Why Do Antidepressants Fail For Some?

Author Article

Serotonin is the chemical messenger that has a major impact on feelings of happiness and wellbeing.

Scientists have long suspected that disruption in serotonin brain circuits is a key factor in major depressive disorder. Selective serotonin reuptake inhibitors (SSRIs) are a significant class of drug that seeks to remedy this disruption by increasing serotonin levels at nerve junctions.

However, for reasons that have been unclear, SSRIs do not work for around 30 percent of people with major depression. Now, researchers from the Salk Institute for Biological Studies in La Jolla, CA, and the Mayo Clinic in Rochester, MN, may have solved the mystery.

A Molecular Psychiatry paper describes how, by studying cells from hundreds of people with major depression, the team uncovered differences that could explain resistance to SSRIs.

“These results,” says senior study author Fred H. Gage, who is president of the Salk Institute and also a professor in their Laboratory of Genetics, “contribute to a new way of examining, understanding, and addressing depression.”

He and his colleagues believe that their findings also offer insights into other psychiatric illnesses that involve disruption of the brain’s serotonin system, such as schizophrenia and bipolar disorder.

Depression and nerve cell response to SSRIs
Depression is a leading cause of disability that affects all ages and contributes in a major way to the “global burden of disease,” according to the World Health Organization (WHO). The United Nations agency estimate that there are around 300 million people worldwide living with this widespread psychiatric condition.

In the United States, the National Institutes of Health (NIH) suggest that in 2017 around 17.3 million adults, or 7.1 percent of all adults, reported having “at least one major depressive episode” in the previous 12 months.

The FDA approve esketamine nasal spray for severe depression
The FDA approve esketamine nasal spray for severe depression
U.S. regulators have approved a prescription nasal spray for the treatment of depression that does not respond to other drugs.
READ NOW
For the recent study, the scientists took skin cells from more than 800 people with major depression and turned the cells into stem cells.

They then coaxed the stem cells to mature into “serotonergic neurons,” which are the nerve cells that make up the brain circuitry for producing and using serotonin.

The team compared serotonergic neurons of “SSRI non-responders” with those of “SSRI responders.” The non-responders were those individuals with depression whose symptoms showed no improvement, while the responders were those whose symptoms showed the most dramatic improvement to treatment with SSRIs.

In previous work, the researchers had demonstrated that cells from SSRI non-responders had more serotonin receptors, causing them to overreact to the chemical messenger.

Structural differences in nerve cells
The new study explored a different facet of SSRI non-response at the cell level. It found no differences between SSRI responder and non-responder cells in terms of the biochemistry of serotonin. However, it did reveal some fundamental structural differences in the cells.

These differences were in the shape and growth of neurites — or projections — that carry signals to and from nerve cells.

The development of the nervous system relies on tight control of neurite growth. Disruption of this process, according to a 2018 study, can lead to “developmental and neurological disorders.”

The team found that the nerve cells of SSRI non-responders had much longer neurites than those of SSRI responders. Genetic analysis also uncovered much weaker expression of the genes PCDHA6 and PCDHA8 in the non-responder cells.

These two genes belong to the protocadherin family and play a key role in the growth and formation of nerve cells and brain circuits.

When they silenced PCDHA6 and PCDHA8 in healthy serotonergic neurons, the researchers found that these also grew unusually long neurites, just like the nerve cells of SSRI non-responders.

Having neurites of the wrong length can disrupt communication in serotonin brain circuits with some regions having too much traffic and others not enough. This could explain, says the team, why SSRIs sometimes fail to treat major depression.

“This paper,” Prof. Gage concludes, “along with another we recently published, not only provides insights into this common treatment but also suggests that other drugs, such as serotonergic antagonists, could be additional options for some patients.”

The team now intends to take a closer look at the role of the two protocadherin genes in SSRI non-responders.

“With each new study, we move closer to a fuller understanding of the complex, neural circuitry underlying neuropsychiatric diseases, including major depression.”

Prof. Fred H. Gage

How New Ketamine Drug Helps with Depression

Author Article

An illustration of a woman suffering from depression who might be helped by esketamine

The FDA approval of esketamine gives doctors another valuable tool in their arsenal against depression—and offers new hope for patients no one had been able to help before. “This is a game changer,” says John Krystal, MD, chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the country.

On March 5, the Food and Drug Administration (FDA) approved the first truly new medication for major depression in decades. The drug is a nasal spray called esketamine, derived from ketamine—an anesthetic that has made waves for its surprising antidepressant effect.

Because treatment with esketamine might be so helpful to patients with treatment-resistant depression (meaning standard treatments had not helped them), the FDA expedited the approval process to make it more quickly available. In one study, 70 percent of patients with treatment-resistant depression who were started on an oral antidepressant and intranasal esketamine improved, compared to just over half in the group that did not receive the medication (called the placebo group).

“This is a game changer,” says John Krystal, MD, chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the country. The drug works differently than those used previously, he notes, calling ketamine “the anti-medication” medication. “With most medications, like valium, the anti-anxiety effect you get only lasts when it is in your system. When the valium goes away, you can get rebound anxiety. When you take ketamine, it triggers reactions in your cortex that enable brain connections to regrow. It’s the reaction to ketamine, not the presence of ketamine in the body that constitutes its effects,” he says.

And this is exactly what makes ketamine unique as an antidepressant, says Dr. Krystal.

However, as the nasal spray becomes available via prescription, patients have questions: How does it work? Is it safe? And who should get it? Read on for answers.

How do antidepressants work?

Research into ketamine as an antidepressant began in the 1990s with Dr. Krystal and his colleagues Dennis Charney, MD, and Ronald Duman, PhD, at the Yale School of Medicine. At the time (as is still mostly true today) depression was considered a “black box” disease, meaning that little was known about its cause.

