Warning Signs Of Bipolar

As a psychiatrist practicing in Palm Beach Florida, I come across a lot of bipolar patients.  What are the warning signs of bipolar disorder? How can you recognize if someone you love or even yourself has bipolar disorder? You can’t get through an hour television program without at least 2 commercials for bipolar medications, so I thought it would be a good idea to talk about it. 

First, what is bipolar? Bipolar disorder is a mental health disorder more commonly found in women that can cause dramatic changes in mood and energy levels. The term bipolar refers to the two poles of the disorder, the extremes of mood. Those two extremes of mood are mania and depression. The symptoms of bipolar can affect a person’s daily life severely as their mood can range from feelings of elation and high energy to depression. There are two types of bipolar, type 1 and type 2. Type 1 is more serious and disruptive than type 2, which can also be called hypomania. 

Bipolar is sort of the Jekyl and Hyde of psychiatric disorders, with cycling of mania and depression. Manic episodes and depressive episodes have very specific signs and symptoms associated with them.

When someone is manic, they do not just feel very happy. They feel euphoric. Key features of mania include, but are not limited to:

– irritability 

– having a lot of energy
– feeling able to achieve anything
– having difficulty sleeping
– using rapid speech that jumps between topics.
– inability to follow through with ideas or tasks

– feeling agitated, jumpy, or wired
– engaging in risky behaviors, such as reckless sex, spending a lot of money, dangerous driving, or unwise consumption of alcohol and other substances
– believing that they are more important than others or have important connections
– exhibiting anger, aggression, or violence if others challenge their views or behavior
– in severe cases, mania can involve psychosis, with hallucinations that can cause them to see, hear, or feel things that are not there.

People in a manic state may also  have delusions and distorted thinking that cause them to believe that certain things are true when they are not. While I have many patients that get delusions of grandeur, I have one patient that comes to mind. Her name is Felicia. Felicia is a 32-year-old receptionist. She was diagnosed with bipolar type 1 when she was 25, which happens to be the typical age of diagnosis. Felicia is on two medications for her bipolar with mixed results. She still cycles occasionally to a manic state. Sometimes that’s a clue that she may not be compliant with her meds. Like many bipolar people, Felicia loves loves loves her manic state. When Felicia is manic, she is on top of the world. Her house is pristinely clean, the meals she makes for her family are total gourmet, and her appearance is perfect. Sounds great, right? You may be thinking ‘Where’s the downside, Dr. A?’ Well, in this manic state, Felicia absolutely positively believes that she is descended from “the true” royalty. She believes that the father of the current Queen of England, the previous King George VI, actually stole the monarchy and the crown from her father. As a result, she believes that she should be the rightful current monarch. In reality, her father is a semi-retired urban planner living just outside of Topeka Kansas. Regardless, when Felicia is super manic, she will relay this story with a voice full of indignation and a perfectly straight face. She will tell anyone this story, so people think she’s totally nuts. 

A person in a manic state may not realize that their behavior is unusual, but others may notice a change in behavior. Some people may see the person’s outlook as eccentric or sociable and fun-loving, while others may find it unusual or bizarre. The individual may not realize that they are acting inappropriately or be aware of the potential consequences of their behavior. In some cases, they may need help in staying safe when they are completely out of touch with reality. Bipolar type 1 patients can be some of the most dangerous patients in my practice, as they can be violent, prone to rage and acting out on that rage. They are chaotic. If you have an untreated or ineffectively treated bipolar 1 person in the household, you will know. One big problem is that patients enjoy the manic state of their disorder. They feel such increased energy and euphoria that they are prone to stop taking their meds. Once that happens, all hell breaks loose. 

But eventually, that mania will cycle into deep depression with all of the symptoms that go with it, and may end with suicidal thoughts or acts. Key features of depressive episodes may include, but are not limited to:

– feeling down or sad
– having very little energy
– having trouble sleeping or sleeping a lot more than usual
– thinking of death or suicide
– forgetting things
– feeling tired
– losing enjoyment in daily activities
– having a flatness of emotion that may show in the person’s facial expression
– In very severe cases, a person may experience psychosis or a catatonic depression, in which they are unable to move, talk, or take any action.

Bipolar type 2, also called hypomania, is a disorder which is sort of like type 1-light. It features episodes of depression and hypomania. Symptoms of hypomania are similar to those of mania, but the behaviors are less extreme, and people can often function well in their daily life. But if a person does not address the signs of hypomania, it can progress into the more severe form of the condition at a later time. I see type 2 patients more often in my practice, and I see them as generally being much calmer than type 1 patients. They do not get as violent, do not hear voices, do not have hallucinations, and are not disorganized in their speech or behavior. However, they are usually irritable. They talk quickly. They have trouble sleeping. They have trouble concentrating. They have trouble getting things done. They have relationship issues. They have trouble sleeping. These periods of hypomania can last anywhere between minutes to days to weeks.

