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Category: Depression

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Seeking help for mental health concerns is a courageous step, and finding the right treatment center can make a significant difference in recovery. With various treatment options available, understanding the types of facilities and their offerings is essential.

This guide will walk you through the different types of mental health treatment centers, how to choose the best one for your needs, and what to expect during treatment.

Understanding Mental Health Treatment Centers

Mental health treatment centers provide structured environments where individuals can receive professional care for mental health disorders. These facilities offer a range of therapies and support systems designed to help individuals:

  • Manage their conditions
  • Regain stability
  • Develop coping strategies

Treatment centers play a crucial role in addressing conditions such as depression, anxiety, bipolar disorder, schizophrenia, and substance use disorders.

Types of Mental Health Treatment Centers

Different treatment centers cater to varying levels of mental health needs. The right choice depends on the severity of symptoms, level of care required, and personal circumstances.

Inpatient Treatment Centers

Inpatient facilities, also known as psychiatric hospitals or mental health wards, provide 24/7 medical supervision in a structured setting. These centers are best suited for individuals experiencing severe mental health crises, including suicidal ideation, psychosis, or an inability to care for themselves. Treatment typically includes intensive therapy, medication management, and crisis intervention.

Outpatient Treatment Centers

Outpatient treatment centers allow individuals to receive care while continuing to live at home. These programs offer therapy sessions, medication management, and support groups, often requiring multiple visits per week. Outpatient care is ideal for those with mild to moderate mental health conditions who need support, but do not require round-the-clock supervision.

Residential Treatment Centers

Residential treatment centers offer a middle ground between inpatient and outpatient care. Patients live at the facility for an extended period—typically weeks to months—while engaging in structured therapy and support programs.

Residential treatment centers provide a more home-like environment and focus on long-term recovery, making them beneficial for individuals struggling with chronic mental health conditions or co-occurring substance use disorders.

How to Choose a Mental Health Treatment Center

Selecting the right treatment center is a crucial decision that should be based on individual needs, treatment approaches, and available resources.

Factors to Consider

  • Accreditation and Licensing. Ensure the facility is accredited by organizations like The Joint Commission.
  • Staff Qualifications. Verify that the center has licensed therapists, psychiatrists, and medical professionals.
  • Types of Therapy Available. Look for evidence-based treatment approaches such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and medication-assisted treatment.
  • Location and Environment. Consider whether a local or distant center is preferable based on family involvement and personal comfort.

Questions to Ask Before Enrolling

Before committing to a treatment center, ask the following:

  • What mental health conditions does the facility specialize in?
  • What is the staff-to-patient ratio?
  • What therapies and treatments are included in the program?
  • What aftercare services are provided?
  • What is the expected length of stay?
  • Are family visits and participation encouraged?

Treatment Options Available at Mental Health Centers

Most treatment centers offer a combination of therapy, medication, and holistic approaches to address mental health conditions.

Therapy and Counseling

Therapy is a cornerstone of mental health treatment, helping individuals process emotions, develop coping strategies, and build healthier thought patterns. Common therapy options include:

  • Individual Therapy. One-on-one sessions with a therapist to address personal challenges.
  • Group Therapy. Sessions where individuals with similar conditions share experiences and support one another.
  • Family Therapy. Counseling for family members to improve communication and support.

Medication-Assisted Treatment

For some mental health conditions, medication is a key component of treatment. Psychiatrists may prescribe antidepressants, mood stabilizers, or antipsychotic medications as part of a comprehensive care plan. Medication is often combined with therapy for the best outcomes.

Holistic and Alternative Therapies

Many treatment centers incorporate holistic approaches to support mental well-being, including:

  • Mindfulness and Meditation. Techniques to reduce stress and improve emotional regulation.
  • Exercise and Physical Activity. Activities such as yoga or outdoor recreation to enhance mental and physical health.
  • Nutrition Counseling. Dietary guidance to support brain health and overall well-being.

What to Expect During Treatment

Understanding the treatment process can help individuals and their families feel more prepared.

Intake and Assessment

The first step in treatment is an intake assessment, where medical and mental health professionals evaluate the individual’s condition, history, and treatment needs. This assessment helps create a personalized care plan.

Daily Life in a Treatment Center

Daily schedules in treatment centers typically include therapy sessions, group discussions, recreational activities, and personal time for reflection. Structured routines help individuals establish stability and focus on recovery.

Aftercare and Ongoing Support

Recovery does not end after leaving a treatment center. Aftercare plans often include continued therapy, support groups, medication management, and relapse prevention strategies. Some centers offer alumni programs to provide ongoing support and community connections.

Taking the Next Step

Finding the right mental health treatment center is a crucial step toward recovery. By understanding the different types of centers, treatment options, and what to expect, individuals can make informed decisions that best suit their needs.

If you or a loved one is struggling with mental health challenges, don’t hesitate to reach out for help. Are you ready to take a powerful step toward healing and well-being? Please contact the Lindner Center of HOPE inpatient team to discuss admission, call 513-536-4673, or contact us online.

You can also contact the National Mental Health Hotline: 1-800-662-HELP (4357) or dial 988 for the 988 Suicide and Crisis Lifeline for immediate attention that doesn’t require emergency services. Dial 911 for emergencies.

Our patients’ journeys are at the heart of what we do. Lindner Center of Hope is proud to be among the top mental health treatment centers that patients and families recommend. You can hear inspiring stories of recovery and well-being that showcase our impact and commitment to providing the best mental health care. Explore some of our patients’ Stories of Hope.

