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Nutritional Psychiatry and Wellness

By Anna I. Guerdjikova, PhD, LISW, CCRC
Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program

The connection between health in general and the foods we consume has been known since the dawn of human kind, and Hippocrates is credited with the “Let food be thy medicine” saying. The narrower connection between overall diet quality and common mental disorders, in particular depression and anxiety, is a much newer field and the term “nutritional psychiatry” was not coined until the most recent decade. Initially, the focus of this discipline was on researching single foods or nutrients and their role in mental health. Gradually, it has been recognized that proper nutrition for good mental health is a very complex landscape. What we consume and how it affects us cannot be researched in isolation and what we eat in excess can be as important as what we do not eat enough of.

The growing data in the field of nutritional psychiatry is encouraging. A recent systematic literature review derived a list of antidepressant nutrients linked to the treatment and prevention of depression1. The twelve identified antidepressant nutrients included: folate, iron, long-chain omega-3 fatty acids, magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc. The most nutrient-dense individual animal foods to fight depression were oysters, mussels and seafood, all rich in DHA which helps form strong membranes that easily transport nutrients into brain cells, lowers inflammation and raises serotonin levels. From plant-based foods leafy greens, lettuces, peppers, and cruciferous vegetables received the highest score, suggesting that regularly incorporating those veggies in one’s diet might improve mood dysregulation.

Another study followed up with patients for 12 weeks in a randomized controlled design study to examine efficacy of adjunctive dietary intervention in the treatment of moderate to severe depression2. The intervention consisted of seven individual nutritional sessions to support adherence to the recommended diet, encouraging consumption of the following key food groups: whole grains (5–8 servings per day); vegetables (6 per day); fruit (3 per day), legumes (3–4 per week); low-fat and unsweetened dairy foods (2–3 per day); raw and unsalted nuts (1 per day); fish (at least 2 per week); lean red meats (3–4 per week),chicken (2–3 per week); eggs (up to 6 per week); and olive oil (3 tablespoons per day), while reducing sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week). The group receiving dietary support along with therapy or medication, showed significantly greater improvement in depressive symptoms suggesting dietary improvement may provide an efficacious and accessible treatment strategy for the management of depression.

A recent review summarized data from 20 longitudinal and 21 cross-sectional studies and concluded that adhering to a healthy diet, in particular a traditional Mediterranean diet (meals built around plant-based foods like  vegetables, fruits, herbs, nuts, beans and whole grains with moderate amounts of dairy, poultry,  eggs and seafood), or avoiding a pro-inflammatory diet (deficient in fruits and vegetables and containing excessive amounts of meat, refined grain products, and dessert foods) might confer some protection against depression in observational studies3.

A healthy gut environment (microbiome) supports production of vitamins, helps train the immune system, supports cleansing of the body and helps modulate the nervous system. The microbiome can be influenced by our diet, providing the direct link between the brain and the gut, as 90% of our serotonin receptors are located in the gut. Consuming a diet rich in both prebiotics (the fiber that feeds the probiotics in our gut found in onions, leeks, asparagus, bananas and garlic) and probiotics (good bacteria that are found in fermented foods like sauerkraut, yogurt with active cultures, pickles, kefir, kimchi, kombucha) is recommended for keeping the microbiome well balanced. Probiotics are associated with a significant reduction in depression and anxiety in two recent analyses, reviewing over 30 individual studies4,5. Moreover, overconsumption on ultra-processed food leads to inflammation in the gut and might dysregulate the microbiome, possibly contributing to a plethora of diseases6.

