Category: Health

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Amanda Porter, MSN, APRN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE Board-Certified in Internal Medicine, Psychiatry/Mental Health, and Addictions

 

The question of “What causes mental health disorders?” is the eternal question on the field of psychiatry. The most widely accepted theory as to the cause of depression thus far has been the neurotransmitter theory; however even with correct diagnosis and appropriate treatment “between 40% and 70% do no respond to treatment, or only partially, while roughly half of patients who do achieve full remission following txt for severe depressed mood relapse within 2 years even when continuing on antidepressants.” (Greenblatt & Brogan, 2016; Keitner & Mansfield, 2012). Even when we place patients on medications meant to boost their neurotransmitters, often remission of mood disorder symptoms is elusive. Therefore, it behooves us as clinicians to seek out complementary and integrative methods (CIM) for treating for mood disorders that can augment or sometimes replace traditional medical treatments.

One method of CIM includes Mindfulness and Meditation. Broadly, this is described as cultivation of awareness, relaxation, focused attention and stillness. This is a methodology pioneered by Jon Kabat-Zinn. Release of serotonin, GABA, dopamine and melatonin occurs during meditation (Newberg, 2010). Since 2009, roughly 10 studies have examined the efficacy of mindfulness practices with patients who were unresponsive to antidepressant therapy. Three-quarters of these studies showed statistically significant reduction in Ham-D scores (Jain, 2015). Mindfulness has been suggested to have the ability modulate the immune system itself as demonstrated in HIV-infected adults who show increased in circulation of CD4+ T lymphocyte counts (Cresswell, 2009).

Another method of CIM includes Spirituality/Prayer. Many of my patients experience depression surrounding some pretty heady questions such as “What is my purpose in life? What was I created for? What happens after I die?” Becoming involved in a faith community, and engaging in spiritual practices associated with that community increase a sense of belonging and self-worth in a person, which leads to overall improved mental health. “In a systematic review of 850 studies of religion and mental health, religion was associated with greater overall well-being in 79% of these studies, lower suicidality in 84%, lower depression 66% and lower anxiety in 51%.” (Koenig, 2001).  Also, it’s postulated that while a sense of well-being and purpose provides greater benefit in preventing depression, a positive relationship with God provides greater benefit after onset of depression.

Another method of CIM includes Yoga and Movement therapies. Yoga and other movement therapies such as Tai Chi or Qi Gong have been found to be helpful for depression, ADHD, anxiety and chronic pain and are especially helpful in vulnerable populations such as pregnancy, adolescents or the elderly. When combined with meditation, this is an incredibly effective therapy, and the beauty of Yoga practice is that even 15 minutes a day can be helpful, so it’s not time-consuming. Yoga practitioners downregulate their HPA axis and modulate their cortisol levels (Sieverdes, et al 2014). Yoga and Tai Chi also have excellent indication for sleep duration with less arousal time. The mechanisms that are involved in the effects of yoga on stress response include the following: positive affect, self-compassion, and inhibition of the posterior hypothalamus and salivary cortisol (Riley, 2015).

Another method of CIM includes Exercise. With depression, often the patient becomes isolated, withdrawn, with poor motivation. This leads to increase in sedentary behaviors. Therefore, it’s important to increase activity in the form of exercise. The higher the dose, the lower the risk of relapse rates in patients with MDD, with 10 days being sufficient to begin seeing an improvement in mood (Knubben, et al, 2007). Exercise increases rate of neurogenesis, production of BDNF, increases serotonin by increasing tryptophan, increases norepinephrine, increases phenylethylamine, decreased cortisol, increase endorphins, and increases dopamine (Greenblatt & Brogan, 2016). It’s hypothesized that exercise helps the brain deal more efficiently with stress by enhancing the body’s ability to respond to stress, and coordinating the sympathetic nervous system response (McWilliams, 2001).

Another method of CIM includes appropriate Nutrition. There is an ongoing discussion about the gut-brain connection and the impact that our nutritional choices have on our mental health. The typical Western Diet consist of high fructose foods or beverages, transaturated fats, with large amounts of carbohydrates in the form of bread products. Sugar and gluten are both incredibly inflammatory, and alter the microbiome of the gut. Factors like alcohol, antibiotic use, NSAIDS, cytokine production, and psychological stress increase also intestinal permeability (Greenblatt and Brogan, 2016). So our dietary choices do have great impact on our mental health. Gluten attacks an enzyme involved in the production of GABA (Kramer & Bressnan, 2016). Patients with schizophrenia and autism are at higher risk for intolerance to gluten, and respond very positively to gluten-free and casein-free diets. Higher dietary fiber content was associated with lower odds of depression; increased consumption of vegetables and nonjuice fruit was associated with lower odds for depression; added sugars, but not total sugars or total carbohydrates, to be strongly associated with depression incidence (Gangswisch, 2015). It’s important to remember that sugar is not the enemy here, but excess sugar is. As with most things in life, balance is key.