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Tracking symptoms is a critical part of managing mental health conditions. Many individuals experience fluctuating symptoms that can impact their daily lives, but without structured monitoring, it can be difficult to identify patterns or assess the effectiveness of treatments.

The Daily Record of Severity of Problems (DRSP) is a valuable tool designed to provide a systematic way to track symptoms over time. Used primarily for conditions like premenstrual dysphoric disorder (PMDD) and other psychological concerns, the DRSP helps individuals and clinicians gain insights that can lead to better treatment decisions.

What Is the Daily Record of Severity of Problems (DRSP)?

The Daily Record of Severity of Problems (DRSP) is a structured self-report questionnaire developed to track daily symptoms, particularly in relation to PMDD and other mood disorders.

Originally designed as a diagnostic aid, it allows individuals to record their experiences with specific symptoms over the course of a menstrual cycle. However, it has also been used for broader mental health monitoring, helping individuals and healthcare providers detect patterns and assess the severity of emotional and physical symptoms.

Purpose and Benefits of Using the DRSP

The DRSP serves as a powerful tool for symptom tracking in both clinical and personal settings. Some key benefits include:

  • Identifying Symptom Patterns. By recording symptoms daily, individuals can detect cycles and trends that may not be obvious otherwise.
  • Aiding in Diagnosis. Many mental health conditions, including PMDD, require pattern-based diagnostic criteria. The DRSP provides clear documentation of symptom timing and severity.
  • Improving Treatment Plans. With structured tracking, healthcare professionals can adjust treatment strategies based on symptom severity, duration, and frequency.
  • Enhancing Self-Awareness. Individuals can gain deeper insights into how their mood, behavior, and physical symptoms fluctuate over time.

How to Use the DRSP

Using the DRSP is straightforward and requires only a few minutes each day. Here’s how to fill it out effectively:

  1. Record Symptoms Daily. Users rate the severity of various emotional and physical symptoms, such as mood swings, anxiety, depression, fatigue, and sleep disturbances.
  2. Use a Consistent Scale. Each symptom is typically rated on a scale from 1 (none) to 6 (extreme) to measure severity.
  3. Note Lifestyle Factors. Some versions of the DRSP allow users to track medications, exercise, sleep, or diet that may influence symptoms.
  4. Maintain Regular Entries. For accurate pattern analysis, it is important to complete the DRSP every day for at least two months.

Interpreting DRSP Data

Once data is collected, individuals and healthcare providers can analyze trends to identify key insights:

  • Recognizing Cyclic Patterns. For those tracking PMDD, the DRSP can reveal whether symptoms consistently appear in the luteal phase (the time between ovulation and menstruation).
  • Measuring Treatment Effectiveness. If a person starts medication, therapy, or lifestyle changes, the DRSP can help determine if those interventions are making a difference.
  • Detecting Worsening Symptoms. A steady increase in symptom severity could indicate a need for medical intervention.

By regularly reviewing DRSP entries, individuals can work with their healthcare providers to refine treatment strategies and improve their overall well-being.

Who Should Use the DRSP?

The DRSP is beneficial for a wide range of users, including:

  • Individuals with PMDD or Mood Disorders. Those experiencing cyclical emotional and physical symptoms can use the DRSP for better self-management.
  • Healthcare Providers. Psychologists, psychiatrists, and gynecologists often use DRSP data to support diagnosis and treatment adjustments.
  • Researchers. The DRSP is commonly used in clinical studies examining hormonal influences on mood and mental health conditions.

Comparing the DRSP with Other Mood and Symptom Trackers

While many mood-tracking tools exist, the DRSP stands out because of its structured format and focus on cyclic symptoms. Unlike general mood trackers that log emotions without a clear pattern, the DRSP provides a consistent scoring system and is widely accepted in clinical settings.

Other trackers may allow more customization, but the DRSP’s standardized approach makes it highly reliable for research and diagnosis.

Where to Get the DRSP

The DRSP is available in printable and digital formats. You can find it:

  • On medical research websites and mental health organizations’ resources.
  • Through healthcare providers, who may supply it for tracking PMDD symptoms.
  • On symptom-tracking apps, where digital versions are integrated into menstrual and mood tracking tools.

Download a DRSP PDF to track mental health symptoms.

There is Hope

Tracking mental health symptoms with a structured tool like the Daily Record of Severity of Problems (DRSP) can lead to greater self-awareness and improved treatment outcomes. Whether used by individuals managing PMDD, mood disorders, or general mental health concerns, the DRSP provides clear, data-driven insights that help both patients and clinicians make informed decisions.

If you or someone you know struggles with recurring mental health symptoms, consider incorporating the DRSP into your daily routine to gain a deeper understanding of symptom patterns and their impact.

Don’t hesitate to reach out for help. If you want to contact the Lindner Center of HOPE inpatient team to discuss admission, call 513-536-4673, or contact us online.

You can also contact the National Mental Health Hotline: 1-800-662-HELP (4357) or dial 988 for the 988 Suicide and Crisis Lifeline for immediate attention that doesn’t require emergency services. Dial 911 for emergencies.

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By Chris Tuell Ed.D., LPCC-S, LICDC-CS
Clinical Director of Addiction Services, Lindner Center of HOPE Assistant Professor, Department of Psychiatry & Behavioral Neuroscience University of Cincinnati College of Medicine

 

 

Alcohol detoxification, commonly referred to as detox, is the initial phase of treatment for individuals with Alcohol Use Disorder (AUD). It involves the process of eliminating alcohol from the body while managing withdrawal symptoms that arise when alcohol consumption is abruptly stopped. Detoxification is a critical step in the recovery journey, as it lays the foundation for long-term sobriety and prevents potentially life-threatening complications associated with alcohol withdrawal.