One popular theory was the serotonin hypothesis, which asserted that people with depression had low levels of a neurotransmitter called serotonin. This hypothesis came about by accident—certain drugs given to treat other diseases like high blood pressure and tuberculosis seemed to drastically affect people’s moods. Those that lowered serotonin levels caused depression-like symptoms; others that raised serotonin levels created euphoric-like feelings in depressed patients. This discovery ushered in a new class of drugs meant to treat depression, known as selective serotonin reuptake inhibitors (SSRIs). The first one developed for the mass market was Prozac.

But eventually it became clear that the serotonin hypothesis didn’t fully explain depression. Not only were SSRIs of limited help to more than one-third of people given them for depression, but growing research showed that the neurotransmitters these drugs target (like serotonin) account for less than 20 percent of the neurotransmitters in a person’s brain. The other 80 percent are neurotransmitters called GABA and glutamate.

GABA and glutamate were known to play a role in seizure disorders and schizophrenia. Together, the two neurotransmitters form a complex push-and-pull response, sparking and stopping electrical activity in the brain. Researchers believe they may be responsible for regulating the majority of brain activity, including mood.

What’s more, intense stress can alter glutamate signaling in the brain and have effects on the neurons that make them less adaptable and less able to communicate with other neurons.

This means stress and depression themselves make it harder to deal with negative events, a cycle that can make matters even worse for people struggling with difficult life events.

Ketamine—from anesthetic to depression “miracle drug”

Interestingly, studies from Yale research labs showed that the drug ketamine, which was widely used as anesthesia during surgeries, triggers glutamate production, which, in a complex, cascading series of events, prompts the brain to form new neural connections. This makes the brain more adaptable and able to create new pathways, and gives patients the opportunity to develop more positive thoughts and behaviors. This was an effect that had not been seen before, even with traditional antidepressants.

“I think the interesting and exciting part of this discovery is that it came largely out of basic neuroscience research, instead of by chance,” says Gerard Sanacora, MD, PhD, a psychiatrist at Yale Medicine who was also involved in many of the ketamine studies. “It wasn’t just, ‘let’s try this drug and see what happens.’ There was increasing evidence suggesting that there was some abnormality within the glutamatergic system in the brains of people suffering from depression, and this prompted the idea of using a drug that targets this system.”

For the last two decades, researchers at Yale have led ketamine research by experimenting with using subanesthetic doses of ketamine delivered intravenously in controlled clinic settings for patients with severe depression who have not improved with standard antidepressant treatments. The results have been dramatic: In several studies, more than half of participants show a significant decrease in depression symptoms after just 24 hours. These are patients who felt no meaningful improvement on other antidepressant medications.

Most important for people to know, however, is that ketamine needs to be part of a more comprehensive treatment plan for depression. “Patients will call me up and say they don’t want any other medication or psychotherapy, they just want ketamine, and I have to explain to them that it is very unlikely that a single dose, or even several doses of ketamine alone, will cure their depression,” says Dr. Sanacora. Instead, he explains, “I tell them it may provide rapid benefits that can be sustained with comprehensive treatment plans that could include ongoing treatments with ketamine.  Additionally, it appears to help facilitate the creation new neural pathways that can help them develop resiliency and protect against the return of the depression.”

This is why Dr. Sanacora believes that ketamine may be most effective when combined with cognitive behavioral therapy (CBT). CBT is a type of psychotherapy that helps patients learn more productive attitudes and behaviors. Ongoing research, including clinical trials, addressing this idea are currently underway here at Yale.

A more patient-friendly version

The FDA-approved drug esketamine is one version of the ketamine molecule, and makes up half of what is found in the commonly used anesthetic form of the drug. It works similarly, but its chemical makeup allows it to bind more tightly to the NMDA glutamate receptors, making it two to five times more potent. This means that patients need a lower dose of esketamine than they do ketamine. The nasal spray allows the drug to be taken more easily in an outpatient treatment setting (under the supervision of a doctor), making it more accessible for patients than the IV treatments currently required to deliver ketamine.

But like any new drug, this one comes with its cautions. Side effects, including dizziness, a rise in blood pressure, and feelings of detachment or disconnection from reality may arise. In addition, the research is still relatively new. Studies have only followed patients for one year, which means doctors don’t yet know how it might affect patients over longer periods of time. Others worry that since ketamine is sometimes abused (as a club drug called Special K), there may be a downside to making it more readily available—it might increase the likelihood that it will end up in the wrong hands.

Also, esketamine is only part of the treatment for a person with depression. To date, it has only been shown to be effective when taken in combination with an oral antidepressant. For these reasons, esketamine is not considered a first-line treatment option for depression. It’s only prescribed for people with moderate to severe major depressive disorder who haven’t been helped by at least two other depression medications.

In the end, though, the FDA approval of esketamine gives doctors another valuable tool in their arsenal against depression—and offers new hope for patients no one had been able to help before.

To learn more, visit yalemedicine.org.

How to Boost Your Sex Drive When You’re on Antidepressants

Author Article

According to the American Psychiatric Association, about 1 in 9 Americans are currently taking antidepressant medication, and this number is said to be steadily rising. While there is absolutely no shame in taking prescribed medication to alleviate depression, for many (myself included), the side effects can make other areas of life, well, sad.

One of those side effects? Sexual dysfunction. Not only is sex a key way to build intimacy in our relationships, it’s pretty great for improving our moods by releasing a slew of feel-good hormones. And not to mention, it’s also really freakin’ fun. But if you’re struggling to get in the mood or climax because of your medications, don’t worry. You’re not alone, and there are a few things you can do to boost your sex drive and life back up.

