How Mindfulness can overcome depression, teach us how to ignore unwanted thoughts and help us choose what is healthy for ourselves.

You've seen the advertisements. They say: "I've been on my medication for a long time and I still suffer from depression. So maybe I should add a second medication."

On the other hand, people say that one definition of craziness is when you are doing something that doesn't work, and you go on doing it. (One medication isn’t working so I’ll take another. That sounds like, "it's bad enough being depressed, they think I'm crazy also?")

I understand where these drug companies are coming from. They say that "depression is a real disease" so it necessitates a real medication. I agree that medication can be an important, and sometime critical, component of the fight against depression. But who says that medication is the only cure for a disease?

You know what depression is: That heavy darkness in which your mind gets stuck on dark thoughts. There is no strength or pleasure. Life seems to continue against your will.

We often find that even after medication helps, there is still no real joy in life. The pain might be gone, but there is still a lingering "stuckness." It seems like sooner or later there will be that inevitable hurdle in life, a wrench in the works, that can push you down again into that black abyss.

So you'll go running for the shelter of some sad little helper (to paraphrase the Stones).

But is there another way? Do you have to rely only on another chemical? What about dealing with the depression itself? Dealing with the thoughts that bring us down? Is there an effective way to move away from depressing thoughts?

CBT and Medication - Can They Bring You Back to Joy?

Many therapists will tell you about Cognitive Behavioral Therapy (CBT), which has been shown in research, when used with antidepressants, to be one of the most effective forms of therapy.

That means that it works about 60% of the time.

That's great if you are not part of the other 40% and you don't mind the side effects of the medication.

Also, CBT does not get you to a place of joy and happiness. While you might not be depressed, most of us still want to feel good and have a real sense of well-being. We would like to be one of those people who are happy to get out of bed in the morning.

While CBT is really on to something when it teaches us to attack depressive thoughts, there is an alternative that will work for many of the people who don’t succeed with CBT. CBT teaches us to confront, attack and change our patterns of thinking. But do we really want to attack, conquer and change our depressive thought patterns. That is a lot of work, and who wants to fight when you're depressed? That is where mindfulness comes in. Mindfulness is a technique that allows us to have thoughts and keep them from bothering us.

Feeling Better with Mindfulness

The main idea in mindful meditations is to look at your thoughts as fleeting curiosities. This is added to a perspective that we need to live in the present. Not to ruminate about the past or worry about the future. Now that already sounds good to people who suffer from depression. It is sort of like when I was a kid, and there was a big kid who would threaten me. My mother would tell me to ignore him. She said if you don't react he'll leave you alone. I said, "But he's going to beat me up!" She told me that he is looking for a reaction and I need to let him find it somewhere else. I said, "but he's picked on me in the past!" She said, "That's in the past. Let it go!"

That's the attitude you need for mindful meditation. You learn to ignore the threatening thoughts. Especially with negative, beating-you-up type thoughts, but also for any thought. In mindful meditation you learn how to observe your thoughts without letting them conquer you or control you or your emotions. You learn to detach yourself from your thinking in such a way that you can consciously decide whether or not the thought is worthwhile engaging or not.

So if you are living in the present, and monitoring your thoughts, what might happen? Let's say you’re eating dinner. Taking your time. Since everybody’s mind is constantly wandering, you might come up with a thought such as, "this is like the time we went out and I messed up." You didn't ask to think this thought. You don't even like it. Usually you begin to push it out. Or embellish it. Or think about how bad it is to think that way. But with a mindful perspective you are able to say to yourself, "Interesting that I have that thought. I wonder what thought will come up next." As you watch your thoughts flow by, sooner or later there might be one you like. You can then decide whether or not to hold on for a few moments or let that one go by also.

Mindfulness - The Two Basic Methods

There are two basic methods to achieve this goal:

One is a quiet training and the other is an active meditation. How are they done?

1. Quiet Mindfulness Training

To train your brain to refrain from unhealthy engagement in its own thoughts you need to practice on a daily basis. Here are the basic steps:

1. Get comfortable. You do not need to be sitting cross-legged on a mat. Any comfortable position is fine. You can even lay in bed, but not if you are going to fall asleep.
2. Make sure that you won’t be disturbed. Shut off your phone. Close the door. You do not really need quiet, since you want to learn to use extraneous noises for your meditation also.
3. Most people find it necessary to close their eyes. This helps you tune into you internal processes. Some people can do this with their eyes open. In the long run it is helpful to gain the skills to be mindful when you are engaged in other activities.
4. Use your mind to focus on your internal processes. “Watch” yourself breathe. Notice the flow of air going gently through your nostrils and into your lungs. Observe the other sensations of your body like the pressure of the chair, the sounds in the air, etc. Breathe normally, and continue to breathe normally.
5. As your mind begins to wander gently bring your attention back to your breath. This is the most important step. This is the actual skill you need to practice. You can note that your thinking has wandered, but don’t engage in the thought. Just say to yourself something like, “Oh, my mind wandered off. OK. Let’s go focus back on the breath.”
6. Continue for at least ten minutes. Some recommend at least 20 minutes. I think everybody is different. Find you own optimal time.
7. Repeat every day.

 2. Active Mindfulness Training

The second method of mindfulness is based on connecting actions with specific thoughts. You take some normal activity and infuse it with a mindful purpose and direction. It should be a normal daily activity and a positive thought that is generalizable to your whole life. 

I want to share with you one of my favorites.

We all wash our hands multiple times a day. We do it without thinking or at least while thinking about something else. We think about the food we are about to eat, or the meeting we are getting late for. Washing hands is a healthful activity which we waste as either protective or preparatory. Why not make it healthful for the emotions and spirit?

This is the suggestion: Take time to notice how the water flows over your hands. Think of this as a metaphor for life. Life flows by, and all things pass. Good and bad. Life just flows on by, and we can catch the opportunity to savor the good parts and allow the bad parts to flow by.

Since you have opportunities to practice this a few times a day, you will begin to train yourself to adapt this perspective.

Give it two weeks of consistent practice, I assure you, you will feel better.

Image Copyright: Premasagar

Although lifestyle changes should not replace professional treatment (medication and psychotherapy) combining treatment with a few easy changes to your daily routine can accelerate the healing process.

Relatively easy to integrate lifestyle changes can help a lot to improve the way you feel. Lifestyle changes are not really a substitute for medication or psychotherapy, but when you make an effort to live better while participating in formal depression treatments, you can improve the rate and totality of your recovery from depressive symptoms.

None of these changes require a great deal from you, none cost money and all are basically good advise for anyone, whether depressed or not. Additionally, taking proactive steps to improve the way you feel can help you to retake some sense of control over your life and emotions – which is an important victory in any journey of recovery.

Here are 9 easy lifestyle changes to ease the symptoms of depression:

1.

Exercise

Getting your heart pumping for 30 minutes, just 3 times a week, can help enormously. Some studies have shown that this limited amount of exercise each week works as well as anti depressant medication for people with mild or moderate depression. Exercise causes the release of “feel-good” chemicals in the brain that can create a better mood. Regular exercise can help you feel better physically, which can translate into better emotional well being, as can improvements in physical appearance related to regular exercise. Regular exercise can also improve energy levels, which is something that people with depression often struggle with.

It can be a challenge to get off the couch when feeling depressed, but the payoff is more than worth it.

2.

Eat well

Eating fatty meals or highly processed carbohydrates can lead to sluggishness or bouncing blood sugar levels. Try to eat a balanced diet, low in processed carbs and high in vitamins and minerals, high in omega 3 fatty acids (from fatty fish) and especially foods high in B-complex vitamins.