The Importance of Alcohol Detox
For individuals physically dependent on alcohol, detox is often necessary to restore physical stability and address the physiological effects of prolonged drinking. Chronic alcohol use alters brain chemistry, particularly in neurotransmitters like gamma-aminobutyric acid (GABA) and glutamate, which regulate relaxation and excitability. When alcohol is suddenly removed, the brain struggles to rebalance, leading to withdrawal symptoms. Detox helps mitigate these effects, ensuring the individual can begin recovery safely.

Symptoms of Alcohol Withdrawal
Alcohol withdrawal symptoms can range from mild to severe, depending on factors such as the duration and intensity of alcohol use, overall health, and co-occurring conditions, such as physical and mental conditions.

Mild Symptoms: Anxiety, tremors, sweating, nausea, headaches, and difficulty sleeping.

Moderate Symptoms: Rapid heartbeat, increased blood pressure, confusion, and irritability.

Severe Symptoms (Delirium Tremens): Hallucinations, seizures, severe agitation, and life-threatening cardiovascular instability.

The most severe form of withdrawal, delirium tremens (DTs), occurs in about 5% of individuals undergoing detox and requires immediate medical attention due to its high mortality risk.

The Detox Process
Detoxification typically occurs in one of three settings: home detox (for mild cases under medical supervision), outpatient clinics, or inpatient facilities. The process involves three main phases: evaluation, stabilization, and preparation for treatment.
1. Evaluation: A medical team assesses the individual’s physical and mental health, addiction history, and risk factors for severe withdrawal. Blood tests may be conducted to identify deficiencies or complications.
2. Stabilization: Medications are often used to alleviate withdrawal symptoms and prevent complications. Commonly prescribed drugs include:
Benzodiazepines: Reduce anxiety, prevent seizures, and promote relaxation.
Anticonvulsants: Address seizure risks.
Vitamins (e.g., thiamine): Prevent Wernicke-Korsakoff syndrome, a neurological complication of chronic alcohol use.
3. Preparation for Treatment: Once withdrawal symptoms are managed, the individual is encouraged to transition into long-term treatment, such as counseling or rehabilitation programs.

Benefits and Challenges of Detox
Detox is a vital step, but it is not a standalone cure for AUD. Its primary benefit is ensuring physical safety while preparing individuals for comprehensive treatment. However, it can be physically and emotionally challenging. Individuals may experience intense cravings, mood swings, and feelings of vulnerability during this period.

Conclusion
Alcohol detoxification is a critical and often life-saving process in the treatment of AUD. By managing withdrawal symptoms and stabilizing the individual, detox provides a safe starting point for recovery. With proper medical supervision and a transition to ongoing treatment, detox serves as the gateway to long-term sobriety and improved quality of life.

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managing bipolar disorder, self-compassion mental health, bipolar disorder medication adherence, bipolar and sleep, bipolar and alcohol, warning signs bipolar relapse, bipolar therapy and self-care.

Understanding Bipolar Disorder: The Key to Long-Term Wellness

Managing bipolar disorder requires a combination of medical treatment, lifestyle adjustments, and emotional self-care. Whether you are a patient, family member, or healthcare professional, understanding the role of self-compassion in treatment adherence and daily stability can significantly improve mental health outcomes. Below are three essential pillars for maintaining balance and well-being.

  1. Stay Consistent with Medication: A Foundation for Stability

managing bipolar disorder, self-compassion mental health, bipolar disorder medication adherence, bipolar and sleep, bipolar and alcohol, warning signs bipolar relapse, bipolar therapy and self-care.Why It Matters:
Taking prescribed medications every day without missing doses is one of the most critical steps for mood stabilization. If you and your psychiatrist or mental health provider have identified an effective medication regimen, consistency is key to preventing mood swings and relapse.

Common Concerns:

    • “What if I don’t like the side effects?”
    • “How do I remember to take my medication daily?”

Tips for Success:

    • Use a daily pill organizer or medication reminder app.
    • Work closely with your doctor to adjust medications as needed.
    • Approach medication with self-compassion—understand that needing treatment does not mean weakness; it is part of managing a medical condition.
  1. Avoid Substance Use and Limit Alcohol: Protect Your Mental Health

managing bipolar disorder, self-compassion mental health, bipolar disorder medication adherence, bipolar and sleep, bipolar and alcohol, warning signs bipolar relapse, bipolar therapy and self-care.The Impact of Drugs and Alcohol on Mood Stability
Substance use—including recreational drugs and even medical marijuana—can significantly interfere with bipolar disorder treatment. Alcohol, even in moderation, may worsen symptoms or interact negatively with medications.

Common Questions:

  • “Is it okay to drink socially?”
  • “Does cannabis help or hurt bipolar symptoms?”

Practical Advice:

  • Prioritize your mental health over social drinking or self-medication.
  • Seek support if substance use is affecting your ability to stay stable.
  • Remember that managing bipolar disorder requires self-compassion—avoiding substances isn’t about restriction, it’s about self-care.
  1. Prioritize 8 Hours of Quality Sleep: A Non-Negotiable for Stability

managing bipolar disorder, self-compassion mental health, bipolar disorder medication adherence, bipolar and sleep, bipolar and alcohol, warning signs bipolar relapse, bipolar therapy and self-care.

Why Sleep is Essential for Mood Regulation
Sleep disruptions—whether caused by staying up too late, shift work, or traveling across time zones—can trigger mood episodes. Research has shown that consistent sleep is crucial for preventing both manic and depressive symptoms.

