ADHD Treatment For Children: What Works

Why And When Do We Need To Treat ADHD

ADHD Treatment For Children

Start With Your Primary Care Doctor

If you are concerned that you have ADHD or that your child has it, the first step is to talk to a professional. We recommend that you speak with someone who has experience assessing and treating ADHD and who can do a thorough assessment. These professionals include psychiatrists, psychologists, psychiatric nurses, and social workers.

Diagnosing ADHD

The process of diagnosis is one of exclusion, because many other disorders such as anxiety, depression, or sleep disorder can have similar symptoms.
Psychological testing is not required to make the diagnosis. The AAP (American Academy of Pediatrics), APA (American Psychiatric Association) and AACAP (American Association of Child and Adolescent Psychiatry) guidelines recommend that the healthcare professionals ask the patient, the parents, the teachers or other adults involved in the interactions with the patient about changes in the behavior in at least two areas (for school age children it is at home and at school).

ADHD and Executive Function

By and large ADHD can be conceptualized as a disorder of “executive function.” Individuals with ADHD show a reduced ability to exert and maintain cognitive control of their behavior. Compared to their peers, individuals with ADHD have a lower ability to react to insignificant external or internal stimuli. The MRI studies of individuals with ADHD show thinning of the cortex in the areas associated with working memory and attention. (Molecular Neuropharmacology; Nestle, Hyman 321-323).
ADHD is diagnosed based on the DSM 5(Diagnostic and Statistical Manual of Mental Disorders, 5th edition) diagnosis criteria. Here are the criteria below in shortened form. Please note that they are presented just for your information and not to be used for self-diagnosis. Only trained health care providers can properly diagnose or treat ADHD.

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development in these areas:

1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months and they are inappropriate for developmental level:
o Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
o Often has trouble holding attention on tasks or play activities.
o Often does not seem to listen when spoken to directly.
o Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
o Often has trouble organizing tasks and activities.
o Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
o Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
o Is often easily distracted
o Is often forgetful in daily activities.

2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
• Often unable to play or take part in leisure activities quietly.
• Is often “on the go” acting as if “driven by a motor”.
• Often talks excessively.
• Often blurts out an answer before a question has been completed.
• Often has trouble waiting his/her turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:
• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Types Of ADHD

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.

ADHD in Adults

ADHD often lasts into adulthood. About 65% of individuals diagnosed as children with ADHD will have persistent impairing symptoms by age 25. (Parikh MD, Baker, MD Adult ADHD: Pharmacology in the DSM -5 era, Current psychiatry, Oct 2016)

Changes In The DSM-5

The fifth edition of the DSM was released in May 2013 and replaces the previous version, the text revision of the fourth edition (DSM-IV-TR). There were some changes in the DSM-5 for the diagnosis of ADHD:
• Symptoms can now occur by age 12 rather than by age 6;
• Several symptoms now need to be present in more than one setting rather than just some impairment in more than one setting;
• New descriptions were added to show what symptoms might look like at older ages; and
• For adults and adolescents age 17 or older, only 5 symptoms are needed instead of the 6 needed for younger children.

Obstacles In The Treatment OF ADHD

One of the obstacles I see in my practice to effectively treat ADHD is the fear of addiction to the medication. This is a myth. In fact, a multi-cohort national study sampling of about 40 000 individuals, recently published in the journal of the AACAP in June 2016 showed that starting the treatment for ADHD early and continuing it for more than 6 years was associated with a rate of substance use which was lower than in the general population. Also, individuals who started the treatment later, and taking the medication for less than 2 years had similar rates of substance use with the general population.

Relative immaturity is one of the challenges that ADHD brings with it. It has been shown that children and adolescents with ADHD tend to be less mature than their peers. (JACCAP 2016;55(10):886-895). The female gender is more protected against developing ADHD than the male gender (JAACAP 2016;55(6):504-512), and that also explains the higher prevalence in males than in females.

ADHD Treatment

1. Medications
a. amphetamine preparations come in short acting and long acting formulations that can be combined according to the individual response. They act through increasing the release of norepinephrine and dopamine that are essential for the frontal brain circuits.
b. methyphenidate preparations also come in short and long acting formulations. Together with the amphetamines they are by far the most effective medications for ADHD. They have common side effects such as insomnia, decreased appetite, growth delay. Combining them would increase the likelihood of the side effects.
c. atomoxetine increases the availability of norepinephrine, is not as effective as a stimulant and can be used as an alternative for people who do not tolerate the amphetamines or methylphenidine.
d. alpha-adrenergic agonist, clonidine and guanfacine also have short and long acting formulations, and can be used by themselves or in combination with the stimulants;
e. bupropion, considered a third line of treatment for individuals who do not tolerate the amphetamines or methylphenidate or can be added to them to enhance the response.

2. Neurofeedback
Evidence from well-controlled studies failed to support neurofeedback as an effective treatment for ADHD (Cortese and collab JAACAP 2016;55(6):444-455).

3. Brain Training Games
Brain training games did not gather solid scientific evidence that it works for ADHD, however these programs are early in their development and it is believed that the future will bring new possibilities. At the present time they are being used for cognitive rehabilitation. (Psychiatric Times, June 2014: The Evidence and Application of Brain Training Games: Science or Sales, Larry Brooks).

Myths About The Treatment Of ADHD

(Strawn, MD/Current Psychiatry October 2016)
1. Contrary to the popular belief that treatment with stimulants would worsen anxiety, a meta-analysis of about 3000 patients showed that a stimulant treatment has a low relative risk for anxiety and many patients experience improvement in their anxiety while some of them could experience an increase in anxiety level.
2. A meta-analysis of 22 studies including 2400 patients showed a lack of association between stimulant treatment and a new onset or worsening of tics despite the ‘contraindication’ included in the package insert.
3. Polypharmacy(the simultaneous use of multiple drugs to treat a single ailment or condition) in ADHD is beneficial because it allows synergistic effects of different medications and does not represent a treatment ‘failure’.