While the field is still working through challenges to identify a clear set of biological pathways and targets that mediate the brain-gut connection, the following few simple recommendations might be helpful as complementary interventions benefiting mild to moderate depression and anxiety:

  • Regulated eating habits (3 meals and 1-2 snacks/day) decrease blood sugar variations and helps stabilize moods
  • Follow a diet comprising mostly of real foods (Mediterranean diet)
  • Probiotic-rich foods and limiting processed food (shopping the “perimeter of the store” preferentially )supports the health of the gut-brain axis and can be beneficial for mood regulation
  1. LaChance LR, Ramsey D. Antidepressant foods: an evidence-based nutrient profiling system for depression. World J Psychiatry. 2018;8:97-104.
  2. Jacka F, O’Neil A, Opie R, et al. A randomized controlled trial of dietary improvement for adults with major depression. BMC Med. 2017;15:23.
  3. Lassale C, Batty GD, Baghdadli A, et al. Healthy dietary indices and risk of depression outcomes; a systematic review and meta-analysis of observational studies. Mol Psychiatry. September 26, 2018
  4. Ruixue Huang, Ke Wang, Jianan Hu  Effect of Probiotics on Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Nutrients 2016 Aug 6;8(8):483
  1. Richard T Liu, Rachel F L Walsh, Ana E Sheehan  Prebiotics and probiotics for depression and anxiety: A systematic review and meta-analysis of controlled clinical trials Neurosci Biobehav Rev,  2019 Jul;102:13-23.
  2. Marit K Zinöcker, Inge A LindsethThe Western Diet-Microbiome-Host Interaction and Its Role in Metabolic Disease Nutrients   2018 Mar 17;10(3):365.

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January 12, 2021– Mason, Ohio

Lindner Center of HOPE Announces 2021 Free Community Education Series

Lindner Center of HOPE is pleased to announce the topics and presenters for its 2021 Community Education Series. The series is intended to offer an expert discussion of mental health, substance use disorders, treatment and coping strategies.

Manor House, Mason, has provided ongoing support for this series. As long as permissible given COVID restrictions, presentations will be offered live at the Manor House the third Wednesday of every other month from 6pm to 7:30 pm EST. Those unable to attend in-person can participate virtually, made possible by the support of Community Partners.

The first session, “What Is OCD and How Is It Treated?” presented by Jennifer B. Wilcox, PsyD, Lindner Center of HOPE Staff Psychologist, will be February 17, 2021 beginning at 6pm.

Participants will:

  1. Develop a basic understanding of what is and is not OCD
  2. Learn about various OCD subtypes/presentations
  3. Learn about the treatment options for OCD

To register for the February 17 session, visit:  https://lindnercenter.ejoinme.org/MyPages/WhatisOCDandHowisitTreated2021/tabid/1200131/Default.aspx

For the schedule and registration visit:  lindnercenterofhope.org/education.

 Lindner Center of HOPE to Offer Four Free Webcasts in 2021

Lindner Center of HOPE is pleased to announce four free webcasts in 2021. The webcasts are part of our Exploring Mental Health Series and offer 1 CEU to participants eligible for continuing ecuation credits.

The first webcast will be February 9, 2021, 5:30-6:30pm EST, presented by Chris Tuell, , EdD, LPCC-S, LICDC-CS, Lindner Center of HOPE, Clinical Director of Addiction Services on The Need for Assessment During/After Detox – Pulling Back the Covers on Substance Abuse.

Registration and the full schedule can be found at:  https://lindnercenterofhope.org/theneedforassessment-webcast/

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic services for all ages and short-term residential services for adults, and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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Transcranial Magnetic Stimulation (TMS) is an innovative treatment for depression. Depression is common and affects 1 in 10 adults. Only a fraction of individuals suffering from depression seek treatment. Of those who do, greater than 30% fail to achieve satisfactory improvement. Not all patients improve when treated with medications or psychotherapy. Up to 25% of people suffering from depression will not respond to multiple trials of medication due to a lack of efficacy or difficulty tolerating medication. Likewise, many people struggle to respond to the best efforts of psychotherapy, either due to a lack of response or a lack of time and/or financial resources that are necessary for psychotherapy interventions. Alternate treatment modalities are critical to addressing the ongoing needs of patients who suffer from the debilitating effects of depression.