1. Take CBD

CBD, or cannabidiol, is a compound found in hemp, hops, and marijuana that’s nonpsychoactive, meaning it won’t get you high. While I still take two antidepressant medications daily, I never leave home without my CBD staples: select vape pens, topical rubs, and Pro tincture oils from Receptra. CBD takes the edge off of anxiety, gently guides me to sleep, and even relieved some my post-op pain after a recent surgery all without the psychoactive properties of weed itself.

In addition to transforming my mood, CBD has also benefited my sex life, too. Three spritzes of Karezza’s In the Moment plant-based mind and body elevation oral spray 15 to 20 minutes before being intimate kicks my drive up a few notches. The spray’s unique blend of CBD from organic, full-spectrum hemp oil plus a multitude of traditional arousal-enhancing herbs, adaptogens, and essential oils is formulated to promote relaxation and fires up my senses. It helps me turn my mind off and truly enjoy myself, taking intimate experiences to the next level.

2. Get Sweaty

If your libido is a bit low, try hitting the gym, yoga mat, or sign up for a kickboxing class. It’s well-known that exercise helps to significantly reduce stress and improve your mood by producing feel-good endorphins and lowering cortisol levels, both of which are necessary for a healthy sex drive. But there are even more benefits to your sweat session. A study by the University of Texas demonstrated that “exercise enhances physiological sexual arousal in women.” Looking and feeling your best boosts your self-confidence, and when you feel good, you’re much more open to being intimate and exploring your sexuality.

3. Communicate With Your Partner

Open communication is one of the best things you can do to increase satisfaction and pleasure during sex, so speak up! Sex doesn’t have to be taboo anymore. Try talking to your partner about what you like, what typically gets you to climax, and how they can help get you there. It takes two to tango, so you both should feel equally satisfied during your intimate times together. Feeling comfortable and supported is necessary to letting go under the sheets.

4. Experiment and Explore

Want to take your intimate time to the next level? Have more fun, because, yes, sex should be fun! Stuck in the same rhythm and routine? Switch it up and try something new! Whether it’s perusing a sex shop together for new toys, donning lingerie, or even moving it outside the bedroom (kitchen table, anyone?), changing up the norm adds an element of excitement and can help relieve pressure on the act itself — which leads to more pleasure for you both.

5. Talk to Your Doctor

If you’re finding that your sex drive is still in a dip or you’re still experiencing more lows than highs, it’s time to chat with a health professional. Schedule an appointment with your doctor, therapist, or psychiatrist ASAP. It’s important to be honest with your doctor about what’s going on with your lifestyle so they can offer solutions catered to your needs. Feeling comfortable with your mental health team is key to recovery, health, and happiness.

Image Source: Getty / svetikd

 

Should I Seek Help?

Author Article

“Doing it yourself is a fad in the United States.”  These were the first words in my first book in psychology, which I coauthored more than 40 years ago.  Turns out we were wrong.  Doing it yourself is not a fad, but a way of life in the U.S.  These days we have so many more resources available to help us help ourselves, including self-help blogs like this one.  And, of course, YouTube, which is a wonderful resource for training videos.  I’ve turned to YouTube to learn the basics of such tasks as caulking a bathroom tub and repairing a hinge on kitchen cabinets. There’s pride in doing things yourself, even if the quality of the work may not match that of a professional.  But I would draw the line at developing a winning tennis serve by following a self-instructional tutorial.  Sometimes a good coach is needed.  There is also a line to be drawn between using the Internet for self-help—even blogs like this—and seeking professional help.

My first book in the field focused on applying principles of behavior therapy to problems in living, from losing excess weight to smoking cessation to overcoming fears and sexual problems.  For many of the problems people encounter in their daily lives, behavior therapy offered practical solutions. This blog continues in that tradition, offering tips for changing your thoughts and attitudes to change your life.  We have explored how to rethink your responses to life’s twists and turns, and along the way offered tips on a range of troubling emotions, from overcoming worry and guilt to coping with fear and managing anger.  We applied the wisdom of ancient Greece to “know thyself” by turning inwardly to examine and evaluate our thoughts and beliefs, especially the negative thoughts that underlie emotional problems like anxietydepression, and anger. We confronted the two worthless emotions, worry and guilt—worthless because we don’t need to be wracked with guilt to recognize our mistakes and correct them or to be consumed with worry to take steps to protect ourselves from impending threats.

Self-Care Is Self-Help

With all this emphasis on self-help, we can lose sight of the importance of a basic principle of self-care—seeking help from others when help is needed.  But how do you know when going it alone is just not cutting it?  The benchmark clinicians typically use is whether problems are persistent and cause significant emotional stress or impair daily functioning.  If you regularly struggle to get out of bed and get going in the morning because you’re feeling down in the dumps, your state of mind is affecting your ability to function effectively.  If you can’t shake off intrusive worrisome or guilt thoughts, or if angry outbursts damage your relationships with others, or if you are continually on edge and can’t sleep at night or relax during the day, then it’s clear your daily functioning is impaired.

Where to Turn for Help

In the forty or so years I’ve been in practice, I’ve witnessed many changes in the field, including the emergence of cognitive behavioral therapy (CBT) as the leading modality of psychotherapy in use today. When I began my practice, psychodynamic therapists schooled in the Freudian and neo-Freudian traditions dominated the field. Today, there are many different forms of therapy and many different types of therapists, from psychologists and psychiatrists to mental health counselors and clinical social workers.  Some forms of therapy, like CBT, offer briefer and more problem-focused treatment approaches than traditional therapies, such as psychoanalysis.  CBT has become the treatment of choice for a range of psychological problems from phobias to social anxiety to insomnia, and evidence from controlled trials shows that CBT more than holds its own when stacked up against other therapies for treating depression and other emotional disorders and when compared to psychiatric medication.