So what can be done for a patient suffering from bipolar disorder, whether type 1 or 2? There are multiple drugs which can be used to balance the patient. I find my go-to drug would be lamotrigine, as it is minimal in its side effect profile, is mood stabilizing, does not put on weight, does not make you drowsy, and does not have many drug interactions. There are other drugs which can be used,  oxcarbazepine and divalproex, which are antiseizure mood stabilizers. These have some effectiveness and have various side effect profiles. In some cases, antipsychotic drugs like lurasidone are useful. Many times I put patients on at least two drugs, one to treat mania and one to treat depression. I can prescribe all the drugs in the world, but they won’t do any good if patients are non-compliant in taking them. So the biggest and most important key feature in treating bipolar is having a relationship with the patient and making sure they are compliant with medicine, because the manic state is so enjoyable to them that they may choose non-compliance. That’s really the biggest barrier to treatment. I always explain to my manic patients that while they may like the mania, they will have to pay the piper, because guess what? Next they’ll be hopelessly depressed and unable to get out of bed.

In my practice, I see many female patients with mood disorders. The way I approach treatment is to find the best tolerated drug. This may not be the best drug on the market, but may be the best drug for that patient because it is better tolerated and has a better side effect profile for that patient. If the drugs cause weight gain, make them drowsy, or cause sexual dysfunction, they won’t take them. And who would blame them? So I work very hard to explore all available pharmaceutical treatment options for each patient as an individual. The goal is to have a drug regimen which is the least invasive in that person’s life and to combine that with psychotherapy. Because bipolar disorder is a lifelong disease, treatment should also be lifelong. If you suspect that you have bipolar or a loved one has bipolar, contact a physician for referral to a mental health professional like myself. For more information, check out my book, Tales from the Couch, available on Amazon.com. 

What Ever Happened To Dating

Whatever happened to dating? I’m part of a lot of talk on this particular topic. Day in and day out, patients tell me about their trials and tribulations in the dating world, and the dialog has definitely changed over the years. So, as an unofficial-official expert, I want to talk about dating. There are discrepancies as to who hit on the idea first, but computer-assisted dating sites came into play as personal computers gained popularity in homes everywhere. Remember the Tom Hanks movie You’ve Got Mail? That romanticized the idea of online dating and spawned sites like Match in the early 2000’s. The advent of Facebook kept people checking for “friends” as a hobby, linking people all over creation. However and whomever launched what doesn’t matter much anymore, dating sites and dating apps are here to stay. The list goes on and on and on, and now sites and apps are getting more specific. They target groups: SilverSingles, OurTime, JDate, BlackPeopleMeet, and Farmers Match…if you can be grouped into a subset, you will be. So what’s the impact of dating sites and apps? They’ve changed the game. If you listen to your grandparents tell their love story, it often includes a meeting of eyes, maybe across a crowded bar or restaurant, hence love at ‘first sight.” Now, if you manage to find love, it may be more like at “first site” or “first swipe.” 

Whole movies are made of dating in the modern world. The process of meeting someone has now moved away from social contact, which is sort of oxymoronic in the age of ‘social’ media. The old rules don’t apply anymore. It used to be that to get a date, you got all gussied up to go out and attract a date. Now you can sit home on your couch in your boxers or fat pants and dangle an electronic lure to attract someone. Sadly, romance is now largely a thing of the past, replaced by an electronic algorithm. You have to be a wordsmith to get a date, not a romantic. Pickup lines aren’t spontaneous. Now someone trolling an app for a date can use a line that it took them a month to come up with, and they can use it over and over until the payoff, the date. Social media can also be very manipulative as well. When my patients tell me about failed dates arranged through social media, one of the most popular reasons they give me is that the person didn’t look like their picture. Blah blah blah… I hear that ALL the time. My only reply is usually “Duh!!! It took that guy / girl three hours to take that picture!” I marvel at how they’re shocked by not getting what they were expecting! And these sites and apps are too easy. Going out to attract a date used to require a little effort and forthought. Where am I going? What should I wear? How’s my hair? Is my breath okay? On sites and apps, it doesn’t matter. They’re a numbers game. Send a line out to enough people and you’re bound to hit on a date at some point. And what happens on that date? Social media has stripped away the art of conversation. It’s been reduced to memes, a series of easily textable phrases and lines. Those aren’t conducive toward building the foundation of a relationship. And there can be a darker side to the use of these sites and apps. Some people believe that participation on these dating sites and apps is essentially implied consent or positive acceptance of sexual advances. If you met someone In the real world, not all advances are welcome. The same is true with participation on an app or site. But the flip side of that coin are the apps where advanves are welcome. There are an increasing number of mobile apps that will let you know when a person of like mind is in the vicinity. Of like mind on these apps usually means down to hook up, which has inherant risks in and of itself. These transactional apps seeking sexual relations really take the human touch out of the whole equation. They’re all about the easy hookup, people as commodities. Phone on, date out. Social media has really changed the idea of participating with one’s community. Now you see young people with no interests beyond their phones. What’s going on in their electronic world takes precedent over what’s happening right in front of them. I discuss this at length in my book, Tales from the Couch. People miss so much of what’s going on around them because they’re buried in their phones. Human interaction goes by the wayside. Another consequence of social media is the downfall of commitment. With more relationships being non-committal, I’ve seen marriage rates among my patients go down. When I ask people about that, they essentially tell me that they’re not into commitment because why should they be? Why settle down and buy one cow when you can have all the milk from all the cows on the internet for free? 

