What you learn in your 20’s

2014-05-05

Sure, most guys have a fumbling experience or two in high school and early college. But as you get older you learn more and more (askmen.com). And if you are thoughtful, each experience with someone teaches you something more. Many guys get the most experience when they are in their twenties. This is a time of self-discovery, liberation, meeting and dating lots of new people. It’s normally the time when we sow our wild oats before settling down to a career, marriage and perhaps children. Though we have more freedom of choice today, most guys still take this route. Though they may have to stave off marriage and kids a little longer, most guys seem to go down the same path. Still, those early days when you first got to chase singles sticks with you. Here’s what you learn in your 20’s. In high school we’re really just grateful that we got someone into the sack. It seemed like a heaven-sent miracle. But in your 20’s the mystery starts to wear off. One thing you begin to notice is that some people are bad in bed. They vary from those who just lay there, to those who get overly enthusiastic and call you a litany of curses, making you think they’re possessed. We begin to get a sense of who we really are, by our likes and dislikes in bed. We also get a handle on who can fulfill us and who cannot. Though you should still be thankful a date wants to take you to bed, it may not be you if things don’t go as well as you both hoped.

A lot of younger men and women think that the other should be a mind reader, know instinctually what the other wants. But in our twenties we start to get a handle on the fact that no one is a mind reader. We have to say what we want. Communication, likes and dislikes, the development of dirty talk, looking one another in the eye and even giving directions, of course in a sexy manner, start to develop somewhere in the second decade of one’s life. Lots of guys grow more sexually confident in their 20’s. In their teens they are often shy, blundering and have access to only a small number of partners. But in your 20’s, especially if you go to college, there are all sorts of people around. You have a lot more access, and bedroom slip-ups don’t get around a college campus the same way they do a high school, or in one particular town. It’s in your twenties that you start to explore more. Different positions, giving someone oral using different techniques, fore-play, and the post-coitus cuddle. We jump into so many different beds in our twenties, the most in our lifetime. But those formative years spell out who we are going to be in bed, what we like, what we look for in a mate, a lover, and a long term relationship. The core of our sexual beings is forged in our twenties. But if you are smart, it doesn’t stop there. Instead, you’re always working to shape up and improve your game.

It’s Time to Pay Attention to Sleep, the New Health Frontier

2014-04-15

Alexandra Sifferlin

Your doctor could soon be prescribing crucial shuteye as treatment for everything from obesity to ADHD to mental health as experts say carving out time for sleep is just as important as diet and exercise

After being diagnosed with brain and lung cancer in 2011, Lynn Mitchell, 68, was averaging about an hour of solid sleep a night. Stressed about her treatments, she was paying for it in hours of lost sleep.

The brain cancer was already affecting her mobility—Mitchell was often dizzy and would lose her balance—but the lack of sleep was exacerbating things. Even walking became increasingly difficult. Exhausted in the mornings, she was practically incoherent. When her doctors recommend she see a sleep therapist, Mitchell was relieved at how benign it sounded in comparison to the chemotherapy she had undergone and the gene therapy trial she was undergoing, which had side effects like nausea and fatigue.

For about nine weeks, Mitchell worked with the sleep therapist to adjust her sleep habits. She got under the covers only when she was extremely tired. She quit watching TV in bed. She stopped drinking caffeinated coffee in the evening. She also learned breathing exercises to relax and help her drift off. It was all quite simple and common sense, and, most importantly, noninvasive and didn’t require popping any pills.

“It’s common knowledge that sleep is needed for day to day function,” says Dr. David Rapoport, director of the Sleep Medicine Program at NYU School of Medicine. “What isn’t common knowledge is that it really matters—it’s not just cosmetic.” Rapoport has long seen people seek sleep therapy because they’re chronically tired or suffering from insomnia, but an increasing number of patients are being referred to his center for common diseases, disorders, and mental health.