Understanding the Benefits of Transcranial Magnetic Stimulation

Evidence shows that TMS is effective in the treatment of moderate to severe depression in patients with a history of treatment resistance. Depression has been linked to an abnormal function of nerve cells in a specific part of the brain. Highly focused magnetic field pulses used in Transcranial Magnetic Stimulation (TMS) therapy gently stimulates these nerve cells. New data emerging from recent studies suggests that in most patients, the clinical benefits of TMS therapy are maintained through 12 months. 

How Transcranial Magnetic Stimulation Works

TMS is a non-invasive, localized treatment conducted using a device that delivers rapidly pulsating and localized magnetic fields that activate a subset of nerve cells in the front part of the brain.

While treatment is administered patients remain awake while sitting in a comfortable reclining chair. A treatment coil is applied to the head and the system generates highly concentrated magnetic field pulses. Transcranial Magnetic Stimulation  is delivered in a series of 37-minute outpatient treatments, typically administered daily, (5 days per week) for 4 to 6 weeks. Technological advancements in equipment has led to decreased treatment durations.

Pros and Cons of TMS Therapy

Some advantages and disadvantages of TMS include:

  • It does not require anesthesia
  • Non-invasive
  • Well tolerated
  • An outpatient service and patient continues normal daily routines
  • Current data demonstrates efficacy in patients who have struggled with medication
  • May be good alternative for patients who responded to Electroconvulsive Therapy (ECT) in the past
  • No significant memory impairment
  • FDA Approved in 2008 for the treatment of depression

Cons of TMS Therapy

  • Facial twitching during the treatment
  • Skin redness at site of coil placement
  • Anxiety before and during treatment
  • Mild discomfort (usually dissipates by end of first treatment)
  • Headache
  • Process for insurance coverage can be cumbersome
  • Time required 30 treatments over 6 weeks

TMS at Lindner Center of HOPE

The Lindner Center of HOPE is a nationally recognized Leader in TMS Therapy. Our expert reputation is a result of years of clinical research and experience in mental illness and collaboration with academic centers such as Johns Hopkins and the Mayo Clinic through the National Network of Depression Centers. For patients, this means the best of the best – the best clinical minds, the best data and the best technology are being applied to achieve successful outcomes.

There is HOPE. For more information on TMS Therapy, call (513) 536-4674 or click here.

 

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By Danielle J. Johnson, MD, FAPA

Lindner Center of HOPE, Chief Medical Officer

Many people have experienced loss of several types during the COVID-19 pandemic – employment, financial security, social connections, a sense of safety, and loved ones.  The way we grieve has changed because we cannot rely on our support systems to be physically there for us due to restrictions with social distancing.  With the increasing number of COVID-19 cases, the holiday season will be different this year – no holiday parties, large family gatherings, or other traditions.  It is difficult to be physically separated from loved ones, but even more difficult for those who may be experiencing their first holiday season after the loss of a loved one.

 

What are some ways that we can manage grief during this unprecedented holiday season?