3.

Get Enough Sleep

It’s tough for anyone to feel upbeat without enough sleep, and chronic sleep deprivation has been implicated in higher rates of teen depression. Getting enough sleep is essential.

4.

Do Yoga or Meditate

Both of these mind-body activities are proven to reduce stress levels and induce a sense of relaxation that lingers long beyond the end of a meditation or yoga session. Anything you can do to reduce stress while depressed can have a great impact on the way you feel.

5.

Get Out of the House to See Friends or Family

People with depression often withdraw socially, but this isolation is not helpful to the recovery process. Make an effort to get out of the house and into the company of friends or family as often as you can. Positive social support and engaging in enjoyable activities out of the house can quicken your recovery.

6.

Limit Your Commitments

Depression saps your energy, compromises your decision making skills and can reduce your memory – while in the midst of a bout of depression, don’t expect to be at your productive best. Trying to maintain a hectic schedule while feeling depressive symptoms creates stress, which can exacerbate the problem. Instead, reduce your commitments and give yourself the freedom to take it easy, without feeling guilty about it.

7.

Get Into the Sunlight

Exposure to sunlight can have a buoying effect on mood, and insufficient sunlight can lead to certain forms of depression. Getting out of the house and into the sunlight each day can do you good.

8.

Steer Clear of Alcohol or Drugs

Although a couple of drinks can elevate mood temporarily, those drinks come with a price tag. Alcohol is a depressant and can worsen symptoms of depression. Alcohol and other drugs should be avoided.

9.

Lean on Your Faith

People who feel a strong sense of spiritual faith are at a reduced risk for depression. We are all spiritual beings, especially during times of hardship, and so relying on a personally meaningful spirituality during a period of depressive symptoms may help.

Image Copyright: Rosswebsdale

Getting out and doing something - anything - may be the last thing you feel like doing, but staying at home and in bed only reinforces negativity and leaves you with little to focus on other than the ruminative thoughts of depression. Learn why getting up and doing pretty much anything can reverse this negative spiral of depression and help get you feeling better, faster.

While prescribing yourself fun activities to counter to feelings of depression sounds about as likely as prescribing yourself a steak dinner to best an upset stomach, doctors say that forcing yourself to do things can help a lot when you’re feeling down.

Withdrawing from responsibilities and activities you enjoy can seem like the best course of action when in the midst of the lethargy and low mood of depression, but while staying at home with the covers over your head may seem like the most sensible course of action when you feel so down, forcing yourself into motion is actually the only thing that will interrupt a negative spiral of inactivity and ever worsening mood, energy levels and guilt. 

Why is staying inactive such a bad idea?

Missing Out on Pleasure

When you feel depressed you may feel like you lack the energy, motivation or desire to get up and do much at all, so when opportunities for fun activities arise – like seeing friends or family, going to the movies, paying sports etc. – you don’t feel like going or feel like you don’t have the energy to go or you can’t face people right now; and so you stay home.

By staying home you miss the opportunity to have an enjoyable experience and to feel pleasure and to get energized and become more available to future opportunities for fun and enjoyment. Instead, you stay at home and feel no joy or energy or fun, and you become just a little bit more entrenched in a negative spiral of lethargy of action and corresponding depression of mood.

Failing to Take Care of Responsibilities

When you feel depressed and lack energy and motivation it’s easy to step back from making decisions and even from taking care of regular everyday tasks at work or around the house – sometimes it’s just easier to bypass the mess in the living room or the taxes that need doing and head to bed for a nap.

Unfortunately, those responsibilities and tasks we neglect have a nasty habit of building on us, and the evidence and reminders (the growing mess in the kitchen, the bill reminders from creditors, emails from unhappy colleagues etc.) of our neglect only make us feel worse, as we feel guilt over our failures and as the prospect of digging out of the hole we’re in seems ever more difficult as the days go by.

How Getting into Action Can Help You to Start Feeling Better

There is no magic cure for depression and you can’t expect a single walk in the park to reverse such a debilitating illness, however, the more you force yourself into action the more you do to fight against the depression that pulls you down.

“We can nudge ourselves to do something… even though we feel like just sitting there instead. This temporary increase in activity helps stimulate the left frontal cortex, which in turn boosts mood and leads to a bit of reduction in depressive symptoms, which then makes it a little easier to initiate more activity, and so on. In other words, by simply engaging in activity–any activity–we can change the brain in a way that helps reverse depression.” ~ Dr. Stephen S. Ilardi¹

It won’t happen immediately, but in time, as you incorporate more pleasure into your life and meet ever more of your responsibilities - the enjoyment, energy and satisfaction you pull from these activities can go a long way to reversing that downward spiral of depression and to restoring a more positive mental outlook.

Not convinced?

Here are 5 meaningful ways that just getting off the couch or out of bed and doing something positive, no matter how small that activity is, helps to get you out of that negative downward spiral of depression...

5 Ways Activity Can Better Feelings of Depression:

1. 

Activity Gives You Something Else to Focus on

When you sit at home inactive you are left with little for stimulation or focus other than your unhealthy ruminative thoughts. When you engage in a purposeful activity you are forced to focus on something other than yourself, if even for a short while.

2. 

Activity Can Bring Pleasure 

You may not think that taking the dog for a walk will do much for your mood, but sometimes it’s hard to fight against the subtle enjoyments of seeing your dog’s happy wagging tail and the smiles of your neighbors you pass and the crisp evening air and so on.

Just do it, because it won’t make you feel worse and it may well bring you some small pleasures.

3.

Activity Can Bring Satisfaction

There is no joy or satisfaction to be found in observing your obligations mount or go unfulfilled. You may not feel at all like taking on a task, but the truth is, not doing it is going to feel worse in the end, so you might as well buckle down and force yourself to take care of something that needs doing.

The important thing here is to keep things manageable. If the whole house is a disaster area, then the idea of tackling that big job can be just too daunting, so break it down into much smaller bits that are easily achievable.  Don’t try to clean the whole house at once – just do one job now, say clean the dishes, and then commit to doing one more tomorrow, for example, cleaning the bathroom.

Your purposeful activity brings you focus, you feel satisfaction for getting something that’s been nagging at you completed and you have a plan to continue with fulfilling your obligations. Now, instead of feeling guilt and dread when looking at your dirty house, you can feel satisfaction and hope…all from just washing the dishes and making a plan to do one more thing!

4.

Activity Can Energize You

While you may feel far too tired to drag yourself out to do something fun or to accomplish something that needs doing, the fatigue of depression is actually worsened by laying around doing nothing and actually reversed by getting out and doing something active – and once you have a little more energy you may just feel like you’re ready to do something else that will bring you even more energy!²

5.

Activity Can Get Your Endorphins Going

Any type of activity that gets your heart rate pumping can lead to an endorphin release and the feel-good benefits of exercise. Moderate exercise is a proven depression beater that also reduces immune chemicals associated with depression.³

So don’t wait until you feel like getting out and doing something – when you’re depressed that day may never come, instead force yourself into action and into doing things you enjoy and things that need doing, and you will soon start reaping the benefits in mood and happiness.

Start small but make a list of a couple of fun activities and a couple activities that need doing and make a commitment to complete these activities over the next few days. It’s important to start off with things that, although you don’t want to do, you know you can manage with reasonable effort.

• Don’t start off by deciding to paint the whole house, start off by deciding to water the flowers
  
• Don’t start off by deciding to attend the all-day company picnic, start off by committing to spending a few minutes today going for a walk, or reading a book

As you start adding activity to your routine, increase it as you’re able, one manageable step at a time - one manageable day at a time. You can do it and you will feel better for it.

