it is bad for your health. It can cause heart attacks, various cancers and circulatory problems leading to leg amputations.

Overeating is another common problem. Comfort food relieves stress, but it puts on extra pounds. As you know it is easier to put weight on than get it off. Being overweight or being obese has its own problems: arthritis in the hips and knees makes walking more difficult. The metabolic syndrome sets in, which is a characteristic metabolic change causing diabetes, high blood pressure, heart attacks, strokes and certain cancers. The more weight you carry, the less likely you are to exercise. This deteriorates your health outlook.

Diabetes

Stress causes too much cortisol secretion from the adrenal glands. This raises blood sugar, and when chronic can cause diabetes. In addition unhealthy eating habits associated with stress can cause weight gain and high blood sugars leading to diabetes.

In a 2012 California study 148 adult Korean immigrants were examined. They all had elevated blood sugars confirming the diagnosis of type 2 diabetes. They had a  elevated waist/hip ratio.

A high percentage of the study subjects had risk factors for type 2 diabetes. This included being overweight or obese and having high blood glucose readings. 66% of them said that they were feeling stressed, 51% reported feeling anxious, 38% said they were feeling restless, 30% felt nervous and 3% said they were feeling hopeless.

An Australian long-term follow-up study computed risk factors for developing type 2 diabetes. Stress was a major contributor to diabetes.

A 30-day episode of any anxiety disorder had a 1.53-fold risk to cause diabetes. A depressive disorder had a 1.37-fold risk to cause diabetes and posttraumatic stress disorder had a risk of 1.42-fold to cause diabetes.

Infertility

Stress changes hormones in women causing ovulation problems and infertility. 1 in 8 couples in America have problems getting pregnant. Physicians identified stress as at least a contributing factor. But in men stress can also reduce sperm count and semen quality as this study describes.

Alzheimer’s disease

A 2010 study from Gothenburg University, Sweden examined 1462 woman aged 38-60 and followed them for 35 years.

Psychologists assessed the stress score in 1968,1974 and 1980. 161 females developed dementia (105 Alzheimer’s disease, 40 vascular dementia and 16 other dementias). The risk of dementia was higher in those women who had frequent/constant stress in the past. Women who had stress on one, two or three examinations suffered from higher dementia rates later in life. Researchers compared this to women did not have any significant stress. Specifically, dementia rates were 10% higher after one stressful episode, 73% higher after two stressful episodes and 151% higher after three stressful episodes.

Remedies for stress

Before you can attempt to remedy stress, you must first detect that you are under stress. You can recognize this when you have problems sleeping, you suffer from fatigue, when overeating or undereating is a problem, and if you feel depressed. Others may feel angry or are irritable. Some bad lifestyle habits may also make you aware that you are under stress. You may smoke or drink more in an attempt to manage stress. Some people abuse drugs.

Here are some suggestions how to remedy stress:

  1. Seek support from family, friends or religious organizations. If you engage in drugs or alcohol overuse or you feel suicidal, it is best to seek the advice from a psychiatrist or psychologist.
  2. Engage in regular exercise. This produces endorphins, the natural “feel-good” brain hormone. This reduces symptoms of depression and improves sleep quality.
  3. Do something that increases pleasure, such as having a meal with friends, starting a hobby or watching a good movie.
  4. Positive self-talk: avoid negative thoughts like “I can’t do this”. Instead say to yourself “I will do the best I can”. Psychologists have developed a technique where they teach patients how to turn negatives into positives. Psychologists call this therapy “cognitive therapy”. You may want to seek the advice of a psychologist to have a few cognitive therapy sessions.
  5. Daily relaxation: you may want to use self-hypnosis, tai-chi exercises or meditation to reduce your stress levels.
Stress Drives Our Lives

Stress Drives Our Lives

Conclusion

Stress is very common. Diverse diseases like heart attacks, strokes, diabetes and Alzheimer’s disease can all be caused by stress. It is important to minimize the impact of stress by seeking family support and support from friends. Engaging in regular exercise will release endorphins and make you feel better. Relaxation exercises and seeking counselling can all help you to manage stress. You cannot ignore or simply tolerate this force in your life. Stress is indeed there, but we can make a difference by managing it to avoid that stress manages us.

