NORTHSHORE INTEGRATIVE HEALTHCARE Phone: NIH (4644)

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1 NORTHSHORE INTEGRATIVE HEALTHCARE Phne: NIH (4644) Nn-Drug Appraches t Help Mve frm Depressin t Feeling Happier With Mre Energy What is depressin? Depressin is an illness that can interfere with a persn s thughts, feelings, behavir, and physical health. Everyne feels sad, blue, r dwn-in-thedumps at times. Depressin is different. It can last fr weeks, mnths, r years and greatly interfere with a persn s life. It is the leading cause f disability in the U.S. frm medical illness. If nt treated, depressin can lead t suicide. The gd news is that mst peple can be successfully treated. Hw d I knw if I might be depressed? Yu might have a cnditin knwn as majr depressin if yu have several f the fllwing symptms at the same time, these symptms are different frm the way yu usually feel, they last lnger than tw weeks, and they are interfering with yur life. Sme peple have few symptms; thers have many. Symptms might be wrse fr sme peple than thers, but als the severity can change ver time fr each persn. Sad r irritable md Majr changes in sleep, appetite, and energy Difficulty thinking, cncentrating, and remembering Physical slwing r restlessness Lack f interest in r pleasure frm activities that were nce enjyed Feelings f guilt, wrthlessness, hpelessness, and emptiness Recurrent thughts f death r suicide Physical symptms that d nt respnd t treatment, such as headaches, digestive disrders, and pain. Are there different types f depressin? There are different types f depressin just like there are different types f ther illnesses. Three f the mst cmmn include: Majr depressin, which invlves a cmbinatin f different symptms that interfere with a persn s daily life and last a lng time. Smene may be diagnsed with mild, mderate, r severe majr depressin. Dysthymia, which is a less serius frm f depressin. The symptms are nt disabling but als last a lng time and can keep a persn frm functining well and/r frm feeling well. Biplar disrder, which is als called manicdepressive illness. It is nt as cmmn as the ther frms f depressin. In this disrder, a persn s md can shift frm depressed t manic. In the manic cycle, the persn might be extremely active, sleep little, talk t much and t fast, and d things that can cause prblems such as spending t much mney. Hw is depressin diagnsed? Depressin can be diagnsed by a primary care r mental health practitiner such as a psychlgist r clinical scial wrker. It is a gd idea t see yur primary care practitiner early n. Sme medical cnditins and medicatins can cause the same symptms as depressin. Thrugh a physical exam, patient interview, and diagnstic tests, the primary care practitiner can determine if smething ther than depressin might be causing the symptms. If ther explanatins are ruled ut, a gd wrk-up will include a thrugh histry f the symptms, e.g., when they started, hw lng they have lasted, hw severe they are, whether yu have had them befre and, if s, whether the symptms were treated, and what treatment was given. LOCATIONS 1800 Hllister Drive, Suite 206, Libertyville, IL * 455 S Rselle Rad, Suite 104, Schaumburg, IL East Erie Street, Suite 702, Chicag, IL * 2150 Pfingsten Rad, Suite 2200, Glenview, IL 60026

2 The practitiner shuld als ask abut yur alchl and drug use, whether yu have thughts abut suicide and death, and if ther family members have had depressin. The practitiner will als ask questins t determine if yur speech, memry, r the way yu think have been affected by the disease. Is grief the same as depressin? Grief ver the death f a lved ne r ver anther lss in yur life (such as the lss f a jb) can cause many f the same symptms as depressin. Hwever grief and depressin are nt the same. A majr lss can cntribute t depressin, but mst peple wh are grieving will nt need treatment fr depressin. It ften takes lnger than peple expect t feel like themselves again after a lss. Almst all cmmunities have resurces such as cunselrs r supprt grups t help peple wh are grieving, and there are many bks that can be