healfrmdepress

In a recent blog, I talked about how I was attempting to cope with a “mini-relapse” without using psychiatric drugs.  In this blog, I will share a turning point in my recovery that shows why we are meant to heal in community.

One Sunday morning in the midst of this episode I awoke in a particularly dismal state. I didn’t have a structure planned for the day. And without something to look forward to, both my anxiety and depression increased.

As I lay in bed, trying to convince myself to get up, the phone rang. It was a cycling friend Sandy, calling to see if I wanted to go on a bicycle ride.

“Let’s take a spin up Rocky Butte,” she said, referring to the 550 foot butte located ten miles from my house.

“No problem,” I replied. “You are giving me a reason to get out of bed.”

“See you soon,” she said.

I hung up the phone, arose, stretched, and got a quick bite to eat. Within the hour I was on my way to Sandy’s house.  By now, most people know that aerobic exercise has a positive impact on mood, and works as well as antidepressants in treating mild to moderate depression. When I told Sandy about my depressed state, she suggested that we climb Rocky Butte twice in order to get the maximum benefit from the mood-enhancing endorphins.

It took us about thirty minutes to cycle to Rocky Butte, and as I approached the start of the climb, I found myself needing to use the rest room. Fortunately, there was a church at the base of the hill, and since it was Sunday, the doors were open. I made my way towards the church, and saw the following sign posted on the front door:

Are you connected?
Get connected?
Come inside to find connection.

At that point an elderly man and his wife opened the door and came towards us.

“Good morning,” he said.

”Good morning,” I replied. “I was just reflecting on the truth of the words posted on the church door. I work in the field of mental health, and I have found that supportive relationships are a central part of mental health recovery.”

That’s right,” he said, “That’s why we and other church members are committed to reaching out to those parishioners who are isolated. In addition my wife and I have found that when we focus on helping others, our own problems don’t seem so bad. “

His comment reminded me of what author Tracy Thompson said in her memoir, “The Beast,”–that when we serve others we are released from “the prison of self.”

We chatted more with the couple, and then Sandy and I headed up Rocky Butte– a 1.4 mile climb with an average grade of 7-8%. When I arrived at the top in a sweat-filled jersey, I noticed that the fog in my brain was lifting.  By the time we finished the second climb, my mood had improved considerably. The combination my body’s endorphins and the interaction with Sandy and the couple had turned my brain chemistry around.

To read more of my thoughts on this matter, please go to this online article:

We Are Meant to Heal in a Community

In my book healing from depression, I state that the first step to mental health recovery is simply setting the intention to heal. This means making the decision that you want to get well, even if you don’t know how. Setting the intention to heal is the starting point of all recovery.

This may seem like a simple act, but it has profound ramifications for your future health and well being. It doesn’t matter how long you have suffered from anxiety or depression. Perhaps, like myself, you have been struggling since childhood; or maybe your first episode began six months or six weeks ago. Regardless of the time involved, the first step is the same—making the decision to heal.

(http://www.youtube.com/watch?v=ok6F9tDp9p0)

For some people, this may be asking a lot, since depression robs us of energy, motivation and hope. Fortunately, at this point, I am not asking you to do anything, only to make a decision. You don’t have to know how your healing will take place. You don’t have to believe that it is possible. If you are feeling particularly hopeless or discouraged right now, ask yourself this question: “Is there a part of me, even if it is ten percent or one percent, that wants to feel better?” If you can find just a molecule within you that says, “I WANT TO LIVE,” your healing journey will have begun.

The tool that you will be using to translate your intention to heal into a reality is the vision statement. Essentially, your vision statement will answer the question, “What would my life look and feel like if I were free from the symptoms of anxiety and depression?”

A vision statement is based on the second habit from Steven Covey’s The Seven Habits of Highly Effective People— “begin with the end in mind.” According to Covey, this habit arises from the principle that “all things are created twice”—first in the mind and then in the world of form. In writing a vision statement, you create an exact mental blueprint or picture of health that you that you are seeking to bring into your life. In a future blog, I will outline the exact steps to creating a vision statement of wellness.

On this web site, I have written that relapse prevention is a critical part of recovery from depression. Surviving an episode of depression is not like having the measles—one does not develop an immunity to the disease. Because the underlying predisposition does not go away, symptoms can always return.