Sep
03
2016

Hidden Cause Of Depression

About 15.7 million Americans suffer from depression every year, but there remains a hidden cause of depression.

Not everybody responds well to antidepressant medicine. Only 30 to 50% of depressed people respond to antidepressants. There are two blood tests many physicians do not know and therefore fail to order: homocysteine blood levels and 5-methylfolate levels (5-MTHF).

Homocysteine as a hidden cause of depression

In 2004 a research group studied 924 middle-aged men. They noted that those men who fell into the highest third of homocysteine levels had a two-fold higher risk of being depressed than those who fell into the lower third of homocysteine levels. Other studies showed that SAMe, a nutrient that is required to build up mood enhancing neurotransmitters was sadly lacking in depressed people. In addition, folate levels were also found to be low in depressed people.

Having found this association between lack of nutrients and depression offered new opportunities to treat depression. Two studies examined the effect of taking 5-methylfolate on the effect of antidepressants. The result was astounding: in one study 7% of patients taking an antidepressant experienced improvement of their depression when assessed with a standard depression score. However, the same group improved their depression by 19% when 5-methylfolate was given in addition to the antidepressant.

Patients with the most severe depression on antidepressants had a 16% improvement of their depression. Adding 5-methylfolate to the antidepressant caused a 40% overall improvement in these severely depressed people, 24% more than without this simple vitamin supplement.

There is other evidence that patients with depression recover faster in the presence of 5-methylfolate. Moderately depressed patients recovered within 231 days on antidepressants alone, but in only 177 days when 5-methylfolate was present as well. The most severely depressed patients recovered within 150 days with antidepressants alone, but recovered within only 85 days on 5-methylfolate and the antidepressant.

Hidden cause of depression and Alzheimer’s disease

The story is getting more involved. Depression is related to proper balance of neurotransmitters that can be influenced by antidepressants and 5-methylfolate. But new research showed that Alzheimer’s disease (dementia) patients with cognitive decline have elevated homocysteine blood levels. A study in the New England Journal of medicine in 2002 found that after 8 years of observation more than 75% of them were diagnosed with Alzheimer’s disease. When blood homocysteine levels exceeded 14 micromole per liter the risk of Alzheimer’s had doubled compared to those with normal homocysteine levels. The researchers concluded that homocysteine is an important risk factor for the development of Alzheimer’s diseases and dementia, although it is not the only one.

Methylation pathway defects as a hidden cause of depression

40% of the population is defective in one or more genes that control the so-called methylation pathway in each of our cells (Ref. 1). This can slow down the metabolism of brain cells including the synthesis of certain neurotransmitters. At the same time it can cause the rising of homocysteine, which is then a useful marker for methylation defects. Another marker is the 5-methyl folate level, which, when low, indicates a deficiency in methyl donors including 5-methylfolate (5-MTHF).

Mental illness is an area where epigenetic factors play an important role. Depression that responds only partially or not at all to SSRI’s (antidepressants) often responds to L-methylfolate, a simple supplement from the health food store as a supplement. Similar epigenetic approaches are useful to treat psychosis, schizophrenia, bipolar disorder and Alzheimer’s disease.

Other illnesses due to methylation defects

Dr. Rozakis mentioned that 92% of migraine sufferers have a defective methylation pathway involving histamine overproduction and they can be helped with a histamine-restricted diet (Ref.2).

Autism, ADHD (hyperactivity) and learning disabilities are other diseases where methylation pathway defects are present. Physicians should check patients with autism for methylation pathway defects, and appropriate supplements and diet restrictions can help in normalizing the child’s metabolic defects. Mothers should consult with a DAN physician (“defeat autism now”) who is knowledgeable regarding all aspects of autism.