Activity Ideas

Not sure where to get started? Here’s a list of ideas for you to think about trying.

1. Read a book, do a crossword, play computer games
   
2. Take a bath, do your nails, get a hair cut
3. Go for a walk around the block
4. Do yoga
5. Play a musical instrument
   
6. Put on some music you like
   
7. Watch a movie, take some time to watch the sunset or look at the stars
8. Go out for a meal with a friend, go to the movies with a friend, go to a sporting event
   
9. Paint or draw or do something else artistic
   
10. Go swimming or go to the beach and sunbathe
11. Go shopping for a new outfit
    
12. Go for a walk and get an ice cream cone
13. Get more involved with your hobbies, whatever they may be
    
14. Cook yourself a good meal
15. Go for a short bike ride, or go for a hike on a nature trail
    
16. Clean the house,
    
17. Wash the dishes
    
18. Catch up on a work project
    
19. Pay some bills
    
20. Answer a few emails
    

Do whatever you enjoy and whatever needs doing! The point isn’t to stress too much about what you should do, and just get out and do anything…it’s all in the doing.

Image Copyright: Jesse.milan

An easy to administer 30 question yes or no test for seniors, used to evaluate the existence and/or severity of depression.

Depression is not a normal part of the aging process and yet far too many elderly patients with depressive symptoms suffer through this mental illness, undiagnosed and untreated.

Doctors may miss the signs, other conditions may mask the symptoms and older patients may feel reluctant to complain about the way they feel, but whatever the reason, untreated depression is a tragedy and older patients respond very well to treatments for depression.

The Geriatric Depression Scale

The Geriatric Depression Scale is a test designed to spot depression or evaluate the severity of depressive symptoms. The test is based on 30 yes or no questions, and was developed as an easier screening test for seniors, including elderly people with diminished cognitive capacities.

The test is easy to administer and since its development in 1982, has proven a reliable indicator of depression.

1. Are you basically satisfied with your life ?
2. Have you dropped many of your activities and interests ?
3. Do you feel that your life is empty ?
4. Do you often get bored ?
5. Are you hopeful about the future ?
6. Are you bothered by thoughts you can't get out of your head ?
7. Are you in good spirits most of the time ?
8. Are you afraid that something bad is going to happen to you ?
9. Do you feel happy most of the time ?
10. Do you often feel helpless ?
11. Do you often get restless and fidgety ?
12. Do you prefer to stay at home, rather than going out and doing new things ?
13. Do you frequently worry about the future ?
14. Do you feel you have more problems with memory than most ?
15. Do you think it is wonderful to be alive now ?
16. Do you often feel downhearted and blue ?
17. Do you feel pretty worthless the way you are now ?
18. Do you worry a lot about the past ?
19. Do you find life very exciting ?
20. Is it hard for you to get started on new projects ?
21. Do you feel full of energy ?
22. Do you feel that your situation is hopeless ?
23. Do you think that most people are better off than you are ?
24. Do you frequently get upset over little things ?
25. Do you frequently feel like crying ?
26. Do you have trouble concentrating ?
27. Do you enjoy getting up in the morning ?
28. Do you prefer to avoid social gatherings ?
29. Is it easy for you to make decisions ?
30. Is your mind as clear as it used to be ?

This is the original scoring for the scale: One point for each of these answers. Cutoff: normal-0-9; mild depressives-10-19; severe depressives-20-30.

1. no
2. yes
3. yes
4. yes
5. no
6. yes
7. no
8. yes
9. no
10. yes
11. yes
12. yes
13. yes
14. yes
15. no
16. yes
17. yes
18. yes
19. no
20. yes
21. no
22. yes
23. yes
24. yes
25. yes
26. yes
27. no
28. yes
29. no
30. no

Image Copyright: Theeerin

Men are often reluctant to get help for a mood disorder, feeling that complaining about "feelings" is somehow, unmanly; yet millions of American men live with depression, it is truly an equal opportunity mental illness! Learn the facts about men's depression, the different ways men display symptoms of the disease and learn how and why to get treatment that works.

Male depression is a silent epidemic. Millions of American men suffer from depression every year, but depression is still viewed in some quarters, as a women’s disease.

Depression greatly reduces quality of life, and although it is a very treatable disorder, men are far less likely to initiate this treatment. Depression is a mental illness with both psychological and physiological consequences; depressed men are more likely to miss work, to get sick, to abuse drugs or alcohol and far more likely to consider, or commit, suicide.

Men may suffer from depression as frequently as women, but millions of American men maintain a silent stoicism about the way they feel, perhaps feeling that real men don’t complain about their emotions; and so they suffer, and their families suffer and their careers suffer – and for very little good reason.

There is nothing unmanly about mental illness, but there is much that is tragic about living unnecessarily with a very treatable condition.

What Are the Symptoms of Depression in Men?

People with depression feel symptoms such as sadness, hopelessness, fatigue and guilt for most of each day, for 2 weeks in a row or longer. 

The actual symptoms of depression vary little between the sexes, but observable symptoms can differ somewhat.  Men may feel less able to express feelings and are less likely to cry or talk of suicide, due likely to gender ideas of how men and women are "supposed" to act. Depressed men are more likely than women to display symptoms of depression such as:

• Irritability
• Risk taking
• Aggression
• A lessening of sexual interest or ability
• Alcohol or drug abuse

Untreated depression is senseless, and although a culture of stoicism influences the way men reveal the way they feel, no one should attempt to soldier through a bout of depression.

Depression is one of the leading causes of suicide, a fact that is particularly of concern for depressed men, as although women are more likely to attempt suicide, men are far more likely to succeed. In American, 80% of those that commit suicide are men.

Getting Better

There is nothing to be gained from “toughing out” a period of depression. It won’t work and you will suffer for nothing. The earlier and more aggressively you initiate treatment, the quicker you can get back to feeling like your usual self.

Treatment most commonly consists of medication and psychotherapy; most people are advised to make certain lifestyle changes as well.

To ensure that treatment works like it should:

• Make sure to honestly discuss how you are feeling with your doctor or health care provider. It can be helpful to write down a few points about your symptoms prior to talking with your doctor, so you remember what you need to say.
• Don’t think trick yourself into believing that medication is enough. Psychotherapy is an integral and effective aspect of treatment, regardless of your gender.
• Stick with treatment – healing takes time, and it can take a couple to many weeks for anti depressant medications to become fully functioning. Too many people discontinue treatment that would have worked, had they just given it a chance.
• Avoid drugs and alcohol. Men are more likely than women to deal with symptoms of depression with substance abuse; and while a few drinks can make you feel better temporarily, over the long-run, alcohol can make the symptoms of depression worse.
• Take care of yourself; get enough sleep and exercise, comply with your treatment routine and avoid stress like the plague!

Image Copyright: Derbobbel

Get the basic facts about this distressing symptom of SSRI/SNRI and tramadol withdrawal. What they feel like, what makes them worse and what (might) make them better.