Tips for Better Sleep:

    • Maintain a regular sleep schedule, even on weekends.
    • Create a calming bedtime routine (e.g., reducing screen time, practicing mindfulness).
    • If you struggle with sleep, talk to your doctor about treatment options.

 

 

Additional Strategies for Bipolar Wellness

Recognizing Early Warning Signs of Mood Changes

Work with your healthcare provider to identify early symptoms of mania, depression, or mixed episodes. Write them down and share them with a trusted support person. This proactive step can help you get ahead of mood shifts before they escalate.

The Role of Therapy and Support Systems

Engaging in psychotherapy—such as cognitive behavioral therapy (CBT) or supportive therapy—can provide valuable coping tools and emotional support. A strong therapeutic relationship helps individuals navigate real-life challenges with greater resilience.

Final Thoughts: Practicing Self-Compassion in Bipolar Disorder Management

Managing bipolar disorder is an ongoing journey that requires patience, self-awareness, and a compassionate approach to self-care. Instead of viewing treatment as a burden, embrace it as an act of self-kindness. By staying consistent with medications, avoiding mood-destabilizing substances, and prioritizing sleep, you can create a strong foundation for stability and well-being.

If you or a loved one is struggling, reach out to a healthcare professional for guidance. You are not alone, and with the right support, stability is possible.

 

Paul Keck, MD, Senior Consulting Psychiatrist and Founding President and CEO – Emeritus is the author of this article. Dr. Keck is Emeritus Professor of Psychiatry and Behavioral Neuroscience at the University of Cincinnati (UC) College of Medicine. He is also Senior Consulting Psychiatrist and Emeritus Founding President and CEO of the Lindner Center of Hope, a state-of-the-science, UC-affiliated comprehensive mental health center in Mason, Ohio. Dr. Keck has conducted extensive research in bipolar disorder, depression and clinical psychopharmacology, supported by grants from the NIMH, NARSAD, the Stanley Foundation, the Marriott Foundation, and industry. Since 1996, he has been in the top 20 of the most cited scientists in the world publishing in the fields of psychology and psychiatry.

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By Kelly M. Heitkamp, LISW-S

 

As someone who sits on both sides of the therapy couch – borrowing that perfect phrase from my colleague Dr. Laurie Bruce’s enlightening podcast “From Both Sides of the Couch” I’ve developed a unique perspective on depression treatment. Let me share what I’m seeing in the field today, both as a clinical social worker and as someone who’s personally navigated the winding path of mental health care. Let me share what I’m seeing in the field today, both as a clinical social worker and as someone who’s personally navigated the winding path of mental health care.

The Tried and True (But Sometimes Not Enough)

Cognitive Behavioral Therapy (CBT) remains one of the most effective approaches for treating depression. This structured therapy helps identify and change thought patterns that contribute to depressive symptoms. Along with other evidence-based approaches like Interpersonal Therapy and Mindfulness-based techniques.

Then there’s medication – those SSRIs and SNRIs that many people have complicated relationships with. Many find life-changing relief, while others struggle with side effects or minimal benefits. When therapy and standard medications work, they really work. But let’s be honest – for about a third of people with depression, these approaches aren’t enough, which is why I’m so excited about what’s emerging.

New Kids on the Treatment Block

Ketamine therapy has gained significant attention. Many patients report experiencing relief within hours rather than the weeks or months typical medications require. The treatment seems to work by creating new neural pathways, helping the brain “reset” established patterns associated with depression.

Right here in our region, the Lindner Center of Hope offers innovative ketamine treatment options. Patients undergo thorough evaluations before treatment helping you and your provider decide if the treatment is right for you. When you are receiving treatment the Center’s medical team carefully monitors each session.

Another exciting treatment offered at the LCOH is Transcranial Magnetic Stimulation (TMS). This non-invasive procedure uses magnetic fields to stimulate nerve cells in the brain and has shown promising results for those who haven’t responded to traditional treatments.

Tech Meets Therapy

The digital mental health space is also exploding. As someone who was initially skeptical about app-based therapy (can an app really replace human connection?), I’ve been surprised by the research showing legitimate benefits from some digital interventions. These tools can be particularly helpful for people who live in areas with therapist shortages or who cannot afford traditional therapy.

Evidence-based apps can serve as supplements to therapy – kind of like “homework” between sessions. They are not replacements for human connection, but they can be valuable additions to your treatment.

What This Means for You (or Someone You Care About)

If you’re struggling with depression, or supporting someone who is, know that the treatment landscape is more promising than ever. The stigma is slowly lifting, and our understanding of what works is expanding rapidly.

What I’ve learned both personally and professionally is that depression treatment isn’t one-size-fits-all. Sometimes it takes trying different approaches or combinations before finding what works. And that’s okay.

The most important thing is to keep going. Whether it’s traditional therapy, medication, newer treatments like ketamine, or some combination that ultimately helps – there are more pathways to healing than ever before.

And as someone who’s been on both sides of this journey, I can tell you that finding your way through is absolutely worth it – even when the path isn’t straightforward.

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By Megan Schrantz, Ed.D., LPCC
Lindner Center of Hope Outpatient and Residential Therapist

Many children and adolescents undergo difficult life experiences during their growing up years. Children may encounter a variety of events that are stressful to varying degrees, such as the divorce or separation of parents or the death of a beloved relative or friend. Many of these events would be considered as within the realm of human experience. Yet the nature of the event or events, as well as the unique characteristics of the child, may contribute to a posttraumatic stress response.