Researchers have known for some time that sleep is critical for weight maintenance and hormone balance. And too little sleep is linked to everything from diabetes to heart disease to depression. Recently, the research on sleep has been overwhelming, with mounting evidence that it plays a role in nearly every aspect of health. Beyond chronic illnesses, a child’s behavioral problems at school could be rooted in mild sleep apnea. And studies have shown children with ADHD are more likely to get insufficient sleep. A recent study published in the journal SLEEP found a link between older men with poor sleep quality and cognitive decline. Another study out this week shows sleep is essential in early childhood for development, learning, and the formation and retention of memories. Dr. Allan Rechtschaffen, a pioneer of sleep research at the University of Chicago, once said, “If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made.”

But to many of us, sleep is easily sacrificed, especially since lack of it isn’t seen as life threatening. Over time, sleep deprivation can have serious consequences, but we mostly sacrifice a night of sleep here and there, and always say that we’ll “catch up.” Luckily, it is possible to make up for sleep debt (though it can take a very long time), but most Americans are still chronically sleep deprived.

While diet and exercise have been a part of public health messaging for decades, doctors and health advocates are now beginning to argue that getting quality sleep may be just as important for overall health. “Sleep is probably easier to change than diet or exercise,” says Dr. Michael Grandner, a sleep researcher at the University of Pennsylvania. “It may also give you more of an immediate reward if it helps you get through your day.” Sleep experts claim that it is one of the top three, and sometimes the most, important lifestyle adjustments one can make, in addition to diet and exercise. And while there’s more evidence linking diet and exercise as influential health factors, sleep is probably more important in terms of brain and hormonal function, Grandner says. “Among a small group of [sleep researchers], it’s always been said that [eating, exercise, and sleep] are the three pillars of health,” says Dr. Rapoport.

In our increasingly professional and digital lives, where there are now more things than ever competing for the hours in our day, carving out time for sleep is not only increasingly difficult, but also more necessary. Using technology before bed stimulates us and interferes with our sleep, yet 95% of Americans use some type of electronics like a computer, TV, or cell phone at least a few nights a week within the hour before we go to bed, according to a 2011 National Sleep Foundation survey. “Many doctors, lawyers, and executives stay up late and get up early and burn the candle at both ends,” says Dr. Richard Lang, chair of Preventative Medicine at the Cleveland Clinic. “Making sure they pay attention to sleep in the same way they pay attention to diet and exercise is crucial.”

To some, sleep has become a powerful antidote to mental health. Arianna Huffington, president and editor-in-chief of the Huffington Post Media Group, advocates that sleep is the secret to success, happiness, and peak performance. After passing out a few years ago from exhaustion and cracking a cheekbone against her desk, Huffington has become something of a sleep evangelist. In a 2010 TEDWomen conference, Huffington said, “The way to a more productive, more inspired, more joyful life is getting enough sleep.” Research linking high-quality sleep with better mental health is growing; a 2013 study found that treating depressed patients for insomnia can double their likelihood of overcoming the disorder.

While 70% of physicians agree that inadequate sleep is a major health problem, only 43% counsel their patients on the benefits of adequate sleep. But there’s growing pressure on primary care physicians to address, and even prescribe, sleep during routine check-ups. In a recent study published in the journal The Lancet Diabetes & Endocrinology, the researchers concluded that health professionals should prescribe sleep to prevent and treat metabolic disorders like obesity and diabetes. And overlooking sleep as a major health issue can also have deadly consequences. It was recently reported that the operator of the Metro-North train that derailed in New York last year, killing four people and injuring more than 70, had an undiagnosed case of sleep apnea.

Sleep therapies can range from simply learning new lifestyle behaviors to promote sleep, to figuring out how to position oneself in bed. More drastic measures involve surgery to open up an airway passage for people suffering from disorders like sleep apnea. Sleeping pills can be prescribed too, to get much needed rest, but sleep therapists tend to favor other approaches because of possible dependencies developing.

A large part of reaping the benefits of sleep is knowing when you’re not getting the right amount. According to a 2013 Gallup survey, 40% of Americans get less than the recommended seven to eight hours a night. While the typical person still logs about 6.8 hours of sleep per night, that’s a drop from the 7.9 Americans were getting in the 1940s.

When it comes to adequate sleep, it’s much more personalized than previously thought. Some people feel great on five hours of rest, while others need ten. The best way to determine if you’re getting the right amount, doctors say, is to find out how many hours of sleep you need to be able to wake up without an alarm and feel rested, refreshed, and energetic throughout the day.