helpful. What causes depressin? Depressin has many causes. The illness can run in families. Sme diseases r medicatins may trigger depressin. Life changes r lng-term stress r the way a persn thinks abut r cpes with this stress can lead t depressin. Many factrs might cmbine tgether t cause a persn s depressin. Fr example, a persn s persnality and family histry alng with a specific situatin and the way the persn has learned t cpe with the situatin can all play a rle. It is nt always clear what has caused depressin fr a particular persn. Smetimes there is n knwn reasn. N matter what the cause, chemical changes r imbalances ccur in the brain when smene is depressed. This means that depressin is an illness. Hw is depressin treated? Frtunately almst all peple can be successfully treated fr this disease. It is imprtant t wrk with a health care practitiner, s that yu receive the treatment that is right fr yu. There are different types f treatments and a variety f appraches within these types. Fr example, there are many kinds f prescriptin drugs used t treat depressin. There are als different kinds f nn-drug treatments. If ne apprach des nt wrk, there are thers t try. Treatment will be determined in part by the level f depressin (mild, mderate, r severe). Sme peple will d well with cunseling and lifestyle changes; thers will be prescribed antidepressant medicatin. A cmbinatin f appraches may be used. If depressin is severe and ther treatments d nt wrk r wrk t slwly t relieve suicidal thughts, electrcnvulsive therapy (which uses electricity t induce a brief seizure) may be used. 2

3 What appraches can be used t help treat depressin ther than medicatin? This handut will give yu sme infrmatin n hw depressin can be treated withut using drugs. It is meant fr peple 1) wh cannt take antidepressant medicatin because f side effects r ther health cncerns, r 2) wh want t treat their depressin withut prescriptin medicatins, r 3) wh want t use nn-drug treatments alng with prescribed medicatin. Used alne, these nn-drug appraches may nt be adequate fr a persn with depressin that is severe. It is imprtant fr yu t talk with yur primary care r mental health practitiner fr help in determining what is best fr yu. What types f nn-drug treatments can be used fr depressin? There are a number f nn-drug treatments that can help treat depressin. They include: exercise and mvement, nutritin, nutritinal supplements, btanicals, mind/bdy appraches, light therapy, and armatherapy. If yu have nt been exercising, start slwly and gradually increase as yu are able. Find an exercise that yu enjy and that yu will d ver time. It helps t try different types f exercise (walking, water aerbics, biking, swimming, dancing, tennis, etc.) Pick sme exercises that yu can d indrs when the weather is bad. Use a perceived exertin scale t gage hw hard t exercise. On a scale f 1-20, with 20 being exercising t the pint f exhaustin, sht fr a level f 14. At this stage, yu shuld be able t talk but nt sing. Exercise fr minutes 3-4 times a week and wrk up t a 14 each time. Participating in a grup exercise with thers may help yu feel even better. It is a gd idea t cntinue t exercise after yu are feeling better; this can help prevent a relapse. Exercise des this better than medicatins d. Des exercise r mvement help depressin? Over 1000 research prjects have studied exercise and depressin. These studies fund that exercise helps peple with depressin as much as prescriptin medicatins d. Als there are n side effects with exercise. Bth aerbic exercise (exercise that increases the heart rate fr a perid f time, thereby increasing the amunt f xygen-rich bld t the muscles) and anaerbic exercise (such as lifting weights) can be helpful. Hw can depressin be treated with nutritin? The fd peple eat can affect their md and behavir. There is sme evidence that eating mre sugar may be related t majr depressin. Als, when peple are stressed, they tend t crave carbhydrates, leading t weight gain. Caffeine intake als tends t increase with depressin; this might be because peple wh are depressed try t cunteract the illness with caffeine. A prblem with this is that t much caffeine can affect the nervus system and lead t fatigue and sleep prblems. 3

