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Tag: Depression

  • The value of psychedelics

    The value of psychedelics

    More people have been turning to psychedelics to treat post traumatic stress disorder, depression and addiction. Mattha Busby reports for The Guardian on the value of psychedelics, including magic mushrooms and MDMA.

    Under the supervision of a psychiatrist, psychedelics have been found to help people cope with nightmarish memories. Psychedelics sometimes can lead to behavioral adaptations. One trial showed that people who took MDMA under the care of a psychiatrist were more than twice as likely to treat their PTSD as people who took a placebo.

    Today, there is no medicinal treatment for PTSD that works, so the value of MDMA could be huge. The FDA might approve it to treat PTSD in 2023 or sooner. It might also approve psilocybin, which is in magic mushrooms. One tiny study found psilocybin to work four times better than standard antidepressants.

    There was a time when lawmakers dismissed psychedelic drugs as having no medical benefits, even though there was no evidence behind their thinking. In their view, psychedelics were dangerous, so they kept research on these drugs to a minimum.

    Even former Texas governor Rick Perry now believes that psychedelics can help veterans who suffer from PTSD. Recently, Texas passed a state law to research the value of psychedelics. Oregon lawmakers have already approved legalization of the possession of drugs for personal use. Oregon has also licensed psilocybin therapy. Now, the state is licensing magic-mushroom companies. In Colorado, emergency first responders are being trained in psychedelic harm reduction.

    People at risk of psychological issues seem to see great benefits from psychedelics in clinical trials. One study published in Lancet showed that people who received a high dose of psilocybin saw their depression abate and their anxiety improve for a substantial amount of time. Psilocybin apparently lets the brain be rewired, helping people let go of old beliefs and memories and allowing them to better handle their emotions.

    One other benefit of psychedelics is that it ties people to nature, changing people’s attitudes and behaviors in ways that show greater concern for nature. They might eat differently. They might garden more. They might engage in environmental activism.

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  • Free local resources to help older adults

    Free local resources to help older adults

    If you’re looking for free local resources to help older adults, your local Area Agency on Aging is a great place to begin. Area Agencies on Aging (AAAs) develop, coordinate and deliver aging services throughout the country. They serve people over 60 at every income level. In fact, they help more than eight million people a year with long-term care choices, transportation options, benefits information and caregiver issues. You can find them in almost every community.

    Most Area Agencies on Aging are also Aging and Disability Resource Centers (ADRCs). ADRCs provide a hub for information on long-term services and supports to help older adults, their caregivers and families; they work to ensure that older adults are better able to live alone in their homes for as long as possible. They are government agencies that work to meet people’s long-term care needs.

    To contact your local Area Agency on Aging for free local resources for older adults or simply to understand available benefits, call the Eldercare Locator 800.677.1116. The Eldercare Locator is a program of the Administration on Community Living. You can also visit the website at www.eldercare.gov.

    LeadingAge, an association of 6,000 community-based non-profit organizations in the U.S., offers another great resource. It has developed on online tool to help you locate non-profit agencies, agencies that “put people before profits,” that provide services and living facilities for older adults.

    By entering a zip code or city, LeadingAge’s Aging Services Directory will let you know about non-profit resources in the community. You can choose from a list of 18 resources, including nursing, transportation, home-delivered meals and dementia care. You can also learn about retirement communities, assisted living, and subsidized housing.

    And, if you need help navigating Medicare, you should contact your State Health Insurance Assistance Program or SHIP.  For the number of the SHIP in your area, click here. Or, for free help, call the Medicare Rights Center national hotline at 800-333-4114.  For other free and low-cost services for older adults, check out Just Care’s Get Help page.

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  • New therapies may help people with dementia who suffer from depression

    New therapies may help people with dementia who suffer from depression

    About one in three people with dementia also suffer from depression. The New York Times reports on new therapies to treat older adults with dementia who suffer from depression. They address loneliness, hopelessness and anxiety in everyday life through different forms of cognitive behavioral therapy.

    In one case the psychologist worked with a 74-year old woman with mild dementia to identify her best qualities. The psychologist wrote them down and handed the paper to the patient to keep. The patient would have that paper to review when she was feeling down.

    PATH, developed at Weill-Cornell Medical Center, uses written information and film tools to treat anxiety and depression in people who struggle to remember. The goal is to help them solve challenges that present themselves on a regular basis. If possible, PATH engages a caregiver, often the patient’s spouse or family member, to help benefit from the tools. Early studies show that the therapy reduces depressive symptoms. 

