 By ABCS RCM Depression is a serious mood disorder that can have dangerous consequences. Equally as threatening are eating disorders, which if left untreated; are also dangerous. However, there is actually a connection between these two health conditions. Some people do not realize that major depression and eating disorders can often occur together. Mental health professionals are aware of the correlation between depression and eating disorders like anorexia nervosa and binge-eating disorder (BED).
Understanding These Conditions: People must understand that depression also inflects many people with more well-known eating disorders like anorexia. In medical terminology this is known as comorbidity. Individuals with anorexia usually fail to consume enough food to maintain a healthy weight. Individuals with BED, a condition that affects 2.8 million people, may also experience depressive episodes. Yet, many people tend to think of eating disorders and depression as separate conditions. Eating disorders are more common among females. Males account for only 5 to 15 percent of anorexia or bulimia diagnoses. For BED cases, this number climbs to 35 percent of males reported having this condition. Whether these differences are caused by societal pressures or biological factors is still unclear. There is a profound influence of social norms and mass media on a female’s perception of themselves. However, this is a topic for another article. The reality is that this is a disease that has a larger impact women and girls. In many cases of anorexia nervosa, a psychological condition to rid the body of food, the disorder is usually associated with a negative self-image. This is also one of the primary traits for people with depression (major depressive disorder). Negative self-image can be the cause or effect of depression. The two conditions are correlated to the same mental health issues. Connections Between Depression & Anorexia: There are other behavior examples that are displayed by individuals struggling with these conditions. People with severe depression may have trouble attending social events and other festivities. Similarly, people with eating disorders may find the abundance of food at social activities especially stressful. In either case, people who are grappling with depression or an eating disorder will display similar behavior patterns. Researchers have discovered that there is a correlation between low serotonin levels in the brain and disordered eating patterns. As a reminder, serotonin is a chemical in the brain which controls things like a person’s mood and appetite. When mental health professionals correctly understand that the root cause of eating disorders is a neurochemical issue in the brain, it provides for additional treatment options. Of course, the occurrence of depression and eating disorders in people is more complex then simply chemicals in their brains. There are a variety of different issues that can create dangerous health complications. A person’s behavior and mental health is part of a larger social context. An individual’s mental health is also influenced by factors such as school, work and their home environment. Experiencing traumatic incidents and social pressures have an additional impact on the development of either depression and/or dysfunctional eating patterns. Depression-based feelings can rise from unrealistic physical expectations of the human body. In this case, people with anorexia try to control the body by excessive exercise and unhealthy weight management. Many researchers argue that this compulsion usually arises from a person’s internal perception that she or he is not meeting society’s beauty standards. In turn, this lack of control and despair is usually cited as a primary cause of clinical depression. However, many binge-eaters turn to food in order to deal with psychological stress rather than facing the circumstances. The Need For Professional Treatment: Thankfully, depression and eating disorders can be treated at the same time. However, the recovery from one mental health disorder does not guarantee a recovery from the other disorder. Both illnesses must be treated as separate conditions. This is why is extremely important that people seek professional help from experienced mental health professionals. Research has documented that untreated depression is deadly. According to the U.S. Department of Health and Human Services the majority of people who have depression do not die by suicide. However, having major depression does increase an individual's suicide risk compared to people without depression. The risk of death by suicide is, in part, likely related to the severity of the depression. Similar statistics exist for individuals with untreated anorexia. Research shows that eating disorders have the highest mortality rate of any mental illness. In fact, people with anorexia are 50 times more likely than the general population to die as a result of suicide. Our Services: For questions about treatment options for depression or eating disorders, contact Providers For Healthy Living. They have been treating patients with depression and eating disorders since 2011. As an experienced mental health provider, they strive to have every patient feel more hopeful after interacting with a member of their staff. Their practice was built on the values of quality, hope and personal responsibility.