A traumatic event involves personal actual or threatened death or threat to life or bodily integrity, or witnessing an event that involves the death, injury, or threat to the physical integrity of another person. Traumatic events are often distinguished as sudden, unexpected, and shocking. Some examples of traumatic events include physical or sexual abuse; witnessing or being the direct victim of domestic, community, or school violence; severe motor vehicle or other accidents; life-threatening illnesses; natural and human-made disasters; the sudden death of a parent, sibling, or peer; and exposure to war or terrorism. The person’s response to such an event is one of intense fear, helplessness, or horror. It is important to note that chronic adverse experiences may detrimentally impact children similar to an acute adverse event. These ongoing events may be underrated or overlooked. Such experiences may include frequent conflict in the home, the various impacts of poverty on daily life, or living in an unsafe neighborhood, just to name a few.

Many people develop characteristic symptoms following exposure to a traumatic event. Common symptoms include fear, depression, anger, anxiety, and difficulty dealing with stress. In children, such an emotional response often presents itself as disorganized or agitated behavior. Children may spontaneously act out their emotions and perceptions of traumatic events through play. Typically, those with posttraumatic stress experience persistent thoughts and memories associated with the event(s), and subsequently attempt to avoid people and situations that are reminders of what happened. They may perceive themselves and others in a negative light or have difficulty trusting others.

A child’s response to a traumatic event will be influenced by his or her age and developmental level. The impact of an identical stressful event may vary from child to child depending on a child’s inherent resiliency and coping skills as well as external sources of family, emotional, and social support. The difference in responses from child to child also occurs because children have unique ways of understanding and making meaning of traumatic events.

The good news is that children and adolescents often respond well to psychotherapy specific to posttraumatic stress. One such evidenced-based intervention is Trauma-Focused Cognitive Behavioral Therapy. Components of trauma-focused cognitive behavioral therapy include:

1) psychoeducation for both children and parents;

2) relaxation/stress reduction;

3) emotional expression and modulation;

4) cognitive coping and skills training;

5) creation of the trauma narrative (story);

6) cognitive processing of the trauma narrative; and

7) looking to the future: safety planning and life goals.

One of the main objectives of TF-CBT is not only for a child to tell their story but to challenge and change their negative thoughts and self-beliefs about it. Importantly, the therapist assists the parent(s) or other adult to bear witness to the child’s narrative, with strength and compassion.

Play therapy utilizes play activities to help children who have experienced trauma process their emotions and experiences in a safe and controlled environment, allowing them to express their experiences through toys, art, and role-playing. Play therapy leverages a child’s natural inclination to play to access and process traumatic experiences in a way that aligns with their developmental stage. Through play, children can symbolically represent their trauma using toys and activities, which can be easier than verbalizing complex emotions. A play therapist observes the child’s play patterns and uses therapeutic interventions to help them understand and manage their emotions, develop coping strategies, and build resilience.

Eye Movement Desensitization and Reprocessing (EMDR) is a treatment modality used in therapy to reduce posttraumatic stress in children and adolescents. The primary goal of EMDR is to help a person transform their negative beliefs about themselves as related to their adverse experiences. Traumatic experiences can strongly impact a person’s sense of safety and control; additionally, such experiences often leave one feeling inadequate, irreparably damaged or responsible about what happened. The aim of EMDR is thus to reprocess irrational and negative thoughts, beliefs, and emotions related to the adverse event(s), as well as the associated negative physiological sensations.

Cohen, JA, Mannarino, AP, & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents, second edition. New York, NY: The Guilford Press.

Craske, MG, Kircanski, K, Zelikowski, M, Mystkowsi, J, Choudhury, N, & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46, 5-27.

De Bellis, MD, Baum, AS, Birmaher, B, Keshevan, MS, Eccard, CH, Boring, AM, et al. (1999a). Developmental traumatology: Part I. Biological Stress Systems. Biological Psychiatry, 45, 1271-1284.

De Bellis, MD, Baum, AS, Birmaher, B, Keshevan, MS, Eccard, CH, Boring, AM, et al. (1999a). Developmental traumatology: Part II. Brain Development. Biological Psychiatry, 45, 1271-1284.

Deblinger, E, Mannarino, AP, Cohen, JA, & Steer, R. (2006). A follow-up study of a multi-site, randomized controlled trial for children with sexual abuse-related PTSD symptoms: Examining predictors of treatment response. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1474-1484.

Hensley, B. (2020). An EMDR therapy primer: From practicum to practice, third edition. Springer Publishing.

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By Jennifer Farley, PsyD
Associate Chief of Psychological Services, Lindner Center of Hope

 

 

 

In many areas, autumn’s colorful trees and darker mornings are reminders of the transition from summer to winter. Evening hours just don’t feel the same compared to the long days of summer when people are more active from sunrise to sunset. While it is common to experience life differently at different times of the year, approximately 10 to 20 percent of people in the United States experience a mild depression during the darker seasons, and 4 to 6 percent of Americans experience moderate or severe depression.

Seasonal Affective Disorder (SAD) is a clinical depression triggered by seasons of the year. SAD is believed to be associated with seasonal changes in the amount of daylight. For most people with SAD, symptom onset is in the fall or early winter, and relief starts in spring. Symptoms of SAD can last up to 5 months. SAD is more common in women than men and is typically not experienced prior to 20 years old. SAD is more common among young adults and the risks of developing SAD decrease with age. People with a depressive disorder or Bipolar Disorder and people with family members with SAD or other forms of depression raises the risk of having SAD. Living in sunnier regions and closer to the equator decreases the risk of SAD, validating why many people become “snow birds” and go south for the winter.