    The Peaceful Mind program, developed at Baylor College of Medicine uses a simple form of cognitive behavorial therapy. It engages patients in activities that give them joy. One study shows that this person-centered approach appeared to help reduce anxiety after three months. And patients said that they had a better quality of life. But, after six months, the benefits were less clear.

    Yet another program, developed at University College London, provides patients with a stack of cards to remind them of different strategies for dealing with stress and anxiety.

    Much as dementia can lead to depression, people who suffer from depression have a higher likelihood of developing dementia. It is not clear why, but some believe that people with depression also often have high levels of the stress hormone cortisol, which can be harmful to the brain’s hippocampus. The hippocampus stores long-term memories.

    People with dementia often lack motivation and are scared. They tend to know that they are losing their ability to remember. Depression and anxiety can aggravate their dementia. Psychotherapy can be safer than prescription drugs patients with dementia and depression.

    Some research suggests that older adults with dementia are less likely to be helped by antidepressant drugs. These drugs often have dangerous side effects. For example, Prozac and other SSRIs prescribed for depression, as well as benzodiazepines, such as Klonopin and Xanax, are linked to falls in older adults. Haloperidol, risperidone and other antipsychotics and psychotropics, prescribed for anxiety, can increase the likelihood of death for patients with dementia.

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  • What you should know about ayahuasca, a psychedelic drug

    What you should know about ayahuasca, a psychedelic drug

    Casey Schwartz reports for the New York Times that many Americans, including many older adults, are taking ayahuasca, a psychedelic drug, native to the Amazon, that is illegal in the United States. Indeed, ayahuasca, pronounced aa·yuh-waa-skuh, which you take as a drink, has become popular across the globe.

    Ayahuasca is not a new drug. People have taken it for many hundreds of years as part of religious traditions in Central and South America. It’s active ingredient is N-Dimethyltryptamine or DMT. But, there is little data about its effects on older adults.

    Today, people from around the world travel to Peru, Mexico and other faraway places to find ayahuasca. That said, it sounds like a challenging drug, which causes hallucinations and excretions of many types, including vomiting and diarrhea. 

    Michael Pollan provides a history of psychedelics and his experiences using them in his bestselling new book, “How To Change Your Mind.” He believes that psychedelics may offer especial value to older adults. “[P]sychedelics seem to be particularly good for … jogging us out of our grooves of habit and allowing us to acquire a fresh perspective on familiar things. And as you get older, you get mired in habits.”

    Pollan further believes that ayahuasca allows people to work through their feelings about death. “And with ayahuasca in particular, which can sponsor some pretty dark journeys, people often come back with insights about death.” Others say that ayahuasca helps older adults find their purpose and combat mental angst and depression.

    But, ayahuasca also has risks. People with heart problems such as arrhythmia likely should stay clear of it. So should people on SSRI anti-depressants.

    If you are considering taking ayahuasca, keep in mind that you should not expect it to bring you joy; it can be extremely painful emotionally as well as physically.

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  • Can virtual reality help people with depression? 

    Can virtual reality help people with depression? 

    Some Americans suffer from a depression that keeps them from feeling any pleasure, called anhedonia. Can virtual reality help them? Stat News reports on research testing this proposition.

    Many of us feel thrills and joy from flying down a ski slope, snorkeling in coral reefs, watching a football game or simply taking a walk in the park. At the University of California, Los Angeles, Michelle Craske is testing whether exposure to these types of thrills through virtual reality can help people with anhedonia to appreciate the good things in life and feel pleasure.

    Craske calls the treatment positive affect therapy. After exposing a person to a pleasurable experience through virtual reality, she talks to the patient about the experience in extreme detail. She might talk to a person about the sights, sounds, physical and emotional responses and much more. Some of her patients say they feel less depressed. Their mood improves.

    What’s particularly interesting about Craske’s approach is that it focuses on helping patients engage in positive activities in order to feel pleasure. Traditional treatment for depression focus on negative symptoms like anxiety and sadness. But, both focus on helping patients change the way they feel and behave.

    The jury’s out as to whether virtual reality can really help. But, there’s lots of research underway. And, there’s some evidence that virtual reality can ease social anxiety and some phobias.