Over the years, the field of psychiatry has become increasingly medicalized, as psychiatrists (medical doctors with specialized training in psychiatry) largely turned from practicing psychotherapy toward medication management. Though psychiatric drugs have important roles to play in the treatment of mental health disorders, especially so with more severe disorders such as bipolar disorder and schizophrenia, popping a pill does not help people solve problems in their daily lives or learn skills they need to change how they think or improve their relationships with others. Moreover, relapse rates are high when patients stop taking psychiatric meds, and for good reason, as these drugs help manage symptoms but do not address underlying emotional or interpersonal problems. On the other hand, patients can carry the techniques they learn in psychotherapy well beyond the course of treatment and continue to apply them in their daily lives.

Am I Ready to Reach Out?  A 10-Item Checklist

If you’re thinking about whether it makes sense to seek help from a professional, you may find the following checklist to be a useful guide. There is no set number of items that determine whether you could benefit from seeking help.  But as a general guideline, answering at least a few of these questions in the affirmative suggests it might be helpful to talk to a psychologist or other mental health professional.

Yes or No? (You be the Judge)

1.       Are my efforts to change my thinking or attitudes working?

2.       Do I continue to struggle with anxiety, depression, or other negative feelings that impact my daily functioning?

3.       Am I able to step back and examine my own thoughts, or would it help to have another person’s perspective?

4.       Do I give up too easily rather than persevere in changing my thoughts and behaviors?

5.       Are other people telling me I would benefit from “talking to somebody”?

6.       Are worries making it difficult to sleep or function effectively during the day?

7.       Am I avoiding situations out of fear or anxiety?

8.       Is my behavior affecting my relationships in negative ways?

9.       Do I find it difficult to make changes on my own or to stick with them?

10.     Might I work better with a professional than going it alone?

Finding a Therapist

If you do decide to seek help, select a therapist who best fits your needs.  Do you want to work with a therapist who uses psychological methods of treatment, such as a psychologist or counselor, or would benefit more from psychiatric medication prescribed by a psychiatrist?

Find a practitioner with the appropriate licensure and credentials—for example, a licensed psychologist, or a licensed psychologist holding advanced credentials (e.g., a Diplomate in Clinical Psychology awarded by the American Board of Professional Psychology, or ABPP), or a board-certified psychiatrist.  Find out whether your medical insurance covers mental health services (check it out with your health care provider) and whether are you covered for out-of-network providers.  As with other specialists, you may need to pay the therapist’s fee upfront and be reimbursed afterwards if the services are covered by your insurance plan, less any deductibles, co-pays, and so on.

Word of mouth is a good source for finding a therapist but be aware that what works well for one person might not work for another.  You might also “google” the practitioner to see if anything untoward turns up or ask your state licensing board if there are any complaints filed against the individual. Be prepared to ask a potential therapist a lot of questions, like whether the therapist is experienced in treating people with similar problems as your own, what specific form of treatment will be used and what evidence supports its effectiveness,  how long treatment is expected to last, what adverse experiences might be expected, such as drug side-effects, whether you are responsible for cancellation fees, and so on.  Licensed professionals will openly discuss these and other questions with potential clients.  If they balk, take that as a sign to look for someone else.

Whether you try going it alone or reaching out for help, the good news is that there is a range of effective therapeutic techniques that can help people live happier and more fulfilling lives.

© 2019 Jeffrey S. Nevid

5 Things to Know Before Attending Your First Psychiatry Appointment

See Healthline Article Here
By Vania Manipod

As a psychiatrist, I often hear from my patients during their initial visit about how long they’ve been putting off seeing a psychiatrist out of fear. They also talk about how nervous they were leading up to the appointment.

First, if you’ve taken that major step to set an appointment, I commend you because I know it’s not an easy thing to do. Second, if the thought of attending your first psychiatry appointment has you stressing, one way to help tackle this is knowing what to expect ahead of time.

This can be anything from coming prepared with your full medical and psychiatric history to being open to the fact that your first session may evoke certain emotions — and knowing that this is totally OK.

So, if you’ve made your first appointment with a psychiatrist, read below to find out what you can expect from your first visit, in addition to tips to help you prep and feel more at ease.

Come prepared with your medical history

You’ll be asked about your medical and psychiatric history — personal and family — so be prepared by bringing the following:

  • a complete list of medications, in addition to psychiatric medications
  • a list of any and all psychiatric medications you might have tried in the past, including how long you took them for
  • your medical concerns and any diagnoses
  • family history of psychiatric issues, if there are any

Also, if you’ve seen a psychiatrist in the past, it’s very helpful to bring a copy of those records, or have your records sent from the previous office to the new psychiatrist you’ll be seeing.

Be prepared for the psychiatrist to ask you questions

Once you’re in your session, you can expect that the psychiatrist will ask you the reason you’re coming in to see them. They might ask in a variety of different ways, including:

  • “So, what brings you in today?”
  • “Tell me what you’re here for.”
  • “How’re you doing?”
  • “How can I help you?”

Being asked an open-ended question might make you nervous, especially if you don’t know where to begin or how to start. Take heed in knowing that there’s truly no wrong way to answer and a good psychiatrist will guide you through the interview.

If, however, you want to come prepared, be sure to communicate what you’ve been experiencing and also, if you feel comfortable, share the goals you’d like to achieve from being in treatment.

It’s OK to experience different emotions

You may cry, feel awkward, or experience various kinds of emotions while discussing your concerns, but know that it’s completely normal and fine.