  • Take charge of your holiday season: Anticipating anxiety about the holiday, especially if it is the first one without a loved one, can be worse than the actual holiday. Taking control of your plans and deciding how you will spend your time can relieve anxiety.  Do not spend time where you do not feel emotionally safe or comfortable.
  • Find nourishment for the soul: Your faith community may offer resources. Look for a support group for people who have suffered a similar loss or for those who are alone.  Due to the pandemic, many support groups are online.
  • Give yourself permission to change your holiday traditions: Some traditions may be a comfort, while others may be painful. Some traditions will have to change due to the pandemic.  It is ok to start new traditions.  Many families are finding ways to celebrate virtually.
  • Change how you give: Give a gift on behalf of your loved one to someone else or donate to a charity in memory of your loved one.  If you are spending less due to not spending the holidays with loved ones, consider giving more to charitable organizations.
  • Do not let guilt overtake you: You can enjoy the holiday without your loved one.  Celebrating does not mean you do not miss or have forgotten about your loved one.
  • Be gentle with yourself: Realize that familiar traditions, sights, smells and even tastes, may be comforting, or may trigger strong emotions. Be careful with your emotions and listen to yourself.
  • Do not pretend you have not experienced a loss: Imagining that nothing has happened does not make the pain of losing a loved one go away or make the holidays easier to withstand. It is ok to talk with others about what you have lost and what the holidays mean to you.
  • Pay attention to your health: It is often difficult for people who have experienced a recent loss to sleep. Make sure you get regular rest.  If you feel overwhelmed, talk with your health care provider.
  • Experience both joy and sadness: Give yourself permission to feel happiness and pain. Do not feel like you must be a certain way because of your loss or because it is the holidays.
  • Express your feelings: Suppressing your feelings may add to distress. To express your feelings, talk with a supportive friend or journal.
  • How can support persons help those who are grieving during this holidays season if we cannot physically be there? Be available to listen. Send cards, gift cards for meals, offer to help shop, or decorate the outside of the home.  If you are concerned about their mental wellbeing, offer to help them find a support group or encourage them to reach out to their health care provider for help.

Resources

https://www.griefshare.org/holidays

https://whatsyourgrief.com/alone-together-14-ideas-for-a-virtual-holiday/

https://coronavirus.ohio.gov/wps/portal/gov/covid-19/families-and-individuals/resources-for-parents-and-families/holiday-celebrations

Crisis Text Line, text CONNECT to 741741 for 24/7 help from a crisis counselor.

Ohio Care Line, call 1-800-720-9616 for 24/7 support from behavioral health professionals.

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Office of Innovation at University of Cincinnati Supported Utility Patent Process for this Method to Modulate Brain-Body Communication

Francisco Romo-Nava, M.D., Ph.D., Associate Chief Research Officer for The Research Institute at Lindner Center of HOPE and Assistant Professor for the Department of Psychiatry and Behavioral Neurosciences at the University of Cincinnati (UC) College of Medicine, has been awarded a United States patent for transcutaneous spinal cord stimulation for the purpose of treating psychiatric disorders. The Office of Innovation at University of Cincinnati supported the utility patent process for this method to modulate brain-body communication in the context of psychiatric disorders.

The utility patent will aid in the advancement of grant proposals for testing the use of this method in treating psychiatric disorders, allowing for concept expansion, the possibility of private company collaboration to further develop the method, and potential funding for the development of technology for delivering the treatment for public good.

Romo-Nava has been exploring a novel “Neuroscience of the Body” research approach that considers psychiatric disorders not only affect the brain, but also the body. Likewise, the body also affects the brain.

In 2018, The Research Institute at Lindner Center of HOPE launched a pilot study specifically looking at the communication between the brain and the body and the role spinal pathways play in the origins of psychiatric disorders. The hypothesis is that the communication between the brain and the body is disturbed in patients with Major Depressive Disorder (and other psychiatric disorders) which contributes to depressive symptoms and consequently may contribute to elevate the risk of medical comorbidity. Though this area needs additional study, it has been gaining focus as it explains why a patient with a psychiatric disorder might also have more physical illness.

The study, which is ongoing, is looking at the impact of non-invasive spinal stimulation for the treatment of Major Depressive Disorder. The team is testing an exclusively investigational device to apply a small electrical current through the skin to modulate spinal pathways and modify the disturbed communication between the brain and the body. The patent will protect the idea of modulating the spinal cord function for the purposes of treating psychiatric disorders with UC as assignee.

“We are proposing that by modulating spinal cord function we can have an effect on the psychiatric disorder. We are gathering these data to give us a signal of how to develop new methods to treat depression and, ideally, expand to other psychiatric disorders,” said Romo-Nava.