4 Try t eat a balanced diet rich in fruits, vegetables, whle grains, and mega 3 essential fatty acids fund in cld-water fish (such as salmn, mackerel, sardines, and herring), walnuts, flax seed, and green leafy vegetables. Limit yur intake f sweets and fds prepared with white flur (such as pastries, white bread, and bagels). Drink n mre than tw 8-unce beverages cntaining caffeine each day. What nutritinal supplements can help depressin? Several nutritinal supplements may be helpful fr depressin: Omega-3 fatty acids, B vitamins, S- adensyl-l-methinine (SAMe), and L-tryptphan (Hydrxytryptphan--5-HTP). Omega-3 fatty acids Omega-3 fatty acids may help prescriptin medicatin fr depressin wrk even better. Taking fish il capsules is ne easy way t get mega-3 fatty acids int the bdy. B vitamins The bdy needs B vitamins t make sertnin, a hrmne that helps the bdy stay in gd wrking rder. This includes regulating md. Sertnin levels may be t lw in individuals with pr nutritin, thse wh abuse alchl, r elderly peple with a cnditin called atrphic gastritis, which is an inflammatin f the stmach. Sme medicatins (such as birth cntrl pills r thse used t reduce acid in the digestive system) can als lwer the sertnin level. Depressin is the mst cmmn symptm when a persn des nt have enugh flate (a B vitamin) in the bdy. Research has fund that taking flate alng with a type f antidepressant (SSRI) may increase the medicatin s effect. Cnsider taking a B-100 cmplex vitamin. (This has abut 100 mg r ug f the B-vitamins). If yu take a prescriptin medicatin fr depressin and it des nt seem t be wrking as well as yu had hped, try als taking 1 mg f flic acid with it. The dse used mst ften in studies is 3 gms f fish il daily. Freezing the fish il capsules and taking them at night helps reduce the side effect f belching a fishy taste. Fish il capsules can spil. If yu are belching a ful fishy taste a lt, try changing brands r buying fresh fish il. Mst fish il supplements have a 3:2 rati f EPA t DHA essential fatty acids. Research suggests that prducts with a higher rati f EPA t DHA may be mre helpful. S-adensyl-L-methinine (SAMe) SAMe plays a rle in mre than 100 different prcesses in the bdy. If smene des nt have enugh Vitamin B 12 r flate, they will have less SAMe in their central nervus system, which can cause a depressed md. One research study fund SAMe t help as much as the antidepressant, Imiprimine, with fewer side effects. 4

5 The usual dse f SAMe is mg a day. Mst studies used 1600 mg. It is usually divided and taken twice a day. Start at a lw dse (200 mg twice a day) and take mre each week up t 800 mg twice a day r until yu feel better. Use prducts that are packaged in blister packs. It can becme inactive if left pen t xygen. (Nature s Made is ne brand that packages in blister packs). SAMe can have side effects such as anxiety, inability t sleep, and excessive happiness. Dn t take it befre bedtime. D nt take SAMe if yu have biplar disease since it can cause mania. L-tryptphan (Hydrxytryptphan--5-HTP) The supplement, L-tryptphan, is cnverted in the bdy t 5-HTP. 5-HTP increases sertnin levels. Taking 5-HTP seems t imprve symptms f depressin even fr peple whse disease has nt been helped with ther treatments. Research suggests that 5-HTP might be as helpful as Fluvxamine (Luvx) and Imipramine (Tfranil), tw drugs ften used t treat depressin. This supplement was initially taken ff the market because sme peple develped esinphilia myalgia syndrme (EMS), an incurable flu-like cnditin which can smetimes be harmful. The prblem was traced back t cntaminatin in ne cmpany that makes the prduct. This prblem has been reslved and the prduct is again available ver the cunter. Research lks prmising fr 5-HTP, but the safety f this supplement is still under questin and ther treatments shuld be tried first. The dse is mg each day. What btanicals can help depressin? Btanicals are treatments made frm plants. Research has shwn