Consequences Of Not Treating ADHD

Here is what the research says about the consequence of not treating ADHD.
1. School failure, peer rejection, and subsequent association with a delinquent peer group can increase the likelihood of substance use, especially in the presence of comorbid conduct disorder (Molecular Neuropharmacology, Nestle, Heyman pg 321-323)
2. ADHD in childhood and adolescence predicted homelessness in adulthood, maybe partly for the high degree of comorbidities with conduct, SUD, arrest, and school dropouts. (Garcia Murillo and colab/JAACAP 2016;55(11):931-936
3. The degree of severity of ADHD symptoms in adults is related to not addressing the symptoms during childhood. In other words, treating ADHD during childhood and adolescence minimizes the symptoms persistent into adulthood. (Roy and colab JCAAP 2016;55(11):937-944
4. Adult functioning is worse, when less ADHD symptoms persist from the adolescence period. (Hechtman, MD and collab/JAACAP 2016;55(11):945-952). It is important to identify ADHD symptoms early and intervene in a timely manner to promote better functional outcomes
5. Adults with ADHD have more traffic violations and accidents and a higher rate of incarcerations and convictions
6. A mortality rate almost 2 times higher with great differences in suicide and accidents (Parikh, Baker Current Psychiatry 2016, October)

Further References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
CDC website: https://www.cdc.gov/ncbddd/adhd/diagnosis.html

Get Help For The Warning Signs Of Depression And Suicide In Children And Young Adults

Suicide Is The Number One Cause Of Death In Young People

warningsignssuicide

Sadly, suicide is the number one cause of death in young people, 15-24 years old, and by 2020 depression will become the number one cause of disability worldwide. It should be noted that 1 in 5 teens will suffer from depression before they reach adulthood. And In 2014, around 15.7 million adults age 18 or older in the U.S.A had experienced at least one episode of major depression in the past year. This represented 6.7 percent of all American adults.

Communicate With Your Child Openly

It is a common belief that if you ask someone if they are considering suicide, you may actually instill that idea in them. However, it has been found that being open and unafraid of inquiring about it when somebody seems depressed might be the only way to get help, and therefore, be more likely to prevent suicide.

A Window Of Opportunity

In the mind of the patient suffering from depression, there is a window of opportunity that allows for intervention. It is during this time that a decision to do something to kill themselves has not been made yet. Teenagers, as we all know, have a more difficult time to talk about how they feel than adults. The most common answer to the question ‘how was your day?’ is typically ‘fine’. That is a normal response from a teenager who is preoccupied with his or her own developmental challenges. However, that should not discourage parents to ask questions which can create opportunities for a dialogue to occur. Just because your teen might signal that he or she does not want to talk about things that preoccupy them- does not mean that you, as a parent, must accept the notion that there is nothing to talk about.

Your Attitude About Psychiatric Treatment Makes A Difference

Before I review several signs that could alert parents that something more serious than normal development may be happening with their teen, I have to share some of my concerns about parents’ attitude with regard to psychiatric treatment.  More often than not, your child will mimic your attitude about mental illness, and model your understanding and acceptance of it. When you, as a parent, have been disparaging about people with mental illness and/or treatment of it, either denying its existence or denigrating those with mental illness who seek help as weak- do not be surprised to learn that your child might not be forthcoming with their feelings or concerns.

Young Adult Body And Mind Changes

Because young adults are still growing and developing, many teens and young adults do not have the language necessary to discuss their emotional states in words. Especially with their parents, teens are even more unlikely to talk about their insecurities or feelings for fear of being considered ‘crazy’, or ‘weak’ or ‘not worthy’ of your love.

Play It Safe-Take Your Child Seriously

Unfortunately, I see way too many parents who do not take seriously their children’s complaints of sadness, lack of interest, energy or extreme worries. These symptoms need to be evaluated by a professional to explore their seriousness so that, if needed, they can be addressed in treatment; either with medication, therapy, or both. Since parents are the decision makers in the administration of their children’s treatment- they need to keep in mind that they are not the ones who are directly experiencing the pain of depression, anxiety or other mental illness.

Resources That Can Help Your Child

A good resource for understanding when to become concerned about your teen is the ‘Facts For Families,’ guide which details the signs that could alert a parent about the possibility of a suicide. These are as follows:

  • change in eating and sleeping habits
  • withdrawal from friends, family, and regular activities
  • violent actions, rebellious behavior, or running away
  • drug and alcohol use
  • unusual neglect of personal appearance
  • marked personality change
  • persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
  • frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc
  • loss of interest in pleasurable activities
  • not tolerating praise or rewards

As it is noted in the ‘Facts for Families’ guide, the above are also signs of depression and the parents should attempt to get help to prevent a suicide attempt by getting the teen or young adult to participate in a psychiatric consultation.

Other Signs To Look For In Your Child

There are some other changes to look for in your child that may signal imminent danger. These include teen or young adult communicating the following thoughts:

  • complain of being a bad person or feeling rotten inside
  • give verbal hints with statements such as: I won’t be a problem for you much longer, nothing matters, It’s no use, and I won’t see you again
  • put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc.
  • become suddenly cheerful after a period of depression
  • have signs of psychosis (hallucinations or bizarre thoughts)

There Is Hope If You Take Action

What is important to know, and to remember, is that depression is a treatable disorder, and so is suicidal ideation, as long as we act fast. As I mentioned above, we must act within the window of time that precedes the decision to move from suicidal ‘idea’ to ‘plan’.  As also previously stated, once the teen has made the decision to kill himself or herself, their mood usually lifts, becomes less obviously gloomy and more peaceful. This is not an unusual behavior for people, adults or teens alike, who shift their mindset from ‘contemplative’ or more ‘passive’ thoughts of death to an actual active plan for completion of the suicidal act. The bottom line here is that you don’t have to make this decision as to what is safe or not by yourself. It is better to err on the side of caution and discuss with your child the decision to have them evaluated, not as a punishment, but, as a way to help them sort out their thoughts and feelings and begin to find ways to make them feel better.

References:

https://www.adaa.org/understanding-anxiety/depression

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/FFF-Guide-Home.aspx

https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

Same Sadness, So Why Different Types Of Depression?

If It’s The Same Sadness, Why Are There Different Types Of Depression?

And How Does This Affect Your Treatment?

By Daniela M. White, MD

 depression treatment houston

 

It Is The Same Illness, So Why Different Medications?

I’m sure that some of you wonder that after seeing your psychiatrist that you received a different medication than your friend, coworker, or even family member. You have many of the same complaints of feeling sad, lacking interest and the energy to do much, isolating, crying at the drop of a hat and having ruminating bad thoughts that sometimes life is not worth living. You appear to have the same feelings, the same complaints, but are receiving different treatments and sometimes, a different diagnosis. This article describes why this might be the case.
From the beginning, it is worth noting that feeling sad, and crying when something bad and unexpected happens is perfectly normal, and oftentimes is expected.  Feeling of sadness by themselves, does not result in a diagnosis of clinical depression, unless several conditions are met at the same time.

 

Different Types of Depression

Even if the criteria for clinical depression is met, there are different types of depression, and they need to be approached with different treatments to obtain a response and eventually remission.

Response, in clinical terms, means that the treatment provides some relief.

Remission means that the symptoms become absent.

 

What is The Commonality Within A Depression Diagnosis?

In all the different types of depression, sadness is the main complaint, usually associated with low self-esteem, sometimes irritability and difficulties enjoying life and increased tendency to cry very easily. However, there are differences in duration, intensity and severity as well as the way these episodes are triggered that make the diagnosis and therefore treatment, different.