Because SAD is a depressive disorder, individuals experience at least some symptoms of Major Depressive Disorder. These can include feeling depressed most of the day, nearly every day, having less interest in enjoyable activities, sleep problems, feeling sluggish or agitated, having low energy, and feeling hopeless or worthless. Additional symptoms can include overeating, social withdrawal, and poor concentration. It is common for people with SAD to oversleep by going to bed earlier and/or waking later. A clinical diagnosis of SAD requires a full remission of symptoms when the season ends and 2 consecutive years of episodes in the same season.

Causes of SAD include lower levels of the neurotransmitter serotonin, disruption of the circadian rhythm, increased melatonin, and a deficiency in Vitamin D. SAD is most typically diagnosed by primary care physicians, but psychiatric clinicians (medication prescribers and therapists) can also identify SAD.

Though there is not much that can be done to avoid getting SAD, symptoms can be managed to reduce their intensity. Some people start treatment or interventions before SAD symptoms start or before the season changes. Methods of treatment include light therapy (i.e., light boxes), medication, cognitive-behavioral therapy, increased Vitamin D, and lifestyle changes. Taking care of one’s body by eating healthy and getting sufficient sleep, exercising, and avoiding alcohol and drugs can help. Managing stress is important, as is being around others. Isolation and loneliness may fuel depression. Planning pleasant daily or weekly indoor or outdoor activities can be helpful to help fight “hibernation”. People also benefit from planning a vacation somewhere warmer and sunnier during the winter, and the experience of anticipating something positive helps reduce depression. Though some people use tanning beds in the winter months, this is NOT recommended due to the harmful exposure of U/V rays.

Individual therapy and/or medication treatment can be quite helpful for those with SAD, and it is especially recommended when depression is at a moderate or severe intensity. Cognitive-Behavioral Therapy in particular helps by replacing negative thoughts about winter with more positive thoughts. Discussing ways to implement lifestyle changes and planning for enjoyable activities can be helpful. Therapy can also offer opportunities to learn and practice mindfulness and to explore how to radically accept the fall and winter by “leaning in” to its opportunities. People do not have to live through darker months with dark mood.

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By Danielle Johnson, MD, FAPA
Chief Medical Officer, Lindner Center of Hope

Mood disorders have distinct disturbances in emotions. Low moods are called depression and high moods are called hypomania or mania. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) categorizes mood disorders into bipolar disorders and depressive disorders. Mood disorders include major depressive disorder, bipolar I and bipolar II disorder, disruptive mood dysregulation disorder, premenstrual dysphoric disorder, persistent depressive disorder, and cyclothymic disorder. In the U.S., almost 1 in 10 (9.7%) adults experienced any mood disorder in the past year, with past year prevalence of any mood disorder being higher for females (11.6%) than for males (7.7%). More than 1 in 5 (21.4%) U.S. adults will experience any mood disorder in their lifetime. Mood disorders are common in children and adolescents with an estimated 15% having any mood disorder. Major depressive disorder and bipolar disorder are the most common mood disorders with 8.3% of all U.S. adults experiencing at least one major depressive episode in the past year and 2.8% of U.S. adults having bipolar disorder in the past year.

When people experience symptoms of a mood disorder that do not look like major depression or bipolar disorder this can lead to a delay in diagnosis and treatment as they might have difficulty articulating their symptoms and healthcare professionals might not ask questions about other disorders. Although other mood disorders are less common and less severe, they still impact quality of life and functioning.

Persistent depressive disorder (dysthymia) was added to DSM-5 in 2013, combining some criteria of dysthymic disorder and chronic major depressive disorder. With PDD, depressed mood occurs for most of the day, for more days than not, for at least two years (one year for children and adolescents). During a two-year period (one year for children or adolescents), a person has never been without symptoms for more than two months at a time. A major depressive episode can occur before PDD, or people can experience “double depression” when major depressive episodes occur during PDD.

Symptoms can include poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; or feelings of hopelessness. PDD is associated with greater childhood adversity and maltreatment, childhood loss of a parent, earlier onset of depression, and higher rates of chronic depression in relatives. People with PDD also experience a higher number of traumatic events during their lifetime. The 12-month prevalence ranges from 0.5% to 1.5%.

Cyclothymic disorder consists of episodes of hypomanic and depressive symptoms that do not meet the full criteria for bipolar or major depressive disorder. The lifetime prevalence is approximately 0.4%-1%. Symptoms last two years, for more days than not with stability of mood for no longer than two consecutive months. Symptoms of depression can include depressed mood, irritability, hopelessness, helplessness, insomnia, fatigue, anhedonia, avolition, negativity of affect, and suicidal ideation. Hypomanic symptoms can include impulsivity, grandiosity, racing thoughts, increased sociability, excess physical activity, and increased speech production.

People with cyclothymia may experience emotional lability, hypersensitivity, recurrent interpersonal altercations, incidents of self-harming, episodes of excessive gambling, reckless sexual activity, multiple divorces, legal or financial problems, and recurrent job loss. The chronic and pervasive nature of cyclothymic disorder can lead to misdiagnosis with cluster B personality disorders.

There are no FDA-approved medications for PDD or cyclothymic disorder. Your psychiatrist or psychiatric nurse practitioner will take a thorough history including past medical history, previous medical trials, and other psychiatric diagnoses and work with you to develop a treatment plan and choose appropriate medications and psychotherapy to treat depressive and/or hypomanic symptoms.