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 Often in our lives, the stressors of life just become overwhelming. Our journey to health is hindered. This happens for everyone. And many seek mental healthcare to find help in some way to lessen that internal tension. I’ve sought therapy being burned out by work, struggling with the death of a loved one, not knowing how to get everything done that I believe I should, and feeling inadequate in parenting. All these were true, and therapy helped with each.
But it seems that talking about emotions and feelings is not enough. Something, at times, seems to be missing. You see, we live in a country in which social insecurity abounds. Hatred seems to flourish as images on the news remind us constantly and repetitively that we should be afraid. . . very afraid. Racial, gender, economic, and religious tensions exist between us, and the repetitive nature of the broadcasts enhances the fears. And with that the language to effectively talk about this stuff diminishes. Being part of a targeted group or a group targeting effects us. Our moral sense of ourselves is challenged. This is different from yet connected to our emotional and cognitive selves. None of this lessens the need for coming up with ways to better manage the ups and downs in emotions and anxiety as they relate to specific events and our lives. Those are needed. I’ve used and benefited from them. But often the fear becomes reduced to event specific and the broader insecurity is not addressed. The need is to recognize that it is often the bigger picture which intrudes into our emotional well being. Events such as the clean water crisis in Flint often dominate our news cycles. I would feel on some level silly, going to a therapist and stating “I feel socially insecure. Have you seen what happened in Flint? My sense of moral safety is eroded” And yet I do retain an awareness that those images affect my emotional well being and connect to many other images in our culture as well. My moral experience surrounding these is difficult to frame. Beliefs about women, race, gender and sexual identity, religion, . . . the list goes on. . . and our interactions with them, can induce fear in ourselves and sometimes in others if we share them. They challenge our own moral safety. We are challenged by our moral experience of events often seeing the wrongs in them and feeling insecure. We know something is not right. This is not the way things should be. Experiencing a powerlessness and hopelessness but not even knowing how to speak about it. This moral experience and subsequent moral insecurity can undermine our well being and journey towards health if not acknowledged and addressed honestly. I encourage you to challenge therapists to engage in such discussion to examine the impact of our social insecurities on us so some positive answers can be found. And the journey to health continues.  Frequently, I have been asked to give my medical opinion on CBD oil as it pertains to anxiety, depression, and other psychiatric symptoms. With the upcoming implementation of medical marijuana in Ohio and the increasing popularity of this question, I figured now would be a good time to review some medical research on this topic.
CBD is a non-psychoactive derivative of the Cannabis sativa plant which is typically administered in the form of oil absorbed under the tongue. Unlike THC, another component of marijuana, CBD is not associated with negative cognitive effects and psychoactive impairment. CBD acts as a CB1 and CB2 inverse agonist, monoamine uptake inhibitor, and 5HT1a agonist, which results in the observed psychiatric benefits, including anxiolytic, antipsychotic, anti-insomnia, and antidepressant effects. Other benefits include anti-inflammatory, analgesia, anti-seizure, and anti-diabetic effects. CBD can be derived from hemp or from marijuana, with hemp being the recommended source by the FDA in order to ensure the absence of psychoactive impairment. According to federal law, any CBD product containing THC in any amount is considered marijuana and is illegal. Because these products are unregulated by the FDA, the legal murkiness becomes the issue here. It is important to specify non-THC-derived CBD if recommending this product to a patient. Blessing et al demonstrated in a 2015 review article that preclinical evidence conclusively supports efficacy of CBD in reducing anxiety in OCD, Social Anxiety Disorder, PTSD, Panic Disorder, and Generalized Anxiety Disorder. This review further determined that most human studies that have been done support preclinical findings and also demonstrated “excellent safety profiles” with minimal sedative properties. Although this evidence is promising, the majority of studies were done in acute settings with short-term dosing. Long-term studies in humans, as well as further clinical studies in humans, will be needed before stronger opinions can be made. As of 9/8/18, Ohio's new medical marijuana law went into effect. It clarifies that CBD oil, which can derive from either marijuana or hemp, depending on the source, is illegal. The law says CBD oil must go through the same rigorous testing procedures and comply with the same rules as actual cannabis. So, Ohio's Pharmacy Board says sales of CBD products are illegal in Ohio if they are not being sold in a licensed dispensary.  