According to the Mayo Clinic, to get a diagnosis of clinical depression, one must meet the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association. The DSM is also used by mental health providers to provide a diagnosis of mental health conditions and by insurance companies to provide reimbursement for mental health treatment.

To get a diagnosis of clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, and nearly every day. At least one of the symptoms must be either a depressed mood or a loss of pleasure or interest. Signs and symptoms may include the following:

  • Depressed mood, such as feeling sad, empty or tearful (in children and teens, depressed mood can appear as constant irritability)
  • Feelings of worthlessness, or excessive or inappropriate guilt
  • Fatigue or loss of energy
  • Significantly reduced interest or feeling no pleasure in all or most activities
  • Insomnia or increased desire to sleep
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected)
  • Either restlessness or slowed behavior that can be observed by others
  • Trouble making decisions, or trouble thinking or concentrating
  • Recurrent thoughts of death or suicide, or a suicide attempt

For a diagnosis of clinical depression, your symptoms must be severe enough to cause noticeable problems in relationships with others, or interfere with your day-to-day activities, such as school, work, or social activities. Symptoms may be based on your own feelings, or on the observations of someone else.

Clinical depression can affect people of all ages, including children. However, clinical depression symptoms, even if they are severe, can usually get better with counseling, antidepressant medications or a combination of the two.

 

Types of Depression Diagnoses

The following list of diagnoses that most mental health clinicians might choose from when determining a diagnosis. The diagnosis is important because proper treatment depends on an accurate diagnosis:

  • Persistent Depressive Disorder (or dysthymia): 
  • Major Depressive Disorder, unipolar
  • Bipolar disorder, Depressed (bipolar disorder I, II and cyclothymia
  • Postpartum Depression
  • Premenstrual Dysphoric Disorder
  • Adjustment Disorder with depressive symptoms
  • Bereavement
  • Depression secondary to medical conditions
  • Substance Induced Depression

As an example of the difference between two types of depression, a lot of times people who have bipolar disorder spend most of their sick time depressed and not hypomanic, or in a state of elation. However, the treatment for a depressed episode of a bipolar disorder is typically a mood stabilizer and not an antidepressant that might make symptoms worse.  Having one episode of mania or hypomania, indicates a diagnosis of bipolar disorder and the treatment should focus on that, avoiding as much as possible an antidepressant without a mood stabilizer to start with.

 

How To Get The Most Out Of An Appointment With Your Care Provider

The best thing that a patient can do is to be as open as possible during the psychiatric evaluation and be willing to work with your doctor without leaving information out that might be essential not only in treating the symptoms but to avoid causing new ones.

 

Diagnoses Can Change Over Time

It is also worth remembering that your initial diagnosis is a working one that can evolve over time as more clinical information becomes available from the sessions. It is also important to see your psychiatrist often before the diagnosis is fully defined and until remission is achieved.

 

See Your Doctor And Psychiatrist Regularly, Even If You Are Feeling Better

Your primary health care and mental health care should be given in a coordinated manner. That is to say, your primary care doctor and mental health provider should be aware of the care the other is providing.  If you haven’t already done so, and you are feeling sad or depressed, we recommend that you first speak with your primary care doctor and get a complete physical exam. The goal of the physical exam would be to try and rule out a physical cause for your depression. During the physical exam, the doctor typically will focus on the most likely causes of depression, the endocrine and neurological systems of your body. The doctor will look for any health concerns that may be contributing to clinical depression symptoms. For example, hypothyroidism is typically caused by an under-active thyroid gland. The under-active thyroid is the most common medical condition that is associated with symptoms of depression. Other endocrine disorders that are associated with depression include hyperthyroidism, caused by an overactive thyroid, and Cushing’s disease, which is a disorder of the adrenal gland. Oftentimes, treating these issues can alleviate symptoms of depression. Also, your doctor might look at other medications that you are taking to see if any of the side effects include depression.

Not seeing your treating physician and mental health care provider regularly can leave side effects unaddressed or allow symptoms to progress or worsen.

 

Monotherapy Vs. Combination Drug Therapy

There are multiple medications and therapies now available. In psychiatry for bringing mental illness to remission, and it is not uncommon to try several medications before finding one or more that are effective. Combination drug therapy is a type of treatment that many doctors and psychiatrists have been increasingly utilizing during the past decade, especially for Major Depressive Disorder, where there is some research to suggest that taking antidepressants from multiple classes may be the best way to treat Major Depression.

 

References:

Combination of Antidepressant Medications From Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized Study   Pierre Blier, M.D., Ph.D., Herbert E. Ward, M.D., Philippe Tremblay, M.D., Louise Laberge, M.D., Chantal Hébert, R.N., and Richard Bergeron, M.D., Ph.D.  March 1, 2010, American Journal of Psychiatry March 2010, Vol. 167, No. 3, pp. 281 – 288

http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/clinical-depression/faq-20057770

http://www.webmd.com/depression/guide/depression-tests – 1

Tips For A Good Nights Sleep

Are You Getting A Good Nights Sleep?

How to get a good night sleep

According to a study published by the Institute of Medicine, an estimated 50-70 million adults in the United States have a sleep or wakefulness disorder. Do you or your partner snore? If so, you should note that snoring is a major indicator of obstructive sleep apnea; however, not everyone who snores has sleep apnea.

 

How Much Sleep Is Enough?

The amount of sleep a person needs depends on many factors, including their age.

We did a search of the literature and found some recommended levels of sleep for each age group. These are approximately as follows:

  • Newborns/Neonates require 16-18 hours a day
  • Infants require 12-15 hours a day
  • Toddlers require 11-14 hours a day
  • Pre-school children require 11-12 hours a day
  • School-age children require 10-11 hours a day
  • Teenagers need 9-10 hours on average

It is recommended that most adults should get 7 to 8 hours a night for the best amount of  sleep. Although there are individual differences in how much sleep people require. For example, some people may need as few as 6 hours, and some may need as many as 10 hours of sleep each night. And women in the first 3 months of pregnancy often need several more hours of sleep than they might usually require.

 

What If You Feel Drowsy During The Day?

For most people, it is normal to feel some daytime sleepiness. This occurs due to the natural rhythms of our bodies. However, you need to differentiate sleepiness from tiredness. When we are feeling sleepy, it can feel like a conscious struggle to remain awake. On the other hand, when we are tired, we may feel fatigued but will still remain relatively alert. It is therefore important that you know the difference. Some sleep experts say that if you feel drowsy during the day, even during boring activities, you may have not had enough sleep at night, or the quality of your sleep needs improvement.

 

Determine The Cause Of Your Sleep Problem

It is important that you let your primary care doctor know about your challenges with sleep so that they can rule out a medical cause.  One rule of thumb, is that if your sleep difficulties last for a month or more then you should let your doctor know. Your doctor can check to see if you have a health condition such as asthma, arthritis, acid reflux, or depression. For some people, taking certain medications can be the cause of a sleep disorder, and the doctor can recommend medication changes that might make a big difference in your quality of sleep.