Sekhon S, Gupta V. Mood Disorder. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558911/

https://www.nimh.nih.gov/health/statistics/any-mood-disorder

https://www.nimh.nih.gov/health/statistics/major-depression

https://www.nimh.nih.gov/health/statistics/bipolar-disorder

Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK541052/

Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK541052/

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Harnessing the power radical openness to enhance connection and psychological well-being.

We as humans, from a biological perspective, are meant to be vulnerable and connected beings. We aren’t the strongest or fastest species, and yet humans dominate the animal kingdom. We do this because of our ability to have and express our emotions and thoughts to others, listen to and respect the thoughts and emotions of others, and to connect and work together.

Despite this innate human characteristic, many of us struggle to let our guards down and be open to others. We often find ourselves compulsively striving for perfection or insisting our way is the right way. Somewhere along the way, we got the message that if we only try harder and be better, our life too will be better. Or we may have come to believe that showing emotions makes us weak and pushes people away. This way of coping is like a suit of armor, we might feel it protects us and makes us stronger, but it actually weighs us down and guards us from others. Remember that we are meant to live in connection with other people, and research shows that this “over-controlled” form of coping contributes to anxiety, depression, and emotional loneliness because it works against connection.

Instead of coping in this way, radical openness is the pathway to well-being. It connects us with our core, authentic human nature and involves three main components:

  • Openness and Receptivity
  • Authenticity and Vulnerability
  • Flexibility and Silliness

Openness And Receptivity.

“We don’t see the world as it is, we see it as we are.” Our unique brains and experiences contribute to how we see the world; thus we are all going to experience the world differently. Examine this inkblot. What do you see? What is the “right” answer?

There isn’t one. How often do we get so stuck on our perspective that we reject others in the process? Radical openness encourages us to acknowledge our own inner experiences, while holding space for other people’s experiences. It is being aware of our own bias and allowing ourselves to grow and learn from what the world has to offer. Doing so will help us live more harmoniously with others and in turn, enhance our own well-being.

Vulnerability and Authenticity. Despite how scary it might feel, being open with ourselves and vulnerable with others builds connection. When was mask our emotions, hide behind the façade that “all is well,” or compulsively strive for perfection, we create emotional loneliness in our own lives. Research shows that people like people who openly revel themselves, they are seen as more trustworthy, and we want to spend more time with them. When we are authentic and vulnerable with the world, others feel safer with us, and in turn we feel more connected to others. Vulnerability creates peace in our inner world and builds community in our outer world.

Flexibility and Silliness. We live in a world that is constantly changing and is unpredictable. Yet, we feel we must be in control and expect ourselves to be perfect all the time. Sometimes we take life too seriously and block ourselves from joy. Radical Openness encourages us to be flexible, to step outside our comfort zone, and have some fun. We are not production robots. We are humans with a life, and life is meaningful when we allow ourselves to flexibly participate. Having a balance between productivity and enjoyment helps sustain our psychological health.

So remember, when it comes to navigating this crazy thing called life, do so with openness, vulnerability, and flexibility. That is what it means to be human. Embrace your humanness and embrace the humanness in others. Connection is the key.

Written by Allison Mecca, PsyD

Staff Psychologist

Lindner Center of Hope

 

 

Concepts based on Lynch, T. R. (2018). The Skills Training Manual for Radically Open Dialectical Behavior Therapy. If you interested in learning more about radical openness and treatment for over-controlled coping, please contact the Lindner Center of Hope or visit lindnercenterofhope.org/dialectical-behavioral-therapy/.

 

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By: Laurie Little, PsyD
Chief Patient Experience Officer and Staff Psychologist,
Lindner Center of HOPE

In recent years, there has been a growing interest in exploring alternative and innovative treatments for mental illness. Among these novel approaches, ketamine has emerged as a promising treatment for various mental health disorders. Traditionally known as an anesthetic and pain-relieving medication, ketamine has shown potential in treating mental health disorders such as depression and anxiety.

History of Ketamine

Ketamine was originally discovered by chemist Calvin Stevens in 1962 for Parke Davis Company and was Food & Drug Administration (FDA)- approved for medical use as an analgesic and anesthetic in 1970.  It is considered a “Dissociative Anesthetic” with different dosages leading to differing effects. Lower dosages can lead to a psychedelic experience and higher dosages can lead to complete dissociation or analgesia. When using Ketamine as an analgesic, researchers noticed an intriguing off-label effect: a rapid and pronounced improvement in mood and depressive symptoms in some patients. This discovery sparked interest in exploring ketamine’s potential as a novel treatment for mental health disorders.

To curb its illicit and recreational use, the United States categorized Ketamine as a Schedule III federally controlled substance in 1999, however research into its mental health benefits continued to flourish. In 2019, the FDA approved the first ketamine derived therapy, called Esketamine, as a therapy for treatment-resistant depression.

Ketamine and Depression

Ketamine’s antidepressant effects are unique compared to traditional antidepressant medications, which typically take several weeks to produce noticeable results. Ketamine often provides immediate relief to patients who are suffering. Ketamine promotes the release of Glutamate, an essential neurotransmitter that is related to cognition, memory and mood.  Traditional antidepressants often affect neurotransmitters such as Serotonin and Dopamine and take longer to notice an improvement in symptoms.

A recently published large, systematic review of published journal articles on Ketamine treatment found “support for robust, rapid and transient antidepressant and anti-suicidal effects of ketamine. Evidence for other indications is less robust but suggests similarly positive and short-lived effects.“ The findings suggest that ketamine facilitates rapid improvements in symptoms among patients with major depressive disorder (MDD), bipolar disorder and suicidality, lasting up to 7-14 days after treatment. In some cases, effects last up to four weeks, depending on the number of ketamine sessions and the underlying mental health conditions.