Romo-Nava received the 2017 Young Investigator Award from the National Alliance for Research in Schizophrenia and Depression (NARSAD) granted by the Brain and Behavior Research Foundation for this study. Dr. Romo-Nava is also currently funded by a NIMH K23 Career Development Award.

The study is currently recruiting participants between the ages of 18 and 55 who are currently moderately depressed for at least one month and not currently on medication for the treatment of depression. Participants would be required to complete a phone screening, attend a screening visit that includes labs and other tests, attend a baseline visit and attend 20-minute stimulation sessions three times per week for eight weeks. Eligible participants will be compensated up to $250 for their time and travel. A pre-screening questionnaire, as well as more information on this and other studies conducted at the Lindner Center of HOPE Research Institute can be found at www.LCOH.info.

 

Lindner Center of HOPE  provides excellent, patient-centered, scientifically advanced care for individuals suffering with mental illness. A state-of-the-science mental-health center and charter member of the National Network of Depression Centers, the center provides psychiatric hospitalization and partial hospitalization for individuals 12 years and older, outpatient services for all ages, diagnostic and short-term residential services for adults and adolescents, intensive outpatient program for substance abuse and co-occurring disorders for adults and research. The center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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By Angela Couch, RN, MSN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE

Anxiety is a common symptom. Anxiety is a part of everyone’s lives, we have all experienced it to one degree or another. Believe it not, anxiety serves some useful purposes. Anxiety can help give you the drive to make a change, or complete task on time.Anxiety can activate the fight or flight instinct, in a “potentially” dangerous situation, giving you the drive to get out of there, or do something to prevent harm. Anxiety can occur when you are enduring multiple stressors, or there is uncertainty, and it’s not entirely unexpected.

For instance, say you hear layoffs are coming in the company, and you’re not sure if your department will be affected. You may experience physical symptoms of anxiety (which could include racing heart, nervous stomach, sweating, tremor, nausea, shortness of breath, and more), and you might also experience worry. COVID-19…yup, that can cause some anxiety, or worry, too! Situational anxiety is a part of life, and often can be managed by rational self-talk, problem-solving, and various positive self-care strategies. (For more on that, see some of our other recent blog articles, for lots of helpful ideas!) So how do we know when the anxiety is more than just “normal” or to be expected, and when to seek help?

According to the National Comorbidity Study Replication, about 19.1% of U.S. adults will have had an anxiety disorder in the past year, and 31.1% experience an anxiety disorder in their lifetime. In other words, it’s pretty common! There are various types of anxiety disorders, and most have an underlying common thread– difficulty in accepting uncertainty in some form. So how do you know if you may need to seek further assessment or help for anxiety, if it’s really so common? If everyone gets it, is it really a problem that requires treatment? The answer is yes, it might. Some symptoms that may indicate problematic anxiety include:

* Feeling “paralyzed” by fear.

* Anxiety is causing you to avoid things you used to be able to do without anxiety, or things that are important to you (this could include social activities, leaving your house, going to your job, driving, engaging in spiritual activities, etc.).

* You have difficulty staying present “in the moment”, which may repeatedly distract you from attending to conversations, being able to complete work or school tasks because of lack of focus.

* You are having difficulty with sleep or eating due to excessive worry or anxiety.

Anxiety is causing significant physical symptoms.

* You cannot determine a cause for the anxiety and the symptoms are persistent or very bothersome.

* You worry about “everything” or “all the time”.

* The anxiety/worry you are experiencing about situations seem excessive.

* You need to engage in compulsive or repetitive behaviors, or do things in a certain way, in order to avoid significant anxiety/worry.

* Anxiety is causing you to turn to self-medication with alcohol or substances.

So you’ve determined you should seek help, now what? Psychotherapy can be helpful for anxiety, and is a very important component of treatment. Psychotherapy may include several modalities such as cognitive behavioral therapy, addressing faulty beliefs contributing to anxiety, psychoeducation about anxiety and worry, problem-solving, exercise and wellness activities/lifestyle changes, addressing sleep hygiene, skills for time management and stress reduction, or exposure therapy, just to name a few.