Being open and sharing your story takes a lot of strength and courage, which can feel emotionally exhausting, especially if you’ve suppressed your emotions for quite a long time. Any standard psychiatry office will have a box of tissues, so don’t hesitate to use them. After all, that’s what they’re there for.

Some of the questions asked about your history may bring up sensitive issues, such as history of trauma or abuse. If you don’t feel comfortable or ready to share, please know that it’s OK to let the psychiatrist know that it’s a sensitive topic and that you’re not ready to discuss the issue in further detail.

You’ll work towards creating a plan for the future

Since most psychiatrists generally provide medication management, options for treatment will be discussed at the end of your session. A treatment plan may consist of:

  • medication options
  • referrals for psychotherapy
  • level of care needed, for example, if more intensive care is needed to appropriately address your symptoms, options to find an appropriate treatment program will be discussed
  • any recommended labs or procedures such as baseline tests prior to starting medications or tests to rule out any possible medical conditions that may contribute to symptoms

If you have any questions about your diagnosis, treatment, or wish to share any concerns you have, be sure to communicate them at this point before the end of the session.

Your first psychiatrist might not be the one for you

Even though the psychiatrist leads the session, go in with the mentality that you’re meeting your psychiatrist to see if they’re the right fit for you as well. Keep in mind that the best predictor of successful treatment depends on the quality of the therapeutic relationship.

So, if the connection doesn’t evolve over time and you don’t feel your issues are being addressed, at that point you can search for another psychiatrist and get a second opinion.

What to do after your first session

  • Often after the first visit, things will pop up in your mind that you wished you had asked. Take note of these things and be sure to write them down so you won’t forget to mention them next visit.
  • If you left your first visit feeling badly, know that building the therapeutic relationship may take more than one visit. So, unless your appointment turned out horrible and unredeemable, see how things go during the next few visits.

The bottom line

Feeling anxious about seeing a psychiatrist is a common feeling, but don’t let those fears interfere with you getting the help and treatment that you deserve and need. Having a general understanding of what kinds of questions will be asked and topics that will be discussed can definitely alleviate some of your concerns and make you feel more comfortable at your first appointment.

And remember, sometimes the first psychiatrist you see may not necessarily turn out to be the best fit for you. After all, this is your care and treatment — you deserve a psychiatrist who you feel comfortable with, who’s willing to answer your questions, and who will collaborate with you to achieve your treatment goals.

Helping Others Get The Psychological Support They Need

See Psychology Today Article Here
By George S. Everly

According to many authorities, currently there is a mental healthcrisis. School shootings, workplace violence, random acts of violent rage, even some acts of terrorism have been associated with, and even blamed on, acute psychological distress, depression, or more frank mental illness. Data from the National Institute of Mental Health suggests that roughly 10 million individuals in the US suffer from some form of severe mental illness characterized by severe impairments to their daily lives. But it has been further estimated that up to another 30 million people may have to deal with psychological conditions that serve to mildly or moderately interfere with their ability to most effectively function socially or at the workplace. How does society begin to address such a problem when traditional approaches are sometimes disappointing?

Clker-Free-Vector-Images/Pixabay
Source: Clker-Free-Vector-Images/Pixabay

Using psychological first aid (PFA) to foster resilience may be one nontraditional approach. This is the third in a series of three discussions of PFA. PFA may be defined as a supportive presence designed to achieve three goals: 1) stabilize (prevent acute stress from worsening) 2) mitigate (de-escalate and dampen acute distress) 3) advocate for and facilitate access to professional assistance, if necessary. Two previous discussions in this series have addressed the first and second goals. This discussion addresses the third goal, facilitating access to supportive psychological care, if needed.

EXPANDING THE REACH OF MENTAL HEALTH SUPPORT

Getting friends, family, and others for whom you care the psychological assistance they might need is not always easy.  The first step is recognition. Family members, friends, co-workers, healthcare providers, and educators all have the potential to reduce the stigma associated with seeking mental health care. Furthermore, they have the potential to help others seek professional guidance when needed. This is achieved by serving as compassionate frontline advocates for the pursuit of such professional mental health support.

Kahll/Pixabay
Source: Kahll/Pixabay

EARLY RECOGNITION

As noted, the first step to removing the stigma associated with seeking mental health support as well as expanding the reach of mental health services is recognition of the  problem. Listed below is a sampling of psychological or behavioral patterns of concern. Recognition of signs and symptoms such as these is a foundation of PFA.

1. Depression: Everyone gets sad, but depression is another matter.  The warning signs of a significant depressive episode may be a persistent sad mood for a couple of weeks combined with a loss of appetite, chronic fatigue, awakening early in the morning (often around 3am) with difficulty falling back to sleep, and a loss of libido. We become especially concerned when there is a questioning of the value of life, and the loss of hope or a future orientation as these may herald suicidal ideation and even self-injurious or suicidal acts. Professional care in such cases is imperative.

2. Debilitating Fear: Fear may be thought of as apprehension and stress arousal in response to a specific threat or challenge. Most people have fears of one kind or another. We become concerned when those fears become debilitating interfering with one’s personal or occupational lives. Persistent phobic (irrational fear) avoidance can be crippling. For example the fear and avoidance of crossing bridges or of flying can be quite debilitating.

3. Anxiety: Anxiety may be defined as apprehension and stress arousal in response to an ambiguous threat or challenge. Anxiety can be especially challenging because of its ill-defined nature. It too can be crippling. When it becomes so, it is time to seek a professional opinion.