Since reforming her sleep habits, Mitchell has been clocking up to seven hours of shuteye a night for the past two months. “I’m alert in the morning, my balance is better, and I feel peppier,” says Mitchell. Getting enough sleep has helped her better deal with her cancers, and its symptoms. The best news is that she recently found out that her brain tumor is shrinking, and there are fewer cancerous spots on her lungs.

Sleep’s Best-Kept Secret: A Treatment for Insomnia That’s Not a Pill Read more: Treating insomnia: forget the pills, use a smartphone app instead

2014-02-18

Why behavior therapy isn’t used more, and what your smartphone can do about that

Do you toss and turn for hours before falling asleep? Or go to bed early but still wake up tired? Or keep waking up during the night? Then you’re among the more than 20% of people in the U.S. who suffer from a sleeping disorder like insomnia and your doctor is probably prescribing sleeping pills to help you doze through the night.

That’s despite the fact that the gold standard for treating sleep disturbances, recommended by the National Institutes of Health and the American Academy of Sleep Medicine, is Cognitive Behavioral Therapy for Insomnia (CBTI). CBTI, which focuses on changing behaviors that can contribute to poor sleep, has been shown to work long-term while sleeping medications tend to lose effectiveness after a few weeks (sleep medications may, however, be prescribed initially along with CBTI).

So why are pills the most common solution? Convenience, for one. Even if you’re willing to seek out a sleep experts who is qualified to give CBTI, you may not find one near you. Despite the epidemic of sleep disorders and their impact on health, there are only a few hundred sleep experts in the whole country.

Doctors may also be unaware of the therapy. “I do not think many doctors know about CBTI,” says Rachel Manber, professor of psychiatry and behavorial sciences at Stanford University Medical Center.  “Some provide sleep hygiene recommendations. However, like dental hygiene, sleep hygiene is best thought of as preventive rather than treatment.” These include sleeping in a dark room, sticking to regular bed times, and avoiding caffeine and exercise before bedtime.

If you did find your way to a sleep clinic expert, you would have an extensive interview about your medical history and sleep problems and fill out a detailed sleep diary for two weeks, then return for treatment. If that information points to a medical problem like sleep apnea, then you would have to spend at least one night sleeping in a lab, hooked up to a multitude of sensors that monitor your respiration, heart rate, and sleep level measured by an EEG. Then, after these recordings help to diagnose your sleep issues, you would start treatments with a therapist to develop habits that condition you to sleep better at bedtime and improve your quality of sleep, by helping you to turn down stressful thoughts and avoid things around you that interfere with good sleep.

Most CBTI treatments take four to six weeks to be fully effective, which helps to explain why it pales in comparison to the immediate, if not long-lasting, benefit of sleeping pills. But now, Israeli scientists have come up with a way to potentially streamline the therapy for some by bypassing the sleep lab and delivering the treatment via smartphone.

SleepRate is an app that helps people who can’t or won’t go to a sleep clinic to generate, in DIY fashion, the same kind of information that all the monitors do to help sleep experts design the right behavioral therapy for patients. Anda Baharav, SleepRate’s founder and a former researcher at the Medical Physics Department at Tel Aviv University says this product can detect sleep disturbances by mathematically defining the connection between sleep, heart rate and respiration. They have combined their diagnostic method with a smartphone adaptation of a Stanford University proprietary CBTI treatment to bring CBTI to more people with sleep disorders. Anyone with an iPhone or certain other smartphones can download the app kit for $99, which comes with the sleep plan and a heart-rate monitor worn across the chest.

Here’s how it works. You sleep in your own bed for five nights with the chest belt and app on, and you also record how you feel subjectively about your sleep and alertness before you start the program, and then again every evening and morning for the five days of the assessment. The app keeps track of all the information in a sleep diary, and provides the results from the previous night’s sleep in an easy-to-read graphic. which the user can see and learn how long it takes to reach stable sleep, how many times you wake during the night, the sequence of your sleep stages throughout the night and how much quality sleep you get. Your phone’s microphone will also record noises around you and identify which ones wake you up.  “If you’re used to living in New York City, for example,” Baharav says, “the traffic and sirens may not wake you, but your fridge banging on at 4 a.m. might.” So your sleep plan might include a service call from your appliance company—or a new fridge.