Further methods of CIM used to treat mood disorders include: Creative Arts including painting, drawing, music, dance, and writing/narrative medicine; Nature therapy; Pet therapy; Water therapy/Floating; Life coaching/Financial planning; Massage therapy; Acupuncture; Micronutrient therapy; Essential oils; Light therapy; Media fasts; Psychotherapy; and TMS/ECT.

At Lindner Center of HOPE, an Integrative Mental Health consult service incorporates the above treatment modalities, aimed at addressing mental health disorders as holistically as possible. The goal is to strive for recovery with the whole person in mind.

 

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Amanda Porter, MSN, APRN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE Board-Certified in Internal Medicine, Psychiatry/Mental Health, and Addictions

 

Depression is a serious and costly health problem facing our country. Depression is the most common form of mental illness, and is a leading cause of disability, and affects more than a quarter of the US population (CDC, 2017). To date the most prevalent theory as to the etiology of depression is the neurotransmitter theory, however not everyone responds to medications which boost neurotransmitters. Only about half of patients respond to antidepressants, and those who do respond will likely experience relapse of depression within two years (Greenblatt and Brogan, 2016). Thus, we need to consider other influences which might be causing depression.

The field of Integrative Mental Health considers other reasons for depression, such as an altered microbiome, chronic inflammation, hormones, mitochondrial dysfunction, dietary sensitivities, genetic mutations, and the role of neurogenesis.

Integrative Mental Health focuses on the whole person in order to promote recovery as holistically as possible from a mental health diagnosis. Integrative Medicine is synonymous with functional medicine and complementary and alternative medicine. Integrative Mental Health Medicine is an area of medicine that is evolving through the work of its pioneer, Dr. Andrew Weil.

It’s important to understand that integrative therapies are not necessarily a replacement for mental health medications. Rather, integrative therapies can supplement your current mental health treatment plan, or at times reduce the quantity of medications a person takes.

At the Lindner Center of HOPE Integrative Mental Health programming includes genotyping that enables the detection of the MTHFR genetic mutation, and treat accordingly. Micronutrient, thyroid, and metabolic testing is also offered with appropriate recommendations on diet and lifestyle changes. As Hippocrates famously said, “Let food be thy medicine.” Through the UC Center of Integrative Health and Wellness, treatment modalities such as massage, yoga, and acupuncture are available.

After an initial consult with an Integrative Mental Health practitioner, an Integrative Mental Health treatment plan will be developed. The treatment plan is also based off the patient’s individual mental health needs. This treatment plan incorporates lifestyle changes such as diet and exercise, nutrient therapy consisting of beneficial dietary supplements, and also considerations for services such as acupuncture, massage therapy, mindfulness, meditation, and hypnosis. The program appeals to patients who are seeking to treat their mental health diagnosis with as few prescription medications as possible. Integrative Mental Health consultations and follow-up visits are covered under many insurance plans.

Sources

Greenblatt, J. M. & Brogan, K. (2016). Integrative therapies for depression. Boca Raton, FL: CRC Press

Mental Health Basics. (2013). Retrieved from https://www.cdc.gov/mentalhealth/basics.htm

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Marcy Marklay, LPCC

Child/Adolescent/Young Adult Therapist, Lindner Center of HOPE

Adjunct Instructor, Dept of Psychiatry and Behavioral Neuroscience

University of Cincinnati- College of Medicine

 

Gender identity is a person’s inner sense of being male, female, neither or both. Gender nonconforming refers to those who have behaviors and interests that run counter to what is expected of a male or female. Gender dysphoria refers to an individual’s affective/cognitive discontent with gender assigned at birth; gender dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.  Transgender people are often unhappy with aspects of their bodies that do not conform to the gender they feel they are on the inside. There is a conflict between gender identity and biological sex and expectations. Transgender refers to the individuals whose gender identity is in contrast to their biological sex from birth.  Gender dysphoria can occur in children, adolescents and adults. Sexual orientation is not the same as gender; it has to do with who we find attractive.