It is commonly held that stress is unhealthy. Health professionals have consistently maintained that stress contributes to a myriad of illnesses that range from the common cold to cardiovascular disease and cancer. More recent research, however, suggests that stress may not be a completely bad thing, in fact, in some instances it may be healthy. In 1998, evidence began to emerge that our understanding of stress was less straightforward than previously thought. Abiola Keller and her colleagues conducted a survey of 30,000 people and then tracked them for 8 years. The survey consisted of two primary questions: “How much stress have you experienced in the last year?” and “Do you believe that stress is harmful to your health?”. Eight years later, they reviewed public records to find out who among those 30,000 had died. Based on their findings they determined that high levels of stress increased a person’s chance of premature death by 43% but only if they believed that stress was harmful to their health. People who reported high stress but did not believe it affected their health had the lowest risk of death of all the people who participated in the study, lower than even those who reported low to moderate levels of stress. The conclusions of the study were that stress alone was a poor predictor of premature death. People also had to believe stress contributes to poor health.
The conventional view of stress is that it elicits a fight or flight response. When this response is experienced the body readies itself for some type of action-oriented response to this danger. Adrenaline is released, heart rate increases and breathing accelerates and deepens, blood vessels in the muscles dilate while other blood vessels constrict, digestion ceases and the sensory system becomes heightened. This response was intended for survival and was adaptive when people were confronted with the real danger of imminent death or severe injury. In modern times people experience a fight or flight response for events which while stressful do not reach the level of true survivalThis type of stress, when regularly experienced, is believed to contribute to health concerns. Keller’s findings suggest that your mindset about stress also matters and there are health benefits related to adopting a more positive attitude about stress. Psychologist and researcher Alia Crum offers a three-step approach to adopting a positive attitude towards stress: • First, acknowledge the presence of stress when you experience it and think about the ways it is impacting you both psychologically and physically. • Second, recognize that when stress occurs it is typically a response related to something you care about. Connect to the positive motivations that are also present in your stress response. • Third, when stress is present, the body generates an increase in energy. Figure out ways to make productive use of that energy. It is generally believed that stress elicits only fight or flight responses, however, other types of stress have been identified, each with a unique physiological profile that motivates different strategies for coping. In contrast to the fight or flight response, these types of stress responses are viewed as beneficial to not only physical health but also mental functioning. The challenge response results in a similar physical responses to that of the fight or flight response. Heart rate increases, breathing deepens and there is an increase in energy to improve performance. But there are differences. The hormone DHEA, which helps people thrive under stress, is released, the mind is more alert and instead of feeling fearful the individual feels focused. The challenge response has been shown to increase self-confidence and helps a person learn from experience. People who are completely absorbed in what they are doing display signs of experiencing a challenge response. Another type of stress has been dubbed the tend and befriend response. This stress response motivates people to protect the people and communities they care about. This type of stress response if driven by oxytocin, a hormone that motivates people to connect with others. Oxytocin dampens fears and promotes courage and bravery. It strengthens social connections and helps people be more responsive to the needs of others. The tend and befriend response was most likely the stress response that was in play with the heroic efforts and willingness to come to the aid of victims of the 911 terrorist attack. While some forms of stress have adverse health effects it is important to remember that all forms of stress have a function whether for survival, or to help achieve goals, or to protect our loved ones or to help others in need or to make social connections. Kelly McGonigal writes, “The stress response is more than a basic survival instinct. It is built into how humans operate, how we relate to one another and how we navigate our place in the world. When we understand this, the stress response is no longer something to be feared. It is something to be appreciated, harnessed, and even trusted.”  Obtaining healthy sleep is important for both physical and mental health. It can also improve productivity and overall quality of life. Everyone, from children to older adults, can benefit from practicing good sleep habits.