I can speak to this matter personally. I recently had a “mini-relapse” into the anxious state that I experienced in the fall of 1996. The current episode was brought about by a series of Job-like calamities that occurred over summer, Finally, the accumulated stress reached a tipping point, which caused something in my nervous system “to snap” and brought about a biochemical state of hyper-arousal and hyper-sensitivity. I felt as if I no longer had an “outer skin.” Every environmental stimulus was magnified a thousand fold. I felt fragile, vulnerable and fragmented. Simply leaving the house seemed like a big deal.

After a few days of being in this state, I decided to call a good friend who also suffers from anxiety. When I explained to him that my symptoms were caused not by catastrophic thinking but by a genuine chemical imbalance, he said, “Well, if the problem is caused by chemicals, then it needs to be treated by chemicals.” (i.e. a benzodiazepine like Xanax or an SSRI antidepressant like Paxil.)  I replied that there are a host of other ways to affect the brain’s neurochemistry, and that I was going to return to these same strategies that I used to cope during my previous episode.

After our conversation ended, I remembered that I had committed to picking up a friend from a doctor’s appointment in 45 minutes. I still had anxiety about leaving the house, so I hopped into my elliptical trainer and worked out for twenty minutes. When I was finished, I felt calmer. The intense exercise had burned off some of the agitating chemicals in my brain.

I was then able to pick up my friend from the hospital. When I returned home. I consumed a meal of rice and lentils and added a B-complex vitamin (good for the nerves), which I washed down with a cup of chamomile tea. My rationale for the rice and lentils was that carbohydrates can boost tryptophan transport across the blood-brain barrier, and tryptophan is a precursor for the feel-good neurotransmitter serotonin. Afterwards, I felt calm enough to go back to my writing.

And so I manage this anxiety, one day at a time. I am learning once more that in the absence of medications, there are “low-tech” tools such as diet, exercise, touch, human love and caring, meditation, and spirituality that we can use to improve our mental and emotional state. If indeed there are no breakthrough psychiatric drugs on the horizon, it is even more important that we become familiar with  these tools, place them in our toolbox and apply them as needed.

I thought that I would post this article from the NY Times, as it shows that we are at a standstill for the development of more effective drugs to treat depression. This is true despite the fact that 1 in 5 Americans takes psychiatric medications and 25 percent of Americans suffer from a diagnosable mental illness in any year.

The lack of more effective medications shows the necessity of using the types of self-help tools to elevate one’s mood that I describe on this website. It takes more than a pill to heal from depression, and never has this been more true.

http://www.nytimes.com/2013/08/20/health/a-dry-pipeline-for-psychiatric-drugs.html

A DRY PIPELINE FOR PSYCHIATRIC DRUGS

By RICHARD A. FRIEDMAN, M.D.

Fully 1 in 5 Americans take at least one psychiatric medication. Yet when it comes to mental health, we are facing a crisis in drug innovation.

Sure, we have many antidepressants, antipsychotics, hypnotic medications and the like. But their popularity masks two serious problems.

First, each of these drug classes is filled with “me too” drugs, which are essentially just copies of one another; we have six S.S.R.I. antidepressants that essentially do the same thing, and likewise for the 10 new atypical antipsychotic drugs.

Second, the available drugs leave a lot to be desired: patients with illnesses like schizophrenia, major depression and bipolar disorder often fail to respond adequately to these medications or cannot tolerate their side effects.

Yet even though 25 percent of Americans suffer from a diagnosable mental illness in any year, there are few signs of innovation from the major drug makers.

After a series of failed clinical trials in which novel antidepressants and antipsychotics did little or no better than placebos, the companies seem to have concluded that developing new psychiatric drugs is too risky and too expensive. This trend was obvious at the 2011 meeting of the American Society for Clinical Pharmacology and Therapeutics, where only 13 of 300 abstracts related to psychopharmacology and none related to novel drugs. Instead, they are spending most of their research dollars on illnesses like cancer, heart disease and diabetes, which have well-defined biological markers and are easier to study than mental disorders.

To understand this predicament, it helps to know how we got here.