After the five-night assessment, you get a personalized sleep plan based on your particular sleep issues. The plan guides users about when to go to bed and when to wake up, suggests exercises to help them unwind and forget about the day’s worries, and even outlines how to spend buffer times, or the one to two hours before bed when it helps to do routine, unexciting things such as taking a bath, listening to music, or reading (but no thrillers). Based on the information you entered, for example, your smartphone screen will alert you about when to start your buffer time activity, with something like a cartoon of someone sitting quietly on a sofa with the instruction: Start Buffer Zone.

The suggestions are offered sequentially over four to six weeks to give you time to learn the new behaviors. If you don’t reach a goal, you try again, and when you achieve your goal, such as getting out of bed at the same time for several days in a row, the program provides a new target. You can also pull up your sleep data at any time to see patterns and trends. And the app reminds you what not to do as well: No! Don’t take a nap now.

While there are other such user-friendly CBTI kits available, Shelby Harris, director of the Behavioral Sleep Medicine Program, Sleep-Wake Disorders Center at Montefiore Medical Center in New York, says SleepRate is “more comprehensive since it also takes into account medical causes for insomnia.” Because there is a shortage of qualified CBTI practitioners, she sees such apps as viable and welcome first-line efforts for helping people with insomnia. If the programs don’t help, she says, then patients can see a sleep specialist.

And what about people who don’t have a diagnosable sleep disorder but are simply sleep deprived? Could such a program, for example, help parents of babies and young children to find more good quality sleep? Baharav says that’s coming soon. Stay tuned.

Read more: Treating insomnia: forget the pills, use a smartphone app instead | TIME.com http://healthland.time.com/2014/01/31/sleeps-best-kept-secret-a-treatment-for-insomnia-thats-not-a-pill/#ixzz2tfsTgFtH

Here’s what to do about your anxiety

2014-01-28

By Dr. Charles Raison

Dr. Charles Raison, CNN’s mental health expert, addresses two questions from readers reacting to a piece on anxiety from Kat Kinsman, CNN Eatocracy managing editor, on her lifelong struggle with the condition. Look for Raison to address other questions in the future.

Q: Can using marijuana or having a drink or two be helpful for people with anxiety? What should they watch out for?

Dr. Raison: If one goes on any search engine looking for study results related to marijuana or alcohol and depression or anxiety, one will immediately see that most of the evidence tells a cautionary tale.

Many studies suggest that regular use of either marijuana or alcohol is associated with an increased risk for a variety of mental health problems, anxiety and depression among them. Increasing data suggests that regular marijuana use in adolescence may also be a risk factor for developing very serious psychotic disorders, especially schizophrenia.

In addition to promoting other disorders, alcohol is especially liable to abuse and dependence and has ruined innumerable people’s lives for millennia.

Far fewer studies have examined whether using these compounds in moderation might improve depression or anxiety.

But as Socrates noted almost 2,000 years ago, alcohol is both a blessing and a curse to mankind. Indeed, now we know that the regular modest use of alcohol actually promotes a number of health factors.

Similarly, it is increasingly clear that many of the chemicals within marijuana hold great promise for the treatment of physical pain. The endocannabinoid system in the brain — which is a primary target for marijuana — has profound effects on how people think and feel.

For example, increasing evidence suggests that the “runners high” many people get after strenuous exercise is produced primarily by activation of the brain’s’ internal endocannabinoid system. Other chemicals in marijuana impact other brain pathways, like serotonin, that are known to play a role in depression and anxiety.

People have been taking a drink or two in the evening since time immemorial. And many people will attest that this practice helps them shed the cares of the day. Recently, I’ve met with several very experienced psychiatrists who have been recommending small amounts of marijuana use for for very depressed patients who haven’t responded to antidepressants. In some patients, they are reporting remarkable improvements.

But the problem at this point is that while many studies have shown an association between alcohol/marijuana and mental illness, I don’t know of any really rigorous studies looking at the therapeutic potential of either for depression and anxiety.