S-adenosylmethionine (SAMe) defects are another type of methylation defect, which associates with certain liver, colon and gastric cancers.

Dr. Rozakis went on to say that methylation defects lead to disbalances between T and B cells of the immune system and are important in autoimmune diseases like lupus or rheumatoid arthritis.

Methylation defects can also cause autoimmune thyroiditis and type 1 diabetes. They can also cause cardiac disease by raising homocysteine levels, which causes dysfunction of the lining of arteries and premature heart attacks.

Epigenetic factors through global methylation defects from vitamin B2, B6 and B12 deficiency can cause many different cancers. Hypomethylation is the most common DNA defect of cancer cells.

With skin diseases it has come to light that atopic dermatitis, eczema, psoriasis, scleroderma and vitiligo are related to methylation.

When we age, certain hormones are gradually missing, which leads to menopause and andropause. This leads to impaired cell function, elevated cholesterol, arthritis, constipation, depression, low sex drive, elevated blood pressure, insomnia, irritable bowel syndrome and fatigue. Replace the missing hormones with bioidentical ones, and symptoms will normalize.

Tests and treatment for hidden cause of depression

It is important for a physician to test patients for homocysteine levels once per year. As we age, we tend to lose some of the methylation pathway enzymes, which can result in an increase of homocysteine in the blood. A normal homocysteine level is less than 7 to 8 micromoles per liter. This is lower than the commonly recommended 15 micromoles per liter.

If the homocysteine level is too high, the treatment consists of methionine containing foods like dairy products and meat. Methionine, an essential amino acid, functions as a donor of methyl groups. The methyl groups normalize the methylation pathway defect and allow the homocysteine level in the blood to decrease. Research studies have been using 1000 to 5000 micrograms of 5-methyl folate daily to reduce homocysteine. Other B vitamins are necessary to reduce homocysteine, like vitamin B2, B6 and B12 in addition to 5-MTHF.

Hidden Cause Of Depression

Hidden Cause Of Depression

Conclusion

Depression and several other illnesses can be related to methylation pathway defects. This can cause a lack of 5-MTHF resulting in high homocysteine blood levels. It is important that a physician checks his elderly patients for homocysteine blood levels once per year. This will prevent depression, Alzheimer’s disease, migraines and a number of other illnesses.

Once a methylation pathway defect has been identified, it is relatively easy to treat the patient. The treatment consists of a proper methionine rich diet and 5-MTHF supplements as well as other B vitamins as discussed. It can prevent a lot of disability and human suffering.

References

Ref.1: William J. Walsh, PhD: “Nutrient Power. Heal your biochemistry and heal your brain”. Skyhorse Publishing, 2014.

Ref. 2: https://www.askdrray.com/life-expectancy-is-influenced-by-lifestyle/

Oct
17
2015

Depression Needs Treatment

Depression is common and depression needs treatment. 10% of all men and 20% of all women have a period of depression in their lives. In people with medical illnesses depression is more common: 20% to 40% (Ref.1).

First, the peak age for depression is usually the age of 25 to 44. There are special groups where depression is also common. In adolescents 5% are affected with depression and 13% of women tend to get depressed after delivery, a condition called postpartum depression.

Second, in any age group with depression there is a risk of suicide, but with adolescents this is particularly true.

Third, about 10% to 15% of people with general medical illness are developing depression, such as patients with Parkinson’s disease, stroke, Alzheimer’s disease, cardiac disease, HIV infection, end-stage renal failure and cancer.

Causes of depression

Officially it is not known what causes depression. That is what medical textbooks say. However, other books like Datis Kharrazian’s book “Why isn’t my brain working?” offers several scenarios that can cause depression and he has examples of cases that were cured of depression (Ref.2). He points out that deficiencies in two major brain transmitters can cause depression: serotonin and dopamine.

