Sunday, August 31st, 2014
Depression is a devastating illness that can ravage a person’s soul and ultimately end their existence. Described by literary great, William Styron, Darkness Visible: A Memoir of Madness: “The madness of depression is, generally speaking, the antithesis of violence. It is a storm indeed, but a storm of murk. Soon evident are the slowed-down responses, near paralysis, psychic energy throttled back close to zero. Ultimately, the body is affected and feels sapped, drained.”
Styron captures the psychological and physical impact of depression. Depression zaps a person of the interest to engage in activities that once gave them pleasure. Social activities, like going out for coffee or going to a restaurant with family or friends, decrease in frequency. Answering phone calls is a chore. Remaining in bed becomes a default response to loss of energy and motivation.
Going on inside the person’s mind, like Styron said, is an unrelenting storm. Thoughts of hopelessness, despair, feelings of worthlessness are colored by an impending sense of death, a death by suicide. Suicidal ideations plague the person’s thinking, leading to the next step, plotting one’s own demise.
Now that you have a better picture of what depression is like, what steps can be taken to help someone? Once a family or friend sees some of the changes related to depression, the person needs to be seen by a primary care physician. A primary care physician can rule out any potential medical conditions that might imitate depression, like thyroid and adrenal disorders, sleep apnea, or medicine interactions.
The doctor can either consider an antidepressant, like Zoloft or Prozac, to mention just a few. Generally, an antidepressant dose will be increased over time and any changes in symptoms or signs may take weeks to improve. If the primary care doctor feels the person is at risk for harm during this time, the person can be hospitalized in a behavioral health unit for safety. In situations where medicine doesn’t alleviate the problem, electroconvulsive therapy will be considered.
ECT sounds scary and part of that is founded in the use of ECT dating back to the 1950s and 60s. Equipment used during that time period was poorly regulated, delivering more or less than the desired voltage. Today, ECT is managed similarly to surgery. The person is given an anesthetic through an intravenous line, then vitals are monitored throughout the procedure. The actual seizure lasts from 30 to 60 seconds. ECT has a success rate of about 80%. However, ECT is not without side effects; the most common is memory loss, which in some cases lasts for weeks after treatment has ended.
The suggested cause or causes of depression vary from genetic, situational to stress, but whatever the cause, a closer look at what is going on in the brain will enhance your understanding. Dr. Amen, from Amen Clinic, has been using brain scans to diagnose and treat individuals with behavioral health disorders for years. Depression impacts a number of areas in the brain: the limbic system, the prefrontal cortex, and basal ganglia. http://www.amenclinics.com/the-science/spect-gallery/depression/
To put this in layman’s terms: the limbic system is the emotional system; the prefrontal cortex helps us problem-solve, organize thoughts; the basal ganglia handles anxiety. The limbic system is overactive in depression, generating the dark thoughts of hopelessness and suicide, while the basal ganglia, also overactive, increases anxiety. And the prefrontal cortex is diminished, making it difficult to focus on any problem-solving.
In summary, depression is a deadly disease, that diminishes a person’s ability to function in areas of social, work, or school. It manifests itself on a physical and psychological level. A person in the midst of depression appears to have given up on life and potentially is at risk for lost of their life through suicide. However, depression responds to medicines, antidepressants in a majority of cases, and 80% of the time when ECT is used.
Until next time: treat yourself and others with kindness, it’s good for your brain.
Sunday, May 11th, 2014
Getting stuck on the same thought, moment after moment, finding it difficult to move onto the next thought easily is one of the defining characteristics of obsessive compulsive disorder (OCD). The thoughts drive the behaviors and impact the ability to make decisions.
For example, did I remember to turn off the stove? A perferectly natural thought, until it builds into a repetitive pattern of checking and re-checking. Handwashing can become a ritual because of distorted thinking: did I remove all of the germs from my hands? When the reasonable turns into extreme patterns of thinking and behavior, then OCD impairs even basic routines and can impair a person’s ability to function in a healthy pattern.
In the make-believe-world of Hollywood, Adrian Monk, a former San Francisco police officer, fights crime as a homicide consultant. But at the same time he fights OCD. “Monk,” as he is affectionately called by Captain Leland Stottlemeyer, is afraid of germs, odors, and asymmetry to mention just a few of his OCD symptoms.