Answering the question of what people who use these substances should watch out for is easier. They should watch out for the possibility that they become more anxious or depressed after drinking or using marijuana. And they should keep a close eye on their use, especially use of alcohol, which can be highly addictive. Whatever potential benefit alcohol and marijuana may offer is 100% lost once they are abused.

Q: What are the best anxiety treatments who don’t want (or are afraid) to take medicines? Is there anything that might ease their concerns? Is there a point where medication becomes essential?

Dr. Raison: By far the best studied non-medicine treatment for depression or anxiety is psychotherapy. Literally hundreds of studies have shown that on average psychotherapy works as well for these conditions as do medications.

Of the various psychotherapies, the best studied is cognitive behavioral therapy, or CBT. But studies are being done all the time, and other forms of therapy are also emerging as highly effective.

Over and above the type of therapy employed, a key factor of therapeutic success is the “fit” between the client/patient and therapist. In practical terms, this means that people should feel comfortable with their therapists. If one feels ignored, looked down upon, dismissed or attacked, it is very unlikely the therapy will be successful. Very often when therapy works people start feeling better within a few weeks, so this is also something to look for.

No other non-medical treatment for depression or anxiety has anywhere near the amount of supporting evidence that psychotherapy does. Having said this, significant evidence now points to the usefulness of exercise for improving mental health.

Especially when it comes to depression, exercise has been repeatedly shown to be of value. Both strength training and aerobic exercise have benefits and combining them is the best of all.

However, to get the full antidepressant effect of exercise requires real commitment. To work optimally, exercise must be engaged in for at least 30 minutes a day five days a week. And the intensity level should be such that one has some difficulty carrying on a conversation while doing it.

However, other health benefits accrue from far less strenuous exercise and in general many people feel better with even moderate exercise.

Several supplements have shown promise in depression. Both SAMe and L-methylfolate have shown promise as additions to people not fully responding to antidepressants. Most of us in the field think they also work by themselves, although more data are needed.

The data for St. John’s Wort is plus/minus. Some evidence suggests that omega-3 fatty acids and N-acetyl-cysteine may also hold promise for the treatment of depression

If someone has a pattern of becoming depressed every winter, bright light therapy with a light box delivering at least 10,000 lux of light has been shown to be very effective. About 10% of the population suffers from some degree of low mood and energy in winter. This phenomenon is more common in cold, dark, gray places than in warm, sunny Southern ones. The power of a light box to lift mood and give energy can really be exceptional. This is an option that is sadly too often overlookied.

Many people swear by a variety of non-traditional approaches. The bottom line is that if someone is helped by these modalities and not harmed, the goal has been achieved.

Dr. Charles Raison is an associate professor of psychiatry at the University of Arizona in Tucson.

What Dreams Are Made Of: Understanding Why We Dream (About Sex and Other Things) Read more: Understanding Why We Dream

2014-01-15

By Francine Russo

Do they predict the future or simply rehash the past? By figuring out why we dream, researchers are hoping to nail down what the nightly cavalcade of images and events means.

Ever since Sigmund Freud published his controversial theories about the meaning of dreams in 1900, we have been fascinated with the jumble of experiences we seem to live through while we slumber. Freud was convinced that dreams represent some unfulfilled desires or hoped-for wishes, while later investigators saw a more pragmatic quality to them, as reflection of waking life. None of these theories, however, have had the benefit of much in the way of solid, objective data.

At least, until now. Two new developments in research — brain imaging and big data — may offer some stronger answers. More detailed and timely snapshots of the brain at work, combined with the information researchers amassed about dreams from experiments in sleep labs, is gradually peeling away the mystery of dreams, and revealing their meaning.

From a strictly biological standpoint, scientists have learned much about the physiological process of dreaming, which occurs primarily in REM sleep. “During dreaming,” says Patrick McNamara, a neurologist at Boston University School of Medicine and the graduate school of Northcentral University in Prescott Valley, Ariz., “the limbic part of the brain—the emotional part—gets highly activated while the dorsal lateral prefrontal cortex, the executive part of the brain, is under-activated. So the kind of cognitions we experience during dreams are highly emotional, visually vivid, but often illogical, disconnected and sometimes bizarre.” That suggests that our dreams may have some role in emotional stability.