"Every morning I jump out of bed and step on a landmine. The landmine is me. After the explosion, I spent the rest of the day putting the pieces together." - Ray Bradbury¹

The brain zaps: hard to describe, impossible to ignore and very poorly understood. Read on to learn:

• More about how other people describe their brain zap symptoms
• What likely causes the brain shivers
• What worsens symptoms
• What might improve your situation

Brain Zap Symptoms

People describe the sensations of a brain zap as like:

• Sudden extreme dizziness
• The feeling of an electric shock in your brain or a brain shiver
• Feeling like your brain is shaking inside your head² 
• Feeling like a flashbulb is going off in your head³
• Feeling like there’s a strobe-light flashing in your head
• A feeling of falling or vertigo
• Feeling lightheaded for a few seconds after the occurrence of the brain shiver, or experiencing nausea or a ringing in the ears for a few seconds after the zap.
• Feeling like you hit your funny-bone…in your brain

Why Do They Happen?

No one knows for sure why they happen or what’s going on in the brain when they happen. Since they occur during withdrawal from medications that increase serotonin, it is logical to assume that a temporary serotonin deficiency causes the symptoms during neural re-regulation.⁴

Are They Dangerous?

No. Although they are quite disconcerting, brain shivers aren’t considered harmful.

What Worsens the Brain Zaps?

Since brain zaps are a symptom of SSRI/SNRI or tramadol withdrawal, you can probably minimize your brain zaps with a slower taper rate.

Anecdotal reports indicate the following may also exacerbate your brain zaps:

• Making sudden movements, especially sudden head turns
• Moving your eyes from side to side quickly
• Bending down
• Being very tired
• Having a cold or fever

Is Brain Shivers or Brain Zaps a Medical Term?

Not really. For lack of a better term doctors sometimes code brain shivers under the term paraesthesia.

Paresthesia is defined by the National Institute of Neurological Disorders and Stroke as:

• A  burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.⁵

Treatments

There is no known treatment to alleviate brain zaps.²

As always, talk to your doctor before making any medication discontinuation decision. Some suggestions your doctor might make include:

1. If tapering and symptoms are bearable, just wait them out, as they’ll probably dissipate within a few days.
2. If tapering and brain zaps are unbearable, try slowing the rate of taper or returning to a dose that’s manageable and then restarting your taper at a slower rate.
3. If tapering off an antidepressant with a quick half life, switch to an antidepressant with a long half life.⁶
   

Alternative Remedies?

Anecdotal reports indicate the following supplements may help.

• Omega 3 fish oil supplements are frequently recommended in forums as a treatment to reduce brain zaps.
• A multi-vitamin and/or vitamin B-12

Note – these recommendations come from laypersons without medical training. Do not take these endorsements as expert advice.

Share Your Experiences

This symptom is a poorly understood creation of modern medicine. Hopefully we will someday update this page with research-backed treatments that work, but until that time, people enduring the brain zaps aren’t left with much to go on.

Given this situation, if you live with the brain zaps and you find a treatment, supplement or home-remedy that seems to help, please leave a comment below to share what you know, because what works for you might also work for someone else.

Image Copyright: Wikipedia

Protect yourself and those you love - Take this 4 item suicide behaviors questionnaire and find out if you’re considered ‘at risk’ to commit suicide.

Here's a grim and saddening fact: today, an American is more likely to die from suicide than from a motor vehicle accident.¹

So just as you take precautions to stay safe on the roads (you buy cars with airbags, you buckle up, etc.) you should also take precautions to protect yourself, and those you love, from an even greater risk of death: You make mental health a priority, you get help when it’s needed and you never ignore the warning signs of self harm or suicide.

As a starting point, ask yourself: are you or a loved one deemed ‘at risk’ of suicide?

Probably not something you'd know offhand; fortunately, you can find out by answering the following 4 questions as truthfully as you can.

4-Questions: The SBQ-R Suicide Risk Assessment²

The SBQ-R is an abbreviated name for The Suicidal Behaviors Questionnaire – Revised. It is a clinically valid and reliable test that is used to quickly identify people who are at increased risk to commit suicide.³

Instructions

Answer each question as honestly as you can. Circle one answer only for each question.

~ ~

Question 1. Have you ever thought about or attempted to kill yourself?

(circle one only)

• 1 = Never
• 2 = It was just a brief passing thought
• 3a = I have had a plan at least once to kill myself but did not try to do it
• 3b = I have had a plan at least once to kill myself and really wanted to die
• 4a = I have attempted to kill myself, but did not want to die
• 4b = I have attempted to kill myself, and really hoped to die

~ ~

Question 2. How often have you thought about killing yourself in the past year?

(circle one only)

• 1 = Never
• 2 = Rarely (1 time)
• 3 = Sometimes (2 times)
• 4 = Often (3-4 times)
• 5 = Very Often (5 or more times)

~ ~

Question 3. Have you ever told someone that you were going to commit suicide, or that you might do it?

(circle one only)

• 1 = No
• 2a = Yes, at one time, but did not really want to die
• 2b = Yes, at one time, and really wanted to die
• 3a = Yes, more than once, but did not want to do it
• 3b = Yes, more than once, and really wanted to do it

~ ~

Question 4. How likely is it that you will attempt suicide someday?

(circle one only)

• 0 = Never
• 1 = No chance at all
• 2 = Rather unlikely
• 3 = Unlikely
• 4 = Likely
• 5 = Rather likely
• 6 = Very likely

Scoring

You circled one answer for each question. Each answer you circled has a number beside it, such as 1, or 2, or 2a or 2b etc. To add up your total score, simply add up the 4 numbers beside your answers.

For example:

(Question 1 = 3a) + (Question 2 = 2) + (Question 3 = 2b) + (Question 4 = 3)

Total score 3+2+2+3 = 10

Are you at risk? - Interpreting Scores

• For adults in the general population: People with a score of 7 or greater are considered at risk of suicide

• For adults in a psychiatric inpatient program: People with a score of 8 or greater are considered at risk of suicide

Image Copyright: Taylor Dawn Fortune

Should you take an SSRI/ Antidepressant? Find out about the FDA's black box warning on SSRIs for those under 25 years of age.

Do Antidepressants/ SSRIs, Such As Prozac, Paxil or Zoloft Cause an Increase in Suicidal Thinking?

The American Food and Drug Agency (FDA) has placed a black box warning label (their strongest label advisory) on the use of antidepressants/ SSRIs for children and teens, and has more recently extended the warning to involve patients up to the age of 24.

The FDA found that SSRIs increased the risks of suicidal ideation, especially during the initial period of treatment.

How Did The FDA Link Suicide to SSRIs?

The FDA reviewed a series of 24 clinical trials that evaluated the use of antidepressant medications on children and teens, to reach their conclusion.

Other organizations, such as the Journal of the American Medical Association, have looked at the issue of SSRIs for use by teens and not found a significant link. Most clinicians agree that more research is needed.

The Problem

Doctors have made fewer diagnosis's of depression (and thus initiated less pharmacological and psychotherapeutic treatments) since the FDA placed the black box warning on the use of SSRIs for those under the age of 24.

While the black box warning was obviously intended to increase patient safety, the warning led to a reduction in prescriptions issued and a corresponding increase in overall rates of teen suicide.

The Biggest Risk of Suicide…

Whether or not SSRIs increase the risks of suicide in certain populations, withholding diagnosis and treatment out of uncertainty does not help. As child and adolescent psychiatrist David Fassler, M.D. of the APA stated before an FDA advisory panel,

"The most important point that I can make is that the biggest risk for a child with depression is to be left untreated."

Do SSRIs Increase the Risks of Suicide in Adults?

Depending on the study quoted, SSRIs have either a neutral or positive effect on the prevention of suicide amongst depressed adults. SSRIs have been shown to prevent suicide amongst depressed seniors.

What Should I Do?

Get informed and get second opinions and to be safe, learn about the risks and warning signs of suicide, and be vigilant, especially during the first phase of SSRI treatment, or any period after an adjustment in SSRI dosage.