    Here’s more from Just Care:

  • For your mental health, feed your brain

    For your mental health, feed your brain

    The New York Times reports on nutritional psychiatrists who advise people to eat as little processed foods, meat and dairy products as possible in order to ease anxiety and mild depression. Instead, for your mental health, they recommend a rainbow of natural foods, including lots of fresh fruits and vegetables. Is it possible that how you feel turns on what you eat?

    Dr. Drew Ramsey, a nutritional psychiatrist, recommends eating oysters because they have vitamin B12 and omega-3 fatty acids. According to some studies, B12 can keep your brain from shrinking. And, you are at risk for suicide and depression without adequate omega-3 fatty acids. Keep in mind, however, that there is no good evidence to suggest taking B12 or omega-3 fatty acids in supplement form has any health benefit. Moreover, Cochrane.org, the gold star for analyzing the research data, says the evidence is not conclusive that eating omega-3 fatty acids treats depression.

    Dr. Ramsey also believes that eating unhealthy foods contributes significantly to depression. Americans eat a lot of calories but do not eat a lot of micronutrients found largely in fruits and vegetables that help our brains to thrive. We need to eat between 12 and 16 ounces of fruit and between 16 and 24 ounces of vegetables every day. Yet, just 10 percent of adults eat that much fruit and vegetables.

    To treat depression, Dr. Ramsey appreciates that talk therapy can be beneficial, as are prescription drugs in many cases. He and others believe that supplementing those treatments with whole foods can be invaluable. In addition to fruits and vegetables, they recommend fatty fish, whole grains and legumes. Foods high in phytonutrients promote the generation of new brain cells and reduce the risk of harmful inflammation.

    There are a few studies to support Dr. Ramsey’s view. One 2016 study of 12,000 Australians found that those who ate more fresh fruits and vegetables were happier and had a greater sense of well-being than those who did not do so. A 2017 study of 422 young adults from the US and New Zealand had similar findings. Canned fruits and vegetables did not deliver the same results.

    A 2017 randomized-controlled trial also showed that a 12-week Mediterranean diet improved people’s moods and reduced their anxiety levels. The Mediterranean diet apparently delivers good gut bacteria. And, good gut bacteria has been found to help process serotonin, a mood elevator.

    Dr. Lisa Mosconi, who directs the Women’s Brain Initiative at Weill Cornell in New York City, has found, based on imaging studies, that people who eat Mediterranean diets typically have brains that look younger and are more active metabolically than people who do not. These people may have a lower risk of dementia.

    In short, it appears wise to pay attention to what you feed your brain. Your brain needs a lot of nourishment; it consumes more energy than any other organ in your body. Avoiding processed and fried foods is a good beginning. It may improve your mood and make you feel better.

    Here’s more from Just Care:

  • Keeping mentally and physically healthy and engaged may prevent dementia

    Keeping mentally and physically healthy and engaged may prevent dementia

    A 2017 study by a worldwide team of dementia experts, published in Lancet, lays out the latest research findings on dementia, and the news is better than you might expect. There are a range of proven ways, particularly through mental and physical stimulation, to prevent or delay dementia.

    Dementia literally translates from the Latin to mean “out of mind.” It is a brain disorder that affects memory and the ability of people to process information. In 2015, 47 million people around the world, mostly people over 65, were living with dementia at a cost of $818 billion. By 2050, there are expected to be almost 150 million people living with dementia. Today, one in three older people die with dementia.

    Though there is no cure for dementia, people’s daily activities may delay or prevent its onset. And, for people diagnosed with dementia, there are ways to slow down the course of the disease and improve quality of life. The data suggest that people who are better educated, as well as more mentally and physically active and socially engaged, are less likely to be diagnosed with dementia.

    Not surprisingly, social isolation, not having friends or family to talk to and spend time with, and poor education, increases the risk of dementia. In addition, people with hearing loss who are not managing that condition are prone to getting dementia.

    Here are a few ways that have been found to delay or prevent dementia:

    • Treatment for hypertension or high blood pressure is important since high blood pressure has been found to cause dementia.
    • It is possible that more than one in three cases of dementia can be delayed or prevented through exercise, having a social network, and engaging your mind.
    • Smoking less.
    • Managing hearing loss,
    • Keeping your blood sugar level under control if you have diabetes.
    • Maintaining a healthy weight; and,
    • Treating depression.

    Getting a diagnosis of dementia in its early stages can allow for treatment interventions that maximize memory and cognition, and reduce stress and depression. There are many people living with dementia who are able to drive and function independently. You can learn more about the living with dementia movement, here.