That does not necessarily mean, most dream researchers believe, that dreams are random expressions of emotion or devoid of some intellectual meaning. While some scientists maintain that dream patterns are strictly the result of how different neurons in the brain are firing, Deirdre Barrett, a psychologist and dream researcher at Harvard Medical School, believes they represent something more.  “I think it’s a fallacy that knowing brain action negates a subjective, psychological meaning any more than it does for waking thought. I think dreams are thinking in a different biochemical state.”

Defining that state, not to mention understanding the rules under which that universe operates, however, is a challenge. It may represent a complex interplay between emotional and cognitive information, says McNamara, so that dreams serve to help our brains process emotional memories and integrate them into our long-term memories. And because traumatic events are associated with higher levels of the stress hormone cortisol, they can cause nightmares. Researchers believe that excessive amounts of cortisol can impair the interaction between the hippocampus and the amygdala, the two main brain systems that integrate memory. “The memories don’t get integrated,” he says, “but just sit around. In post traumatic stress disorder, they get re-experienced over and over.”

In fact, from sleep studies in which people were exposed to images, learning tasks or other experiences immediately before they dozed off and then examined when they awakened, many scientists believe that dreams can help us rehearse for challenges or threats we anticipate—emotionally, cognitively and even physiologically. In our dreams we may try out different scenarios to deal with what’s coming up. Although much of the evidence for this is anecdotal, McNamara says, someone practicing piano or playing video games in waking life may start to do the same while dreaming. People solving a puzzle or studying a foreign language, he adds, can have breakthroughs with dreams that go beyond the perceptions that simply taking a break from the problem can produce. 

And now, Barrett says, brain imaging holds the promise of being able to help scientists “see” what until now could only be reported by subjective, possibly inaccurately recalled, dream accounts. For example, in research with rats trained to run through mazes to get rewards, investigators were able to record neuron activity in sleeping rats and determined that the rats were running the same mazes in their dreams.

In other experiments with humans, scientists monitored volunteers who slept inside an fMRI scanner while hooked up to EEG electrodes that measured brain wave activity. When the EEG indicated they were dreaming, the participants were awakened and asked what images they had seen in their dreams. The investigators were later able to match certain patterns of brain activity to certain images for each person.  “There’s a crude correspondence between the brain scan and the image. “From the scan, you can guess it’s an animal with four legs,” says Barrett. Despite the primitive state of this dream decoding, the ability to actually glean content from a dream is getting closer.

Mining big data bases of reported dreams holds another kind of promise. Until now, researchers have been working on relatively small samples of dream accounts, usually fewer than 200 per study. But new dream websites and smartphone apps like DreamBoard and Dreamscloud are encouraging thousands of people to report their dreams into larger repositories so researchers can finally answer their most urgent questions.  McNamara, for example, is excited to study dreams from different countries to see whether there are cultural differences in what people’s brains do when they aren’t awake.

The data bases also provide an opportunity to investigate the intriguing but under-studied realm of sex dreams. Until recently, says McNamara, they represented only 10% of reported dreams, likely because people are not eager to share this type of content with researchers in white lab coats. But self-reporting via the apps and websites, despite its potential biases, may provide more information on these types of dreams. “This is a wide open area crying for investigation,” he says.

McNamara is also eager to study individuals’ dreams over time to observe differences and changes in emotional tone, colors, words and other significant patterns and connect these to events in their lives. That would bring him closer to answering whether dreams are, in fact, prophetic — it might be possible, for example, that certain kinds of dreams precede getting the flu, or that other other dreams are more associated with happier events.

Such investigations could also reveal more about less welcome dreams, such as nightmares, and potentially lead to ways to control or avoid them. Barrett plans to mine the new database to study how often nightmares occur, and how they relate to an individual’s trauma or a family history of anxiety disorder. One of her first projects will involve the dream data from DreamBoard.com, which has accumulated 165,000 dreams over the last two years. Because Dreamboard has coded the dreams by the gender, colors, emotions (joy, anxiety, anger) and the number and categories of people in a dream, Barrett says she can identify basic patterns.