that the herb, St. Jhn s Wrt, can be helpful fr depressin in the mild t mderate range. Studies have used St. Jhn s Wrt extract with 0.3% hypericin cntent. The usual starting dse is 300 mg three times daily. The dsage can be gradually increased up t 1200 mg /day if needed. It is imprtant t tell yur health care practitiner if yu want t try St. Jhn s Wrt. It can interfere with ther medicatins, s that they are nt as effective. Be especially careful if yu take mre than ne medicatin, birth cntrl pills, anti-retrvirals (drugs used t treat viruses such as HIV), r antibitics (drugs used t treat infectins). St. Jhn s Wrt can cause the skin t be mre sensitive t the sun. Avid being in the sun fr lng perids f time and use sunblck. What are mind/bdy appraches and hw can they be helpful? Mind/bdy appraches make use f the cnnectin between a persn s physical health and her/his mind r spirit. As yu are learning frm this handut, there are many ways t treat depressin. An advantage f mind/bdy appraches is that fr sme causes f depressin a persn may learn skills t help prevent a recurrence. 5

6 Psychtherapy (cunseling) Nn-Drug Appraches t Help Mve frm Depressin Research has shwn that cunseling by experienced therapists can be as effective as prescriptin medicatins fr depressin but might take lnger t wrk. Therapists use many different methds f psychtherapy. Tw shrt-term types that have been especially helpful fr depressin include cgnitive therapy (r cgnitive behavir therapy) and interpersnal therapy. Cgnitive therapy Cgnitive therapy helps individuals hear the negative r distrted (inaccurate) thughts they have and learn t replace these thughts with psitive r mre accurate nes. This helps individuals see things thrugh mre realistic eyes. Interpersnal therapy Interpersnal therapy fcuses n the relatinships in a persn s life and cmmunicatin patterns with thers. It helps a persn learn hw current relatinships might cause r maintain symptms. The gal is t rapidly reduce symptms. Frequently, mre satisfying relatinships result frm therapy. Psychtherapy als hnrs the healing effects that ccur thrugh human relatinships. The ability f clinicians t develp rapprt and trust may trump the benefits seen with medicatins. In a study f psychiatrists effects n depressin, it was fund that gd therapists (thse able t fster relatinships f trust) were mre effective at treating depressin with placeb than pr therapists were with an active drug (Imipramine). Cunseling can be as effective as prescriptin medicatin. It may take lnger t wrk. When lcating a therapist, ask what apprach is used and ask fr an explanatin f that apprach. Chse a type f therapy that feels right fr yu. Tw t cnsider are cgnitive therapy and interpersnal therapy. Wrk with a cunselr whm yu feel gd abut. Psitive psychlgy Psitive psychlgy is a rather new field f psychlgy. Its gal is t imprve life fr peple by strengthening what is psitive in their lives. This is in cntrast t traditinal psychlgy which fcuses n relieving negative cnditins in a persn s life. Psitive psychlgy fcuses n the strengths peple have, what prvides meaning in their lives, and helping them develp well-being. Yu may benefit frm wrking with psychtherapists, life caches, and medical prfessinals wh are using new appraches resulting frm research in this new field. Learning frm emtins Fr sme causes f depressin, a persn can learn frm the emtin. In the Buddhist traditin, depressin may be cnsidered as suffering. The experience f suffering is seen as a great teacher because nce the individual realizes why he/she is suffering, he/she learns why symptms are present and can learn t abandn its cause. The prcess may draw a persn s attentin t an emtin that he/she didn t knw was there. This can lead t an understanding f why it is there and what is needed t vercme it. This prcess f recgnizing suffering, understanding why it is present and abandning its cause can result in mre happiness. This prcess als can help the individual learn frm the symptms t prevent a recurrence. 6