Transgender individuals face discrimination and report a staggering rate of attempted suicide. It is estimated that 41 percent of transgender individuals have attempted suicide. This is greater than 25 times the rate of attempted suicide of the general population.  It is estimated that 75 percent of transgender youth experience harassment; many experience physical assault and sexual violence.  Anxiety and depression can often be found in transgender individuals. The needs of this community range from basic—safety, shelter, food, protection against discrimination and violence, to dealing with family, school and dating relationships, to transitioning with hormones and or surgery, and coming out concerns. It is crucial to respect them and respect the preferred name and pronouns they identify as, not to assume the gender or pronouns they use. Transgender individuals may face a lack of support or even open hostility from their family and friends, churches and communities. This rejection fuels high levels of anxiety and depression and makes the coming out process very difficult for many transgender people. They often have higher rates of peer isolation and hopelessness.

Coming out is a process of telling others that one is transgender, or gay, lesbian, bisexual or questioning. Parents need to educate themselves and be open to understanding their transgender child. Parents may have strong reactions with feelings of loss, worry what others may think, concerns for harassment, physical harm, possible regret, too young, not believe the child is really transgender, etc. It is important to work with a trusted mental health professional. Parents have their own social, cultural and religious views that must be addressed. `It is important to keep the communication open so the transgender child or teen can understand it is a difficult transition for the parents as well. Transgender teens and their parents benefit from support groups, in person or in a safe online network.

Each student needs to be in a supportive school environment. School administrators, counselors and teachers can help implement zero tolerance policies on bullying so that all students, including transgender students, can feel safe in school. Schools can establish a GSA, or gay straight alliance organization for transgender and other LGBTQ youth. Schools can develop a harassment policy that is specific regarding gender and sexual orientation. There needs to be a number of “safe” adults or advocates within each school. Transgender youth face challenges in the school setting also with practical issues in use of restrooms, locker rooms, use of legal name versus preferred name and pronouns if the child has not had a legal name change, etc. Issues of safety and respect are primary. Parents may be advocating for their transgender child with the school. It is important for the transgender youth to work on self-advocacy as well.

To be an ally of transgender people, it is important to spread a positive message and combat prejudice, to respect their preferred name, pronouns, accept them without judgment, give them a safe space where they do not have to hide who they are, and work on empowering them and giving them hope for the future. There are resources for both parents and transgender teens. The Gay, Lesbian, and Straight Education Network (GLSEN) is the largest national education organization working to ensure safe schools for all students. Parents and Friends of Lesbians and Gays (PFLAG) is focused on promoting the health of LGBTQ and transgender people, their families and friends. The Trevor Project is a free and confidential 24/7 crisis and suicide prevention helpline for LGBTQ youth. Trevor Space is a free, monitored social media and peer networking site for LGBTQ youth ages 13-24.

Sources of information:

 DSM-5, Diagnostic and Statistical Manual of Mental Disorders, fifth edition, American Psychiatric Association.

The World Professional Association for Transgender Health, www.wpath.org

 The Transgender Child by Stephanie Brill and Rachel Pepper, Cleis Press, 2008.

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By Michael O’Hearn, MSW, LISW-S

The drum is one of the oldest musical instruments. An interesting paradox of medical and cognitive neuroscience is how a range of intra- and inter-personal stress mediation, self-regulation, and mind-body continuity interventions are accomplished through ancient
traditions of meditation (mental training) (Davidson & McEwen, 2012; Khalsa, Rudrauf, Davidson, & Tranel, 2015), and drumming (Bittman, Berk, Fleton, Westenguard, Pappas, & Ninehouser, 2001; Bittman, Berk, Shannon, Sharaf, Westenguard, Guegler, & Ruff, 20015; Bittman, Croft, Brinker, van Laar, Vernalis, & Elisworth, 2013).
This paper outlines a drumming technology that naturally integrates with Shamatha (Object) meditation (Ponlop, 2006). Drumming technology is a source of practically limitless transverse, bi-lateral, fine, and gross motor algorithms for individuals, couples, or groups. The targeted and individualized interventions (algorithms) serve as the object of Shamatha meditation. The psychoneuromuscular (PNM) practice not only conditions self-regulation, mind-body continuity, and stress mediation; the acquired abilities are eventually habituated in procedural or working memory (Sacks, 2007; Sapolsky, 2017) in
client systems.
The proposed drumming technology is central to a theoretical paper on music-based learning culture in former totalitarian undergraduate, graduate, and post-graduate education. It is expected to be published by Summer, 2018. Michael Radin, Ph.D., a classically trained pianist and Mathematics Professor at the Rochester Institute of Technology and Riga Technical University, and Liga Engele, Head of the Music Therapy
Center at Leipaja University, Latvia are lead and co-authors.