 

Why Is It Important To Deal With Your Sleeplessness?

Insufficient sleep has been linked to the development and management of a number of chronic diseases and conditions, including diabetes, cardiovascular disease, obesity, and depression.

Depression and Sleep Disorders: Is There A Connection?

Since we see a lot of people suffering from depression- we want you to know that the relationship between sleep and depression can be quite complex. While sleep disturbance has been known to be an important symptom of depression, there is recent research that has indicated that depressive symptoms may decrease once sleep apnea has been effectively treated and sufficient sleep restored. This relationship between depression and sleep suggests that it is essential to assess and monitor sleep disorders in people with depression.

 

What is Good Sleep Hygiene?

The promotion of normal sleep is known as sleep hygiene. The following is a list of 10 sleep hygiene tips which sleep experts recommend to improve sleep:

  1. Make sure that the room you go to sleep in is the right temperature
  2. Your bedroom should be conducive to sleep; quiet, dark, and generally relaxing
  3. Go to bed at the same time each night and wake up at the same time each day
  4. Make sure you have a comfortable bed that provide adequate support
  5. Use your bed only for sleeping, and not for reading, watching television, or music listening
  6. Do not have large meals before bed
  7. Do not work out before bedtime
  8. Write down your thoughts in a journal or notebook before going to bed. For many people, thinking about things that happened during the day keeps them up
  9. Reduce or avoid alcohol, caffeine, and nicotine, especially near bedtime. Reducing alcohol will also reduce the time going to the bathroom at night, and improve your quality of sleep
  10. Turn off TVs, computers, and other blue-light sources an hour before you go to bed. Cover any displays you can’t shut off. Then, read a book, take a bath, meditate, or listen to calming music

 

Is Taking A Nap Good For Sleep or Will It Affect Sleep?

We have seen mixed reviews on whether taking naps is recommended; with some experts saying if you take a nap after lunch, you see increased productivity throughout the rest of the day, and other experts saying not to take naps because it may affect your sleep at night. The consensus is that if you have to take a nap-you should keep it to 20 minutes or less, and try to take a nap in the earlier part of the day. Some people report that naps provide them with a short-term boost in alertness and performance. However, you should note that taking a nap doesn’t provide all the other benefits of sleeping during the night-time.

When To See A Doctor and What To Do Before You See One

As mentioned above, it is important that we practice good sleep hygiene. However, if your sleep problems persist despite your attempts, and if they interfere with how you feel or function during the day, you should seek evaluation and treatment by your primary care physician.  If your primary care doctor does not resolve the issue, you may want to seek further evaluation and consultation from a medical provider who has experience with assessing and treating sleep disorders. Before visiting your physician, it may be helpful to keep a diary of your sleep habits for 7-10 days. This will help you to better understand and convey the issues you are having to the doctor so they can provide you with a better diagnosis. We have provided a couple examples of sleep diaries in the references below for you to choose the one you like best. However, we recommend that you include the following information in your sleep diary.

The times when you:

  • Go to the bedroom to sleep
  • Fall asleep
  • Wake up
  • Get out of bed
  • Take naps
  • Exercise
  • Consume alcohol
  • Drink caffeinated beverages

 

Need Help?

If you believe that you have a mental health concern that is affecting your ability to sleep- then seek help from a mental health professional. Call us at 713-426-3100 to learn more about our approach to psychiatric treatment, or to make an appointment.

 

 

References:

  1. Institute of Medicine. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: The National Academies Press; 2006.
  1. Schwartz DJ, Kohler WC, Karatinos G. Symptoms of depression in individuals with obstructive sleep apnea may be amenable to treatment with continuous positive airway pressure. Chest2005;128:1304–1306.
  1. Zimmerman M, McGlinchey JB, Young D, Chelminski I. Diagnosing major depressive disorder I: A psychometric evaluation of the DSM-IV symptom criteria. J Nerv Ment Dis2006;194:158–163.
  2. http://www.webmd.com/sleep-disorders/guide/sleep-requirements
  1. https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html
  1. https://sleepfoundation.org/sleep-diary/SleepDiaryv6.pdf
  1. http://www.cci.health.wa.gov.au/docs/ACF1946.pdf

 

 

Fairy Tales And Kids

The Importance of Fairy Tales and Folk Stories in Fostering An Emotionally Healthy Child

Fairy Tales And Kids

A subject of interest for me is the role of fairytales and folk stories in bringing out and nourishing children’s spirituality.

There are many reasons why I think fairy tales are good for kids development. This article outlines just a few. Fairy Tales do the following:

  • Teach right from wrong
  • Help children deal with emotions
  • Foster imagination
  • Develop cultural literacy introducing them to different cultures
  • Develop critical thinking skills
  • They are fun!

Parents have a great opportunity when their kids are young to help them learn about people, the world, and themselves. Fairy tales provide kids the chance to put themselves in the shoes of the characters, which allow children and begin to develop essential decision-making skills. These are skills that will help children throughout their lives.

 

The Role Of Myths And Fairy Tales

Myths and fairy tales give children the opportunity to figured out how to apply the meaning of the stories in their own lives. The answers that are offered by fairytales are suggestive, not definite (Bruno Bettelheim). Which allows room for interpretation and questioning.

Sometimes children accept and internalize lessons more easily from fairy tales than from their parents. Fairy tales speak a language that is familiar and makes sense to children.  Children tend to think animistically, everything has a soul, and both inanimate and the animate object freely interact. Since there is no clear distinction between the two worlds, kids may believe that death can be reversed, and things and people can come back to life. Fairytales and folkloric tales answers children’s fundamental questions such as: who am I, where do I come from, where am I going, and what is life all about?

From the adult’s point of view, the explanations given by the fairy tales are not realistic and in a rushed analysis, could be presented as ‘false,’ to a child’s mind that lacks certain abstract thinking. These realistic explanations are difficult to comprehend. Parents can serve as guides through the fairy tale world, helping their children to understand the underlying concepts in terms they can understand.

fairy tale castle

The story of Snow White and the Seven Dwarfs is a great fairy tale that has many lessons. Among the lessons are the following:

  • Be cautious with strangers
  • It’s great to have friends
  • Never give up hope
  • Bad deeds rarely go unpunished
  • Watch what you eat
  • Insecurities do not justify a mean attitude
  • Real beauty comes from within

Fairy tales are a great way to spend quality time with your kids, and help them learn about life.  It is important that kids be exposed to fairy tales at the right stage of their development. Fairy tales are ideal bedtime stories, especially for 3 to 10-year-olds. Here are some websites that I like for book suggestions of various ages:

http://fairydustteaching.com/2010/11/age-appropriate-fairy-tales/

http://www.waldorflibrary.org/articles/977-choosing-fairy-tales-for-different-ages

https://parenting.blogs.nytimes.com/2009/01/12/are-fairytales-to-scary-for-children/?_r=0

 

To learn more about Psychiatry for Children, contact Daniela White, M.D. Psychiatrist for Children Houston at 713-426-3100.