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As many as 5% of adolescents will suffer a major depression, and depression dramatically increases the risks of suicide, the 3rd leading cause of teenage death. Thankfully, teen depression, if recognized, is very treatable.

Although parents sometimes discount the odd behaviors of a teenage son or daughter as just “typical teenage moodiness” teens with depression face a lot more than just normal adolescent angst.

Between 4 and 5% of teens will experience a major depression during their adolescent years.

Only about a third of these teens will receive treatment, yet treatment can help to reduce the symptoms of teen depression in about 80% of cases.

What Are the Symptoms of Teen Depression?

Few teenagers seek help for depression on their own, in most cases, it is a concerned parent, teacher or friend that raises the alarm and causes the initiation of treatment.

For this reason, it is important for anyone who lives or works with adolescents to know the signs and symptoms of teen depression.

The symptoms of teen depression can include:

• Regular sadness, crying spells, or feelings of guilt or hopelessness
• Anger, aggression or irritability
• Changes in eating or sleeping habits
• A sudden and sustained drop in school performance
• Social withdrawal
• Feelings of low self esteem or low self confidence
• Indecisiveness and forgetfulness
• Unexplained and frequently occurring aches and pains
• Feeling very sensitive to criticism
• A lack of motivation or energy to do much of anything
• Alcohol or drug abuse
• Frequent boredom
• Suicidal thoughts or actions

Teens who display any of these symptoms for 2 weeks or longer may have a treatable mental illness.

Who Is Most at Risk for Teen Depression?

Having a close relative who has experienced a major depression increases your risks for the disorder; depression is a genetic disease, but genetics do not tell the whole story. Some people who are very genetically susceptible to the disorder never experience it, and other people who have no family history of depression, succumb. Environmental factors are significant.

• Stress is a major causative factor for depression. Living in a home with a lot of conflict, breaking up with a boyfriend or girlfriend or suffering from trauma or assault are all the kinds of events that can increase stress and increase the risks of depression.
• Teens who have low self esteem or who have a very critical or pessimistic personality type may be at increased risk
• Poor school performance is correlated with an increased risk of depression
• Recent research indicates that teens who chronically under sleep may be at an increased risk
• Poor social skills are correlated with increased incidence rates

Girls are twice as likely to be diagnosed with depression, due likely not to an increased incidence rate but rather to an under diagnosis of depression in men of all ages.

Teen Depression Treatments

Depression treatments for teens are similar to those for adults, and they work very well for the majority of people. Depression does not necessarily go away or get better on its own – sometimes it gets worse and lasts for years. The sooner a depressed teen initiates treatment, the sooner they can start feeling good again.

A doctor will likely want to test for and exclude certain medical conditions (such as hyperthyroidism) that can cause depressive symptoms.

The 2 most common treatments for teen depression are:

1. Psychotherapy (talk therapy)
2. Antidepressant medications

Although SSRIs (the most commonly prescribed medication for teen depression) have been implicated in some incidents of suicidal ideations and attempts, most experts still recommended their use. The SSRIs are better tolerated than other types of antidepressant and most experts feel that the advantages of medication treatment outweigh the slight risks. Experts will recommend that parents of teens using SSRIs pay close attention to changes in behavior and to any signs that might indicate a worsening of depression or suicidal thoughts, particularly during the initial phase of medication treatment.

Lifestyle Modifications

Teens diagnosed with depression should always seek professional help and should generally comply with recommended treatments. In addition to medication and psychotherapy though, teens can make certain lifestyle modifications that can prove helpful, such as:

• Making sure to get enough sleep
• Eating a healthy diet moderate in carbohydrates
• Engaging in regular cardiovascular exercise
• Minimizing life stresses as much as possible
• Keeping a journal
• Avoiding alcohol and drugs

Teen Depression and Suicide

• Suicide is the third leading cause of death for teens, and teens with depression are 12 times more likely to attempt suicide
• 90% of those that commit suicide have a mental illness and 80% of teens who commit suicide ask someone for help in the period leading up to the event
• Girls are far more likely to attempt suicide, but teen boys are far more likely to succeed. Teen boys are more likely to use guns, and guns are used in about half of all successful suicides
• According to the National Youth Violence Prevention Center, 1 in 5 teens has thought about suicide

Please read teen suicide risk factors and signs, for a more complete overview of the subject.

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There have been recent reports about how Ketamine, also known as "Special K", has surprisingly quick and positive effects on the symptoms of bipolar disorder. Many people might be tempted to try it. What is Ketamine? Is there evidence of its effectiveness? Is it worthwhile? For whom might it be worthwhile?

Could a dangerous and abused recreational drug be a miracle cure for a psychiatric disorder?

This is what seems to be one of the latest buzzes in the popular mental health blogosphere. Ketamine, also known as Special K, is being touted as a possible cure for major depression and bipolar disorder. Is it true? Is it worthwhile? Should you consider trying it?

What Is Ketamine?

Ketamine is a drug of a class called dissociative anesthesia.

That basically means that it changes perception (a hallucinogen) and dulls pain. If you have ever been given laughing gas at the dentist you might have had a taste of something similar. But this stuff is much stronger. It is used in animal medicine and sometimes used in human medicine especially for chronic pain (particularly in cancer patients) and sometimes as a local anesthesia. And yes even in some dental procedures.

As a super strong laughing gas, one can easily understand why it is also used as a recreational drug. It enhances other hallucinogens such as LSD but since it is basically a “downer” it can (theoretically) prevent some wild consequences of LSD. This is at least the rumor, but I have not seen any real evidence of it. Since it can also induce amnesia it has been used as a date rape drug. Doesn’t sound nice to me.

Research Findings

The news started about three years ago with a report of a very small trial of 18 treatment resistant patients suffering from bipolar disorder. 

The article, by Dr. Carlos A. Zarate Jr., hit the major newsfeeds and reported pretty amazing results. Nobody would suggest serious treatment after just eighteen trials. But the news was that this worked really really fast (within an hour) and abated all the symptoms!

It just sounded too good to be true. And you know what they say: “If it sounds too good to be true, it probably is!” However, Dr. Zarate emphasizes that the research is far from becoming ready as a treatment protocol.

He is continuing his research and he replicated his findings and published a study in December 2012, and this new study is all important for two reasons.¹

1. First, it seems that for severely suicidal patients one dose might help reduce the suicidality in as little as 40 minutes. No other treatment can come close to such a claim. 
   
2. Secondly, it works in a way that is completely different from all the other medicines. Almost all antidepressants work on building serotonin while this works on something called NMDA.

Pros and Cons

The exciting possibilities of Ketamine for bi-polar disorder, if it actually becomes a realistic treatment option, include:

• It is extremely fast working: the effects are seen within an hour
• It does not stay in the body for a long time, usually about three days. This means that it probably does not cause neurological toxicity
• It seems to have few major side effects (dizziness and nausea)

There are a few real problems with this miracle drug.

• First of all, nobody knows what effects it might have when used for a long period of time
• We know that people can get addicted to ketamine and that is it is a pretty ugly addiction
  
• It does not stay in the body for a long time. This means that it has to be administered every three days. We do not know what happens when a dose is missed

Will It Work for Everyone with Bipolar?

There is still another issue that needs to be considered in this whole discussion. We are talking about using a specific drug, Ketamine, for a specific disorder, bipolar disorder. But is bipolar a specific disorder? Besides the distinction between bipolar I and bipolar II, is it a disease treatable in the same way as a strep throat?