4. Posttraumatic Stress and Posttraumatic Stress Disorder (PTSD):These are perhaps more correctly envisioned as posttraumatic stress injuries (PTSI): Stress following the exposure to a trauma, usually thought of as either direct or vicarious exposure to a life threatening experience, can be intense and disorienting, but that stress reaction usually diminishes within weeks and resolves within months. When one becomes acutely disabled or continues to vividly re-imagine the experience, becomes psychologically numb or depressed, and experiences irritability, anger, or impulsiveness which interferes with one’s personal or professional life for more than a few weeks, it is then important to seek professional assistance.

5. Strange, erratic, or self-debilitating behavior of any kind, including self-medication: In the final analysis, whether it is crippling depression, anxiety, phobic avoidance, posttraumatic stress reactions, or self-debilitating behavior of any kind that interferes with one’s happiness or personal and professional life, the guidance of a mental healthcare provider should be sought.

Ricinator/Pixabay
Source: Ricinator/Pixabay

COMPASSIONATE ADVOCACY

Beyond recognition, what else can be done? If you recognize a perceived need for professional mental health guidance or support in someone you care for, work with, supervise, or mentor, compassionate advocacy may be useful in facilitating access to such care.  Listed below are some simple steps to assist.

1. Stressful life experiences can make one feel alone and overwhelmed. Make it clear there is no reason for anyone to endure distress alone.

2. Anticipate barriers to seeking professional support and be prepared to address them.  Barriers include such things as stigma, a perception of weakness, or a misunderstanding about what mental health providers actually do. Help the person reinterpret getting help as a sign of personal strength, not a weakness. Reframe seeking professional guidance more as a means of fostering resilience, less as seeking treatment. Create a positive and hopeful expectation of improvement or recovery. Point out that delaying intervention can lead to a needlessly  prolonged period of distress or inability to function effectively. Lastly, suggest that getting professional support is a sign of respect and concern for others, such as family, friends, and co-workers, as well as well, as themselves.

3. Be prepared to address practical and logistical concerns such as where and how to seek professional services. Be prepared to offer specific options about trusted providers, pastoral counseling options, telephone hotlines, financial counseling services, community-based mental health services, employee assistance programs, or other employer-based services.

4. Use encouragement in a compassionate and supportive manner, but be persistent in your encouragement.

© George S. Everly, Jr., PhD, 2019.

Medications for Lack of Motivation From Depression

See Livestrong Article Here
By Tyffani Bernard

Young woman on psychotherapy session
(Image: KatarzynaBialasiewicz/iStock/Getty Images)

Depression is the leading cause of disability for Americans aged 15 to 44, according to the National Institute of Mental Health. It affects both mental and physical aspects of life, sometimes making it difficult to even rise in the morning. There are many medications available that aid in restoring drive and inciting action for a fulfilling life.

SSRIs

Selective serotonin reuptake inhibitors, or SSRIs, aid in relieving depression by increasing the levels of serotonin in the brain. These drugs accomplish this by preventing nerve cells from reabsorbing serotonin, which improves the mood and symptoms of depression. According to MayoClinic.com, SSRI effectiveness depends on the patient’s genetic make-up. In addition, individuals may have varying responses to different SSRI drugs. Therefore, patients must often try several drugs before they find the one that is most effective.

TCAs

Tricyclic antidepressants, or TCAs, treat depression by restoring the balance of certain neurotransmitters in the brain. They increase levels of epinephrine and norepinephrine while simultaneously decreasing acetylcholine. MayoClinic.com indicates that TCAs also affect other receptors in the brain, which leads to possible side effects of drowsiness, weight gain and nausea. Not only do TCAs treat depression, they are also used for obsessive-compulsive disorder, panic disorder and chronic pain.

SNRIs

Serotonin and norepinephrine reuptake inhibitors, or SNRIs, treat depression by increasing levels of both norepinephrine and serotonin in the brain. MayoClinic.com indicates that the mechanism of action for SNRIs is not established, but the higher neurotransmitter levels may improve the mood by enhancing transmission in the brain. Side effects include insomnia, anxiety and agitation.

 

Insomnia Series: Sleep Deprivation Was More Powerful Than Antidepressants For Me

See Vice Article Here
By Jesse Noakes

On a Saturday night last year, not long after the death of my grandmother, I went to her house to try a little experiment. I’d been depressed again for more than a week. I felt stodgy and frozen, woozy with lethargy, and at the same time prickling with a static sense of anxiety that became especially charged around other people.

I woke just after 2 am on a sofa bed in her guest room. The house was icy cold and lonely. I switched on the heater in her living room, made myself coffee, and sat down at her heavy dining table with my laptop. Five hours, another coffee, and a couple of thousand words later, the sun was up and I drove to the gym. By the time I met my aunt at a cafe near the beach a couple of hours later, I felt fresh and clear in the sunshine. I could lock eyes and smile with the lovely woman at the table next to us and my conversation with my aunt was fluid and enthusiastic. I was feeling good again.

About a decade ago, I figured out that if I stayed up all or most of the night, I’d usually feel a lot better in the morning. For years, I’d been managing major depressive disorder—I was ill at ease with myself, awkward in conversation, and clumsy and self-conscious in my body. My long-term psychiatrist thought I could be bipolar, and put me on a high dose of the mood stabilizer lithium, to no noticeable effect. I spent the remainder of my early 20s playing the pharmaceutical lottery, to no avail.

It was only recently that I started experimenting with sleep deprivation again, after I learned that others had the same idea. In fact, since the early 1970s, when a young German psychiatrist called Bernhard Pflug noticed that some of his patients felt better after a night without sleep, there has been a tiny but growing school of research studying the potential of sleep deprivation as a fast-acting antidepressant.

In a 2015 study that compared the efficacy of exercise versus sleep deprivation, 75 depressed patients in Copenhagen who were treated with three all-nighters in a week had almost double the remission rate compared to another group who used daily exercise. Seven months after their treatment, 62 percent of the sleep-deprived no longer met the criteria for clinical depression. A 2017 meta-analysis looked at 66 studies of sleep deprivation and its effects on depression published in the past three decades, and found that 50 percent of patients had a clinically significant response to the treatment.