Your behaviors during the day, and especially before bedtime, can have major impact on your sleep. They can promote healthy sleep or contribute to sleeplessness. Your daily routines – what you eat and drink, the medications you take, how you schedule your days and how you choose to spend your evenings - can significantly impact your quality of sleep. Even a few slight adjustments can, in some cases, mean the difference between sound sleep and a restless night. Completing a two-week sleep diary can help you understand how your routines affect your sleep. The term "sleep hygiene” refers to a series of healthy sleep habits that can improve your ability to fall asleep and stay asleep. These habits are a cornerstone of cognitive behavioral therapy for insomnia, the most effective long-term treatment for people with chronic insomnia. CBT can help you address the thoughts and behaviors that prevent you from sleeping well. It also includes techniques for stress reduction, relaxation and sleep schedule management. Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. Cognitive behavioral therapy for insomnia, sometimes called CBT-I, is an effective treatment for chronic sleep problems and is usually recommended as the first line of treatment. Most cases of insomnia are related to poor sleep habits, depression, anxiety, lack of exercise, chronic illness, or certain medications. Symptoms may include difficulty falling or staying asleep and not feeling well-rested. Treatment for insomnia consists of improving sleep habits (see tips above), behavior therapy, and identifying and treating underlying causes. Sleeping pills may also be used, but should be monitored for side effects. Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems. How does cognitive behavioral therapy for insomnia work? The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. This type of therapy can help you control or eliminate negative thoughts and worries that keep you awake. The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well. Depending on your needs, your sleep therapist may recommend some of these CBT-I techniques:
The most effective treatment approach may combine several of these methods. If you are struggling with poor sleep or insomnia, talk to your prescriber or therapist today. Quick Sleep Tips If you have difficulty sleeping or want to improve your sleep, try following these tips to establish healthy sleep habits. (Talk to your doctor if your sleep problem persists.):
In addition, meditation, yoga, and biofeedback may reduce tension and promote better sleep. Visualization or guided imagery, during which you hold a peaceful image in your mind before bedtime, can also be an effective path to relaxation. You can learn learn more about these techniques from your prescriber or therapist. If you wake up at night and can't go back to sleep, remain quiet and relaxed. Even normal sleep can be punctuated by periods of restlessness or even waking. Be patient; sleep usually returns. Remember, a few nights of poor sleep do no long-term harm. Even if you toss and turn trying to get to sleep, you are probably getting more periods of sleep than you think.  What medications can cause heat-related illness?
As the weather becomes more hot and humid this summer, keep in mind that almost all psychotropic medications can decrease the body's response to heat which may put you at risk for heat-related illness. Medications that can decrease heat tolerance include common medications prescribed here at Providers For Healthy Living. Some medications that can decrease heat tolerance include: • Antidepressants (e.g. Zoloft, Prozac, Wellbutrin, Cymbalta, Effexor, and others) • Antipsychotics ( e.g. Abilify, Geodon, Seroquel, Latuda, Risperdal, and others) • Amphetamines (e.g. Adderall, Vyvanse, and others) • Beta-Blockers (e.g.propranolol, atenolol, nadolol, and others) • Diuretics or water pills (e.g. furosemide, hydrochlorothiazide, and others) • Anticholinergics ( e.g. Cogentin, Artane, and others) • Lithium - Increased perspiration and water loss can cause higher levels of lithium in your blood which puts your at risk for lithium toxicity. Signs and symptoms of lithium toxicity include: dizziness, unsteadiness, tremor, slurred speech, lethargy, and confusion. Please seek immediate treatment or go to the emergency room if signs lithium toxicity occur! *This is not a comprehensive list. Please consult your medication provider or pharmacist about your specific medication(s). Are some populations at increased risk of heat-related illness? Yes. The elderly or those