Serotonin

First of all, serotonin is produced in the midbrain from the amino acid tryptophan in two biochemical steps. It is important to realize that these biochemical conversions require iron, vitamin B6, vitamin B12, niacin, folic acid and magnesium as cofactors. But you also need the “large neutral amino acid transporter” (LNAA) to transport tryptophan through the blood/brain barrier into the brain.

Dopamine

Furthermore, dopamine is a neurotransmitter that is produced in the frontal lobes of the brain. Notably, it is also necessary for learning. The brain synthesizes dopamine from tyrosine, which has to be manufactured in the liver from the amino acid phenylalanine. You need to have a healthy liver to produce tyrosine, which needs to be transported through the blood/brain barrier into the brain; similar to tryptophan this requires the “large neutral amino acid transporter” (LNAA). People with hepatitis, fatty liver, insulin resistance or diabetes may have problems with the LNAA transporter, which can cause dopamine deficiency (Ref.2). But they may also have low serotonin, if tryptophan did not enter the brain because of a transportation problem. This will happen with sugar overconsumption, as insulin resistance develops and affects the LNAA transporter resulting in both low serotonin and dopamine (Ref.2).

Inflammation

Finally, in the 1990’s researchers confirmed that inflammation is also a possible factor in the causation of neurological disease including depression. Ref. 2 points out that gut issues can become brain issues as inflammatory substances can leak trough a leaky gut into the blood stream and trough a leaky blood/brain barrier into the brain. Hypothyroidism can activate brain inflammation and lead to an imbalance of the neurotransmitters. Gluten sensitivity is also an important cause of depression through the inflammatory connection, but few physicians recognize the full impact of this.

Tests for depression

There are no laboratory tests that would define depression. However, every patient should receive a blood test to check for hypothyroidism, a common cause of depression. When the tests confirm hypothyroidism, the physician can easily treat this with thyroid hormone replacement.

Otherwise the physician diagnoses depression by doing a mental status examination, history and review of symptoms. A good start is to ask: “In the past 2 weeks how little interest or pleasure in doing things have you had?” and “Have you been feeling down, depressed, or hopeless in the past 2 weeks?” (Ref.3).

There are detailed psychometric questionnaires available such as the Beck Depression Inventory that can assist the physician to establish the diagnosis.

Myths of depression

One of the myths regarding depression is that it would be contagious. As a matter fo fact, a study on 2000 high school students showed that depression was not infective. The contrary was true: human interaction with friends who had a “healthy mood” improved depression. By the same token, when you constantly compare yourself with your Facebook friends, and you are not in the best mood, your mood may worsen and you could become depressed.

Treatment of depression

Despite advances in the treatment of depression the response rate with antidepressant therapy has a limit of 60% to 70%. According to Ref.4 inadequate dosing and misdiagnoses account for the fact that 30% to 40% of treated people with depression have treatment failures. Typically the first antidepressant involves a selective serotonin reuptake inhibitor (SSRI), but newer trials have shown that the older monoamine oxidase inhibitors (MAOIs) have a higher success rate when treating depression initially (Ref.4).

For example, a good antidepressant for mild to moderate depression is St. John’s wort, which is recommended by Ref. 5 as having less side-effects as other antidepressants.

In treating resistant depression the psychiatrist often employs other combinations of antidepressants. In addition the health professional recommends to add cognitive/behavioral therapy, which makes the overall treatment more successful. It goes without saying that complicated cases of depression belong into the hands of an experienced psychiatrist.

Suicides

Unfortunately a mental disease like depression still has a stigma attached to it. As a result many people are in deep denial about the fact that mental disease exists. Friends who do not understand depression may inadvertently say things that make the symptoms of the depressed person more severe and distance themselves at a time when they would need support from friends. The end result is that the patient feels lonely, misunderstood and that suicidal thoughts enter the mind. Men often resist seeking treatment for depression, women are better in seeking professional help and getting effective treatment.