We already know, she says, that women dream equally about men and women while men’s dreams are two-thirds populated by men. Research so far also shows that men’s dreams may show slightly more anger and physical aggression while women’s display a bit more sadness and verbal hostility. Interpreting what these differences mean, however, will require deeper studies.

What’s been discovered so far, however, suggests that such studies could reveal an enormous amount about what role dreams play in our lives, and how important they are for biological, psychological or social reasons. With this research, McNamara believes, scientists can find out if what shrinks have been saying for years is true — that reflecting on our dreams is useful and can give us insight into ourselves. Psychologists say so, and many people think so. But this research, he says, gives us the potential to know.
Read more: Understanding Why We Dream | TIME.com http://healthland.time.com/2014/01/14/what-dreams-are-made-of-understanding-why-we-dream-about-sex-and-other-things/#ixzz2qRNr8LsX

Primary-Care Doctors Don’t Have the Best Tools for Treating Depression Read more: Primary-Care Doctors Don’t Have Best Tools for Treating Depression

2013-11-07

By Alexandra Sifferlin

Not all doctors are able to treat depression effectively, including those who are most likely to see patients’ first symptoms.

Even though patients may turn first to their primary-care physicians with any concerns about depression, the tools that those doctors use to evaluate their patients for mental-health disorders aren’t necessarily helping to improve their patients’ symptoms, according to the latest study published in the Journal of the American Medical Association of some of the most common practices used by these physicians.

Researchers from the University of California, Davis, looked at techniques, designed for patients, that help primary-care physicians to assess mental-health symptoms more easily in a doctor’s office or even the waiting room. The depression engagement video (DEV) helps patients to identify depression and guides them on how to talk to their doctors about symptoms. The interactive multimedia computer program (IMCP) similarly helps patients to recognize and discuss depression with their doctors, via an interactive program that gives them feedback about their symptoms and their level of depression.

Among 925 adult patients treated by 135 primary-care doctors in the study, 603 patients were already diagnosed with depression and 322 patients did not show signs of the condition. All the patients were randomly assigned to either of the two digital assessments, or to a control group, and then followed up 12 weeks later to see if the interventions improved the patients’ mental-health symptoms.

Doctors were more likely to offer referrals to mental-health programs or antidepressant medications after evaluating patients using the DEV or IMCP, at rates of 17.5 % and 26%, respectively, compared with those who didn’t rely on the programs. And patients were more likely to ask for information from their doctors about depression if they used the tools.

That did not mean, however, that the patients who were referred to additional services such as seeing a therapist or prescribed medications fared better than those in the control group. When the researchers assessed the participants’ depression symptoms 12 weeks later using a questionnaire, they found that those who received the additional services and those who did not scored similarly on the mental-health evaluation. So while the strategies may appear to help primary-care doctors to better assess depression, the researchers say the tools may not be as effective as hoped for matching the right treatments to the right patients in order to improve their symptoms. And that, potentially, could lead to worsening symptoms and deeper depression. “Further research is needed to determine effects on clinical outcomes and whether the benefits outweigh possible harms,” the authors write.

Could you be almost depressed?

2013-10-28

By Shelley Carson, Special to CNN

Editor’s note: Shelley Carson is an associate of the Department of Psychology at Harvard University. She’s the co-author of “Almost Depressed: Is My (or My Loved One’s) Unhappiness a Problem?“

Consider whether the following questions describe you or someone you love:

Are having trouble enjoying things in life that used to be fun?

Do you find that you are constantly irritable and overreacting to petty incidents? Are you are regularly finding excuses to avoid spending time with friends or family?

Does it seem like you’re “just going through the motions” and barely getting through the day? Do you feel overstressed and believe there is no way you can ever catch up with what you have to do?

If any of these questions rings true, you may be almost depressed. And you are not alone. Research suggests that as many as 12 million people in the United States may be suffering from low-grade depression symptoms that are not severe enough to warrant clinical treatment.

Almost depression is not a mental disorder. It is a state of low mood that can leave you exhausted and de-energized, keeping you from savoring life and working at your peak performance level. It is a gray area of mood problems that lies on a continuum between the ups and downs of normal mood, and full-blown major depression.