How do you know if psychotherapy is enough to manage the symptoms? Medication can be a helpful component in treatment of anxiety, particularly if symptoms are not improving with other psychotherapeutic interventions mentioned above. Medications alone are rarely enough to treat anxiety disorders adequately. Medication can often make it easier to engage in meaningful psychotherapy, to make those helpful lifestyle changes, or try new ways of coping with the anxiety/worry. If you are experiencing suicidal thinking or significant depression, medication should be a consideration. If the anxiety symptoms are preventing you from being able to work or do other essential tasks, medication may be indicated. If your therapist suggests a medication consultation, you should consider it.

The important things to remember are, everyone has some anxiety, not all anxiety is bad, and when anxiety does become problematic or excessive, there are evidence-based treatments to help, so don’t be afraid to reach out for help!

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By Nicole Mori, RN, MSN, APRN-BC
Research Advanced Practice Nurse, Lindner Center of HOPE

Depression is a common mental health complaint.  Although there are effective treatments available, many patients fail to experience satisfactory improvement.  There has been increased interest in nutritional supplements as an adjunct or alternative to medications in the treatment of depression.  This has contributed to the growth of the dietary supplement industry (projected to reach 230 billion by 2026).  Let’s examine the evidence for the dietary supplements that have generated interest in recent years.

Omega-3 fatty acids (EPA/DHA)

A systematic review shows mild-moderate improvement in depressive symptoms, with the best outcomes in studies where omega-3 supplementation is concomitant to standard antidepressant therapy.  There is a great deal of heterogeneity in dosing, duration of treatment and EPA/DHA content.  Products with a high EPA content appear to be more efficacious than other omega-3 supplements.    However, quality of evidence is low due to methodological flaws.  Differences in study design and methodology makes it difficult to analyze data across studies.  Omega-3 supplements have a favorable safety profile and are well tolerated.

 

B group vitamins

Folate- Possible dose dependent response in depression but level of evidence is low.  Although folate is well tolerated, it has been associated with risk for proliferation of carcinogenic cells in the colon.

L-methylfolate-Available as pharmaceutical product FDA approved for depression.  Data shows efficacy at 15mg/d.  Some studies show efficacy as augmentation strategy for depression as comparable to lithium and atypical antipsychotics.  Usually well tolerated with lower risk for proliferation of cancerous cells than folate.

Vitamin D

A 2019 systematic review of clinical trials showed improvement in depression ratings associated with supplementation.  Findings remain tentative due to paucity of studies and methodologic bias.  Vitamin D is a fat-soluble vitamin commonly found in multivitamins and other commercially available products.  In the absence of a deficiency, the recommended dose is not to exceed 600IU/day.

SAM-E (S-Adenosyl methionine)

Clinical trials show mixed results.  A 2016 systematic review suggested SAM-E was no better than placebo.  The low quality of evidence makes it difficult to draw conclusions about efficacy.  There is a need for randomized clinical trials with antidepressant comparators.  SAM-E usually well tolerated but there is a possible risk for inducing mania in patients with bipolar depression.

Tryptophan/5-HTP (5-Hydroxytryptophan)

There are few high quality studies of 5-HTP.  Two depression studies suggest 5-HTP is superior to placebo.  Overall, level of evidence is low.  Possible risk for serotonin syndrome when administered concurrently with SSRI antidepressants.  Maximum recommended dose is 50mg/kg/day.

 

Magnesium and Zinc

There is some positive data from animal studies but evidence for efficacy in humans is low quality. There is no conclusive data on the efficacy of magnesium and zinc as coadjutant therapy in depression.  Zinc and magnesium are common micronutrients and usually well tolerated.