 

 

What is Positive Psychiatry Treatment?

Positive Psychiatry Treatment

“The goal is to produce mental health not to merely alleviate mental illness.”  ~ George Vaillant

 positive psychiatry treatment

My Patients, Coping and Positive Psychiatry

As a psychiatrist, I found myself interested in the wellbeing of the patients who were struggling for long periods of time with chronic depression, anxiety or even ADHD. I observed that they usually did not develop a healthy way to cope with the stress of daily life, such as exercising regularly, having positive mindset, asking for help when needed, etc. I realized that the biological treatments, such as medications, and more recently Transcranial Magnetic Stimulation, were able to bring the patient to a level where they could start being interested in developing other aspects of their lives that would then move them to better overall wellness. One type of Psychiatry I use, Positive psychiatry, as George Vaillant said, “is meant to produce better mental health and not only alleviate mental illness.”

 

Definition of Positive Psychiatry

One definition of positive psychiatry describes it as the “science and practice of psychiatry that seeks to understand and promote well-being through assessments and interventions aimed at enhancing the Positive Psychosocial Factors (resilience, optimism and social engagement).”

This points to the realization that we cannot just look at managing mental health in isolation-we must look to improve the overall health of the individual. The World Health Organization has defined health, not as an absence of sickness or disease, but as a state of complete mental, physical, and social well-being.  And there is a growing body of research that shows that higher levels of positive psychosocial characteristics (PPCs) such as optimism, resilience, and social engagement are associated with objectively measured better health outcomes, which include living longer, as well as with people’s feelings of well-being.

Positive psychiatry is rooted in biology and tries to figure out the underlying biological causes of positive psychosocial characteristics and eventually tries to increase health and well-being through psychosocial/behavioral and biological interventions.

 

Positive Psychiatry and Promoting Well-Being

There are a couple positive interventions which have been reported to promote wellness, as well as preventing and treating mental illness. For example, research has indicated that setting personal goals, practicing optimism, and using character strengths have been shown to enhance well-being and relieve depressive symptoms.

 

Positive Psychiatry and Lifestyle Interventions

There are several lifestyle interventions which we encourage our patients to practice. The first is exercise.  Exercise has been found to be as effective as medication for patients with mild to major depression and it is also shown to have longer lasting results. One study showed that moderate exercise may also help prevent depression. In addition to helping with depression, physical activity has been shown to optimize learning by improving impulse control, attention, arousal and also reduces learned helplessness. We also recommend some form of meditation. It doesn’t matter which kind you choose. Meditative practices such as tai chi, qigong, and mindfulness meditation also have a place in the clinical setting and have been shown to enhance positive affect, decrease anxiety and negative affect, and have potential benefits across a range of psychiatric conditions. Moreover, many people find that yoga has a beneficial impact in reducing stress and inflammation as well as improving immune function and overall health.

Research has also shown that eating a healthy diet can reduce the risk of severe depression, while junk food, sugar, and processed meats may increase depressive symptoms. And most of us know that of all diets, the Mediterranean diet has been associated with decreased risk of late-life depression and cognitive dysfunction.

Additionally, we encourage and educate our patients on the importance of good sleep hygiene. This can make a big difference in the quality of sleep and quality of life. Decreasing alcohol, nicotine and caffeine intake; increasing physical activity; and keeping the bedroom dark and free of distractions like a cellphone, tablet or computer, are well-documented strategies to improve sleep.

Positive psychology is an integrative treatment approach that we practice here at Midtown Psychiatry & TMS Center. If you are interested in a consultation-feel free to contact Daniela White, M.D. Psychiatrist at 713-426-3100.

References:

  1. World Health Organization. WHO Definition of Health. http://www.who.int/about/definition/en/print.html. Accessed October 13, 2014.
  2. Diener E, Chan MY. Happy people live longer: subjective well-being contributes to health and longevity. Applied Psychology: Health and Well-Being. 2011;3:1–43. doi:10.1111/j.1758-0854.2010.01045.x
  3. Rasmussen HN, Scheier MF, Greenhouse JB. Optimism and physical health: a meta-analytic review. Ann Behav Med. 2009;37(3):239–256. PubMed doi:10.1007/s12160-009-9111-x Show Abstract
  4. Vaillant GE, Mukamal K. Successful aging. Am J Psychiatry. 2001;158(6):839–847. PubMed doi:10.1176/appi.ajp.158.6.839
  5. Bolier L, Haverman M, Westerhof GJ, et al. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health. 2013;13(1):119. PubMed doi:10.1186/1471-2458-13-119
  6. Blumenthal JA, Babyak MA, Doraiswamy PM, et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007;69(7):587–596. PubMed doi:10.1097/PSY.0b013e318148c19a Show Abstract
  7. Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45(5):649–657. PubMed doi:10.1016/j.amepre.2013.08.001 Show Abstract
  8. Ratey JJ, Hagerman E. Spark: The Revolutionary New Science of Exercise and the Brain. New York, NY: Little, Brown and Company; 2008.
  9. Yin J, Dishman RK. The effect of Tai Chi and Qigong practice on depression and anxiety symptoms: a systematic review and meta-regression analysis of randomized controlled trials. Ment Health Phys Act. 2014;7(3):135–146. doi:10.1016/j.mhpa.2014.08.001
  10. Arora S, Bhattacharjee J. Modulation of immune responses in stress by yoga. Int J Yoga. 2008;1(2):45–55. PubMed doi:10.4103/0973-6131.43541 Show Abstract
  11. Yadav RK, Magan D, Mehta N, et al. Efficacy of a short-term yoga-based lifestyle intervention in reducing stress and inflammation: preliminary results. J Altern Complement Med. 2012;18(7):662–667. PubMed doi:10.1089/acm.2011.0265
  12. O’Neil A, Quirk SE, Housden S, et al. Relationship between diet and mental health in children and adolescents: a systematic review. Am J Public Health. 2014;104(10):e31–e42. PubMed doi:10.2105/AJPH.2014.302110

 

Why Is Spirituality important in Therapy?

The Importance of Spirituality in Therapy

Why-Is-Spirituality-important-in-Therapy

Studies have been reported that in some areas of the United States, up to 90 percent of patients rely on religion for comfort or strength during times of serious illness. A recent review of more than 1,200 studies of religion and health reported that at least two thirds of the studies evaluated had shown significant associations between religious activity and better mental health, better physical health or lower use of health services.