While Monk is examining a crime scene, he can become distracted by a picture frame that is hanging unevenly on a wall or a smudge on a mirror. This hampers his acute perception and he misses the forest for the trees so to speak. The series portrays Monk as a super-crime fighter mixed with humorous jabs at his OCD.
But in the world far from the glitz and make-believe of Hollywood, people with OCD can have severe behaviors and consequences. Hygiene takes on extreme levels: fear of germs in food, water or even on the skin. The obsession drives extreme behaviors: excessive bathing, throwing clothing, bedding and dishes away. And in severe cases, the person may avoid eating altogether. (These are just a few of the symptoms of OCD.)
What do neuroscientists and psychiatrists believe is going on in the brain? Like the parts in a car engine, each having a different function, but together making the car move, the brain has, a part, the cingulate gyrus (CG). The purpose of the cingulate gyrus is to help us move easily from one thought to the next, making decisions, adjusting to a changing environment.
During a conversation, the CG helps us shift from one thought to the next. In addition the CG allows us to make decisions, like deciding to make a right turn at a signal light in advance of the turn. A more complicated example involves Captain Sullenberger’s dive into the Hudson River a number of years back and the sequence of steps he needed to perform, quickly, in order to bring the plane down safely. Without a normally functioning CG, daily tasks, much less heroic measures, are challenging at every turn.
So how is obsessive compulsive disorder treated? The key is to lower the activity level of the cingulate gyrus. A number of years ago, Luvox was introduced to treat OCD. Today, any number of antidepressants, called SSRIs, like Prozac and Zoloft, can be used. In addition, cognitive behavioral therapy (CBT) helps the person address the faulty thinking. This is introduced under the guidance of a counselor and requires daily practice. With the correct help, OCD can be managed.
If you prefer pictures, go to www.brainplace.com to examine a brain image of an active cingulate gyrus. You can also go to the National Institute of Mental Health to learn more about OCD.
Until next time: treat others with kindness, it’s good for your brain.
Monday, January 20th, 2014
Borderline personality disorder is a major mental illness, often afflicting women. Rarely mentioned by mainstream media, it is commonly discussed in mental health circles. Borderline personality disorder (BPD) is like an emotional rollercoaster. Mood can change rapidly like a light switch: one moment the person is feeling good but in the next instance, feelings of rage engulf the person.
Relationships can be destructive, engaging in risky sexual encounters. Consequently, sexual trauma is common. Establishing close relationships are challenging and filled with turmoil. (The movie “Fatal Attraction” starring Glenn Close and Michael Douglas, portrays a woman who has borderline personality disorder.) In addition, BPD involves self-injurious behaviors, like cutting, either superficially or in some cases, fatally. Attempts at suicide are common.
Medicines, like antidepressants, mood stabilizers and antipsychotics, have been tried to ameliorate the varying symptoms and behaviors. It is not uncommon to see a variety of medicines – “a cocktail” – prescribed at one time to treat BPD. Medicines, however, only marginally resolve the destructive behaviors and rapidly changing moods. Marsha Linehan, from the University of Washington, took a different strategy, with the development of Dialectical Behavior Therapy (DBT).
DBT was designed to address the emotional turmoil and resulting destructive behaviors. The program is a relatively lengthy investment, almost a year, but it is well worth the time. Participants engage in serious classroom work, involving assignments, practice and counseling. DBT helps the person modulate the emotional turmoil while helping them strengthen their rationale mind.
DBT can be provided in an inpatient setting or in an outpatient setting. A commitment to participate is necessary given the length of the program. The results are far better than any medicines alone or therapy. DBT provides the tools to help a reduce hospitalizations, substance abuse, anger and improve relationships. Ultimately it helps a person live a healthier more productive life.
For more information about DBT: http://behavioraltech.org/index.cfm.
Until next time: treat yourself and others with kindness, it’s good for your brain.
Saturday, November 30th, 2013
Alcoholics Annoymous (AA) was founded in the 1930s, as the method of treatment for alcoholism. For the majority of the century it was the sole strategy for treatment. Later in the century, persons addicted to narcotics took a page from AA’s book and founded Narcotics Anonymous (NA) based on the same 12-step process. Treatment of alcoholism and substance addictions was not without controversy: was it a medical disease? social malady? moral failing?
With advances in research on addiction, a majority of scientists support the medical model and tools have been developed to treat this disease. Recognized as a medical disease, that impacts the brain, scientists developed some biological tools to complement AA and NA.