What was remarkable about this research was the speed with which the transformation happened. Where antidepressant meds typically take several weeks to kick in, with these sleep deprivation studies, participants saw an improvement in their mood (at least temporarily) overnight. This represents a significant boon for anyone stuck in the airless swamp of depression, but, according to a small 2014 pilot study in South Carolina, it could be especially potent for those experiencing suicidal thoughts or ideation. That research found that a single night of sleep deprivation led to a 63 percent mean reduction on the Columbia Suicide Severity Rating Scale.

“Even in the ‘70s it was clear—when you’ve seen a severely melancholic patient turn into somebody who can actually talk to you and even smile just by staying awake all night, you think it’s absolutely a miracle,” says Anna Wirz-Justice, professor emeritus at the Centre for Chronobiology in Basel, Switzerland, who first became interested in its therapeutic potential shortly after the first publication of Pflug’s remarkable responses.

It seems almost too good to be true—and in some ways, it is. For the vast majority of patients, as many as 95 percent, the effects wear off as soon as they have a decent sleep. As a psychiatrist once put it to Wirz-Justice, “why offer people paradise just to take it away again?”

Several people with depression I’ve spoken to recently have said that non-clinical, DIY sleep deprivation gives them relief, but with cautious enthusiasm. “It’s notable, but nothing life-changing,” David, a 33-year-old from Quebec, tells me. He usually prefers to “sleep a couple hours and have a decent next day with a slightly less noticeable mood boost,” rather than staying up all night but suffer headaches as a result. “But it doesn’t sustain itself for me.”

The cognitive, behavioral, and physical health deficits of sleep deprivation are well-established, and we all recognize them. But the impairments to motor control, memory, and higher cognitive function that the majority report after little or no sleep are also characteristic of depression. Therefore, for depressives, the short-term antidepressant effects of sleep deprivation counter-balance and may outweigh its negative cognitive effects.


More from Tonic:


In recent years, most clinical trials have added adjunctive therapies to build on the immediate antidepressant effect of the sleep deprivation. Light therapy, a long-standing treatment for seasonal affective disorder in which patients sit for half an hour in front of a very bright light box, is often used for several mornings after the initial all-nighter. Another method is sleep phase advance (SPA), which begins with early bedtime the night after sleep deprivation and gradually returns the patient’s sleep pattern to normal within a few nights.

It’s also common for patients to be on a longer course of antidepressants like fluoxetine (Prozac), or a mood stabilizer such as lithium, to cement the improvement after the immediate treatment is completed. The combination of sleep deprivation, light therapy, and either SPA or ongoing medication is referred to as ‘triple chronotherapy,’ Wirz-Justice explains. “The idea is you use everything you’ve got to get out and keep out of depression in four days. Isn’t that something to aim for? Why doesn’t it catch on?”

I can think of several reasons, and the main one is it’s just really hard. When I’m depressed, I sleep a lot. A lot of depressed people do. I spent much of my 20s lying in bed, staring at the wall with the blinds down. Getting up at all is an effort, let alone staying up all night. Recognizing this, some clinicians use a partial sleep deprivation where patients sleep the first part of the night and are woken at 2 am—it’s an easier sell, and works almost as well.

This is the protocol I’ve adopted. Studies have found little difference between a full all-nighter and grabbing a couple of hours’ rest, says Francesco Benedetti, head of the psychiatry and clinical psychobiology unit at San Raffaele Hospital in Milan and one of the leading researchers in the field. “[Partial sleep deprivation late in the night was followed by response rates similar to those obtained after total sleep deprivation…but the issues of efficacy, timing and stress are yet debated,” he says.

As for doing it at home, as I’ve done recently? “If you’re knowledgeable about it you can find the information and follow the protocol, but to do it on your own I think is very tough,” says David Veale, consultant psychiatrist at the Priory Hospital in North London, where he is running the UK’s first clinical trial of sleep deprivation for depression. He says it’s more difficult than dangerous.“ Perhaps the only potential risk is for people with bipolar disorder who may become manic during the program—so I wouldn’t recommend it if you’re on your own…though it’s probably no different from other medications. If you’ve ever met somebody having a manic episode, it isn’t difficult to tell,” Veale adds. Mania is typically characterized by grandiosity, racing thoughts, irritability, sleeplessness and heightened impulsivity.

It’s not only personally counterintuitive to stay up all night when you’re depressed, it also goes against every prevailing cultural norm. The premium importance of sleep is reinforced everywhere, and with good reason. “If you don’t have depression and you stay up all night, you feel pretty crap, don’t you?” Veale says. Patients with serious clinical depression may respond differently, though. “Depressed patients will have some tiredness, of course, but if they’re responding then they’re also recovering from their depression.”

Part of the reason for this apparent paradox is the neurotransmitter dopamine. A study in the Journal of Neuroscience suggested that a night of sleep deprivation causes increased dopamine production, which “correlated with increases in fatigue and with deterioration in cognitive performance.” However, dopamine also functions as the brain’s reward mechanism, and its subjective effect is often an increase in mood, short-term energy and feelings of positivity. As Veale explains, patients may be fatigued but they’ll also be feeling better in spite of their tiredness.

Another neurochemical that increases in the sleep-deprived brain, adenosine, has been shown to correlate with resilience to depression and its mind-numbing effects while also mediating the effects of an all-nighter, and it seems to be central to the action of other depression treatments, like ketamine. In fact, according to a paper by Benedetti, sleep deprivation affects “almost all the neurotransmitters targeted by antidepressant drugs.”