Failure to not consider a client’s spiritual/religious beliefs in one’s bio-psychosocial assessment and delivery of treatment to them is considered a very serious oversight. Spirituality or religion may be a collection of adequate, simple, unquestioned beliefs about the world and oneself, or it may involve an active search for meaning and purpose greater than oneself. Due to these factors, Spirituality plays an integral role in the lives of many, but not all, people. Having an understanding of the role of spirituality in one’s life can help the clinician help the client.

 

Competency, Spirituality and Counseling

According to Geri Miller, an associate professor in the Department of Human Development and Psychological Counseling at Appalachian State University, Boone, North Carolina, in order to be considered competent to help clients address the spiritual dimension of their lives, a counselor should be able to do the following:

  1. Explain the relationship between religion and spirituality, including similarities and differences
  2. Describe religious and spiritual beliefs and practices in a cultural context
  3. Engage in self-exploration of his/her religious and spiritual beliefs in order to increase sensitivity, understanding and acceptance of his/her belief system
  4. Describe one’s religious and/or spiritual belief system and explain various models of religious/spiritual development across the lifespan
  5. Demonstrate sensitivity to and acceptance of a variety of religions and/or spiritual expressions in the client’s communication
  6. Identify the limits of one’s understanding of a client’s spiritual expression, and demonstrate appropriate referral skills and general possible referral sources
  7. Assess the relevance of the spiritual domains in the client’s therapeutic issues
  8. Be sensitive to and respectful of the spiritual themes in the counseling process as befits each client’s expressed preference, and
  9. Use a client’s spiritual beliefs in the pursuit of the client’s therapeutic goals as befits the client’s expressed preference.

 

What’s Included In A Spiritual Assessment?

When helping their patients, clinicians should consistently use a standardized assessment designed for this purpose.  Included in a spiritual assessment, at a minimum, should be a determination of the patient’s denomination, beliefs, and what spiritual practices are important to them. This information will assist the counselor in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment that might be needed. Other possible questions that might be included in the assessment are as follows:

1) Who or what provides the patient with strength and hope?

2) Does the patient use prayer in their life?

3) How does the patient express their spirituality?

4) How would the patient describe their philosophy of life?

5) What type of spiritual/religious support does the patient desire?

6) What is the name of the patient’s clergy, ministers, chaplains, pastor, rabbi?

7) What does suffering mean to the patient?

8) What does dying mean to the patient?

9) What are the patient’s spiritual goals?

10) Is there a role of church/synagogue in the patient’s life?

11) How does your faith help the patient cope with illness?

12) How does the patient keep going day after day?

13) What helps the patient get through this health care experience?

14) How has illness affected the patient and his/her family

15) How do you think about life? I mean, do you think there’s a God; what’s the meaning

16) Why are you here?

17) What does this belief/idea/faith do for you? What role does it play in your life?

18) Is there anything you’d like to change or improve about it/you?

19) What do you want more of in your life?

20) What do you want more of in your spiritual life?

21) How would you feel if you got what you wanted spiritually?

22) What kind of person would you be if you had it?

23) What is keeping you from it?

24) Do you have the courage to ask your Higher Power to make you that kind of person?

 

Why Assess a Client’s Spirituality?

Spiritual assessment is the process by which health care providers can identify a patient’s spiritual needs pertaining to their mental health care. The determination of spiritual needs and resources, evaluation of the impact of beliefs on healthcare outcomes and decisions, and discovery of barriers to using spiritual resources are all outcomes of a thorough spiritual assessment.

Here are some important reasons why a religious/spiritual assessment is necessary:

  1. Prognosis – Religious involvement is predictive of positive physical and mental health outcomes, possibly even serving a protective factor. When religious involvement did not appear to provide benefit, the inquiry should look into where it may have been protective, but then was overwhelmed by other influences, or may have even been detrimental to the client. Clearly, the person’s religious history and present sense of spirituality must be considered in sufficient detail and in relation to other available data. (Miller, 1999).
  1. Context — The clinician can expect that for many clients their spirituality and religion are an important or even central elements in their larger worldviews and life context within which presenting concerns will be addressed. Understanding clients’ spirituality can promote clearer communication, offering contextual information that is important to the process of treatment. As the clinician explores the cognitive, affective, and unconscious elements of mental health issues, they can help clients by an alert openness to how spiritual and religious threads may be woven into such concerns and used in their resolution.
  1. Outcome – As treatment progresses the individual’s spiritual and religious beliefs will provide not only resources to draw upon, but may also change in some respects themselves. As much as religious beliefs may have positive value for health, there is also a possibility that some aspects of the individual’s beliefs may increase risk or exacerbate problems (e.g., a rigid, unforgiving divinity).
  1. Intervention – Utilizing the client’s own specific spiritual perspectives to enhance and integrate treatment strategies can produce good results. Building on certain assumptions, practices, or following the logic of a certain belief are all examples of how the individual’s beliefs can become important resources for change.
  1. Comfort and Acceptance — Discussing the client’s spiritual and religious beliefs and experiences with them in a sensitive and appropriate manner can often constitute an intervention in itself. Frequently, all that is necessary is to listen to the patient’s responses, providing presence and support, rather than demonstrating expertise in religious matters. When religion/spirituality is what gives meaning, purpose and hope, the client often feels supported and comforted by sharing these beliefs with the concerned clinician. Likewise, if there are religious doubts or anxieties present, sharing these feelings with a caring, accepting professional may help with resolution. “Cure sometimes; relieve often; comfort always.” Possible assessment results In arriving at a conclusion regarding the client’s spiritual/religious status, it is important to realize that this is only a functional analysis, and that among other limitations, it is important to realize that more than one of these categories may be at play in the individual’s experience.

 

To make a referral for Psychiatry or counseling please contact Daniela White, M.D. Psychiatrist in Houston at 713-426-3100.

 

References:

Spirituality in Counseling –Drab, Kevin J. and  Hays, P. A. (2001).

Miller, G. (1999). The Development of the Spiritual Focus in Counseling and Counselor Education. Journal of Counseling and Development, 77(4). Fall. p. 500. 2

How Do Mental Health Clinicians Assess Children’s Spirituality?

Assessing A Childs Spirituality

assessment of children

How do we assess how spirituality is nourished in a child’s life? I usually start with open ended questions that allow them to keep their language in here and now or take it to different dimensions.  I always assess their ability, and where they are in the process of achieving that ability, to shift between perceptual positions in understanding the world around them through some of these questions.

 

What to be Prepared for When You Discuss Religious and Spiritual Beliefs

The assessment of religious/spiritual beliefs are very personal questions, and patients can be reluctant to reveal sensitive information when responding to these questions. This can be even more so, if the patient or family adheres to a religious tradition with a history of persecution. Although, we have found that many patients and families want their medical providers to understand the importance of these aspects of their lives, we must respect their right to privacy, go at a pace that is respectful, and building trust is key to receiving reliable information.