A Drumming Technology
The following is a description of drumming technology components and processes, some dyadic tables, and a low complexity algorithm. Table 1 and 1a outline phalange/hand, and foot sources for drumming algorithms:

 

 

 

 

 

 

 

Time Signatures. Time signatures are expressed as fractions; Table 2 illustrates a 4/4-time signature. The denominator represents the total number of beats per measure; the numerator represents the number of beats played per measure. Any source combinations can fit with practically any desired time signature.
Additional time signatures are not limited to 3/3, 3/4, 2/4, and 6/8.

Basic Rhythms. The following are basic rhythmic patterns ubiquitous in drumming and dance choreography. Again, any combination of  sources can fit these basic rhythms.

 

 

 

Accents. Downbeat and syncopation are two examples of various  accents to basic rhythms. Table 2 also illustrates the downbeat accent in 4/4 time.

 

 

Syncopated rhythms have accents that are not necessarily patterned or predictable; the accent often “anticipates,” or is played on the half-beat in Latin rhythms, Jazz, and progressive rock music. As syncopated  rhythms require additional effort and resources to capture and integrate, they are indicated to enhance integration in trauma recovery (van der Kolk, 2009; 2014) patients.

Medium. Drum kit, hand drum, finger drum, homemade drum, lap,  belly, table, or other are examples of medium – the instrument selected for a drumming algorithm.

Tuplet. Tuplet is the number of strokes attributed to each beat (the numerator) in any time signature; typically, single, double, or triple.

Tempo. A metronome is a meter that measures tempo in beats per minute/second (bpm/s), and provides an auditory “click track.” The  practitioner plays at a precise tempo, in sync or “on meter” with the  metronome. There are advantages to fast and slow tempo. Drumming  algorithms can emphasize one, the other, or include both.

Duration. Duration is the length of time of practice session, or the number of repetitions a drumming algorithm is played.

Examples of Dyadic Tables and a Drumming Algorithm.
The following are samples of fine and gross motor, transverse and bi-lateral dyadic tables for drumming algorithms. It is followed by an  illustration of a low complexity drummingalgorithm.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUMMARY
Meditative drumming is a psychoneuromuscular (PNM) intervention for individuals, couples, and groups that facilitates self-regulation, mind-body continuity, and stress reduction.
Individualized drumming algorithms are designed to engage one or a combination of: autonomic/vagal, cognitive, emotional, language,  visual-spatial, fine/gross motor, and memory along transverse and/or  bi-lateral pathways. Acquired abilities from meditative drumming algorithms are eventually habituated in procedural or working memory (Sacks, 2007; Sapolsky, 2017).

Its value for generating nonlinear efficacy in all settings (including all levels of care continuums), is matched only by its portability and cost efficiency.

REFERENCES
Davidson, R. & McEwen, B. (2012). Social influences on neural plasticity: Stress and interventions to promote well-being.
Nature Neuroscience, 689-695.
Khalsa, Rudrauf, Davidson, & Tranel. (2015). The effect of meditation on regulation of internal body states. Frontiers in Psychology, 1-15.
Bittman, B., Berk, L., Felten, D., Westenguard, J., Pappas, J., Ninehouser, M. (2001). Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects, Alternative Therapies In Health and Medicine, Jan: 7(1), 38-47.
Bittman, B., Berk, L., Shannon, M., Sharaf, M., Westenguard, J.,
Guegler, K., Ruff, D. (2005). Recreational music-making
modulates the human stress response: a preliminary
individualized gene expression strategy, Medical Science
Monitor, 11, BR31-40.
Bittman, B., Croft, D., Brinker, J., van Laar, R., Vernalis, M., & Elisworth,
D. (2013 Recreational music-making alters gene expression pathways in patients with coronary artery disease, Medical Science Monitor,19, 139-147.
Ponlop, D. (2006). Mind beyond death. Ithaca, NY: Snowlion.
Sacks, O. (2007). Musicophilia. NY: Vintage.
Sapolsky, R. (2017). Behave: The biology of humans at our best and worst. NY: Penguin.
van der Kolk, B. (2009). Presentation of Trauma and Recovery, to the Milton H. Erikson Foundation Evolution of Psychotherapy Conference, Sacramento, CA.
van der Kolk, B. (2014). Trauma Recovery presentation to the 2014 International Trauma Conference, Boston, MA.