For example, Campral was introduced in the U.S. early in the 21st century. The purpose of the drug is to reduce the physical and emotional distress of abstinence. Generally, Campral is prescribed to persons who are able to demonstrate abstinence.
In addition to Campral, Naltrexone was designed to help persons addicted to opiates and alcohol. The intended purpose of the medicine is to lessen the positive feelings gained from opiates or alcohol. It works in the brain by blocking opioid receptors thereby diminishing the positive feeling or “high.” (Naltrexone should not be given if the person has liver disease. Also, it should not be given if a person is taking methadone.)
Other supportive medicines have been tried to ameliorate addictions: Topamax, a mood stabilizer, Ativan, a class of medicines called benzodiazepines, and Antabuse, causing sickness when a person drinks alcohol.
Medicines can’t combat addictions alone. Treatment programs, lifestyle changes and positive social support are necessary to improve the lives of persons who have addictions.
Until next time: Treat yourself and others with kindness. It’s good for your brain.
Tuesday, September 24th, 2013
Alcohol and drug use have at least one primary purpose: to provide pleasure. The risks of obtaining drugs – breaking the law – or abusing alcohol – hangovers – are miniscule in comparison to pleasure. Without the component of pleasure involved, “the war on drugs, ” and the disease of alcoholism never would have been issues. So, how does the motive of pleasure lead to the tragedy of addiction?
Moral depravity? Addictive personalities? Dysfunctional families? Of course, none of these choices provide relevant answers to the explanation for addiction. Recent brain studies, brain scans of persons with chronic addictions to drugs from heroin to marijuana and alcohol lead us back to pleasure and a neurotransmitter, vital to pleasure, called dopamine. We experience a similar response when we have a cup of coffee or eat a good meal. But what happens when a “street drug” enters the brain?
For example, methamphetamine is injected intravenously or inhaled, and the chemical referred to as “meth” locates its targets or receptor sites on nerve endings in the brain. Dopamine, a neurotranmitter, is released and there’s a rush of “euphoria and ecstacy.” The rush or chemical avalanche leads to more receptors responding to dopamine, extending the high for hours, depending on the chemical. (You can substitute any drug in the example, like cocaine, marijuana, heroin; each drug has its own desired effects.)
As use continues for weeks and months, the brain responds with an adaptive trait: the dopamine receptors on the nerve cells (neurons) diminish in number, a response to overuse of “pleasure-causing drugs.” To the person experiencing an addiction, the highs or “rush” becomes more difficult to achieve with the same amount of drug. As a result, a person addicted to the drug increases his dose in an attempt to achieve the same level of pleasure that he initially obtained. As more and more receptors diminish, the addiction cycles into a downward spiral of trying to maintain a high at greater costs to brain health.
At this point, the deadly manifestation of addiction is on full display: break-up of families, legal problems, and loss of life. But what can be done to help someone who is addicted break this tragic and potentially deadly cycle? Next time: a look at treatment and beating the pleasure game.
For more information about drug abuse go to the National Institute of Drug Abuse, blog link.
Until then: treat yourself and everyone with kindness, it’s good for your brain and theirs.
Sunday, July 14th, 2013
For decades, scientists debated whether addictions were the result of failure of moral fiber or medical disease. Dr. Nora Volkow, pictured on left, ended that debate by demonstrating the relationship between addiction and the brain.
Drugs and alcohol promote pleasure, leading to a pattern of behavior that’s repeated, seeking a high. If we look more closely, it isn’t a weak will or lack of moral fiber that leads to addiction, but it is the nature of the drug and how our brain responds to specific chemicals. For example, even something as benign as chocolate tugs at our brain’s biochemistry, pushing the dopamine button, so to speak.
Dopamine is one of many neurotransmitters in the brain, but its role is primary in importance when talking about addictions. Nerves or neurons, literally billions, communicate to one another through chemical messengers. Each neurotransmitter has a specific function: in the case of dopamine it is our reward chemical.
In addition, our brain has a “reward circuit” called the limbic system. The limbic system regulates mood, eating, and motivation. And when illicit drugs are taken, like heroin or marijuana, the limbic system becomes more active, resulting in greater feelings of pleasure. Like most things that lead to pleasure, our brain wants to do it again and again. In an addict, that creates cravings!
The National Insitute of Drug Abuse has an abundance of articles and videos to promote a better understanding of the nature of drug addictions. Please go to the following link to learn more: http://www.drugabuse.gov/related-topics/addiction-science.