    Here are ways to help people living with dementia remain independent. And, here are best practices for communicating with a person with dementia.

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  • This is your brain on exercise

    This is your brain on exercise

    To support brain health, we know many things that people should not do, such as smoke, drink alcohol heavily, use most recreational drugs, and engage in activities associated with frequent head trauma. But other than getting adequate sleep, there isn’t much that we know people should do to promote brain health, sharp cognition, and good mental health. Of course, we recommend eating a healthy, well-balanced diet, but very few individual foods or nutritional supplements have been proven to be good for the brain. The same goes for “brain teaser” activities and “cognitive skills training” programs. Contrary to logic, they haven’t been shown to produce sustained benefits. However, time and again, one activity has been connected to robust improvements in brain health and prevention of brain diseases and mental health problems: exercise. And the encouraging results keep rolling in.

    Regular aerobic exercise has been linked to reduced risk of developing dementia, such as Alzheimer’s disease. This type of exercise has also been repeatedly shown to prevent depression, and has even been proven to be an effective treatment for depressive and anxiety disorders, with effect sizes roughly equivalent to medications. These benefits have been consistently demonstrated in both human studies and in studies examining animal models of mental illness. More recently, non-aerobic weight training has also been definitively associated with positive effects on brain and mental health outcomes.

    As if this news wasn’t good enough, the amount or “dose” of exercise that people need to promote brain health is not as high as you may think. Minimal amounts of exercise such as 20-30 minutes of walking or gardening a day – not even enough to lose weight – may be enough to boost cognitive functioning and lower the risk of mental health problems. So, it should be possible to fit into all but the very busiest schedules.

    Exactly how exercise helps the brain is unclear, and there are many theories, multiple of which may be simultaneously true. Exercise may increase blood flow and oxygen supply to the brain. It may also increase the production and activity of “neurotrophic” (literally “brain feeding”) factors, such as brain-derived neurotrophic factor (BDNF) []. BDNF in critical brain areas such as a memory center called the hippocampus promotes brain health and mental resilience through stimulating the growth of new neurons and connections between them. Exercise causes chemicals to be released from muscles and bones that may be essential to sustaining proper brain functioning. In addition, physical activity causes the release of several “feel good” substances, such as endorphins and endocannabinoids, which have been implicated in the feeling of general well-being and relaxation after a workout often referred to as a “runner’s high.” Finally, exercise may benefit your brain for the same reasons that it is good for the rest of your body – it lowers blood pressure and inflammation levels and enhances proper blood flow and heart functioning.

    Regardless of the exact reasons why it’s so healthy, we know that exercise is a relatively easy-to-do, inexpensive, and fun way to improve brain health and reduce the risk of mental illness and cognitive decline. So, do your brain a favor and grab those running shoes or that bicycle and head outside!

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  • Concerns about your antidepressant? Talk to your doctor!

    Concerns about your antidepressant? Talk to your doctor!

    On April 8, 2018, the New York Times published a front-page article titled, “The Murky Perils of Quitting Antidepressants After Years of Use.” The day before, the online version, “Many People Taking Antidepressants Discover They Cannot Quit,” was the most-shared article.

    In this analysis, Benedict Carey and Robert Gebeloff describe a growing trend over the past few decades in which millions of people have been taking prescription antidepressant medications long-term. For instance, they cite data showing that over fifteen million Americans have taken antidepressants for five years or more. They go on to attribute this phenomenon mostly to antidepressants causing “dependence and withdrawal,” rather than people needing long-term antidepressants to manage psychiatric illness or choosing to remain on them because of their benefits.

    While Carey and Gebeloff do cite a few studies looking at rates of withdrawal after stopping long-term antidepressant use, they only mention one survey from New Zealand that shows that withdrawal is even a common complaint among individuals taking antidepressants. Most of their argument is based on individual stories (i.e., anecdotal evidence) combined with critiques of how antidepressants have been studied. While the individual stories are compelling and the critiques of research may be valid, this approach makes their case linking long-term antidepressant use to supposed widespread withdrawal circumstantial at best.