7 Tls t help bring awareness t emtins Feelings-Images-Talk (F.I.T.) Practice. This is smething yu can practice n yur wn each time yu feel a negative emtin. Explring the fllwing questins can help yu better understand the emtin yu are feeling. Feelings: What feelings are yu experiencing? Images: What pictures cme t mind with this emtin? Talk: What are yu saying t yurself? Jurnaling Write abut a time that has been stressful r traumatic. Frgiveness Learn the pwer f frgiveness. Psychtherapy/Cunseling (See abve) Mindfulness-Based Stress Reductin (MBSR) Prgrams The Center fr Mindfulness in Medicine, Health Care, and Sciety at the University f Massachusetts Medical Schl keeps a list f MBSR prgrams acrss the cuntry. Yu can access it at the fllwing website: Patients can als call clinics and hspitals in their area fr pssible classes. Psitive affirmatins Practice thinking psitive thughts. Tw Eastern techniques that have been fund t be helpful include: 1. Lving Kindness Meditatin This meditatin practice has been arund fr ver 2,500 years and shuld first be directed twards neself and then twards an individual r prcess that is causing stress, anger, r difficulties. 2. Tnglen is a Tibetan wrd that means sending and taking. This practice invlves breathing in a negative emtin, image, r prcess and changing it within neself t a psitive ne. Imagine that yu are yur liver and yur jb is t remve the pisn frm a negative emtin. The negative emtin is breathed in, and then changed t a psitive emtin, which is breathed ut. Resurces fr Tnglen include: Tnglen taught by Pima Chӧdrӧn, a Buddhist teacher. Tnglen Practices Three practices f Tnglen frm a spiritual care prgram web site: Three Practices f Tnglen 7

8 Hw can light therapy help? Ultravilet light helps the bdy make hrmnes t stay healthy. Light therapy is a cmmn treatment fr peple with Seasnal Affective Disrder (SAD), a frm f depressin that tends t ccur in winter when there is less natural light. Research has shwn that light therapy may be helpful fr ther frms f depressin als. A meta-analysis (research that lks at the results f many studies) suggests that light therapy helps shrt-term, but mre studies are needed t prve lng-term benefit. Using a light bx fr at least 20 minutes twice daily may be very helpful. Yu can buy a light bx t use in yur wn hme. Sme dependable websites that ffer light bxes include: Start using the light bx with a dse frm 2,500-10,000 lux f light fr 20 minutes, twice a day (mrning and early afternn). Yu can wrk up t 60 minutes tw t three times/day. Using the light bx in the mrning helps the mst. Sit within three feet f the light bx. D nt lk straight int the light On a sunny day, try t spend time utdrs. NOTES Hw can armatherapy help? Armatherapy uses essential ils t affect md and prmte health. An essential il is ne that has the dr r flavr f the plant frm which it cmes. These ils may be used in massage r inhaled as vaprs. Sme research is prmising, but s far there is n prf that armatherapy helps depressin. Use cautin since sme ils (such as camphr) can be harmful. The fllwing may be helpful fr depressin and are generally safe if used three times/day: lavender, citrus, rse, and chammile. One small study fund citrus helpful fr men with depressin. Lavender may be mre helpful fr insmnia (difficulty sleeping) which ften ccurs alng with depressin. T lcate smene knwledgeable abut armatherapy, see if yur clinic has a list f hlistic practitiners r lk at listings fr alternative medicine r hlistic practitiners in the yellw pages f yur phne directry. The infrmatin in this handut is fr general educatin. It is nt meant t be used by a patient alne. Please wrk with yur health care practitiner t use the infrmatin in the best way pssible t prmte yur health. This handut was created by Lynda Warglet, health psychlgy therapist at Nrthshre Integrative Healthcare, Libertyville, IL. Cntent adapted frm infrmatin frm the websites f the Natinal Alliance n Mental Illness (NAMI), the Natinal Institute f Mental Health (NIMH), and Schneider, C. & Lvett, E. (2007). Integrative Appraches t Depressin. In: Rakel DP (Ed) Integrative Medicine, (2nd Ed). Philadelphia, PA: WB Saunders. 8