We know that for many people with a diagnosis of bipolar disorder there is a history of childhood trauma.² We also know that there are people who have bipolar that do not have such a history. Are these actually two different diseases? Since we can't answer this important question we obviously can't know if novel treatments would work for all people labeled with bipolar.

A Research Case Study on a Special Population

When I worked in the children’s psychiatric department in a local hospital we had a six year old patient who clearly had bipolar disorder. Most of the time she was quite a pleasant little girl. But she could not sleep through the night without terrible nightmares and during the day she acted out terrible fears. She talked of killing her parents and dismembering them in the kitchen. She had no history of trauma. Her mood swings were generally a few times a day.

Demitri Papolos is currently the Director of Research at Juvenile Bipolar Research Foundation at the Albert Einstein college of medicine. He sees a lot of bipolar children like the one I met years ago in the children's psychiatric hospital. I heard a story on NPR this past month (March 25, 2013) where Dr. Papalos describes treatment of bipolar disorder in children with ketamine. He talks about children whose rage is triggered by extreme fears. They seem to be constantly vigilant for fear of life itself. This is what triggers the rapid manic symptoms.

There is also an additional symptom that is often overlooked. They have a problem with heat. The show describes a boy that needed an ice pack on his head in order to fall asleep. Dr. Papalos realized that Ketamine calms fears and lowers body temperature. He tried it on patients like this and it seems to cure the patients very rapidly. Like in less than an hour, and with small doses every three days the patients remains completely symptom free.

Dr. Papalos’s published article only cites a dozen clinical trials.³ This means that the same caveats for the use of ketamine cited above are also relevant. But here are two differences. First, this is a well defined subset of bipolar disorder that might not be bipolar at all. Second, it is partially defined by a symptom that is not behavioral at all.

Uncertainty...But a Lot of Promise

Yes, ketamine is an addictive drug and we do not know how it will affect these patients in the long run. But I cannot forget that little girl in the hospital. If it were my daughter, I would definitely consider Ketamine.

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An evidence based (proven to work) kind of psychotherapy for the treatment of depression; CBT helps people change the way they think, so they can change the way they feel.

Cognitive Behavioral Therapy (CBT) is a very frequently recommended therapy for depression (and other mental disorders), but what is it?

Firstly, it's probably not what you're thinking of when you think of talk therapy in a psychologist's office; you'll spend very little or no time talking about your past or childhood! CBT is a therapy that looks at the present and the way you feel today and examines how your thoughts influence your moods and behaviors. CBT helps people change the way they think about themselves (wrongly) so that they feel better and enjoy life more.

CBT offers someone with depression a way to start feeling better.

An Example of CBT

Here is an example that illustrates how our thoughts influence our moods and our behaviors.

• Situation – 2 work colleagues are laughing and looking in your direction.
• Thought – You assume they are laughing at you.
• Feeling – You feel embarrassed and saddened.
• Behavior – You ignore them and then later give them dirty looks.

When we are depressed we often use "distorted thinking" to evaluate our world. When we are depressed, we often feel low self esteem, guilty or ashamed and this distorts our perceptions of environmental events.

Someone with low self esteem might assume that others were laughing at him and thus feel even lower – and by later giving dirty looks and acting negatively, he would increase the likelihood that next time, those work colleagues really would be laughing at him. Our thoughts influence our feelings and actions, and our negative thoughts can create real world negatives (very much like self fulfilling prophesies).

Alternatively

Someone who had received CBT training might look at those same work colleagues laughing, fight the negative impulse to assume they were laughing at him and evaluate the situation more objectively. An objective evaluation would reveal no reason for them to be laughing at him, and so he might look over with a smile and ask to be included in the joke. His work colleagues would then come over and point out the humorous scene unfolding directly to his rear.

In this second scenario, a cognitive restructuring led to his enjoying a joke, feeling included and accepted by work colleagues, and building a base of friendship for the future.

Distorted Thoughts Can Perpetuate Feelings of Depression

When we process an environmental situation using distorted thinking, our negative thoughts produce negative emotions and negative actions.

In the example above, the dirty looks given by the man who thought he was being laughed at would likely earn his colleagues' animosity, increasing the likelihood of future negative situations and future negative feelings.

The way we think and act can perpetuate depression.

CBT Therapy Sessions

Patients will typically attend CBT therapy once a week (or more) and practice CBT techniques with homework assignments to be done daily. CBT therapy can be individual or group based and is even offered online.

CBT is a combination of cognitive therapy and behavioral therapy

CBT therapists will try to change:

1. Negative thinking patterns (distorted thinking) that propagate negative feelings and behaviors
2. Behaviors that propagate negative feelings

Cognitive Therapy

Clients are taught how to look at a situation objectively and to evaluate thoughts using more rational judgment.

If you apply for a job and don't get it – don't automatically think you're worthless and feel bad, look at the situation objectively and realize that 200 applicants applied for a single position.

Thinking you were worthless might lead you to feel hopeless and give up a job search, which would lead to continuing unemployment and continuing low feelings.

Realizing that 200 applicants had applied for the job you didn't get might cause you to send out many more resumes that would lead to interviews and an eventual position – and increasing self esteem.

Changing thoughts to change feelings and behaviors – which in turn change thoughts once again; CBT is nothing if not cyclical in nature!

The CBT therapist will work with you to root out the distorted thinking that occurs and will then help you to recognize when distorted thinking may be influencing your judgment. Once you can recognize erroneous thinking in daily life, you will practice techniques to change these ways of thinking.

Using cognitive therapy, clients learn:

1. To understand the difference between feelings and thoughts
2. To understand that our thoughts can influence our feelings, and that this can be a bad thing
3. That since our thoughts can influence our emotions in negative ways, we must evaluate our thoughts to ensure that they are accurate before allowing them to create a negative mood

CBT is a practical therapy that offers you tools to manage your life.

Behavioral Therapy

Clients are also encouraged to change behavior patters to induce more positive thoughts.

Most people who are depressed tend to avoid or minimize social interaction and fun outside activities, yet this isolating behavior only entrenches feelings of depression. A CBT therapist will encourage a depressed patient to schedule and engage in frequent enjoyable social outings; knowing that social outings are likely to elevate mood and that elevated mood can lead to increased social outings; again, a cyclical improvement.

How Well Does CBT Work?

CBT is the most effective psychotherapy for moderate and severe depression and works about as well as medication for many types of depression. Many doctors will recommend that CBT be used in conjunction with anti depressant medications, especially for more severe depression.

CBT Lowers the Risk of Relapse

Some studies have shown that those treated with CBT or CBT and medication are less prone to relapse than those treated with medication alone. The sudden discontinuation of medication can lead to the reemergence of symptoms, but since CBT offers learned strategies to help manage negative thoughts and moods, preempting their effects, CBT offers lasting protection against the re-emergence of depression.

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One woman in 8 will succumb to depression during a lifetime. Why are women at a greater risk of this disorder than men? Scientists aren’t yet sure, conclusively, but they have some theories.

Twice as many women as men succumb to depression during any given year.

Scientists can't yet explain this huge gender gap, but they have some theories about what makes women more vulnerable:

Hormonal differences

Fluctuating levels of estrogen and progesterone during a monthly menstrual cycle cause premenstrual syndrome, and in some women, may cause a very severe form of PMS known as PMDD, premenstrual dysphoric disorder, a form of cyclical depression.

PMDD causes symptoms of PMS severe enough to cause problems in daily life.

Pregnancy

Having a baby increases a woman's chances of depression. The causes of postpartum depression remain unknown, but are likely a combination of hormonal and environmental factors, combined with the stress of care giving.