Next time, I will explore how cravings go awry in addiction.
Until then, treat yourself and others with kindness, it’s good for your brain.
Tuesday, July 2nd, 2013
The wars in Iraq and Afghanistan inflicted trauma to soldiers’ brains resulting in what is called Post Traumatic Stress Disorder or PTSD. Armed Forces were unprepared to treat the mental health wounds of war, manifested in the forms of addiction, domestic violence, and suicide. In addition, some veterans found themselves incarcerated for horrible crimes, including murder.
However, treatment of PTSD is available and effective. Veterans in Minnesota can seek help by contacting their local Veterans Service Officer for resources. Willmar has a service officer located at the Kandiyohi Health and Human Services building. St. Cloud Veterans Administration has an inpatient mental health unit and mental health outpatient clinic. There is also a Veterans Administration Outpatient Clinic located in Montevideo.
Treatment begins with an assessment to determine the extent of the problems. Medicines may be prescribed to decrease or lower activity, in certain areas of the brain, that became overactive during war. In addition to medicines, group support with peers provides a safe place to share similar stories and reduce a sense of isolation.
Addiction to drugs and or alcohol, an attempt to “self-medicate” symptoms of PTSD, needs to be reduced or stopped. This may require treatment in an inpatient chemical dependency program or outpatient program depending on the severity of the addiction.
Family education and support also is a component of healing. Family members have experienced both the terrifying fear of losing a loved one in battle and now by the assault of PTSD. Family members need support and someone to listen to them. They need to know that there is hope and that their loved one can recover.
Please go to http://www.ptsd.va.gov/index.asp.
And until next time, treat others and yourself with kindness; it’s good for your brain.
Thursday, June 6th, 2013
Soldiers from the 3rd Platoon, Charlie Company, 306 Infantry, were known as the “Band of Brothers.” Their mission in Iraq was to drive the same highway, in the Sunni Triangle, patrolling for IEDs (Improvised Explosive Devices). They called their mission, “Mad Max.” On Veterans Day, 2004, a car crashed through barriers and exploded, wounding 7 soldiers of the 3rd Platoon, including Sgt. Shawn Huey.
Ryan Krebs, the platoon medic, witnessed the bloodshed. Smoke and dust were everwhere; two kids were dead. And Sgt. Huey was covered in blood. Krebs attempted to help Sgt. Huey, but shrapnel had severed a major artery. Sgt. Huey’s eyes appeared lifeless according to Krebs.
When Krebs returned home from Iraq, he experienced PTSD. He had nightmares; walking down the street he would check for snipers on buildings, felt depressed, paranoid and saw people in crowds that he knew had died in Iraq.
The other members of 3rd platoon returned to Ft. Carson, near Colorado Springs, one year after their deployment. They were asked if they were experiencing any signs of PTSD, and all of the soldiers said they were fine, for fear of bing stigmatized or thought weak.
It was during the first three years of the Iraq war that there was a rise in failed drug tests. David Nash, age 19, became a cocaine addict. Nash said he felt paranoid and unsafe; cocaine helped him feel calm. He didn’t care about anything else. Cocaine helped shut off his mind from the bad memories.
Ft. Carson experienced an increase in suicides and homicides: 36 suicides and 17 convicted or charged with murder, attempted murder or manslaughter. The leadership at Ft. Carson was unprepared for the problems that followed the soldiers home from war. Since 2002, the diagnosis of PTSD, at Ft. Carson, has gone from 26 cases to 1,120.
Information for this post comes from “The Wounded Platoon,” broadcast in May, 2010, on PBS.
For complete coverage: http://www.pbs.org/wgbh/pages/frontline/woundedplatoon/
Until next time, treat youself and others with kindness; it’s good for your brain.
Monday, May 20th, 2013
Post-traumatic stress disorder may be caused by trauma from war, sexual assault or catastrophic disasters. Veterans of the wars in Afghanastan and Iraq have witnessed unspeakable horrors. As a result of these experiences, soldiers returning home to their communities, homes and families carry emotional scars that will extend far beyond the end of the war. Some of the soldiers’ emotional scars will manifest in the form of nightmares, flashbacks and hyperarousal: the cluster of symptoms fall under the disorder of post-traumatic stress disorder or PTSD. http://www.ptsd.va.gov/public/pages/symptoms_of_ptsd.asp
As a result of the symptoms, it may become extremely difficult to engage in intimate social contacts with a partner, complete tasks at work or participate in community activities, like church or clubs. Flashbacks may be triggered by noises, arousing fear and vivid images of the battlefield or traumatic event. Trust is diminished and intimate relationships become stressed. And events or situations that remind the person of past trauma are avoided. All of these manifestations of PTSD result in a terribly chaotic life to the person and to the person’s family and friends.