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By Nicole Mori, RN, MSN, APRN-BC, Research Advanced Practice Nurse

Medical mobile phone apps are changing the doctor-patient relationship by promising patients greater control over their care, lower costs, improved safety and convenience.  Patient demand for apps is increasing with an estimated 50% of smartphone users having a medical app by the end of 2017.  Acceptance among clinicians is increasing, with as many as 1/3 of doctors recommending health and wellness apps to their patients.  In mental health, mobile apps have great potential as platforms for psychoeducation, self-management and enhanced patient-provider communication, in addition to increasing access and improving care for patients in rural and underserved areas.

Even though mental health apps could be useful, the market is still dominated by low-quality products that may not follow best clinical practice guidelines.   There is little published research and reliable information to guide patients and clinicians while app store and user-generated ratings do not correlate with quality of content.  This is a rapidly-evolving market, with new products and updates arriving on a weekly basis, therefore, clinicians need a framework to evaluate products, weigh risks versus benefits and offer guidance.

A review of recent literature, including 2016 published review of commercially-available mental health apps reveals significant concerns1:

Quality, functionality and reliability:  Mobile health apps are often developed without the input of clinicians and without validation by research or reference to best practice guidelines.  Information is often generic, incomplete and in some cases, inaccurate.  Few apps cited their sources of information.  Less than 50% of mental health apps used validated symptom scales, and when these were used, developers failed to properly credit the sources.

Patient Safety:  Symptom-monitoring apps may not issue safety alerts instructing patients with high illness severity scores (such as severe suicidal ideation) to seek prompt medical evaluation.  Few apps are designed to respond to indicators of deteriorating condition.

Burden on clinicians:  Apps may generate large amounts of data that may not be clinically-relevant or useful.  There is no framework for reimbursing patients for the costs of downloads or physicians for the time spent reviewing the data.

Absent regulatory oversight:  Laws and regulations have failed to address privacy and cybersecurity risks associated with health apps.  The majority of apps marketed to patients are exempt from regulations, with only a small number subject to FDA oversight.  Security and disclosure standards are left to the discretion of developers who often lack the expertise and resources to manage protected health information.

Privacy and confidentiality:  Health app developers are generally exempt from HIPAA regulations.  Products storing sensitive patient information pose significant privacy and security risks but many still lack mechanisms to safeguard patient information such as passwords and encryption.  There are no laws against the sale of patient information to data aggregators, who may in turn sell it to third parties such as credit card and insurance companies. Few products have comprehensive privacy policies, disclosing how personal information would be stored, used and protected.   Patients assume that information entered into mobile apps is private, when this is often not the case3.

In view of these quality concerns, more research and development of evidence-based mobile apps driven by clinicians is needed in addition to legal protections to safeguard the privacy and security of patient data.  At the present time, clinicians should be aware of the uneven level of quality in the app market and be familiar with a few reliable websites patients can visit for health education and be able to offer some guidance to patients using apps that store personal health information.

Discussion should address potential security risks and unauthorized disclosure of personal data, whether the product is evidence-based and in agreement with best practice guidelines and consider risks and potential benefits.

Note:  The American Psychiatric Association has developed an App Evaluation Model to help clinicians evaluate health apps.  The guidelines provide a list of issues that must be considered in order to make an informed decision about an app 2.

Sources
1         Nicholas, J., Larsen, M. E., Proudfoot, J., & Christensen, H. (2015). Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality. Journal of Medical Internet Research, 17(8), e198. http://doi.org/10.2196/jmir.4581
2         APA (Ed.). (n.d.). App Evaluation Model. Retrieved November 16, 2017, from https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/app-evaluation-model
3         Sarah R. Blenner, Melanie Köllmer, Adam J. Rouse, Nadia Daneshvar, Curry Williams, Lori B. Andrews. Privacy Policies of Android Diabetes Apps and Sharing of Health Information. JAMA. 2016;315(10):1051–1052. doi:10.1001/jama.2015.19426

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By Nicole Mori, RN, MSN, APRN-BC, Research Advanced Practice Nurse

The use of dietary supplements or vitamins for the treatment of depressive symptoms is increasingly common among patients. Factors driving this trend include unsatisfactory response with standard treatments, adverse drug events, skepticism about psychiatric medications and the perception of dietary supplements as “natural” and safe.

Although evidence increasingly supports the relationship between quality of diet and mood, more research is needed to clarify the role of dietary supplements in the management of depression. Consumers often take supplements based on inconclusive data from small, methodologically-flawed studies. Unlike FDA-approved drugs, supplements do not have to demonstrate unequivocal evidence for efficacy or safety. Adulteration, contamination, variations in potency, and product instability are not uncommon. When treating depressed patients, it is important to ask about use of dietary supplements and to be ready to offer guidance regarding the evidence for potential benefits, possible risks and drug-supplement interactions. The following are commonly-used supplements with a potential effect on depressive symptoms.