There is also preliminary but growing evidence base supporting the efficacy of ketamine therapy for substance use disorders, anxiety disorders (generalized, social, OCD, PTSD)  and eating disorders.  However, just like its antidepressant effects, ketamine’s reductions in anxiety are also short-lived, and symptom recurrence is common after several weeks.

Patients who receive adjunctive psychotherapy appear to achieve the most long-lasting benefit compared with ketamine administration alone.

Ketamine Assisted Psychotherapy

Research shows that Ketamine is most beneficial when it is combined with psychotherapy. There is no current standard for how therapy and Ketamine should be combined. Some practitioners combine lower doses of Ketamine and engage in therapy during the treatment. Other practitioners use higher doses of Ketamine and have the patient engage in therapy either the following day or later in the week. Since patients notice an immediate improvement in their mood, they are more able to benefit from therapy and are more open and receptive to thinking about their current circumstances in a new, helpful way.

The Benefits and Challenges of Ketamine Treatment

The most notable benefit of ketamine treatment is its rapid and profound antidepressant effect. Unlike traditional medications, ketamine can provide relief within hours. This immediate response is particularly crucial for patients in crisis, who are suicidal or those struggling with treatment-resistant mental health conditions.

Moreover, ketamine treatment may benefit individuals who cannot tolerate or have not responded well to other standard treatments. Unfortunately, a significant percentage of patients do not find relief from standard therapies and it is important to have multiple treatment options available.

However, ketamine treatment does come with its challenges and risks.

  • Long-Term Data. One major obstacle is the lack of long-term data on the safety and efficacy of ketamine as a mental health treatment. While research has shown short-term benefits, the question of how long the benefits last requires additional investigation.
  • Misuse. Due to its powerful impact, Ketamine is also often misused. Research is still needed on the abuse potential of Ketamine. Interestingly, there is some evidence to suggest that Ketamine itself can be effective in the treatment of other substance use disorders such as alcohol and heroin. There is still much more to be learned
  • Insurance Coverage. Ketamine treatment is often not covered by insurance for mental health conditions, making it financially inaccessible for many patients. The cost of treatment, coupled with the need for repeated administrations to maintain benefits, raises concerns about equitable access to this innovative therapy.

Ketamine treatment represents a groundbreaking shift in the approach to mental health treatment. Its rapid and transformative effects on depression, anxiety and other mental health conditions have sparked hope for those who have exhausted conventional therapies. While ketamine shows immense promise, ongoing research is needed to fully understand its long-term safety and efficacy.

As the field of mental health continues to evolve, ketamine treatment has the potential to offer a lifeline to those who struggle with treatment-resistant conditions. It is crucial for the medical community, researchers, clinicians, policymakers, and insurers to collaborate in ensuring equitable access to this promising therapy.

Ketamine Therapy & Treatment in Cincinnati

If you’re seeking Ketamine Therapy in Cincinnati, the Lindner Center of HOPE is an excellent place to begin your mental health care journey. Reach out to explore your available options.

 

References

Banoff, MD, Young, JR, Dunn, T and Szabo, T. (2020). Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: A review of the literature. CNS spectrums, 25(3), 331-342.

Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger, R., Charney, D. S., & Krystal, J. H. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351-354.

Feder, A., Rutter, S. B., Schiller, D., & Charney, D. S. (2020). The emergence of ketamine as a novel treatment for posttraumatic stress disorder. Advances in Pharmacology, 89, 261-286.

Krupitsky, E. M., & Grinenko, A. Y. (1997). Ketamine psychedelic therapy (KPT): A review of the results of ten years of research. Journal of Psychoactive Drugs, 29(2), 165-183.

Mia, M. (2021) Glutamate: The Master Neurotransmitter and Its Implications in Chronic Stress and Mood Disorders. Front Hum Neurosci. 15: 722323.

Murrough JW, Iosifescu DV, Chang LC, Al Jurdi RK, Green CE, Perez AM, Iqbal S, Pillemer S, Foulkes A, Shah A, Charney DS, Mathew SJ. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013 Oct;170(10):1134-42. doi: 10.1176/appi.ajp.2013.13030392. PMID: 23982301; PMCID: PMC3992936.

Chadi G. Abdallah and Lynnette A. Averil

Ragnhildstveit, A., Roscoe, J., Bass, L., Averill, C., Abdallah, C. and Averillhe, L.. (2023). Potential of Ketamine for Posttraumatic Stress Disorder: A Review of Clinical Evidence. Ther Adv Psychopharmacol, Vol. 13: 1–22, DOI: 10.1177/.

Reznikov L. R., Fadel J. R., Reagan L. P. (2011). “Glutamate-mediated neuroplasticity deficits in mood disorders,” in Neuroplasticity, eds Costa e Silva J. A., Macher J. P., Olié J. P. (Tarporley: Springer; ), 13–26. 10.1007/978-1-908517-18-0_2

Walsh, Z., Mollaahmetoglu, O., Rootman, J., Golsof, S., Keeler, J., Marsh, B., Nutt, D., and Morgan, C. (2022). Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. BJPsych Open (2022) 8, e19, 1–12. doi: 10.1192/bjo.2021.1061

Witt K, Potts J, Hubers A, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. Australian & New Zealand Journal of Psychiatry. 2020;54(1):29-45. doi:10.1177/0004867419883341

Wolfson, P., & Hartelius, G. (Eds.). (2016). The ketamine papers: Science, therapy, and transformation. Multidisciplinary Association for Psychedelic Studies.

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Luckenbaugh, D. A., … & Manji, H. K. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856-864.