    Fortunately, several psychiatric care providers and even patients quickly responded to counter this somewhat misleading article. To be fair, the authors do point out that antidepressants have greatly helped millions of people, and they quote psychiatrists who are expert in treating depression, such as Dr. Peter Kramer. However, overall, the piece uses logically and scientifically shaky arguments to trigger suspicion and fear of antidepressants among the general public and mental health patients alike. Given that depression and other mental illnesses that antidepressants treat (e.g., anxiety disorders) are very common, highly impairing, sometimes dangerous, and exceedingly under-treated, this type of journalism is risky.

    The fact is, antidepressant medications are effective, especially for moderate-to-severe depression, and while all medications have side effects, newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are far more tolerable than older versions. In addition, the past few decades have seen a growing consensus that depression (and many other mental illnesses) is a chronic condition requiring long-term treatment, like diabetes and hypertension. (No one would say that millions of people are on long-term blood pressure medications for hypertension because of fear of withdrawal.)

    Therefore, many psychiatrists recommend (and many patients readily choose) long-term antidepressant treatment to avoid relapse once a person has had more than one depressive episode. “Withdrawal” from antidepressants (actually called discontinuation syndrome) is in fact a well-known and not-rare phenomenon. However, it is usually very mild and can be managed with a slow taper in the medication’s dose. For the relatively rare, more severe cases, a good psychiatrist can almost always reduce or eliminate it with various interventions such as adding low-dose fluoxetine (Prozac) for a while (due to its long half-life) and/or using other prescription drugs in a time-limited manner to treat discontinuation symptoms.

    Just like in any medical specialty, not all psychiatric care providers are attentive, responsive, or skilled enough to avoid or successfully manage discontinuation syndrome, but that’s a different problem that can’t be solved by avoiding antidepressant treatment to begin with. So, rather than an inability to stop them due to “withdrawal,” doesn’t it seem much more likely that growing numbers of people are on antidepressant treatment long-term either because they need the medication to prevent symptoms from returning and/or choose to remain on the medication because of low side effect burden and protection against relapse?

    The article does make some valid and important points. The research on antidepressants mostly involves relatively short-term studies, so there is a great need to examine the longer-term efficacy and adverse effects of these prescription drugs. And the discontinuation syndrome has received far too little research attention.

    These deficits in the science are indeed likely due to pharmaceutical companies having little incentive to investigate prescription drugs that have gone generic or to emphasize problems with the products they produce and market. However, it is unfortunate that these valid critiques were packaged into a misleading and highly public message, which has the potential to discourage people from seeking treatment for mental illness and encourage patients to stop their medications.

    Advice from this psychiatrist: Discuss your goals for treatment and any problems with medications with your healthcare provider before changing or stopping them on your own. No one – not even your doctor! – can force you to stay on a medication that you no longer want to take, but only an experienced professional can help you to change medications in a safe and healthy way.

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  • Get the preventive care you need: Medicare pays for it

    Get the preventive care you need: Medicare pays for it

    Preventive care is very important, especially as you age.  As you get older, vision, hearing and balance should be checked annually. And, you should get a flu shot every year as well.  Fortunately, Medicare now pays for many of these services in full, as well as an annual wellness visit.  Medicare covers some tests annually and others every few years.

    Cost:  Medicare covers the full cost of many, but not all, preventive services.  If you have traditional Medicare, for full coverage, you will need to see a doctor who takes assignment, a “participating provider,” who accepts Medicare’s approved rate as payment in full.  Fortunately, the vast majority of doctors accept assignment.  If the doctor finds a problem and needs to do more tests, you may have to pay a deductible or coinsurance for those services.  If you are in a Medicare Advantage plan, for full coverage, you will need to see an in-network doctor.

    Medicare covers 100 percent of the cost of the following services:

    Medicare covers 80 percent of the cost of the following services:

    • glaucoma, trainings for diabetes self-management,
    • barium enemas to detect colon cancer, and
    • digital rectal exams to detect prostate cancer.

    Keep in mind that health care screenings can have risks. Screenings may turn up issues that warrant addressing; they also may turn up issues that would be best left alone. If the screening results turn up something out of the ordinary, doctors often do not know whether there is a problem that should lead to more tests or a surgery. For example, a breast screening may reveal a possible tumor, but the tumor may be best left untouched because it will never grow large or present a health risk. It should not be removed. The risk to you can come from removing a tumor that does not present a health risk. Surgery involves its own set of risks, including bacterial infections. The US Preventive Services Task Force, an independent panel of experts in primary care and prevention, recommends certain preventive care services, and it does not recommend others, based on the evidence of effectiveness.

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