Probiotics

Depression has been associated with poor diet and altered intestinal flora.  Research has shown a relationship between gut health and mental health.  A 2016 metaanalysis of probiotics showed an effect in reducing risk of depression in normal subjects and reduced symptoms in subjects with depression.  The effect was limited to subjects under age 60.  Clinical studies vary greatly in terms of bacterial species, dose, duration of treatment as well as the method of measuring of depressive symptoms.  Probiotic supplements are vastly heterogeneous in terms of species composition and dosage.

There is a need for further research to determine optimal composition, dosage, duration of treatment for efficacy.  Furthermore, it is important to remember that quality of diet is a major determinant in the composition of gut flora.

In conclusion, evidence for the efficacy of dietary supplements in depression remains limited.  Commercially available dietary supplements vary significantly in terms of composition and bioavailability.  Although supplements are well tolerated, it is important to be aware of increased risks for adverse events in some patients.  Supplementation with omega-3 fatty acids as an adjunct to standard antidepressant therapy seems to hold the most promise.   Further research in the area of dietary supplements is needed to determine their role in the management of depression.

For more information about Depression research studies at the Lindner Center of HOPE

call 513-536-0707 or visit https://lindnercenterofhope.org/research/

https://redcap.research.cchmc.org/surveys/?s=YKW8CE4FRF

 

References

Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry. 2019;18(3):308-324. doi:10.1002/wps.20672

Martínez-Cengotitabengoa M, González-Pinto A. Nutritional supplements in depressive disorders. Actas Esp Psiquiatr. 2017;45(Supplement):8-15.

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By Jessica Kraft, APRN, PMHNP-BC, Psychiatric Mental-Health Nurse Practitioner, Lindner Center of HOPE

Everyone needs to shop from time to time, but at what point does shopping become a problem? And is this a diagnosis? Compulsive buying disorder (CBD) is a mental health condition characterized by “excessive, impulsive, and uncontrollable purchase of products in spite of severe psychological, social, occupational and financial consequences”. While this diagnosis is not found in the DSM-V, shopping addiction was described and discussed clinically in the early 20th century by Bleuler and Kraepelin (Black, 2007). There is still much to be learned about the causes of CBD or shopping addiction, but several factors thought to be contributing include materialism, social anxiety, a general lack of social support, loneliness, or trauma history (Harnish, Bridges, Gump, & Carson, 2018). It is not uncommon for those with CBD to also struggle with anxiety disorders, mood disorders, substance use disorders, eating disorders, or disorders of impulse control.

Most consumers of goods take value and usefulness into consideration when making a decision about a

purchase and emotion is not often involved in the decision. This has also been referred to as “utilitarian shopping”, where someone only shops when they need something. Those who struggle with CBD more often make purchases in order to improve their mood, cope with stress, gain social approval, or improve their self-esteem. This has been referred to as “hedonic shopping” where the primary purpose of shopping is for entertainment, distraction, or pleasure. Research has shown that CBD has relation to reward sensitivity and the mesolimbic dopamine reward circuit in the brain (Günüç & Doğan Keskin, 2016). Over time this behavior becomes reinforced and can create a pattern similar to those seen with behavioral addictions like gambling, sexual addiction, or internet addiction (Granero et al., 2016).

Some might think that during a global pandemic with economic uncertainty people would be less likely to spend and work towards curbing unhealthy shopping impulses. For some who struggle with CBD, this isn’t necessarily the case. With the emphasis and ease of online ordering and curbside pick-up options combined with the increased stress that many are feeling related to the pandemic, coping with shopping addiction has been more challenging for some. This year credit and debit card use increased by 79% in May compared to April in New Zealand. As shops reopened in Australia over the summer there were “Christmas size crowds”. A recent study in the UK showed that those with underlying mental health conditions (primarily depression and anxiety) were more likely to resort to “panic buying” or compulsive buying in response to the pandemic (Jaspal, Lopes, & Lopes, 2020). Considering that loneliness is a contributing factor to compulsive buying as well as the need to cope with stress it really isn’t very surprising that the pandemic has exacerbated these unhealthy buying behaviors in those who struggle with CBD.