Need for a psychiatrist to help prevent suicides

This is where a psychiatrist needs to intervene. If this does not happen, people start attempting suicide and finally commit suicide. In the US committed suicides have a gender ratio of male to female of 3:1 to 10:1. These situations become very difficult. The family needs to step in and talk to the patient. It is best to accompany the patient to the hospital for an assessment. You may want to go to the hospital in your private car or by ambulance. Don’t be shy to call 911 for an ambulance. Better to be cautious than have a major crisis that ends in completed suicide.

Alternative depression treatments

There are alternative treatments for depression.

  1. Magnetic therapy for depression: This therapy is also called transcranial magnetic stimulation (TMS) and was approved for Canada and in 2008 by the FDA. But it is not as powerful according to Ref. 3 as unitemporal electroconvulsive therapy.
  1. Bifrontal electroconvulsive therapy (ECT): Electroconvulsive therapy with two pedals applied to the front of the skull appears to have the best results in terms of treating depression.
  2. Omega-3 fatty acids (EPA and DHA) are powerful anti-inflammatory agents, which will take care of the inflammatory component of depression. Both fish oil and krill oil in combination give the optimal response as outlined here.

Vitamin D3 and light box therapy

  1. Vitamin D3 is also anti-inflammatory and will contribute to an improvement with existing depression, but it also helps prevent the development of depression when taken in regularly as a supplement.
  2. Light box therapy: The observation of seasonal affective disorder (SADS) can develop as a result of lack of light. This has led to the discovery that light boxes are helpful for treating depression and also for prevention of depression due to seasonal affective disorder.

The patients should use a light box for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often it takes up to 4 weeks to reach its full benefit.

Avoid alcohol and too much sugar

  1. It is known for a long time that alcohol is a depressant; it can actually cause depression and in persons with bipolar disease it can trigger a flare-up of that disorder as well.
  2. Finally it matters what you eat: sugar and too much starchy foods (high glycemic index carbs) lead to insulin overproduction and insulin resistance. This causes inflammation, and this will cause depression. As mentioned earlier it also lowers the two key brain transmitters, dopamine and serotonin.

The solution is an anti-inflammatory diet, the Mediterranean diet without sugar and high glycemic index carbs; only low glycemic index carbs are part of this diet. This will normalize insulin production and eliminates inflammation.

B vitamins, electroacupuncture and exercise

  1. Vitamin supplements: Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid often helps. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.5). Folate and vitamin B12 are methyl donors for several brain neuropeptides.
  2. The symptoms of depression often improve with electro acupuncture, as shown in many studies. This treatment ameliorates the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.6).
  3. Exercise on a regular basis helps to equalize the mood and seems to exert a slight anti-depressant effect on the person who engages in regular physical activity.
Depression Needs Treatment

Depression Needs Treatment

Conclusion

I have attempted to show the complexity of depression and what we know about its causes and treatment. Very likely there are several causes for depression and further research will hopefully bring more clarity to this. Over the years psychiatrists have developed treatment modalities, both conventional and unconventional, by trial and error. The physician and patient need to use common sense: if a treatment is working, stick to it and use it. If it does not work, move on and try something else. More complex cases should be referred to a psychiatrist who has the most experience with patients that are difficult to treat. Do not neglect life-style factors and alternative depression treatments as they can often help to stabilize depression significantly. We all must be vigilant about suicide risks in depressed patients and act by calling 911, if necessary to intervene.

More info on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

1. Depression, Major: Fred F. Ferri M.D., F.A.C.P., Ferri’s Clinical Advisor 2016, by Elsevier, Inc.

2. Dr. Datis Kharrazian: “Why Isn’t My Brain Working?” © 2013, Elephant Press, Carlsbad, CA 92011

3. Goldman-Cecil Medicine “Major depressive disorder” 2016, by Saunders, an imprint of Elsevier Inc.

4. Massachusetts General Hospital Comprehensive Clinical Psychiatry, Second Edition: Theodore A. Stern MD, Maurizio Fava MD, Timothy E. Wilens MD and Jerrold F. Rosenbaum MD © 2016, Elsevier Inc.

5. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.

6. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA