Travels With George: Depression Takes a Backseat

A year ago, I started volunteering at a Church on the East Side of Buffalo, the poorest and most segregated section of town rife with a high crime rate, violence, drug trafficking, and prostitution. And right in the middle of it all is St. Luke’s Mission of Mercy.

St. Luke’s was an abandoned Catholic Church twenty-five years ago that had become empty and useless after the Polish immigrants who built it in 1930 left for the suburbs.  Into this void came Amy Betros, a big woman with an even bigger smile and hug, who owned a restaurant where college students hung out.  Amy decided, moved by something deep inside her, to chuck it all and do something for the poorest of the poor.

So, she sold her restaurant and, together with a guy named Norm Paolini, bought the broken-down church. It quickly became a place where people could sleep on the church’s floor to get out of the elements and get some hot food.  But just as important, that got some food for their souls. They got big servings of hope and seconds if they wished.

St. Luke’s has since grown into a huge community with an elementary school, a food and clothing shelter, and one of two “code blue” places where desperate street people can go to find warmth and a cot to sleep in the transformed for the emergency school cafeteria.

Rewire Your Burned-out Brain

Burnout often results from extended periods enduring the emotional stress precipitated by unaccomplished expectations or failure to fulfill unreasonable demands. The symptoms can include intensified emotional exhaustion, physical fatigue, lowered self-worth, changes in eating and exercising habits, social withdrawal, sleep disorders, anxiety, and depression.

If You’re Burned Out, Your Brain Has Rewired to Survival Mode

There are specific and reproducible patterns of changing neural activity and brain connectivity associated with the stress buildup that leads to burnout. In the high-stress state subjects’ neuroimaging scans reveal less activity in the higher, reflective brain (Prefrontal cortex/PFC) and more activity in the lower, reactive brain that controls involuntary behaviors and emotional responses. Prolonged stress correlates with structural increases in the density and speed of the neuron-to-neuron connections in the emotion-driven reactive networks of the lower brain and corresponding decreases connections in prefrontal cortex conscious and reflective control centers.

The explanation of these changes is attributed to the brain’s neuroplasticity defined by the phrase: “neurons that fire together, wire together.” The brain literally rewires to be more efficient in conducting information through the circuits that are most frequently activated.

When stress is frequent, the more frequent activation of the neural pathways to the lower, stress-reactive brain results in their strengthening from enhanced wiring (dendrites, synapses, myelinated axons). These pathways can become so strong that they become your brain’s fast route to its lower, reactive control centers. The stressful, burned out state when the lower, reactive brain is in charge overcomes the calm, reflective, and productive higher neural processing in the (PFC) – the preferred brain locale for control of behavior and emotional self-management.

As your efforts to achieve unreasonable goals are thwarted or increasing demands recur, and the lower brain dominates more frequently, you lose touch with your reflective brain. With less management coming from your reflective PFC, it becomes harder and harder to logically see these challenges in realistic perspective or to solve problems creatively.

Disappointments take on more emotional power and without your higher brain’s perspective, they are interpreted as personal failures. Your self-doubt and stress further activate and strengthen your brain’s involuntary, reactive neural networks. The spiral down to burnout accelerates as these circuits become the automatic go-to networks. Your brain achieves less success in problem-solving and emotional control and ultimately reacts by withholding efforts to escape the burnout state.

Reset Your Brain’s Default Neural Network from Retreat to IGNITE!

The good news is you can apply what we’ve learned from neuroscience about your brain’s survival mode to take actions to retrieve voluntary control of your choices and emotional wellbeing.

You can activate the same neuroplasticity, that gave dominance to the lower brain networks in the burnout state, to construct a new, stronger positive default response. With increasing successful experiences in achieving goals, you can reset the circuits to redirect your brain to access its highest cognitive resources. You can build up newly improved circuitry switching your responses from retreat to IGNITE for mindful awareness and creative problem-solving!

Since an effort-failure pattern sets up the brain’s survival response to withhold effort, you’ll need to strengthen your brain’s recognition that effort toward your goals can result in success. Your weapon of mass reconstruction can come from your brain’s very powerful drive for its own intrinsic neurochemical reward— dopamine and the deeply satisfying and motivating pleasure it brings. When the brain releases dopamine in rewarding bursts, you experience a deep intrinsic satisfaction along with increased motivation, curiosity, perseverance, and memory. Dopamine is particularly released when your brain recognizes that you’ve achieved a challenge (from the “I get it” of figuring out a joke to the satisfaction of completing a marathon).

To get the dopamine-pleasure response from challenges achieved, you’ll need to plan for your brain to experience frequent recognition (feedback awareness) of incremental progress. The choices of what you set as a goal should be guided by their desirability and the goal’s suitability to be broken down into clear segments. You want to set goals, the progress of which, you can chart or easily recognize with each stepwise challenge and success. The pleasure burst of dopamine’s intrinsic motivation accompanying your brain’s recognition of each progressive increment achieved in the goal pathway will keep you motivated to persevere.

Goal Buy-In for Your Brain’s Neural REWIRING

Buy-in and relevance are important in choosing your rewiring goal. Since your goal is to rewire your brain’s expectations that your goal efforts do yield progress, despite increasing challenge, you need to really want the goal. This is not the time to challenge yourself with something you feel you should do, but won’t really look forward to, such as dieting, climbing stadium stairs, or flossing after every meal.

The idea of planning and achieving goals as a burnout intervention is probably not new to you. These are likely to be activities you’ve considered but didn’t do for the obvious reason. They take time. when it comes to adding another activity to your schedule, past experiences have left you with the expectation that there is not enough time.

These first goals that can provide ongoing awareness of your progress are often tangible (visible, such as planting a garden or making pottery on a wheel, or auditory such as playing an instrument, or physical such as learning tai chi), but your goal can also be spending more time at something you already do, but want to do more frequently or successfully, such as journaling, practicing yoga, or sketching.

You’ll Find Your Own Goal for Buy-In, but Here are Some Examples of Planning 

Physical goals: Notice I didn’t say exercise. That’s not as motivating as “training” for a physical goal you want to achieve, even though they often overlap. If you want to run a 10K, and you enjoy running, the goal for an achievable challenge could first be building up to the distance starting with your baseline distance you comfortably run now. Then, plot out the increments that you’ll consider progressive successes, such as adding 100M each day or a week (with increments based on what you consider both challenging and achievable). Once you reach 10K goal, speed can become the next goal again plotted out in segments of incremental progress before you start.

Hobbies: From woodworking to shooting wooden arrows, hobbies really are opportunities for brain rewiring. Again, plan your stepwise achievable challenge increments. If you select darts, start with a home dartboard—low initial investment and throw from a close, but challenging distance at first. As you get better in accuracy move back further. Record your results with the notations of the distance of each improvement you set as an achievable challenge. If you get so good that you are no longer challenged by the dartboard, try that archery!

Mindfulness and meditation are certainly positive interventions for burnout and will be topics of a subsequent blog.

Your Rewired Brain’s Default Changes from Defeat to Ignite

With your understanding of what happened in your brain to create the hopeless frustration of burnout, you’ll hopefully have more positive expectations to help you put in the effort to try (or retry) suggested interventions. Your own natural dopamine-reward system will then be at work deconstructing the resistance network built by your burnout as you reset your circuits of motivation.

The repeated experiences of dopamine-reward you’ll experience as you monitor your goal progress will literally change your brain’s circuitry. Repeated effort-reward experiences promote the neuroplasticity creating neural networks that expect positive outcomes in your new default network. This is because your brain will build stronger connections into the memory pattern. The expectation in achieving this challenge will bring pleasure. As with other less used networks, the previous lower brain stress-activated go-to response network you developed in burn-out, that caused you to react negatively to stressors, will be pruned away from disuse.

You’ll be rewired with optimism and renew positive expectations about your self-efficacy. With your higher, reflective brain back in control, as you access your perseverance, innovation, and creative problem-solving when you need them.

Just be sure to take the time to break down big challenges into opportunities to recognize incremental progress as you achieve each small step en route to your goals. With that positive recharge, your well-deserved dopamine reward will sustain your brain’s motivated perseverance on to the next step of the path to your goals.

Dr. Judy Willis is a board-certified neurologist and middle school teacher, specializing in brain research regarding learning and the brain. With a unique background as both a neurologist and classroom teacher, she writes extensively for professional educational and parenting journals and has written six books about applying the mind, brain, and education research to classroom teaching and parenting strategies. The Association of Educational Publishers honored Dr. Willis as a finalist for the Distinguished Achievement Award for her educational writing. Check out her website.

 

 

Up, Up and Away: Lifting Depression By Tweaking Your Antidepressants

In my last post, I wrote about a recent downward turn in my mood. While not severe, it still sucked: low energy and motivation,  sadder more often than I’d like, and lack of joy in things that formerly made me happy.

If felt like I had one foot in gooey, hot asphalt. I keep trying to yank it out to no avail. Finally, I called my trusty psychiatrist. His name’s Chris.

We hadn’t seen each other for six months. Over the past ten years or so since he’s been my shrink, that was about normal because not much had changed in the past decade: we’d found a combination of two pills seven years ago that was effective in managing my depression.  Sure, there had been some ups and downs over that period of time. But nothing like the psychic hurricane that blew through my brain when I first experienced major depression years ago.

He suggested I stay with my two old friends: Cymbalta and Lamictal. But, he said that we could “tweak” my treatment by adding

Depression and Suicide: A Catholic Perspective

As a psychiatrist, I had been aware, prior to his death, that Robin Williams struggled with a severe mood disorder – major depression and bipolar disorder, depending on the source of the reporting – along with related problems and drug dependence.

The vast majority of suicides are associated with some form of clinical depression, which in its more serious forms can be a sort of madness that drives people to despair – leading to a profound and painful sense of hopelessness and even delusional thinking about oneself, the world and the future.

I knew all of this, and yet this death still shocked and surprised me, as it shocked and surprised so many others. Williams seemed to be the consummate humorist, the funny man who would be just so much fun to be around. Unlike some comedians who trade only on irony and cutting humor, Williams appeared to us as a warm, big-hearted, endlessly fun, brilliantly quick, incredibly talented man. Though he was a celebrity, he was the kind of person that people felt like they knew – like the cousin, everyone just adores and hopes will show up at the family reunion.  Williams was the kind of guy that people wanted to be friends with, the kind of person that one wanted to invite to the party.

This is not the typical stereotype of mental illness, which why the typical stereotype must be relinquished: Quite simply, it is false.

Mental illness can afflict anyone, of any temperament and personality. In the wake of his death, the strange truth gradually began to sink in: In spite of outward appearances, Williams’ mind was afflicted by a devastating disorder that proved every bit as deadly as a heart attack or cancer. He suffered in ways that are difficult for most people to imagine.

Why couldn’t Williams see himself as other saw him – as a person of immense gifts and talents, a man who stood at the pinnacle of achievement in the world of comedy and entertainment?

Why couldn’t he see himself as God saw him – as a beloved child, a human soul of immense worth, a person for whom Christ died?

This is the tragedy of depression, which is so often misunderstood by those who have not suffered its effects.

Novelist William Styron – whose memoir Darkness Visible represents one of the best first-person attempts to describe the experience of depression – complains that the very word “depression” is a pale and inadequate term for such a terrible affliction.  It is a pedestrian noun that typically represents a dip in the road or an economic downtown. Styron prefers the older term “melancholia,” which conjures images of a thick, black fog that descends on the mind and saps the body of all vitality.

Indeed, the title of his book – Darkness Visible – comes from John Milton’s description of hell in Paradise Lost. We’re not talking about hitting a rough patch in life or the everyday blues that we all experience from time to time. We are talking about a serious, potentially fatal, disorder of mind and brain.

Fortunately, in most cases, depression is amenable to treatment. Because the illness is complex – involving biological, psychological, social, relational and, in some cases, behavioral and spiritual factors – the treatment likewise can be complex. Medications may have a very important role, but so do psychotherapy, behavioral approaches, social support and spiritual direction.

In some cases, hospitalization may be necessary, especially when an afflicted individual is in the throes of suicidal thinking or when one’s functioning is so impaired from the illness that he or she has difficulty getting out of bed or engaging in daily activities. For the severely depressed, even brushing one’s teeth can seem like an almost impossibly difficult chore.

This level of impairment is often puzzling to outsiders – to the spouse or parent who is trying to help the loved one. Unlike cancer or a broken bone, the illness here is hidden from sight. But the functional impairments can be every bit as severe.

I recall one patient, a married Catholic woman with several children and grandchildren, who had suffered from both life-threatening breast cancer and from severe depression. She once told me that, if given the choice, she would choose cancer over the depression, since the depression caused her far more intense suffering. Though she had been cured of cancer, she tragically died by suicide a few years after she stopped seeing me for treatment.

Depression is neither laziness nor weakness of will, nor a manifestation of a character defect. It needs to be distinguished from spiritual states, such as what St. Ignatius described as spiritual desolation and what St. John of the Cross called the dark night of the soul.

Tragically, even with good efforts aimed at treatment, some cases of depression still lead to suicide – leaving devastated family members who struggle with loss, guilt, and confusion.

The Church teaches that suicide is a sin against love of God, love of oneself and love of neighbor.  On the other hand, the Church recognizes that an individual’s moral culpability for the act of suicide can be diminished by mental illness, as described in the Catechism: “Grave psychological disturbances, anguish or grave fear of hardship, suffering or torture can diminish the responsibility of the one committing suicide.”

The Catechism goes on to say: “We should not despair of the eternal salvation of persons who have taken their lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives.”

Robin Williams’ death – like the death of so many others by suicide who have suffered from severe mental illness – issued from an unsound mind afflicted by a devastating disorder. Depression affects not just a person’s moods and emotions; it also constricts a person’s thinking – often to the point where the person feels entirely trapped and cannot see any way out of his mental suffering. Depression can destroy a person’s capacity to reason clearly; it can severely impair his sound judgment, such that a person suffering in this way is liable to do things, which, when not depressed, he would never consider. Our Lord’s ministry was a ministry of healing, in imitation of Christ, we are called to be healers as well. Those who suffer from mental-health problems should not bear this cross alone. As Christians, we need to encounter them, to understand them and to bear their burdens with them.

We should begin with the premise that science and religion, reason and faith are in harmony. Our task is to integrate insights from all these sources – medicine, psychology, the Bible, and theology – in order to understand mental illness and to help others to recover from it. In cases where recovery proves difficult or impossible, we pray for the departed and never abandon those who still struggle.

Aaron Kheriaty, M.D., is associate professor of psychiatry and human behavior at the University of California-Irvine School of Medicine. He is the co-author with Msgr. John Cihak of The Catholic Guide to Depression.

The Blues Is Depression. Should You Treat It With Pills?

What people refer to as the blues is usually depression.  Depression, or the blues, is an unpleasant emotional state characterized by what therapists refer to as “the negative cognitive triad.”  That’s 1) negative thoughts about oneself, which are the voices of your inner critic harping on you for what you supposedly have done wrong, should have done differently, and on and on 2) negative thoughts about others that lead you to see what you don’t like in them instead of heeding their virtues and enjoying them, creating relationship problems and 3) negative thoughts about the future.

Some people describe the blues, and also depression, as feeling like there’s a dark cloud over you.  Others refer to depression as seeing the world through dark glasses.  Feelings of hopelessness and helplessness are another indicator.

How can you get rid of your blues and your inner critic by treating the underlying depression?

There are four main strategies:

  1. Change your feelings.Take pills or use one of the newer treatment methods that change your bluesy mood by changing your inner body chemistry and brain functioning.
  2. Change your thoughts.  Eliminating the inner critic may get rid of the depressed, bluesy feelings.
  3. Change your actions. Get exercise.  Go out and be with people.  Express more gratitude.  Do acts of kindness.
  4. Identify and address the problem that initially triggered your depressed feelings and thoughts.  Find a new solution and both the negative feelings and the negative thoughts will evaporate.

Why do people take antidepressant medications?

There are four main reasons why people who may be distressed by something in their lives end up defining their depression as an illness and taking medication.

First and foremost, depression is a terrible feeling that sufferers sorely want to get rid of.

Second, most folks have not been fully informed of the medications’ downsides. I’ll elaborate on drug dependency below.  In addition, these medications can cause serious weight gain, a significant drop in libido (ability to enjoy sex), hazy thinking, and a general emotional numbness that blocks feelings of joy in addition to feelings of depression.

Third, people who take the medications may not have been informed of their relatively low rate of effectiveness.  They can be effective if they work, but they only work for something like about 60% of people who use them.

Fourth, most people who take anti-depressant medications have not been informed by their doctor about alternative treatment options.  To a man with a hammer, the world is a nail.  Physicians know about illness and prescribe medications.  As psychologist Martin Seligman has explained, depression is a relatively normal, if quite unpleasant and often self-defeating, response of giving up in response to a challenging life circumstance.

What are the downsides of assuming that depression is an illness and therefore needs pills? 

As mentioned above, two particularly negative side effects of medication that doctors do not sufficiently explain include potential weight gain and decreases inability to experience sexual arousal. Doctors may mention them but often do not clarify that both extra pounds and decreased interest in sex can have strongly negative impacts on personal self-esteem, on attracting a mate and on sustaining a marriage.

The other significant risk that doctors may or not fully explain is that users may have a hard time getting off these medications.  When a drug company says that their anti-depressant medication is not addictive, strictly speaking, they are telling the truth.  A strict clinical definition of an addictive substance or activity is one that induces both dependency and craving.  Antidepressants do not induce craving.  Over time they do, however, make users drug dependent.

Craving is a familiar feeling to anyone who has fallen in love.  The intense sexual desire that drives someone in love to find every way possible to be near the object of their desire is a craving.  Someone who craves alcohol similarly may wake up in the morning already urgently wanting a drink.

What does “drug dependent” mean?   Drug dependency is the state a body goes into when it has adapted to the presence of a chemical to the point that the body requires steady doses of the substance to maintain normal functioning. We are all, for instance, chemically dependent on water.

Our society is highway-dependent.  Many of us have become accustomed to having highways that enable us to drive to work from the suburbs.  Having bought a house in the suburbs on the assumption that we can take the highway to work, we have become highway dependent.  It’s unlikely that anyone has a craving for highways.  Many of us though have become highway dependent.

If you for some time have been taking an antidepressant medication, the odds are that your body has become drug dependent.  That means that if you should decide today that as of tomorrow you will no longer take the medication, starting tomorrow, you are likely to discover that without the pills that you normally take your body will plunge into a serious depressive state.

Does this depression mean that you need after all to stay on your meds because the pills are all that have stood between you and the depths of despair?   Not at all.  To the contrary, this depression means that your body has become dependent on the antidepressant pills.  Is this addiction?  No, but it is drug dependency.

I am not saying that no one should ever take antidepressant medication.  They do help some people.  Some people experience relatively few to zero negative side effects.  My point is just that if you are considering taking these medications, or have for some time been using them, you deserve accurate information about the factors to take into account in your decision, including information about other treatment options.

Here are six vital points to consider.

1) There now are multiple excellent alternatives to medication for working your way out of depression, including various kinds of talk therapies such as CBT, energy therapies such as Bradley Nelson’s Emotion Code and Body Code, acupuncture, exercise, electrical stimulation of the brain, the visualization you can download for free from my website, or read about how to do on one of my other blogposts, couples therapy, and more.

2) Depression is induced by a situation in which you have experienced insufficient power. If you close your eyes and picture whom or what you may feel angry at, you will see an image of the trigger person or situation. Fix that situation, and your depression will be likely to go away.

3) If your doctor is recommending medication as a short-term fix, use the pills until you feel better. Use your renewed energy to address the power-loss situation. Then begin the medication-weaning process asap.

4) Wean slowly. Consult your prescribing doctor for an appropriate weaning schedule for the particular medication that you are taking.

5) Be aware that research has shown that the most powerful way to overcome depression and keep it far from you, in the long run, is the combination of therapy and medication. Medication alone and psychotherapy alone have very similar effectiveness rates, but medication has an impact more quickly, and psychotherapy tends to have more longer-lasting impacts.

6) There is a visualization exercise that you can do with a therapist, a friend, or on your own that may help you conquer the depression in just a few minutes.  See my posting on A New Treatment for Depression.

6) In my clinical experience, I find that most depression is a response to relationship problems. Look into marriage educationcouples counseling, or a combination of both to upgrade your relationship. These treatment routes can make you a double winner.  You can both end the depression and simultaneously gain a vastly more gratifying marriage or romantic partnership.

Susan Heitler, Ph.D., a Denver Clinical psychologist, is an author of multiple publications including From Conflict to Resolution for therapists, The Power of Two and poweroftwomarriage.com for couples who want to strengthen their relationship. Dr. Heitler’s most recent book is Prescriptions Without Pills, with a free companion website at prescriptionswithoutpills.com.

 

Depression: A Psychiatrist’s Recommendations for Self-care

Psychiatrist Monica Starkman, M.D. writes, “In clinical research, one uses the scientific method and studies just one treatment alone in order to assess its effectiveness. But in clinician mode, I am convinced that a combination of effective techniques increases the probability of a strongly positive result – and I don’t really care which of them did the most good. Here are five simple yet powerful treatments I recommend because they are both scientifically valid and clinically effective. Read her entire blog.

Decoding Depression

depressed-woman

When I talk about medicine and mental health to large audiences, I often start with the following imagery and facts: think of a woman you know who is radiantly healthy. I bet your intuition tells you she sleeps and eats well, finds purpose in her life, is active and fit, and finds time to relax and enjoy the company of others. I doubt you envision her waking up to prescription bottles, buoying her way through the day with caffeine and sugar, feeling anxious and isolated, and drinking herself to sleep at night. All of us have an intuitive sense of what health is, but many of us have lost the roadmap to optimal health, especially the kind of health that springs forth when we simply clear a path for it. The fact that one in four American women in the prime of their life are dispensed medication for a mental health condition represents a national crisis.

Humans have used mind-altering substances to try to dull and deaden pain, misery, sorrow, and suffering since time immemorial, but only in the last few decades have people been persuaded that depression is a disease and that chemical antidepressants are the remedy. This is far from the truth. Many of my patients have been to multiple doctors, bumping up against the hard ceiling of what conventional medicine has to offer. Some have even tried integrative medicine, which aims to combine both traditional medicines (i.e. prescriptions) with alternative treatments (e.g. acupuncture). After all, they are told that there are great natural complements to all the wonders pharmaceutical products have to offer. But the reason they can’t find a solution is because nobody has asked why.  Why are they unwell? Why are their bodies creating symptoms that manifest as depression? Why didn’t they stop to ask this important and obvious question the first time they experienced a flat mood, anxiety, insomnia, and chronic exhaustion?

Before I even get to the answers, let me be the first to tell you that the only path to a real solution is to leave the medical world you know behind. This, the journey I will take you on, is not just about symptom suppression, it’s about health freedom. First let me tell you that I was once a typical doctor, not to mention a typical American who loved pizza, soda, birth control, and ibuprofen. My message is from a personal journey and thousands of hours of research that has compelled me to share the truth about prescription-based care: we’ve been duped.

Yes, my entire training was based on a model of disease care that offers patients only one tool – a drug – and never a shot at true wellness. We’ve handed over our health to those who seek to profit from it, and we’ve been buying into a paradigm based on the following notions:

  • We are broken.
  • Fear is an appropriate response to symptoms.
  • We need chemicals to feel better.
  • Doctors know what they are doing.
  • The body is a machine requiring calibration (via drugs). A little too much of this, too little of that.

I call this collective set of notions the Western Medical Illusion. It sets up a vicious system that ushers you into lifelong customer status, dependent and disempowered.

As you can likely guess by now, I love to rant. But I do so with the best evidence science can offer, and there’s a lot we know today about the real root cause of depression – and how to treat the condition safely and successfully – without a prescription pad. If there’s one lesson I will drive home, it’s this: shed the fear, take back your inner compass, and embrace a commitment to your best self, medication free. Even if you don’t already take a prescription drug, I bet you still doubt living the rest of your life prescription free and reliant on your own inner intuition to know what’s best for you. The idea of supporting your body’s innate wisdom may sound quaint at best or like dangerous hippie woo-woo at worst.  From now on, I want you to embrace these new ideas:

  • Prevention is possible.
  • Medication treatment comes at a steep cost.
  • Optimal health is not possible through medication.
  • Your health is under your control.
  • Working with lifestyle medicine – simple everyday habits that don’t entail drugs – is a safe and effective way to send the body a signal of safety.

How can I make these statements, and what do I mean by life-style medicine? I’ll be presenting scientific proof.  When I first meet with a woman and her family, I speak about how to reverse her anxiety, depression, mania, and even psychosis. We map out the timeline that brought her where she is and identify triggers that often fall under one or more of the following categories: food intolerances or sensitivities, blood sugar imbalances, chemical exposures, and thyroid dysfunction, and nutrient deficiency. I forge a partnership with my patient and witness dramatic relief within thirty days. I do this by teaching my patients how they can make simple shifts in their daily habits, starting with the diet. They increase nutrient density, eliminate inflammatory foods, balance blood sugar, and bring themselves closer to food in its ancestral state. It’s the most powerful way to move the needle because food is not just fuel. It is information (literally: “it puts the form into your body”), and its potential for healing is a wonder to me every single day.

Achieving radical wellness takes sending the body the right information and protecting it from aggressive assault. This isn’t just about mental health; it’s about how mental health is a manifestation of all that your body is experiencing and your mind’s interpretation of its own safety and power. It’s also about how symptoms are only the visible rough edges of a gigantic submerged iceberg.

prozac6002pps0

Not that none of these concepts connects with substances in the brain that might be “low.” If you had to define depression right now, before reading further, chances are you’d say something about it being a “mood disorder” or “mental illness” triggered by a chemical imbalance in the brain that probably needs to be fixed through medications like Prozac or Zoloft that will lift levels of brain chemicals associated with a good mood. But you would be mistaken.

So many patients today who are being shepherded into the psychiatric medication mill are overdiagnosed, misdiagnosed, or mistreated. Indeed, they have “brain fog,” changes in metabolism, insomnia, agitation, and anxiety, but for reasons only loosely related to their brain chemicals. They have all the symptoms that are mentioned in a Cymbalta advertisement that tells them to talk to their doctor to see if Cymbalta is right for them. But it’s like putting a bandage over a splinter in the skin that continues to stir inflammation and pain. It’s absolutely missing an opportunity to remove the splinter and resolves the problem from the sources. And it’s an iconic example of how conventional medicine can make grave mistakes, something the pharmaceutical industry is more than happy to encourage.

In holistic medicine, there are no specialties. It’s all connected. Here’s a classic case in point: Eva had been taking antidepressants for two years but wanted to get off it because she was planning to get pregnant. Her doctor advised her not to stop taking the drug, which motivated her to see me. Eva explained that her saga had begun with PMS, featuring a week each month was she was irritable and prone to crying fits. Her doctor prescribed a birth control pill (a common treatment) and soon Eva was feeling even worse, with insomnia, fatigue, low libido, and generally flat mood dogging her all month long.  That’s when the doctor added the Wellbutrin to “pick her up,” as he said, and handle her presumed depression. From Eva’s perspective, she felt that the antidepressant helped her energy level, but it had limited benefits in terms of her mood and libido. And if she took it after midnight, her insomnia was exacerbated. She soon became accustomed to feeling stable but suboptimal, and she was convinced that the medication was keeping her afloat.

depressed-middle-aged-woman

The good news for Eva was that with careful preparation, she could leave medication behind – and restore her energy, her equilibrium, and her sense of control over her emotions. Step one consisted of some basic diet and exercise changes along with better stress response strategies. Step two involved stopping birth control pills and then checking her hormone levels. Just before her period, she had low cortisol and progesterone, which were likely the cause of the PMS that had started her whole problem. Further testing revealed borderline low thyroid function, which may well have been the result of the contraceptives – and the cause of her increased depressive symptoms.

When Eva was ready to begin tapering off the medication, she did so following my protocol. Even as her brain and body adjusted to not have the antidepressant surging through her system anymore, her energy levels improved, her sleep problems resolved, and her anxiety lifted. Within a year she was healthy, no longer taking any prescriptions, feeling good – and pregnant.

I require my patients, and I implore you to think differently about health-care decisions and consumerism. Part of my motivation in writing about depression was to help you develop a new watching, questioning eye that you can bring to every experience. For my patients to be well, I know that they will need to approach their health to an extreme commitment to the integrity of their mind and body. Personally, I have no intention of ever returning to a lifestyle that involves pharmaceutical products of any kind, under any circumstances.

Why?

Because we are looking at the body as an intricately woven spider web – when you yank out one area of it, the whole thing moves. And because there is a more powerful way to heal.

It’s so simple that it can be considered an act of revolution.

You might think of yourself as adverse to conflict – someone who wants to keep the peace, keep your head low, and do what’s recommended. To be healthy in today’s world. However, you need to access and cultivate a reliance on yourself. And you’re going to do that by first shifting your perspective forever. Look behind the curtain and understand that medicine is not what you think it is.  Drug-based medicine makes you sick. I will go so far as to say that hospital care makes you sick; though estimates vary, it’s reasonable to say that hospital care claims tens if not hundreds of thousands of lives annually due to preventable medical mistakes such as wrong diagnoses and medications or surgical errors, infections, and simply screwing up an IV.

The Cochrane Collaboration, a London-based network of more than 31,000 researchers from more than 130,000 countries, conducts the world’s most thorough independent analysis of health-care research. Based on the data from the British Medical Journal, the Journal of the American Medical Association, and the Centers for Disease Control, it has found that prescription drugs are the third leading cause of death after heart disease and cancer. And when it comes to psychotropic drugs, the Cochrane Collaboration’s conclusions are compellingly uncomfortable. In the words of the Collaboration’s founder, Dr. Peter Gotzsche, “Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good.

By and large, doctors are not bad people. They are smart individuals who work heard, investing money, blood, sweat, and tears into their training. But where do doctors get their information? Whom are they told to trust? Have you ever wondered who’s pulling the strings? Some of us in the medical community are beginning to speak up and to exposed the fact that our training and education is, for the most part, bought.

“Unfortunately in the balance between benefits and risks, it is an uncomfortable truth that most drugs do not work in most patients.” Before I read this quote in the prestigious British Medical Journal in 2013, I had already begun to explore the evidence that there really isn’t much evidence to support the efficacy of most medications and medical interventions, particularly in psychiatry, where suppressed data and industry-funded and ghostwritten papers hide the truth. Another 2013 study published in the equally respected Mayo Clinic Proceedings confirmed that a whopping 40 percent of current medical practice should be thrown out.  Unfortunately, it takes an average of seventeen years for the data that exposes inefficacy and/or a signal to harm to trickle down into your doctor’s daily routine, a time lag problem that makes medicine’s standard of care evidence-based only in theory and not in practice. Dr. Richard Horton, the editor in chief of the much-revered Lancet at this writing, has broken rank and come forward about what he really thinks of the published research – that it’s unreliable at best, if not completely false. In a 2015 published statement, he wrote: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”

In 2011 the British Medical Journal performed a general analysis of some 2,500 common medical treatments. The goal was to determine which ones are supported by sufficient reliable evidence. The results:

  • 13 percent were found to be beneficial
  • 23 percent were likely to be beneficial
  • 8 percent were as likely to be harmful as beneficial
  • 6 percent were unlikely to be beneficial
  • 4 percent were likely to be harmful or ineffective

The treatments in the remaining 46 percent, the largest category, were found to be unknown in their effectiveness. Put simply, when you visit a doctor or a hospital, you have only a 36 percent chance that you’ll receive a treatment that has been scientifically proven to be either beneficial or likely to be beneficial. Such results are strikingly similar to those of Dr. Brian Berman, who analyzed completed Cochrane reviews of conventional medical practices, finding that 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.”

Are these exceptions? I would like to argue that they aren’t. This is because the whole pharmaceutical approach is predicated on wrong-headed information. Pharmaceutical products as we know them have not been developed or studied with modern science’s most relevant principals in mind, such as the complexity and power of the human microbiome, the impact of low-dose toxic exposures, autoimmune disorders as a sign of environmental biochemistry. Because medicine operates under the now antiquated one gene, one illness, one pill rubric, efficacy will be measured through a skewed lens, and safety cannot be accurately assessed or discussed with individual patients.

Many of us move through life with a sneaking fear that the other health shoe could drop at any moment. We can easily fall prey to the belief that our breasts are ticking time bombs that infections are just a cough or handshake away and that life is a process of adding more medications and drugs to put out small fires as we age. Before I stopped prescribing, I had never once cured a patient. Now people are cured every week in my practice. As I mentioned, my patients are my partners. We collaborate, and they work hard. They work hard at a time when they can’t lift a finger – when the prospect of walking to the corner drugstore with a slip of paper twinkles like the North Star in their dark sky. They follow my lead because they feel inspired by my conviction and hope in this new model – one that asks the question “Why?” and has the goal of not only symptom relief but an incredible boost in their vitality.

Excerpted with permission from the book, “A Mind of My Own,” by Kelley Brogan, M.D.

All rights reserved. 

KELLY BROGAN studied cognitive neuroscience at MIT before receiving her MD from Weill Cornell Medical College. Board certified in psychiatry, psychosomatic medicine, and integrative medicine, she is one of the only doctors in the nation with these qualifications. She is the author of the best-selling book, A Mind of Your Own: What Women Can Do About Depression That Medication Can’t. She practices in Manhattan and is the mother of two young daughters. Check out her website.

 

 

 

 

 

 

Many Depressed Adults Not Getting Treatment: Study

Most American adults who suffer from depression aren’t getting treatment, a new study finds. After screening survey data on more than 46,000 people, researchers found that 8 percent had depression, but only a third were being treated for the mood disorder. Read the rest of the Story.

Book Review: ‘Ordinary Well: The Case for Antidepressants

Dr. Abigail Zuger writes in The New York Times, “Dr. Kramer’s bottom line is well summarized by the double meaning of “Ordinarily Well: The Case for Antidepressants” — he argues that antidepressants work just about as well as any other pills commonly used for ailing people, and that the drugs keep people who take them reasonably healthy.” Read the News

Depression and Anxiety in Later Life

file0tt4iKI’m Dan Lukasik from Lawyerswithdepression.com. Today’s guest is Dr. Charles F. Reynolds, III, co-author of the book, “Depression and Anxiety in Later Life: What Everyone Needs to Know.” He is a professor in Geriatric Psychiatry at the University at Pittsburgh School of Medicine and Director of its Aging Institute and Center of Excellence in the Prevention and Treatment of Late Life Mood Disorders. Dr. Reynolds is internationally renowned in the field of geriatric psychiatry. His primary interests focus on mood, grief, and sleep disorders in later life.  Thanks for being here with us Dr. Reynolds.

I think the first place to begin for our audience and listeners is to have an understanding of what clinical depression is.

Dr. Reynolds:

The term clinical depression really refers to a syndrome or collection of symptoms which are debilitating and cause suffering and distress. At the core of the notion of clinical depression are two symptoms. The first is a lack of pleasure or interest in usual activities. The clinical term for that being anhedonia and the other core aspect of depression is a persistent lowering of mood – a sense of sadness and pessimism or even of hopelessness. These symptoms occur most days for at least two weeks and typically for a longer period of time and then as the full syndrome of depression develops, Dan, you also see other changes, for example, in sleep, concentration, or appetite, or energy levels and of great importance is the emergence, in many people, of suicidal feelings as part of the clinical syndrome of major depression.

Dan:  

Part of the title of your book is anxiety – what is clinical anxiety?

Dr. Reynolds:

Well, like depression, clinical anxiety refers to a syndrome or collection of symptoms that are both distressing and impairing in day-to-day function. The principle types of anxiety are first, excessive worrying such as we see in generalized anxiety disorder or panic attacks such as we can see in panic disorder with or without agoraphobia. Like depression, anxiety disorders can be quite debilitating and distressing. It is also important to understand that anxiety and depression can co-occur in the same patient and often represent risk factors for each other.

Dan:

In the book title you say depression and anxiety in later life.  When you talk about “later life,” what does that mean?

Dr. Reynolds:

Later life generally refers to folks sixty and older. That varies somewhat according to the study that you’re reading, but most of us accept age sixty or sixty-five as a threshold for beginning the later years of life. That being said, Dan, it’s important to understand that the later years of life can and often do cover several decades. And so we often speak of “young old,” say sixty-five to seventy to eighty, and “old-old” as covering the years beyond seventy-five or eighty. That distinction, young-old and old-old is important for clinical practice because the various benefits and risk of the treatments that we have may shift gradually with the age of the patient.

Dan:

When we think of depression in our society, how common is depression statistically and is there any difference in the older population?

Dr. Reynolds:

If you look, Dan, at primary care medicine clinics where most people get treatment for depression, older adults, if they get treatment at all, at any one point in time six to ten percent of the patients attending primary care clinics will have major syndromal depression and then another ten percent or so will have a clinically significant level of depressive symptoms. So this is by no means a rare disorder.  The other important thing to remember, and this is to your point about depression’s occurrence in older adults, it frequently coexists with medical issues and often with cognitive issues as well. The depression typically doesn’t exist in pure culture, but rather is an “unwanted co-traveler” of many of the common medical problems that afflict older adults and thereby amplifies the disability and distress of those disorders.

Dan:

What causes depression, Dr. Reynolds?  When we think of depression – and we’ve come a long way in understanding some of the causes – many people don’t know the difference between sadness or “the blues” and clinical depression. What are we talking about? What are the causes?

Dr. Reynolds:

The causes are many, Dan, and I think it’s very helpful to think in terms of there being many pathways to depression in older adults. In some cases, it’s possible that there is a genetic cause because depression can run in families.  Although in late life, depression, we think that genetic factors are maybe less important than they are in younger adults or kids who develop depression. Depression also occurs in the context of the life events that can occur in later life such as bereavement or other major transitions in social role functions. It’s also not unusual to see depression in the wake of certain medical events like a heart attack, or a stroke, or depression to develop in the context of things like age-dependent macular degeneration which results in a decreased ability for a person to see. These are important contextual factors and a good treatment plan will take these contextual social and medical factors into account.

Dan:

When we think of depression, once it’s been diagnosed, what can older adults do to manage depression?

Dr. Reynolds:

I think there are many things that older adults can do, Dan, but also they can be helped by family members and caregivers as well. This is a key point. I almost always will try to see family members and caregivers as well as the adult with depression themselves. Adopting a healthy lifestyle is very important set of strategies, Dan, both for preventing and treating depression and among these healthy lifestyles are physical activity, maintaining good social connections, and social support, and getting primary medical problems attended to such as blood pressure, blood fat, and blood sugar levels and having your immunizations and cancer screenings done on time.  Behaviorally, it’s very important for people to engage in the activities that give them pleasure. Behavioral activation, as we call it, is at the core of many psychosocial treatments for depression including problem-solving therapy, cognitive and behavioral therapy. Medications are also very helpful. There are antidepressant medications now available which are safe and generally well tolerated by older adults. I would say that upwards of eighty percent or eighty-plus percent of older adults with depression can be successfully treated to good response if not remission particularly using a combination of counseling and medication and then we have other treatments for other people whose depressions are difficult or resistant to treatment.

Dan:

Let’s turn our attention now to the topic of anxiety and that’s certainly an important topic you address in your book where you talk about anxiety in later life. For our audience, what is anxiety? We talk about it. A lot of people talk about being “stressed out”. We’re a stressed-out culture. But what is the difference between stress, being stressed-out, and true clinical anxiety?

Dr. Reynolds:

That’s good, Dan. You’ve made an important distinction there. All of us can experience stress, for example, in relation to life events which feel threatening to us or which seem to turn our worlds upside down, but there is a difference with anxiety disorders.  Anxiety disorders are constituted by specific symptoms that often last for months and months and months and can be disabling and distressing.  Principal among these things are obsessive worry or panic attacks which seem to come out of nowhere. These constituent actual distinct mental disorders and there are useful treatments for them. We rely heavily, for example, on teaching people relaxation techniques as well as better problem solving skills. There’s a good deal of literature also to support the use of medications called Selective Serotonin Reuptake Inhibitors. These are medications that have shown to be effective in the treatment of anxiety disorders in older adults. The reasons you want to treat these disorders is that the symptoms are burdensome, they cause distress and impairment, they undermine the quality of life, and also increase the risk for depression.

Dan:

When we talk about clinical depression and clinical anxiety, and you’ve just done a wonderful job of distinguishing them from everyday sadness and everyday stress, do they ever happen together?  Can we have a person who has both clinical depression and anxiety?

Dr. Reynolds:

We see that, Dan, in really about a third of our patients. So at any one point in time, probably a third of our patients with major depression, also can be diagnosed with one or another anxiety disorders. So they do co-occur and they need to be treated. Sometimes it can be challenging to treat that combination, but we learned how to do that. The other thing to remember though is that people living with anxiety disorders are at risk for the subsequent onset of depression.  So it’s important for that reason to address anxiety disorders. The other part of this constellation that I like to pay a lot of attention to is sleep disturbance. Sleep disturbances themselves represent a risk factor themselves for the onset of common mental disorders. Sleep disturbances are also a symptom of common mental disorders and when I’m treating depression or anxiety and my patient continues to have sleep disturbance, then I focus additional effort on helping them to get a better night’s sleep because if their sleep disturbance isn’t addressed independently, then it constitutes a risk factor for an early relapse or recurrence of depression or anxiety.

Dan:   

Can you tell us a little more about your work at the Aging Institute at the University at Pittsburgh Medical College and the Center and Treatment of Late Life Mood Disorders?

Dr. Reynolds:  

For the last five years I’ve served as Director of the Aging Institute at the University at Pittsburgh Medical Center.  The Aging Institute was created by the UPMC Health System and its health plan and also by the six schools of the Health Sciences at the University at Pittsburgh and by the Provost at the University at Pittsburgh.  Basically, Dan, we do three things.  We geriatricize the work force.  That is to say we teach the skills of caring for older adults to clinicians across all parts of medicine: doctors, nurses, pharmacists, social workers, etcetera.  The second thing that the Aging Institute does is to develop new models of care to improve the long-term delivery of care to older adults and their family members. And finally, the third thing we do is to sponsor research. We are very interested in innovative pilot research that can lead subsequent National Institute of Health and other federal support. The other thing I do at Pitt is to direct the Center for Depression Prevention and Treatment Research. This is a Center of Excellence, one of only two or three in the United States funded by the National Institute of Mental Health. We have been working now since 1995 and are in our twenty-first year. We do a great deal of intervention research. We also train the next generation of younger scientists, both physicians and Ph.D.’s, to do intervention research in older adults at risk for living with mood disorders like major depression or bipolar disorder.

Dan:

One of the things you mention in your book, and by the way, it’s a remarkable, insightful read, “Depression and Anxiety in Later Life,” one of things you mention in your book, you talk about the importance for older people to find and maintain a sense of purpose.  Why is that so important and how do older people go about finding a sense of purpose if it’s lacking?

Dr. Reynolds:

Yea, it’s a really key point, Dan, and I think that all of us need to have a sense of purpose; a sense that our lives matter to other people to help us get up in the morning.  Feeling a sense of connection, feeling a sense of belonging is very strong medicine to preserving a sense of wellbeing throughout all of the years of life. There’s also a substantial body now of research, of epidemiological research, that shows that being a member of a community of faith may both help buffer depression and but also help to recover from depression and keep it at bay. So I think that’s one key strategy to create a sense of belonging and purpose. Those are two key words that I like to use – belonging and purpose.

Dan:

And in closing Dr. Reynolds, for those in our audience that are interested in this, interested in being evaluated and treated at your center, how do they go about doing that?

Dr. Reynolds:

You can give us a call in Pittsburgh.  We are happy to take calls. We’re also happy to help callers find local resources from wherever they may be calling because we’re part of a network of colleagues around the country. One good way to seek help though is to call the help desk at the University at Pittsburgh Medical Center because we’re able to connect callers with all kinds of resources they may need. We typically get over 600 calls per year now, both from family caregivers and health care professionals.  I recommend that people visit our website or call us at 866-430-8742.

Dan:

Dr. Reynolds, thank you so much for taking the time to talk with us today. It’s been very informative, insightful and encouraging. I’m Dan Lukasik with Lawyerswithdepression.com.  Join us next week for another interesting interview.

 

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