(You may wonder how you can tell if your mood symptoms put you in the almost depressed range, or if they are serious enough to be considered major depression. If you are thinking about death or suicide, have lost a significant amount of weight because of appetite changes, or have feelings of hopelessness or extreme guilt, or if you believe your symptoms may be severe enough possibly to warrant a diagnosis of major depression, please contact a mental health professional.)

At Harvard Medical School, we have been investigating the effects that almost depression and other subclinical conditions can have on an individual’s quality of life. People who are almost depressed report a number of issues, including lower job satisfaction, lower satisfaction with their marriage and other personal relationships, more anxiety issues, less control over their lives and lower overall well-being than people who do not fall into the almost depressed range.

In fact, on some of these measures, people who are almost depressed report feeling worse off than people who actually fall into the clinically depressed range. Clearly, even though almost depression does not rise to the level of a diagnosable mental disorder, it is nevertheless associated with a substantial amount of distress and suffering.

There is also another more serious problem: Research indicates about 75% of cases of low-grade depression will devolve into full-blown major depression if they are not recognized and arrested.

Major depression is a deadly disorder. People who are depressed have four times the risk of heart disease and almost six times the risk of dying after a cardiac event than people who are not depressed.

People who are depressed also have between nine and 16 times the risk for suicide than people who are not depressed.

It is therefore vitally important to recognize the symptoms of almost depression in yourself and your loved ones, and to take steps to reduce the suffering it causes.

There are a number of things you can do to combat almost depression that have been shown to be effective in randomized clinical trials (the gold standard of treatment testing). Here is a list of some these “evidence-based” steps:

Make sure you are getting enough exercise. The minimum amount for treating depression is 30 minutes of continuous aerobic exercise (70% to 85% of maximum heart rate) plus a 10-minute warm-up and cool-down period three times a week.

Integrate activities you have found pleasurable in the past into your weekly calendar. Even if you feel that you no longer enjoy them, such activities will increase the activation of the pleasure centers in your brain. As your symptoms resolve, you will regain pleasurable feelings.

Use creative outlets to express your negative feelings. You don’t need experience or talent to express yourself creatively, so paint, write or play music. Expressive creative work reduces depressive symptoms.

Manage your stress level. Stress has negative effects on both the brain and the body and can be a major source of depressive symptoms.

Challenge the way you think. Our moods are dependent not upon what happens to us in our lives, but in how we interpret what happens. Changing your interpretation has been shown to reduce depressive symptoms.

Increase your level of mindfulness. Mindfulness training and practice is an effective way to keep depression at bay.

Reduce the power you give to your “inner critic.” Often the negative and critical things we say to ourselves lead to feelings of depression and powerlessness.

Increase your social support circle. Having a strong social support system is a known protective factor against depression.

Improve your self-care. Poor nutrition and poor sleep habits can augment feelings of depression. In some cases, specific nutritional supplements can work wonders.

The steps that work for you will be dependent upon your specific signs and symptoms, the severity of your symptoms and your personality. If one step doesn’t work, do not give up.

There are many pathways to wellness, and with patience you will find the way that works for you.

You don’t have to be almost depressed. You can take charge of your symptoms and make your way out of the gray shadows and into the full light of good mental health.

Fewer Drugs Being Prescribed to Treat Mental Illness Among Kids

2013-10-01

By Alexandra Sifferlin

?As rates of behavioral disorders like attention deficit-hyperactivity disorder (ADHD) and anxiety rose among children, so did concerns about treating them with psychotropic drugs.

From the early 1990s to the early 2000s, the number of young children on psychotropic drugs, which include anti-depressants, stimulants, mood stabilizers and anti-anxiety agents, increased by two- to three- fold. Some drugs, including several ADHD medications, have been approved for use in children ages six to 12, while others have not studied long term in younger patients.

But in a new study published in the journal Pediatrics, researchers report that psychotropic drug treatments among children is stabilizing, according to data from a national sample of more than 43,000 kids between the ages of two and five. These drug prescriptions peaked between 2002 and 2005, and leveled off from 2006 to 2009.