 

How Children Understand Their World

Ages 1-4

At a younger age, most children understand their world through what we call a first perceptual position, meaning how everything starts and ends with me. What are my needs? How are they met? How do other people around me meet my needs and understand me?

 

Ages 4-5 and Older

Older kids, 4-5 years and older, would be able understand other people’s needs and feelings, being able to put themselves in a second perceptual position: how would Dennis feel if I take his ball?

 

Ages 11-13

A preteen and a young adolescent (11-13 years old) would be able to shift to what is called a third perceptual position, when he can perceive how a third person, or an outside observer would ‘see’ an interaction between he/she and a peer. At this age, a sense of morality is usually developed.  And some people would also consider a forth perceptual position, when the child wonders how his actions and the world he is involved with is seen from very high above, by God, how each of us understands Him.

 

Age Appropriate Development

Once we understand where the child is in his or her development compared to other kids of similar age, we can begin to assess the development of their spirituality which can help in the therapeutic process to be able to relate to the child at their level and to help them grow to an age appropriate level.

 

Read more about Why Is Spirituality important in Therapy?

 

If you know of a child who is in need of an assessment, or a family in need of support- feel free to refer them to us by calling Daniela White, M.D. Psychiatrist for Children in Houston at 713-426-3100.

How To Be More Resilient: Resilience and Therapy

Resilience Affects Response To Trauma

resilience through yoga

My Interest in Resilience

I have a particular interest in resilience because of my own experience of growing up in a communist society where people were exposed to trauma. When I came to this country and interacted with patients, I noticed that there were many who were sometimes exposed to the same degree of trauma as we experienced but ended up having different degrees of suffering. As I read about the concept of resilience, and reviewed the relevant research on the subject of resilience- I discovered that a person’s degree of resilience affects their level of mental health. This is consistent with many researchers and authors findings. Related research over the years, has revealed that spirituality and/or religion have been recognized as sources of resilience.

 

What is Resilience?

Rabbi Harold Kushner said in his book “When Bad Things Happen to Good People” knowing how to pray for strength to go through difficult situations is basically praying for resilience, not for a change in outcome. Resilience means, simply said, “to make the best out of not such a good situation.”  In the context of Positive Psychiatry, George Vaillant quoting Werner and Smith (1982), said that “resilience is the capacity to ‘bend without breaking’ and ‘once bent, to spring back’.” In that sense, he continues, resilience has a similar meaning to the term ‘homeostasis’.

 

What Resilience Really Means

In essence, resilience is the ability to bounce back when something difficult happens or doesn’t go as planned in our lives. It is the ability to once again pick ourselves up after a trauma or painful experience. Our levels of resiliency will change and develop throughout our live, and at points we will find that we do not cope as well as others, as well as surprising ourselves when we manage a difficult situation. In another sense, resilience is just one of many psychological tools we implement to get us back to feeling normal again.

 

Why is Resilience Important For Our Emotional Health?

Important Benefits Of Being Resilient Include:

  • Less likely to get depressed or develop mental health difficulties or issues
  • More likely to protect ourselves emotionally and less likely to get overwhelmed during stress
  • Live longer and happier lives
  • Have better relationships
  • Reduced risk taking behaviors, such as drugs, alcohol, or smoking
  • Increased involvement in community or family activities
  • Improved learning and academic achievement
  • More successful at work or school
  • Lower rates of illness and absences from work or study

 

Ways to Build Resilience

The ultimate goal in building your resilience is to get stronger both physically and emotionally, so that it is easier for you to overcome whatever challenges you might face.

Here are some ways you can begin to build your resilience:

  • Exercise regularly, do yoga, bike, run, swim, walk, etc
  • Set specific and achievable personal goals
  • Get enough sleep
  • Make time for incorporating spirituality and religion in your life
  • Go easy on, and forgive yourself and others
  • Practice relaxation and meditation, e.g. listen to music, take a bath, get a massage, etc.
  • Eat healthy foods
  • Be honest and straightforward with others
  • Live your values
  • Find ways to build your self-confidence, praise and reward yourself
  • Focus on thinking positively
  • Try to reflect on, and learn from the mistakes you make
  • Make time to build relationships
  • Cultivate support networks of friends, family and colleagues
  • Pursue interests and hobbies, and make time for them
Want Support In Building Your Resilience? We Can Help!

Obviously, doing these things is easier with a little help. If you are interested in building your resilience by pursuing counseling with us, feel free to schedule an appointment for a consultation, or call Psychiatrist Daniela White, M.D. at 713-426-3100.

 

References:

Kushner, Harold S. (2004). When Bad Things Happen to Good People. Knopf Publishing Group.

Vaillant G.E., (2008), Positive Emotions, Spirituality and the Practice of Psychiatry. In: Medicine, Mental Health, Science, Religion, and Well-being (A.R. Singh and S.A. Singh eds.), MSM, 6, Jan – Dec 2008, p48–62.

Werner, E. E., & Smith, R. S. (1982). Vulnerable, but invincible: A longitudinal study of resilient children and youth New York: McGraw-Hill.

Can Antioxidants Help Treat Depression and Anxiety?

Antioxidants Depression and Anxiety

When it comes to stress-induced psychiatric disorders, anxiety and depression are the most common. I see this often in my practice. We know that stressful life events can produce a state of vulnerability to depression and anxiety in some people. The mechanisms that contribute to vulnerability of mental illness is an area which needs further study. Although promising research has been done in the past few years that indicates that there are biochemical changes that occur in the body as a result of stress that can be addressed.  For patients suffering from stress-induced psychiatric disorders, it is essential to understand the role of antioxidants on stress-induced psychiatric disorders so a plan can be created and implemented to help cope with the effects of stress.

 

Stress and Nutrition

Research has shown that stress places a demand on the body in terms of nutrition. During a period of stress, it has been discovered that there is an increase in adrenal production and mobilization. There is also an increase in vitamins and minerals, such as vitamin C, vitamin E, magnesium, potassium, and micronutrients, This further accelerates the metabolism of proteins, fats, and carbohydrates which produces quick energy that is needed to overcome the stress response.

 

Antioxidants and Stress

To combat the biochemical changes which occur as a result of stress, there is something researchers call “antioxidant defence” in the biological system. The research on this states that “primary defence is by enzymatic antioxidants such as superoxide dimutase, glutathione peroxidase, catalase, nicotanamide adenine diphosphate, glutathione transferase and glutathione reductase, while secondary defence is by the non-enzymatic antioxidants such as vitamin E (alphatocopherol), vitamin C (ascorbic acid), β-carotene, minerals, and trace elements like zinc.” This indicates that stress and vitamins are related and we need to replace any vitamins that are depleted in order to maintain healthy functioning.