A closer look at the brain reveals a disturbance to an area called the basal ganglia. Under normal circumstances, the basal ganglia helps regulate or set an acceptable level of anxiety. If the area becomes overactive, as is the case in PTSD, then the person’s level of fear is exacerbated. Each experience, whether going to the grocery store or visiting a friend, might be charged with extreme anxiety and perhaps an exaggerated fear of death. Please check brain scan displaying PTSD: http://www.amenclinics.com/the-science/spect-gallery/item/anxiety?category_id=141. Unless this overactive area of the brain is treated, the outcome is poor.
Treatment combines medicines, counseling, and peer-supported groups. Medicines like Depakote, Tegretol or Lithium might reduce the overactive basal ganglia. This results in the reduction of anxiety and decline in fear. As a result, the person is more likely to participate in counseling and group activities with peers. In addition, family relationships can begin to mend, and the person can make inroads toward reconnecting with community. Life becomes less chaotic.
For more information about PTSD, go to the Department of Veterans Affairs: http://www.ptsd.va.gov/index.asp
Next time: I will take a more detailed look at the human side of PTSD. Until then, treat yourself and others with kindness, it’s good for your brain.
Monday, May 13th, 2013
At the Mendota Heights Mental Health Institute (Madision, Wisonsin) in the 1970s, mental health professionals observed that persons discharged to the community, following treatment in a hospital, returned multiple times to the hospital over the years. This phenomena was called, “the revolving door.”
At the Mendota Heights Mental Health Institute, Len Stein, Mary Ann Test, Arnold J. Marx, William H. Knoedler and Deborah J. Allness devised a model of care to disrupt “the revolving door”: the model was called Assertive Community Treatment. Assertive Community Treat or A.C.T., in essence, brings treatment to where the person is living: an apartment, supported-living environment, homeless shelters. They found that treatment interventions needed to be extended into the community in order to strengthen gains made in the hospital.
The Assertive Community Treatment team generally consists of a psychiatrist, team leader, nurses, rehabilitation specialists or generalists, vocational rehabilitation specialist, and a chemical dependency counselor. The idea is to integrate the strengths of the team with a level and frequency that fits the person’s needs at the time.
For example, a person with schizophrenia may need help with medicine adherence. As a result, the A.C.T., team can either bring medicines to the person a number of times a week and do “eyes on meds.” This intervention will reduce the risk of stopping medicines and subsequent risk of symptoms returning. The number of visits each week can be adjusted based on the benefits and outcome.
Another advantage of A.C.T., services is that the team is much more responsive and efficient than traditional services in mitigating a crisis. Since the A.C.T., team is in contact with clients on a routine basis, the team is more sensitive to changes in behaviors. And as a result, the A.C.T., team can adjust their schedule of visits to meet the person’s needs during those critical periods. This may include an unscheduled contact with the team’s psychiatrist.
A.C.T. has another advantage: the team can continue to work with the person for an extended period of time, thereby strengthening gains the person has made in their recovery. This ability to maintain a long-term relationship results in a strong working-knowledge by the team of the person and a sense of confidence by the person that things aren’t going to fall apart again.
A.C.T. teams cover both metro and rural areas. Some of the teams are linked to local mental health centers. In 2005, I was a member of the Great River A.C.T., team in Monticello, MN., which was connected to Central MN. Mental Health Center from St. Cloud, MN. In Willmar, Woodland Centers maintains an A.C.T., team that serves the surrounding area, helping persons with severe mental illness live in their communities.
The model of care designed by the pioneers at Mendota Heights Mental Health Institute in the 1970s has solved the “revolving door” problem. And today, A.C.T., is recognized as an “evidenced-based” practice. The benefits to persons with mental illness have been shown, under scientific scrutiny, to work.
You can learn more about accessing an A.C.T., service in your area by contacting your county social services or local mental health center. For more information about A.C.T. check out this link: http://www.nami.org/Template.cfm?Section=ACT-TA_Center&template=/ContentManagement/ContentDisplay.cfm&ContentID=132547
And until next time, treat yourself and others with kindness, it’s good for the brain.