Monday, February 28, 2011

Mind Body Medicine

What is Mind/Body Medicine?
Mind/body medicine is an approach to healing that uses the power of thoughts and emotions to influence physical health. As Hippocrates once wrote, "The natural healing force within each one of us is the greatest force in getting well." This is the essence of mind/body medicine.
Does Mind/Body Medicine work?
While phrases such as "mind over matter" have been around for years, only recently have scientists found solid evidence that mind-body techniques actually do combat disease and promote health. In 1989, a landmark study by David Spiegel, M.D. at Stanford University School of Medicine dramatically demonstrated the power of the mind to heal. Of 86 women with late-stage breast cancer, half received standard medical care while the other half received the standard care plus weekly support sessions in which the women were able to share both their grief and their triumphs. Spiegel discovered that the women who participated in the social support group lived twice as long as the women who did not.
What are Mind/Body Techniques?
The key to any mind/body technique is to "train" the mind to focus on the body without distraction. It is in this state of "focused concentration" that an individual may be able to change his or her health. The following are some of the most commonly practiced techniques.
Biofeedback: Biofeedback is a technique in which people are trained to improve their health by learning to control certain internal bodily processes that normally occur involuntarily, such as heart rate or blood pressure. These activities can be measured with electrodes and displayed on a monitor that both the participant and his or her practitioner can see. The monitor thereby provides feedback to the participant about the internal workings of his or her body. This person can then be taught to use this information to gain control over these "involuntary" activities. Biofeedback is an effective therapy for many conditions, but it is primarily used to treat tension headache, migraine headache, and chronic pain.
Relaxation Techniques: There are three major types of relaxation techniques:
  • Autogenic training. This technique uses both visual imagery and body awareness to move a person into a deep state of relaxation. The person imagines a peaceful place and then focuses on different physical sensations, moving from the feet to the head. For example, one might focus on warmth and heaviness in the limbs, easy, natural breathing, a calm heartbeat, and a cool forehead.
  • Progressive muscle relaxation. This technique involves slowly tensing and then releasing each muscle group individually, starting with the muscles in the toes and finishing with those in the head.
  • Meditation. The two most popular forms of meditation in the U.S. include Transcendental Meditation (students repeat a mantra [a single word or phrase], maintaining an "oh well" attitude if other thoughts arise) and mindfulness meditation (students focus their attention on their moment-by-moment thoughts and sensations).
Hypnosis: During hypnosis (taken from the Greek term hypnos, meaning "sleep") a person's body relaxes while his or her thoughts become more focused and attentive. It is in this state of deep concentration that people are highly responsive to a hypnotherapist's suggestions. There are three layers of hypnosis: the first is absorption (becoming deeply engaged in the words or images presented by a hypnotherapist); the second is dissociation (letting go of critical thoughts); and the third is responsiveness (complying whole-heartedly to a hypnotherapist's suggestions). Today, many mental health professionals use hypnosis to treat people with addictions, pain, anxiety disorders, and phobias.

The Measure of Mental Health

From cures to care, a better understanding of mental health can help sufferers gain control of their conditions


Mental health is the capacity to feel, think and act in ways that enhance one's ability to enjoy life and to deal with challenges that come our way. By understanding the science and genetics behind mental health, as well as the fundamental mechanisms behind thought, emotion and behavior, we can begin to see how some people cope better than others.

According to the "Global Burden of Disease," a study commissioned by the World Health Organization and the World Bank, mental health disorders represent four of the 10 leading causes of disabilities for people five years of age and older. In the United States, major depression is the leading cause of disability. Also common are manic-depressive illness, schizophrenia and obsessive-compulsive disorder.

Mental disorders are tragically linked to mortality, as suicide represents one of the leading causes of preventable death in the US and around the world. Often striking early in life, they frequently have chronic and severe symptoms that can destroy the life and productivity of affected individuals and that of their families and loved ones.

While many types of therapy and medication can now control the symptoms of mental disorders, they cannot cure the disorders themselves. Many medications have unacceptably serious side effects and the medicinal effects of herbs and nutrition need to further study to prove their efficacy in treating various disorders.

Although to some, the term "mental health" carries a stigma, it is the standard and only accurate and all-encompassing term used to address this fundamental component of our well-being. Some aspects of mental health have to do with our emotions, feelings and state of mind. But it would be undermining many other conditions, and the people who suffer from them, to describe them as anything less than illnesses that often have neurological and genetic roots that have to be cared for.

The promotion of mental health requires the involvement of the population as a whole -- both the sick and the well. Instead of defining people by their vulnerabilities, people who practice mental health care should nurture their strengths. Through education, research and community resources, we can better understand mental health and give people control over their own life experiences

Thursday, February 24, 2011

Depression and Mania

A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Types of depression


Depressive disorders come in different forms, just as in the case with other illnesses such as heart disease. Below we discuss three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms (see list below) that interfere with the ability to work, study, sleep, eat and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of depression and mania


Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression

  • Persistent sad, anxious, or "empty" mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being "slowed down"
  • Difficulty concentrating, remembering, or making decisions
  • Insomnia, early-morning awakening, or oversleeping
  • Appetite and/or weight loss or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania

  • Abnormal or excessive elation
  • Unusual irritability
  • Decreased need for sleep
  • Grandiose notions
  • Increased talking
  • Racing thoughts
  • Increased sexual desire
  • Markedly increased energy
  • Poor judgment
  • Inappropriate social behavior

Causes of depression


Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder.

Depression in women


Women experience depression about twice as often as men. Many factors may contribute to depression in women -- particularly such factors as menstruation, pregnancy, miscarriage, postpartum period, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

Depression in the elderly


Some people have the mistaken idea that it is normal for the elderly to feel depressed. On the contrary, most older people feel satisfied with their lives. Sometimes, though, when depression develops, it may be dismissed as a normal part of aging. Depression in the elderly, undiagnosed and untreated, causes needless suffering for the family and for the individual who could otherwise live a fruitful life. When he or she does go to the doctor, the symptoms described are usually physical, for the older person is often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss.

Depression in children


Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary "phase" or is suffering from depression. Sometimes the parents become worried about how the child's behavior has changed, or a teacher mentions that "Johnny doesn't seem to be himself." In such a case, if a visit to the child's pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a psychiatrist who specializes in the treatment of children. If treatment is needed, the doctor may suggest that another therapist, a social worker or a psychologist, provide therapy while the psychiatrist will oversee medication if it is needed. Parents should not be afraid to ask questions: What are the therapist's qualifications?

Treatment


The first step to getting appropriate treatment for depression is a complete physical examination by a family physician or internist. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview, and lab tests. If a physical cause for the depression is ruled out, a psychological evaluation should be done, usually by a psychiatrist or psychologist.

Treatment choice will depend on the outcome of the diagnostic evaluation.

Herbal therapy


In the past few years, much interest has risen in the use of herbs in the treatment of both depression and anxiety. St. John's wort (hypericum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the US. St. John's wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany, hypericum is used in the treatment of depression more than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.

Psychotherapies


Many forms of psychotherapy, including some short-term (10-20 weeks) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal "give-and-take" with the therapist. "Behavioral" therapies help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive-behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's internal conflicts. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require psychotherapy for the best outcome.

Source: National Institute of Mental Health