Infertility may also cause stress, anxiety and depressed mood, which may lead to a clinical condition.

Menopause

The fluctuating hormonal levels of perimenopause and menopause, as well as the changing estrogen levels after menopause, can all increase a woman's risk of depressive symptoms.

Women who experienced an earlier in life episode of depression may be at greater risk during menopause.

Poverty

Living in poverty increases the risks of depression. Women, especially single mothers, are at greater risk of poverty than men.

Discrimination

Women may experience lower pay or underemployment as a consequence of their gender. Stress, powerlessness and frustration emerging from discrimination can increase the risks of depression.

Care Giving Stress

Stress is a major cause of depression and women are at greater risk of care giving stress. Women are more likely to be single parents than men and are more likely the caregiver tending to the needs of multi generational extended family relatives.

Trauma or Abuse

Women are more likely than men to suffer sexual abuse or trauma.

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If you’re struggling with depression and lacking the energy or motivation to get out of the house as much as you should try this easy diary activity to schedule in a few more worthwhile activities each week.

Depression robs you of motivation and energy and it’s not surprising that when feeling down you’d probably rather just stay home and in bed a lot of the time.

Unfortunately, by minimizing social contact and exposure to sunlight and fresh air and by spending less time doing what used to be really enjoyable you only perpetuate a negative cycle of depression:

You’re feeling tired and lethargic so you don’t go for a walk or do any physical activity – and then you have trouble sleeping at night and you feel even more tired the next day…and so on.

You ruminate on negative thoughts – thinking, “No one can stand to be around me because I am so unlikable” and so you decline to meet up with friends as you used to do. After a while, no one calls you to meet up anymore (since you always decline) and you take this as confirmation that no one likes you.

Although it’s very hard, if you’re feeling up to some depression self help, spending more time out of the house and with other people can do a lot to help you on your path to recovery.

However, because it’s so hard to break out of habits of inactivity, you’ve got to do more than just say to yourself that you’ll try to get out more – you’ve got to make a structured activity plan and make a serious effort to stick with it, even when you don’t feel like it.

Depression Self Help - Using an Activity Plan to Get Out and Get Active¹

1. If you just rely on your motivation at any given moment there’s good chance you’ll spend a lot of time on your couch, doing little and feeling low.
2. By carefully scheduling worthwhile activities to a weekly plan – such as things you used to enjoy doing or social outings with friends – there’s a greater chance that you’ll actually get out and get active, even when you don’t feel like it at the time.
3. By getting more active you’ll start to break out of behavioral and mental cycles that perpetuate depression.

Get Organized

Use your phone or tablet's organizer or buy an organizer/planner type book, one that has a schedule for the day/week with time slots to pencil in appointments and commitments etc.

Write Out a Time Schedule of Your Obligations and Responsibilities

Starting for the week ahead of you, take a few minutes to pencil in all the things you must do over the course of the next 7 days.

Some examples might include:

• Mon - 2:30 dentist appointment
• Mon to Fri - cook dinner for family 5:30 to 6:00 and clean up kitchen from 6:30 to 7:00
• Tue - do grocery shopping from 2:00 to 3:00
• Mon to Fri – walk dog from 9:00 to 9:30 in the morning
• Saturday – take son to hockey practice from 7:00 to 9:00

Be thorough here and try to write down all of your obligations for the upcoming 7 days because it’s within the blank time-spaces that remain that you’re going to start adding  worthwhile activities.

Brainstorm a List of Worthwhile Activities

Take a few minutes to make a list of activities that you might want to add to your diary. Using categories can help you get started.

Try writing activities under the following categories, as well as any other that are relevant to you, and remember that since this is the brainstorming stage, you can write down anything that comes to mind, no matter how outlandish.

• Social Activities - Such as going to your parents’ house for dinner or meeting with friends to go to a movie
• Hobbies and other interests - Reading a novel, spending some time tinkering with the car engine, gardening etc.
• Exercise - Heading to the gym, going for a brisk walk, riding your bike etc.
• Activity Treats - Going shopping to buy a new outfit, going to the spa or getting a massage
• Relaxation Activities - Meditating or doing yoga
• Sleeping Times – Scheduling a consistent 8 or 9 hours of sleep on a regular schedule can improve the way you feel and up your energy levels

Adding Worthwhile Activities to Your Weekly Schedule

OK, now that you’ve got your list of ideas at the ready it’s time to add worthwhile activities to your weekly schedule.

Since you don’t want to get overwhelmed, it’s a good idea to start off by adding only 1 or 2 worthwhile activities per day. If that works well for you, you can always add in 3 or more per day in future weekly schedules.

Sticking to Your Schedule (Except When You Don’t)

This may sound a bit contradictory, but it’s important that you make a serious effort to stick to your weekly schedule and to complete your worthwhile activities, even when you don’t feel like it. That being said, it’s also important that your weekly activity diary not cause undue stress, so if you really can’t or really don’t want to do something, it’s OK to skip it or to adjust your schedule accordingly.

Things will come up – that’s OK, just do your best to complete as many of the activities you’ve scheduled as you can.

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A review of the effectiveness and risks of 4 clinically tested supplements for the treatment of depression (SAMe, L-methylfolate, St John’s Wort and 5-HTP).

Ideally, you never tackle depression with just one weapon.

Effective medications work better when you combine them with psychotherapies like cognitive behavioral therapy, and when you add in lifestyle changes like regular exercise and a healthy diet, you further increase your chances of symptoms improvement.

And sometimes, complementary supplements can also play a role, as an adjunct treatment to further improve the odds of really getting better.

But with so many supplements on the market all promising so much – which ones really deliver?

Here’s a quick overview of some of the most promising supplementary medicines, with research examples of their efficacy, and cautions, where applicable, about their dangers.

4 Clinical Research-Backed Depression Treatment Supplements:

St John’s Wort

Probably the most commonly used herbal depression supplement, St John’s Wort is a yellow flowered weed that grows widely throughout the US. People with depression most commonly take capsules of St John’s Wort powder (typically 300 mgs) three times a day, and there is some research evidence that it works as well as antidepressants in the treatment of mild to moderate depression - while inducing fewer unpleasant side effects.

A Cochrane Review of 29 clinical studies on St John’s Wort as a depression treatment found that the supplement consistently worked better than placebo as a treatment for mild to moderate depression – working about as well as standard antidepressants – and that people reported fewer side effects with the supplement than with typical antidepressants.¹

Cautions

Studies have not found St John’s Wort effective as a treatment for more serious depression and it can limit the effectiveness of some medications, such as birth control pills and antidepressant medications, among others. Obviously, you need to consult with your doctor before initiating a course of this, or any, herbal medicine.

5-HTP

Low levels of the neurotransmitter serotonin are associated with depression.

5-HTP is a necessary precursor for the production of serotonin and so using 5-HTP supplements can result in more serotonin and less depression. Many common antidepressants, such as Zoloft or Prozac also work in the brain to increase serotonin levels to reduce depression symptoms. In some ways, 5-HTP may be considered a more natural form of a serotonin based antidepressant.

Manufacturers derive 5-HTP supplements from the ground seeds of the griffonia simplicifolia plant.

A review of studies shows that 5-HTP works better than placebo as a treatment for depression, but because of side effects, an overall lack of solid clinical research and some lingering questions about the supplement’s safety, most experts do not endorse its use.²

Cautions

The supplement can cause side effects such as nausea and vomiting. More worrisome, the use of tryptophan supplements has been linked to a possibly fatal syndrome called, eosinophilia-myalgia syndrome. Due to some lingering uncertainty about its safety and because existing serotonin based antidepressants work well, experts do not generally endorse the use of 5-HTP as a treatment for depression.