with medical conditions such as diabetes, respiratory disease, heart disease and alcohol use disorders may be more susceptible to heat-related illness. You should know that alcohol, benzodiazepines, and opioids (pain medications) may decrease your awareness of heat-related illness. Drugs such as cocaine, anabolic steroids, hallucinogens, and ecstasy or MDMA may also decrease your heat tolerance. What are the signs and symptoms of heat-related illness? Heat-related illness varies from mild forms such as heat exhaustion (with warning signs such as heavy sweating, paleness, muscle cramps, weakness, dizziness, headache, nausea or vomiting) to a severe form such as heat stroke (a deadly form of heat-related illness that occurs when we cannot control our body temperature so the temperature rises rapidly with warning signs that include confusion, unconsciousness, body temperature higher than 103 degrees Fahrenheit, red/hot/dry skin, or throbbing headache). Please call 911 or seek treatment immediately if signs of heat stroke occur! How can heat-related illness be prevented? You can help prevent heat-related illness by drinking plenty of fluids, eating regularly, and avoiding caffeinated beverages and alcohol. Wear sunscreen as well as loose fitting and light-colored clothing while outside. Spend time in cooler environments when possible. Try to eliminate heat in your home by keeping the drapes closed during the day. Avoid outdoor activity during the hottest hours of the day. For more information, please consult with your medication provider about heat-related illness and request the "Heat-Related Illness in Individuals using Psychiatric Medication" pamphlet published annually by the Ohio Department of Mental Health.  Postpartum Depression (PPD) is a mood disorder that affects nearly 1 million women in the U.S. each year. Symptoms of PPD can begin during a woman's pregnancy through the first year following childbirth. PPD is beyond baby blues, which is a normal adjustment period that happens during the first 2 weeks of birth affecting 80% of new moms. Many people have heard of PPD, but did you know symptoms of PPD can expand beyond depression symptoms and include anxiety or OCD symptoms? Postpartum depression, anxiety, and OCD symptoms can impact a mother's daily functioning, potentially interfering with her ability to take care of herself or her family.
Symptoms of Postpartum Depression may include:
Symptoms of Postpartum Anxiety & OCD may include:
Any woman who is pregnant or has had a baby in the last year can be at risk for PPD. However, factors like history of mental illness, being a first time mom, ambivalence about the pregnancy, lack of support system, partner problems, infertility, complications during childbirth, and recent stressors can all increase of woman's chances of developing PPD. A woman's health care provider can help her choose the best course of treatment. Treating PPD can include individual counseling, medication, and postpartum support groups.  The Brain Injury Association of America (BIAA) defines traumatic brain injury (TBI) as “an alteration in brain function, or other evidence of brain pathology, caused by an external force.” Every year there are approximately 2.5 million ER visits, hospitalizations, or deaths associated with TBI in the United States. The leading cause of TBIs between 2006-2010 was falls. There are an estimated 1.6 to 3.8 million sports-related TBIs annually, however, only 300,000 result in loss of consciousness. Traumatic brain injuries can occur without the loss of consciousness.
Symptoms of a TBI may not appear for several days following the injury. Post-concussion syndrome (PCS) occurs 7 to 10 days after a TBI and can last for weeks, months, a year or even longer in some individuals. The severity of the injury does not correlate to the duration of PCS or type of symptoms experienced. The symptoms fall into four categories: physical, cognitive, sleep, and emotional. 1. Physical Symptoms:
2. Cognitive Symptoms:
3. Sleep Disturbance:
4. Neuropsychiatric Conditions Associated with TBI:
The mental health of patients with TBI may be greatly impacted. Neuroimaging techniques, biological markers, and neurological/cognitive screening could result in earlier detection and treatment of TBI, improving the outcome for these patients in the future.  If you’re new to therapy, or even if you already have an established relationship with a therapist, the following suggestions can help you to ensure the success of your time in therapy.
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