However, the precise mechanism of how sleep deprivation works for depressed people remains largely mysterious. Both Benedetti and Wirz-Justice note that similar confusion surrounds our understanding of most antidepressant meds. “Maybe you just have to shake up the neurotransmitters,” Wirz-Justice says an old mentor told her. Especially with something as fundamental to our biological and circadian rhythms as sleep, the idea of resetting the clock, so to speak, is a powerful one.

Yet it’s not something that’s caught the popular, or commercial, imagination, Veale says. The fact you can’t patent “not sleeping” might have something to do with it. “How do you do double-blind placebo-controlled trials for something like staying awake all night?” Wirz-Justice says. “Who pays for it? How do you calculate the costs? It’s so different from a pill.”

If I’d known a decade ago that there was clinical evidence for sleep deprivation, I’d have been less likely to dismiss my own experience as just a curiosity, and kept at it. Instead, for years I largely forgot about it—until my uncle emailed a link about Veale’s study, and I decided there might be something to it after all.

One night last week, around 2am, when my emails finally crossed the incoherency threshold, I flipped my Macbook closed and left the couch for bed. I woke before my 5 am alarm with the birds through the window, to hit the gym and beach as usual. By the time I was happily ensconced in the cafe with free refills of Ethiopian coffee, I felt more alert and in sync than I had all week.

Three days later and I’m still in the clear. I’ve felt consistently lucid, engaged, and energized. Last night, after a long Saturday in the Australian sun, I fell asleep at half past nine still in my tennis clothes. It’s not necessary, or possible, to stay up all night every night. Instead, it can act as a jump-start—after that, it’s over to me to channel and maintain my energy through exercise, people, and things that matter.

Like Veale, Wirz-Justice acknowledges the close link between circadian rhythms and the bipolar. “The switch into mania is nearly always accompanied by a lack of sleep, and with medically prescribed sleep deprivation you can switch someone out of depression. So it’s very deeply rooted with bipolarity.” I explained to her that I experience life itself as a fairly up-and-down affair, to which her response was tart: “Yes, well, I prefer the ups.”

02 Snowboarding & Suicide Series: Identifying Depression (How It Took A Suicide Attempt To Show Me I Was Depressed)

*Just some of the symptoms of depression.
I always recommend doing some research yourself because depression looks different to each person.

Depression is a fickle bitch and her face looks different to everyone she meets. Sometimes you don’t even know her real name until she is eating at your table and sleeping in your bed. Sometimes she is loud and the center of attention… locking you in your room and cutting all ties, chaining you to the bed. Sometimes she is like a mom that pretends she’s cool and hip but really can’t let loose. Always nagging at you if you do anything that might be off the beaten path. Whether she restrains or reminds you, she is there.

It turns out I have high-functioning depression.


I really don’t know how I didn’t know I was so depressed at the point of killing myself. I have a B.S in Psychology, I am in Psi Chi – the International Honor Society in Psychology.. I scored in the top 1% in the nation on my Psychology exit exams and have some internship and doctorate training in Clinical Neuropsychology under my belt. This is kind of my thing. I had no idea how bad my mental state had gotten.

I have always had high-functioning anxiety, and some episodes of depression, but I was always convinced that I didn’t need antidepressants or anything – but my xanax is always by my side.

I was able to hold down a job, and manage to get through each day good enough to make myself believe that I was fiiiiiine. Sure, I had no sex drive, didn’t get out of bed if I didn’t have work, barely slept and didn’t do a goddamn THING unless I took a piece of my (prescribed) Adderall. I was getting by.

Why wouldn’t I be anything but happy?
I was number 1 in sales, case commissions, and wine club sign ups for 5 straight months. I was living in Oregon with my amazing boyfriend and our dog child. I was financially secure & had a great support system. What is there to not be happy about?

The thing I didn’t realize until after I tried to kill myself was that it was not that I wasn’t happy… I was numb. Going through the motions. I felt nothing at all. That’s why swallowing the pills and the actuality of how close I was to dying never really sunk in. It didn’t it even feel like it was me that tried that. TOTAL DETACHMENT. I just got back to my life as though it didn’t happen. My boyfriend knew better than to push it but I knew he was worried. Things had to change soon & I knew that, but where do you go when you can’t even grasp the heaviness of the situation and feel any emotion towards it?

The moral of the story is to check in with yourself. Yeah, some stuff in life is going to suck because that is just how it goes. But this shouldn’t be the norm. If you notice that shit that used to get you all excited sort of has a blunt affect then maybe do a little reflecting on how things are going in general.

Laziness, and regular tiredness are not the same as not showering or leaving your bed for three days with the excuse that they are your days off. Every daily situation shouldn’t feel like a hassle you want to escape from, I didn’t realize that wasn’t normal until the Lexapro finally kicked in and I actually had an enjoyable time GETTING HEALTH INSURANCE yesterday. Enjoyable and Health Insurance usually aren’t in the same sentence. That was eye-opening.

Regularly check in with yourself, your habits, and your feelings.






Night Sweats – Antidepressants

If this happens to be one of my first few posts, I apologize. But shit’s getting real. So, y’all, LEXAPRO. I have taken every anxiety medication under the sun, but not so much antidepressants. A recent failed (more later) suicide attempt led me to this medication. While I’m lucky to not have most side effects… the night cold sweats are real. My insomnia is already as fucking real as it is almost a funny joke. The constant changing throughout the night sure is NOT making it better. Of course I have done my fair share of google searches but I need to prepare myself if this is a forever thing but

It is a bittersweet thing. I feel like my mind is getting right but my body is just shitting on my goddamn dreams to be happy.

Anyone relate? Know how to make it stop?