Omega 3 polyunsaturated fatty acids: Eicosapentanoic acid (EPA) and Docosahexaenoic acid (DHA)

Omega 3 fatty acids are long chain lipids found in oily fish. High dietary intake has been associated with low rates of depression. Omega 3 fatty acids enhance neurotransmission, neurogenesis and reduce inflammation. There is support for supplementation in Major depression with several meta-analyses showing efficacy. There is some evidence for efficacy of omega 3 fatty acids for bipolar depression. Over the counter products vary greatly in composition and EPA/DHA ratio. Evidence supports the use of EPA-dominant formulations. Adverse events and drug interactions are uncommon, but risk for excessive bleeding must be considered. Dose 1-2g of EPA/day.

Folic acid and Methylfolate

Involved in dopamine, serotonin and norepinephrine synthesis. Folate deficiency has been associated with increased risk for depression. Evidence supports adjunctive use of methylfolate with antidepressants for the reduction of Major depression symptoms. An FDA approved formulation of l-methylfolate available by prescription has shown efficacy at the 15mg/d dose level. Evidence for the efficacy of folic acid and Depression is mixed and there is no evidence supporting the use of either folate or methylfolate in Bipolar depression. Methylfolate is usually well-tolerated, although there are concerns about use masking B12 deficiency and historical concerns about cancer. Routine folate supplementation >1g/d is not recommended. l-methylfolate dosage is 7.5-30mg/day, maximum 1g/day (folate).

S-adenosylmethionine (SAMe)

An endogenous aminoacid involved in neurotransmitter synthesis. Decreased serum and CSF levels are associated with depression. A few studies support efficacy for supplementation in Major depression but more research is needed.  There is no data to support use of SAMe in bipolar depression. Adverse events include nausea and anxiety. May interact with serotonergic antidepressants and increase risk for manic and hypomanic episodes in Bipolar disorder. Dose 200-800 twice/day.

Vitamin D

Low serum concentrations have been associated with depression. Vitamin D acts as a receptor ligand in the prefrontal cortex and hypothalamus. Some evidence supports supplementation for reducing symptoms in clinically-depressed patients but further research is needed. Evidence does not support supplementation as a therapy for bipolar depression.  Caution regarding risk for hypercalcemia and toxicity with excessive intake. Dosing varies.

N-acetylcysteine (NAC)

Available as a nutritional supplement and as prescription medication for treating acetaminophen overdose. NAC has antioxidant and anti-inflammatory properties and modulates the glutamate pathway.  Some evidence for reduction in bipolar depression symptoms. Not effective in Major depression. Gastrointestinal upset may occur. Dosing 1-1.5g twice/day.

St. John’s Wort

A perennial herb containing active compound hypericin, which inhibits reuptake of dopamine, norepinephrine and serotonin. Some support for short-term efficacy in depressive symptoms, but more long term and safety data is needed. Significant risk for drug interactions due to interaction with serotonergic drugs (serotonin syndrome) and interference in the metabolism of hundreds of drugs by induction of Cytochrome P450 enzymes make this an undesirable adjunctive option. Dosing varies due to variability in potency.

Probiotics

Alterations in intestinal flora have been implicated in mood disorders, although the mechanism is unclear. Probiotic supplements are thought to impart a health benefit by optimizing intestinal flora and are used to manage gastrointestinal symptoms. Animal studies show blunting in inflammatory response and improvement in mood symptoms with supplementation, but few clinical trials yielded positive results. Products on the market vary in terms of bacterial strain content, stability and bioavailability. Adverse events are rare, except for opportunistic infection immunocompromised individuals. Dosing varies.

There isn’t a one size fits all or best supplement for depression. There are some benefits to adding in supplements for depression symptoms and in other areas more research is needed. Be sure to work with a medical professional and consider the potential benefits, possible risks and any drug-supplement interactions for medications you may already be taking.

If you are seeking help for your depressive symptoms, contact us at the Lindner Center of HOPE. There is HOPE.

 

References

Sarris J, Murphy J, Mischoulon D, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016;173(6):575-87. Nahas, R., & Sheikh, O. (2011).

Complementary and alternative medicine for the treatment of major depressive disorder. Canadian Family Physician, 57(6), 659–663.

Sarris J. Clinical use of nutraceuticals in the adjunctive treatment of depression in mood disorders. Australas Psychiatry. 2017;:1039856216689533.