SAMe (S-adenosyl-L-methionine)

SAMe, which is pronounced ‘Sammy’, is a chemical your body manufactures in the liver which is involved in over 40 metabolic processes, including the synthesis of neurotransmitters like dopamine. Although researchers aren’t exactly sure how it influences mood, SAMe is believed to have antidepressant properties through some moderation of neurotransmitters in the brain.³

Research studies have found that up to 1600 mgs of SAMe daily work better than placebo and about as well as tricyclic anidepressents in the treatment of depression. It seems well tolerated and it may begin to work more quickly than other antidepressants, which can take a number of weeks to become effective. Unfortunately, there have been no high-quality large-scale clinical trials on the effectiveness of SAMe nor any large-scale clinical trials comparing the effectiveness of SAMe to SSRI antidepressants.

Cautions

SAMe is not recommended for people with bipolar disorder as it can induce mania. People should not take SAMe without first consulting with their doctor as it may alter the potency and effectiveness of other antidepressant medications.⁴

Folate or L-methylfolate

If you have depression, it’s a good idea to talk to your doctor about whether you should get your folate levels checked out.

People with depression who also present with low blood cell folate levels are less likely to get full effectiveness from their antidepressants, typically present with more severe symptoms of depression and typically wait longer before seeing the positive results of antidepressant therapy.⁵

Studies of people with depression who use folate supplements or L-methyfolate (which is a form of folate which crosses the blood brain barrier) have demonstrated a role for the supplement in the treatment of depression.⁶

In research studies, patients with depression who added folate or L-methylfolate supplements as an adjunct to antidepressant therapy got better results than people who used antidepressants and a placebo.^{7 8}

Cautions

L-methylfolate may increase the risk of seizures in people already prone to having them and may accelerate colon tumor growth for people with colon cancer.

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Answers to common questions about a frequently prescribed class of antidepressant medication.

Selective Serotonin Reuptake Inhibitors (SSRIs)¹ are the most frequently prescribed medication for major depression. They work very well for about two out of three people and they produce fewer side effects than other comparable antidepressants. SSRIs are most commonly prescribed as the medication pillar of a more comprehensive treatment plan for depression that includes psychotherapy and lifestyle changes.

Doctors generally prescribe SSRIs first and only prescribe other varieties of anti depressants should the SSRI fail to work.

SSRIs allow for more efficient use of the brain's natural levels of the neurotransmitter serotonin. Low serotonin levels are thought to play a role in depression and SSRIs increase the functional amount of serotonin in the brain.

Here are some commonly asked questions about these common and effective medications.

What Are Some Common Types of SSRIs?

American doctors have prescribed SSRIs since 1987; the year Fluoxetine (Prozac) first became available.

Other types of SSRIs include:

• Setraline (Zoloft)
• Escitalopram (Lexapro) 
• Paroxetine (Paxil)
• Citalopram (Celexa)

How Well Do SSRIs Work?

SSRIs work about as well as other types of anti depressants (MAOIs and tricyclic antidepressants) which is a little better than two thirds of the time. Doctors generally prescribe SSRIs before trying other types of antidepressant medications due to the reduced side effects and greater safety associated with the SSRIs.

How Do SSRIs Work?

Serotonin is sent from one cell, through an extracellular medium, to another cell which has a serotonin receptor ready to catch the neurotransmitter. Once the serotonin has been 'passed and caught' a serotonin reaction can occur, and the more serotonin that floats in the extracellular space between 'passing' neurons and the 'catching' serotonin receptors, the greater the effects of the serotonin.

After a neuron 'passes' a quantity of the neurotransmitter to a 'catching' neuron, the 'passing' neuron will suck back in any extra neurotransmitter floating in the extracellular space. SSRIs work by limiting the amount of serotonin that gets sucked back into the 'passing' neuron cell and thereby increase the amount available over time to stimulate the 'catching' neuron's receptors. The net effect of SSRIs is to increase the efficiency and effect of existing neural levels of serotonin.

SSRIs are preferred over other anti depressants, as they are much more selective. They do not influence the activity of other neurotransmitters as much as older and less selective medications. This limits the dangers and side effects of the medication.

Why Does It Take Several Weeks for SSRIs to Start Working?

SSRIs take a while to start fully working, between 2 and 8 weeks, most typically, depending on the medication used and genetic variations.

As soon as a person starts taking an SSRI, neural levels of serotonin between brain cells (in the synaptic gap) increase dramatically. The brain adjusts to this sudden increase in serotonin by decreasing the sensitivity of serotonin receptors in the brain, over a period of several weeks. SSRIs do not become fully effective until the serotonin receptors are modified to handle the suddenly increased quantity of serotonin available to them.

How Long Does Antidepressant Treatment Take?

SSRI treatment takes a while. It takes a number of weeks for the medication to become fully active, and even once depressive symptoms subside, most doctors recommend that patients continue to take the medication for several months longer, to reduce the likelihood of a relapse back to depression.

SSRI Side Effects?

SSRIs are a very well tolerated type of medication, and most people that use them report no or only very minor side effects. A small minority of people will experience intolerable side effects and will need to try a different anti depressant medication or a different dose of SSRI.

Some side effects sometimes associated with SSRIs include:

• Sexual dysfunction
• Shakiness
• Heavy sweating
• Headaches
• Dry mouth
• Anxiety
• Nausea
• Diarrhea
• Changes in appetite
• Light headedness

Some people will feel increased anxiety during the first weeks of treatment, but this will usually go away as your body gets accustomed to the medication.

People tend to tolerate these medications very well.

Although all SSRIs work similarly, slight differences between the various types can cause varying side effect responses. If you experience severe side effects to one SSRI, you might find that switching to a different SSRI offers the same symptoms relief with fewer side effects.

Although taking large quantities of any medication can be dangerous, SSRIs are safer than other anti depressant medications.

Can You Get Addicted to Antidepressants?

SSRIs are not addictive and if you stop taking the medications suddenly, you won’t feel drug cravings for the medication.

Stopping the use of SSRIs very suddenly can lead to a "discontinuation syndrome" similar to a syndrome of withdrawal symptoms. This can be avoided by tapering down your dosage over time, instead of stopping all at once.

Discontinuation symptoms can include:

• Nausea
• Light headedness
• Lethargy
• Symptoms similar to the flu
• Headache

SSRIs and Suicide?

SSRIs may be associated with an increased risk of suicidal thoughts and suicide², particularly when taken by people under the age of 24; particularly during the first months of treatment.

What is Serotonin Syndrome?

Combining SSRIs with certain other medications can cause very high levels of serotonin in the brain, a condition called serotonin syndrome.

Combining anti depressant medications of the MAOI class with any SSRI can be very dangerous and can lead to this syndrome. People are advised to wait at least 2 weeks after the last use of an SSRI before taking an MAOI.

Taking other medications, such as tramadol (Ultracet, Ultram), sumatriptan (Imitrex), rixatriptan (Maxalt) and St John's Wort with any SSRI can lead to serotonin syndrome.

Serotonin syndrome can be fatal. Symptoms of the condition include:

• Diarrhea
• Rapid heart beat
• Confusion, agitation or restlessness
• Hallucinations
• Nausea
• Un-coordination
• Vomiting
• Changes in body temperature
• Coma
• Seizures
• Fever

Anyone suspecting serotonin syndrome needs immediate emergency medical attention.

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