What are the symptoms of CBD?

  • Urges to make a purchase are strong and the act of purchasing creates a “high” feeling
  • Preoccupation with shopping or planning purchases
  • Making a trip to the store and purchasing more items than originally intended
  • Most purchases made are unnecessary items
  • Debt, maxed out credit cards, or spending beyond one’s means
  • Hiding purchased items from family members or friends due to guilt
  • Feeling unable to stop oneself from shopping or making unnecessary purchases

What can you do to decrease urges to shop?

  • Seek professional help. While there are few evidence-based treatments for CBD there has been interest and anecdotal success with antidepressants (SSRIs),  cognitive behavioral therapy (CBT), and habit reversal training (HRT)
  • Join a support group or surround yourself with understanding and supportive people
  • When feeling the urge to purchase something make yourself wait a minimum of 24-hours
  • Declutter your space, organize, and get a better idea of what you have and what you love
  • Identify and avoid triggering situations – for example, unsubscribe from e-mails from your favorite stores if this has led you to make unnecessary and impulsive purchases in the past
  • Be mindful of who you follow on social media and how this influences your shopping behaviors
  • When looking at an advertisement ask yourself what they are trying to sell you and how this makes you feel about yourself. For instance, does this company benefit financially from you feeling badly about yourself or wanting a different lifestyle?

 

Sources:

Black, D. W. (2007). A review of compulsive buying disorder. World Psychiatry, 6(1), 14-18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805733/#B1

Granero, R., Fernández-Aranda, F., Mestre-Bach, G., Steward, T., Baño, M., del Pino-Gutiérrez, A., … Jiménez-Murcia, S. (2016). Compulsive Buying Behavior: Clinical Comparison with Other Behavioral Addictions. Frontiers in Psychology, 7(914). https://doi.org/10.3389/fpsyg.2016.00914

Günüç, S., & Doğan Keskin, A. (2016). Online Shopping Addiction: Symptoms, Causes and Effects. Addicta: The Turkish Journal on Addictions, 3(3). https://doi.org/10.15805/addicta.2016.3.0104

Harnish, R. J., Bridges, K. R., Gump, J. T., & Carson, A. E. (2018). The Maladaptive Pursuit of Consumption: the Impact of Materialism, Pain of Paying, Social Anxiety, Social Support, and Loneliness on Compulsive Buying. International Journal of Mental Health and Addiction, 17. https://doi.org/10.1007/s11469-018-9883-y

‌Jaspal, R., Lopes, B., & Lopes, P. (2020). Predicting social distancing and compulsive buying behaviours in response to COVID-19 in a United Kingdom sample. Cogent Psychology, 7(1). https://doi.org/10.1080/23311908.2020.1800924

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Professor Susan McElroy of the Lindner Center of HOPE leads a group researching potential new medications for BN and BED. As part of this work, Professor McElroy and her colleagues Anna Guerdjikova, Nicole Mori and Francesco Romo-Nava recently investigated the potential of existing drugs in treating binge eating conditions.”

 

Read their latest findings and learn more about the important need for identifying new binge eating medications: http://cdn.researchoutreach.org/Flipbooks/RO118/index.html#  pages 74-77.

 

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A panel of local business leaders partnered with the Cincinnati Business Courier on Thursday, October 22 to host Mental Health During a Pandemic: A Roundtable Discussion. The webinar was moderated by Rob Daumeyer, editor, Cincinnati Business Courier and the panelists included Michael Rosen, LPCC-S, MA, vice president of clinical services, Center for Addiction Treatment and Paul Crosby, M.D., president and COO, Lindner Center of HOPE.

Read the transcript.  https://www.bizjournals.com/cincinnati/feature/table-of-experts/mental-health-during-a-pandemic.html