Rakofsky JJ, Dunlop BW. Review of nutritional supplements for the treatment of bipolar depression. Depress Anxiety. 2014;31(5):379-90.

 

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FOR IMMEDIATE RELEASE                                                                                                                                     

CONTACT:
Jennifer Pierson
Lindner Center of HOPE
(513) 536 -0316
[email protected]

Free Community Education Series to Address Substance Use Disorders, Behavioral Addictions, Treatment and Strategies for Coping

March session to explore Stress and Family Functioning

Lindner Center of HOPE with the support of Manor House in Mason, Ohio is offering a Free Community Education Series in 2017 on topics related to addiction. The series will offer expert discussion of Substance Use Disorders, Behavioral Addictions, Treatment and Strategies for Coping for community members seeking information.

The series will be held at Manor House, 7440 Mason-Montgomery Rd., Mason the third Wednesday of the month at 6 p.m. starting January 18, 2017 for one year (though sessions will not be offered in May 2017 or December 2017. On May 7, 2017 Lindner Center of HOPE will offer their second Education Day, a ½ day workshop about mental illness and addiction.)

Register by calling Pricila Gran at 513-536-0318. Learn more by visiting lindnercenterofhope.org/education.

The third session is March 15, 2017. Michael K. O’Hearn, MSW, LISW-S, Clinical Director of the Lindner Center of HOPE’s Stress Related Disorders program and staff provider, will present Stress and Family Functioning.

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 and short-term residential services for adults and adolescents, outpatient services for substance abuse through HOPE Center North location 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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Nicole Mori, RN, MSN, APRN-BC

Research Advanced Practice Nurse, Research Institute at Lindner Center of HOPE

Obesity, defined as a body mass index (BMI) ≥30 mg/kg, remains one of the main contributors to preventable disease and health care costs. It is also associated with increased risk for Type 2 diabetes, cardiovascular disease, and some cancers, in addition to lower quality of life and functional impairment.   Patients with psychiatric illness are 50 percent more likely to be obese than the general population.  The higher rates of obesity are contributing directly and indirectly to the marked reduction in life expectancy among those with mental illness.  In addition to being an important medical comorbidity, obesity has been associated with a more severe course of psychiatric illness, lower health-related quality of life, poor self-esteem, stigma, and discrimination.  Obesity, like mental illness, is a complex, chronic condition requiring long term management.  The treatment of overweight psychiatric patients poses unique challenges and both the psychiatric illness and the weight problem must be targets for treatment in order to achieve optimal outcomes.

The strong relationship between obesity and psychiatric illness is evidenced by the high prevalence of obesity among drug-naïve patients. Commonly-occurring symptoms such as psychomotor retardation, inactivity, hypersomnia, increased appetite, and hyperphagia are thought to contribute to weight gain.  Furthermore, binge eating behavior, eating unusually large amounts of food with a sense of loss of control over eating, is very common in people with psychiatric illness.    Binge eating behavior is a risk factor for obesity, and when present in psychiatrically ill people, is associated with greater psychiatric and medical morbidity.  Lastly, treatment with most mood stabilizers, antipsychotics, and some antidepressants is associated with significant weight gain, which renders them less acceptable to patients and leads to discontinuation.

Weight management poses unique challenges to psychiatric patients. As we have seen, both the behaviors associated with psychiatric illness and the use of certain psychotropic medications, contribute to weight gain.  In addition, the symptoms and cognitive deficits associated with mental illness are a barrier to participation in behavioral weight loss interventions.  Finally, the use of most weight control drugs is limited by their psychiatric side effects and their interactions with psychotropic medications.  Obesity and excessive weight gain place a disproportionate burden on psychiatric patients’ health, complicate adherence to treatment, and reduce quality of life.  Treatment of psychiatric illness needs to include weight management strategies and a greater integration of behavioral and medical care.

Clinicians can help improve outcomes by maintaining a focus on both the psychiatric condition and the weight problem when treating this population. First of all, regular monitoring of psychiatric symptoms should be accompanied by monitoring of weight, BMI, vital signs as well as metabolic lab parameters (e.g., lipids and glucose).  Assessing for binge eating behavior or an eating disorder is important because additional referrals and greater integration of behavioral and medical care may be indicated for patients with disordered eating.

Prescribers can mitigate weight gain associated with psychotropic medications by selecting medications with lower potential for weight and metabolic disturbances whenever possible.   Knowledge of the pharmacology of obesity and eating disorders is helpful in guiding treatment choices and avoiding adverse events.  Some FDA-approved weight-loss agents have antidepressant effects, and some off-label adjunctive medications may be beneficial to depressed patients who binge eat.  Treating mental health patients with FDA-approved weight-loss drugs requires caution due to the potential effects on psychiatric symptoms as well as drug-drug interactions.  For instance, in treating patients with bipolar disorder, medications with lower risk for mood de-stabilization should be used and most medications should be avoided in patients with hypomanic, manic or mixed symptoms.