 

What Are Antioxidants?

The term “antioxidant” was originally used to refer to a chemical which prevented the consumption of oxygen. We now use the term “antioxidant” to describe small molecules that interact with free radicals and neutralize them ensuring proper function of all physiological functions of the body. Free radicals and oxidants can play a dual role as both beneficial as well as toxic compounds. As such, they can either have a helpful or harmful effect on the body. Free radicals are continuously generated by our bodies through internal processes, exposure to different external pathogens or stress. The best sources of antioxidants come from richly colored fruits and vegetables. Different colors characterize different types of antioxidants.

vegetables

Green Vegetables

Brightly colored green vegetables such as kale, broccoli, peas, zucchini celery, collard greens, asparagus, Brussel sprouts, and spinach are rich in lutein and zeaxanthin, antioxidant nutrients deposited in the retinas of your eyes. It is believed that eating an adequate amount of these green vegetables can help prevent the vision loss caused by macular degeneration.

The cabbage family is rich in B vitamins, needed to properly convert glucose to ATP.

 

Yellow and Orange Vegetables and Fruits

Carotenoids are yellow and orange vegetables and fruit, such as butternut squash, carrots, pumpkin, yellow and orange bell peppers, and sweet potatoes. The body converts carotenoids to the nutrient vitamin A which benefits your skin, bones, immune system, vision, bones, and heart.

fruit

Red Vegetables

Red vegetables also contain flavonoids called anthocyanins, which have properties of antioxidants and may help your memory, boost immunity, protect urinary tract and reduce your risk of disease. These include vegetables such as radishes, beets, red onions, and tomatoes. Many foods with natural red pigments also contain lycopene, which is an antioxidant phytonutrient which may help protect against cancer of the prostate.

 

Purple and Blue Vegetables

Purple and blue vegetables such as purple cabbage, purple onions, eggplant, purple peppers, and purple potatoes contain phenolic flavanoids and ellagic acid which are anti-inflammatory compounds. Eating these color vegetables may improve cognitive function, prevent some types of cancer, and reduce your risk of cardiovascular disease.

 

Oxidative Stress, Free Radicals and Illness

Researchers believe that a balance must be maintained between free radicals and antioxidants within the body for healthy functioning. If this balance is not maintained, the free radicals may exceed the body’s ability to neutralize them, which can change different proteins, molecules, DNA, lipids, and carbohydrates, resulting in illness. Antioxidants must be present in the body in order to stabilize the reaction by-products (free radicals), otherwise, it is believed that they damage the cellular tissue.

We get these needed antioxidants from our food. We know that if we eat a diet which is lacking proper nutrients our mitochondria cannot properly process glucose. This results in free radical by-products which can cause ongoing damage to cells and proteins. This, in turn, may accelerate the aging process, increase the risk of auto-immune diseases, degenerative diseases, cancer, and other illnesses.

The term of oxidative stress refers to this imbalance between the free radicals that become excessive to the antioxidants defenses, resulting in molecular changes and eventually illness.

 

Oxidative Stress and Mental Health

Oxidative stress has been shown to be an important contributor to inflammatory conditions, and in recent years has been implicated in the underlying mechanisms that result in depression and anxiety. One of the proposed pathway in developing depression has been the increased oxidative stress which pairs up with inflammatory mechanism leading to cellular aging, and possibly depression and anxiety. Studies that look at the common factors that underlie depression, cellular aging, cancer and dementing illnesses seem to find the oxidative stress a common denominator.

 

Alternative Treatment and Depression

There is an ongoing research in finding “out of the box” modalities to help in the treatment of depression, and most of the alternatives to the traditional pharmacological treatment try to address the inflammation through moderate exercise and a noninflammatory diet. A diet that has anti-inflammatory properties is rich in flavonoids or  ‘nutraceuticals. ’  These seem to have good antioxidative properties, and are primarily found in brightly-colored fruits and vegetables. Others kinds are also found in food, the vitamins such as vitamin C (ascorbic acid), Vitamin E (tocopherols), or B carotenes.

 

Research On Antioxidants, Anxiety and Depression

In a study exploring the role of antioxidants in generalized anxiety disorder (GAD) and depression, it was observed that patients with GAD and depression had significantly lower levels of vitamins A, C, and E in comparison to healthy controls. The study results reported that after dietary supplementation of these vitamins for a period of 6 weeks, a significant reduction in anxiety and depression scores of patients was observed (P<0.001). A significant increase in the blood levels of antioxidants was observed in patients (P<0.05) except that of vitamin E in the group of depressed patients.

 

The Reality of Diets

We know that while the amount of antioxidants needed could be obtained through good nutrition, it would be necessary to eat between 6-10 servings of fruits and or vegetables daily. Oftentimes, that is not possible.  Therefore, we recommend supplementing with good multivitamin/antioxidants called nutraceuticals which gives you a better chance of ensuring that you are getting enough antioxidants and helps with good absorption and bioavailability.

 

Diet and Illness

Although further study on the effects of nutrition is needed to maximize the potential of nutrition on health, the research, to date, demonstrates clearly that diet can play a huge role in preventing or ameliorating illness. As can be seen from the research detailed above- having a diet rich in different colored vegetables, and supplementing with nutraceuticals can be a great start in getting the antioxidants your body needs.

 

Below is a list of references that can help you in your journey to feeling good both physically and mentally.  Click here to schedule a mental health consultation.

 

References:

Role of antioxidants in generalised anxiety disorder and depression.

Gautam M, Agrawal M, Gautam M, Sharma P, Gautam AS, Gautam S.
Indian J Psychiatry. 2012 Jul;54(3):244-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512361/

 

“Minding My Mitochondria: How I overcame secondary progressive multiple sclerosis” By Terry Wahls, MD

 

Dr Wahls’ super-nutrient paleo diet, that reversed her Multiple Sclerosis

 

Phytochemical and Pharmacological Profile: A Review. … Lobo, V., A. Patil, A. Phatak, and N. Chandra. 2010. “Free Radicals, Antioxidants and Functional Foods: Impact on Human Health.” Pharmacognosy Reviews 4 (8): 118–126.

 

Free radicals, antioxidants in disease and health.

Pham-Huy LA1, He H, Pham-Huy C.
Int J Biomed Sci. 2008 Jun;4(2):89-96.

 

Depressive and Anxiety Disorders Showing Robust, but Non-Dynamic, 6-Year Longitudinal Association With Short Leukocyte Telomere Length.

Verhoeven JE1, van Oppen P1, Révész D1, Wolkowitz OM1, Penninx BW1.
Am J Psychiatry. 2016 Jun 1;173(6):617-24. doi: 10.1176/appi.ajp.2015.15070887. Epub 2016 Mar 4.