All of our current antidepressants, antipsychotics and anti-anxiety drugs share the same molecular targets in the brain as their prototypes from the 1950s. For example, the new antipsychotic drugs block dopamine receptors in critical brain regions, just like the first antipsychotic, Thorazine, synthesized in 1950. And all of our current antidepressants increase the levels of one or more of the neurotransmitters serotonin, dopamine or norepinephrine, just like the early tricyclic antidepressants.

With rare exceptions, it is hard to think of a single truly novel psychotropic drug that has emerged in the last 30 years. True, the new psychotropic drugs are generally safer and more tolerable than older prototypes, but they are no more effective. So why has the pharmaceutical industry churned out so many copycat drugs?

The simple answer is that we don’t yet understand the fundamental cause of most psychiatric disorders, in part because the brain is uniquely difficult to study; you can’t just biopsy the brain and analyze it. That is why scientists have had great trouble identifying new targets for psychiatric drugs.

Also, knowing how a drug works in the brain doesn’t necessarily reveal the cause of the illness. For example, just because an S.S.R.I. antidepressant increases serotonin in the brain and improves mood, that does not mean that serotonin deficiency is the cause of the disease; many depressed patients get better with medications that have no effect on serotonin.

Until very recently, scientists have relied on the same animal models to screen for potential psychotropic drugs that had been used for decades, which predictably yielded a raft of “me too” medications that shared the same mode of action as the old drugs.

Sure, this old method of drug development has produced commercially successful blockbuster drugs, like the antipsychotics Seroquel and Abilify. But soon the patents on these medicines will expire, and there is little new in the pipeline.

Perhaps, though, the pharmaceutical industry is making a mistake, running away from the brain just when things are getting interesting. Consider ketamine (known on the street as Special K), an anesthetic agent that has recently shown unusually powerful antidepressant effects.

Ketamine acts on a target in the brain where no other drug in psychiatry currently does: the NMDA receptor, which it blocks. The receptor is the site of action of glutamate, a neurotransmitter critically important in learning and memory — and, it turns out, in depression.

Several promising early studies found that depressed patients who had failed to respond to multiple antidepressants experienced rapid resolution of their symptoms within a few hours of ketamine infusion.

Unlike standard antidepressants, which typically take weeks to work, ketamine’s effect is rapid because its target, the NMDA receptor, is fast-acting. But this is a tricky biological system to modulate: too little glutamate function at this receptor can produce psychosis, and too much can kill neurons.

Whether ketamine, or a similar compound, will ultimately prove safe and effective as an antidepressant is unclear. Presently, though, the pharmaceutical industry has little taste for the long-term financial risk of discovering new psychotropic drugs.

In contrast, academic researchers, who are not beholden to shareholders, are much freer to do high-risk, high-gain experiments that can fail. Large multisite research programs like the Brain Activity Map, along with the latest gene-sequencing technology, can help identify the circuits and genes that are linked to various psychiatric disorders and find promising new targets for drugs. These discoveries, in turn, may entice the drug makers to reinvest in psychiatric drug development.

As consumers desire new treatments, they have to recognize that innovation carries risks. Drugs are approved by the Food and Drug Administration on the basis of short-term studies, so there is always limited knowledge about the long-term safety of new medications. This is particularly true for drugs that act on new targets in the brain about which relatively less is known.

But if we are to find better medical solutions for the mental illnesses that disrupt and destroy so many lives, we need to acknowledge a simple truth: there can be no innovation without financial — and medical — risk.

Dr. Richard A. Friedman is a professor of clinical psychiatry at Weill Cornell Medical College.

For years I have been talking to my readers and clients about the importance of sleep: the key to mental and physical health. During sleep, the brain “reboots” and regenerates itself and forms new memories. Adequate sleep is essential for good concentration and mental focus–qualities that we lose when we become depressed or anxious.

Now there is an excellent talk that you can watch by the British neuroscientist Russell Foster. It recently appeared on the TED talks website. Here is the link.

http://www.ted.com/

At the end of this engaging talk, Foster says that disrupted sleep is both a cause and a symptom of mental health disorders. He proposes that one day scientists will know how to directly regulate the areas in the brain that lead to good sleep and thus good mental health.