Although new weight-loss medications have come to market in recent years, there is no research to inform their use in mental health patients.   Clinical trials typically exclude people with a psychiatric illness and those taking psychotropic medication.  Research to find effective weight-control medications that are safe for this population is greatly needed.

 

References

Allison, D. B., Newcomer, J. W., Dunn, A. L., Blumenthal, J. A., Fabricatore, A. N., Daumit, G. L., … & Alpert, J. E. (2009). Obesity among those with mental disorders: a National Institute of Mental Health meeting report.American journal of preventive medicine, 36(4), 341-350.

McElroy, S. L., Crow, S., Biernacka, J. M., Winham, S., Geske, J., Barboza, A. B. C., … & Frye, M. A. (2013). Clinical phenotype of bipolar disorder with comorbid binge eating disorder. Journal of affective disorders, 150(3), 981-986.

McElroy, S. L., Guerdjikova, A. I., Mori, N., & Keck Jr, P. E. (2016). Managing Comorbid Obesity and Depression through Clinical Pharmacotherapies. Expert Opinion on Pharmacotherapy, (just-accepted).

The Research Institute at the Lindner Center of HOPE is conducting a 40 week, placebo-controlled study of liraglutide, a novel weight loss agent, in patients with bipolar disorder with a BMI ≥30 or with a weight-related medical comorbidity and a BMI ≥27. For additional information, contact Anna Guerdjikova @ 513-536-0721. [email protected]

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On October 28, 2015, Dr. Elizabeth Wassenaar, Lindner Center of HOPE Psychiatrist and Williams House Medical Director, joined Lon Woodbury on the Woodbury Report radio show.  Their discussion focused on outlining the benefits of a residential assessment for mental health concerns in adolescents.

Click here to listen.

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Susan L. McElroy, MD

Lindner Center of HOPE, Chief Research OfficerUniversity of Cincinnati College of Medicine, Professor of Psychiatry and Neuroscience

Intermittent Explosive Disorder (IED) is a common and serious disorder that is often unrecognized and untreated. People with IED are periodically unable to restrain impulses that result in verbal and physical aggression. The aggressive behaviors are unplanned, out of proportion to provocation, and cause distress and psychosocial impairment, including interpersonal difficulties, divorce, school suspension, job loss, and financial and legal problems.

The violent behaviors of IED, often called explosive outbursts or rage attacks, are often preceded by aggressive or violent impulses, described as “the need to attack,” ‘the need to defend oneself,” “the need to strike out,” “seeing red,” or “an adrenaline rush.” These impulses are associated with tension, anger, increased physiological arousal, and increased energy. The explosive outbursts are brief, lasting 10 to 30 minutes, and usually followed by feelings of depression, remorse, guilt, and fatigue.

Once thought to be rare, we now know that IED is very common. Research has shown that the lifetime prevalence of IED in the general population is 1 to 7 percent. The average age of onset is 14 to 18 years among adults, and 13 among adolescents. IED is most common males and younger people. Of note, people with IED often have other psychiatric disorders, like depression, bipolar disorder, alcohol or drug abuse, and anxiety.

The cause of IED is unknown but biological, psychological, and social factor are thought to be involved. Importantly, IED runs in families suggesting that genetic factor are involved. Research also suggests that abnormalities in serotonin function in the central nervous system plays a role in IED.

IED is usually treated with medications and/or cognitive behavioral therapy (CBT). Medications that may be helpful include serotonin reuptake inhibitor s (like fluoxetine), anti-epilepsy medications (like carbamazepine ), or mood-stabilizers like lithium. When treating IED, it is crucial that other psychiatric conditions are identified and properly managed.

No medication, however, is approved by the United States Food and Drug Administration for the treatment of IED.   Hence, Azevan Pharmaceuticals is sponsoring a study to see if a novel medication is efficacious for IED in adults. This medication affects vasopressin, a hormone in the brain thought to play an important role in regulating aggressive behavior. This medication has been shown to reduce aggressive behavior in animals. The Research Institute at the Lindner Center of HOPE will be participating in this study which is scheduled to begin in late August. The Research Institute will be recruiting volunteers with IED to participate at that time. If an individual has questions about the study and might be interested in participating, they can call 513-536-0710 for further information.