Some of these issues can be troubling. I especially wonder what happens to the people who don’t have profiles posted everywhere, who don’t want to swipe right or left to get dates and find companionship. Are they doomed to forever be single? Will they miss out on their happily ever after? Maybe.They may need to bite the bullet and throw a line into the electronic world of dating. For all it’s foibles and downfalls, social media doesn’t seem to be going anywhere anytime soon. Good, bad, or indifferent, that’s dating today. For more on the world of social media, check out my book Tales from the Couch, available on Amazon.com.

Help me… I need to Lose Weight and Get into Shape

I’ve been a psychiatrist in Palm Beach, Florida for the past 30 plus years. Being that Palm Beach is all about beautiful people and seeing and being seen, I have a constant stream of patients worrying about their their image. Botox, fillers, face lifts, tummy tucks…the list goes on and on, but there’s only so much a plastic surgeon can do, especially when it comes to the appearance of the body. Obese patients can have a lap band or gastric bypass to lose a lot of weight, but not everyone requires such drastic measures. A lot of patients complain of being just a little heavy, a little out of shape, and they come to me asking what they can do to lose some weight and get in better shape. The first thing I do is ask them about alcohol intake and smoking habits, and how much they indulge in these activities. Then in order to get an idea of how physically fit they are- or aren’t-  I ask them to tell me their activities of a single weekday, from the time they wake up to the time they go to bed. What I typically hear is that they get up, shower, go to work (often skipping breakfast), eat something quick for lunch at work, go home from work, make dinner, eat, and relax in front of the television until they fall asleep. Most never include any physical activity.     

I then educate them in terms of diet and physical activity. I explain that while a minimum of 30 minutes a day is ideal, even spending 15 minutes a day exercising is beneficial. I’m generally concerned with three areas: stretching, cardio, and strength/resistance training. Stretching really should be done each and every day prior to exercising to improve flexibility and decrease the chances of hurting yourself. Cardio and strength training are also important to your workout regimen if you want a fit, lean body. These can be done on alternating days. 30 minutes of cardio increases your heart rate and pulmonary capacity, building endurance. Strength training using weights builds muscles and definition. Along with a healthy diet, all of these things are key components of a fit body and healthy lifestyle. 

But don’t think that you need a gym membership to start down this road. I always tell patients to start at home. Why? There are always persuasive excuses that win the “going to the gym” battle: too far away, too nice out, too cold, too tired and so on. Working out at home makes it easier to incorporate a workout into your daily routine. It makes excuses to not work out much harder to find. It’s really only upside: the commute time to the extra bedroom only lasts 14 seconds, you can blare whatever music you want, you can watch last night’s show on Netflix, and you don’t have to wear those rubber shower shoes for your post-workout shower. Bonus!

So what kind of a workout can you get at home? If you’re intereated in fancy toys, you can buy the latest state of the art exercise machine. If you use it, it’s a great workout, but it seems to me that it ends up being a very expensive clothes hanger. What can you do without any of that. The answer: everything you need to. There are even exercise programs on demand from most cable companies. These are great if you need more guidance to work out at home. But when you get down to the basics, you can still get a good workout at home with little or no gym equipment. I suggest that after stretching, go for cadio; try running in place and jumping jacks to increase your heart rate. Then do some floor exercises like squats, pushups and situps. These are erecises that strengthen your core and define muscles. I’ve found that those stretch bands are great to incorporate into floor exercises. Tou can pick them up on Amazon. While there, check out my book, Tales from the Couch. It’s a great read, and full of interesting and educational patient stories I’ve gathered in my 30 year career.

We all know that exercise is beneficial, but in case you need extra motivation, I want to discuss a few of the benefits of exercise. 

Heart health: The heart is a muscle like any other. Cardio strengthens the heart and helps protect against heart related illness. By getting your heart pumping at a faster rate on a regular basis, you’ll keep it healthy and in shape.

Good vibes: Workouts release positive endorphins. These “feel good” hormones have considerable impact on your overall health. They help alleviate the symptoms of depression and fatigue as well as releasing hormones that will suppress your appetite. These stress-relief hormones can be extremely beneficial to your overall outlook on life, simply because of the positive effect these hormones have on the system.

Better sleep: Half of the world’s population suffers from some sort of sleep disorder. A study published by The National Sleep Foundation found that individuals who performed cardio exercises at least 3 times a week fell asleep 54% faster and slept 37% longer than individuals who did not. Most of us know the importance of getting enough sleep at night. It’s iimportant for productivity, mood, and overall health. So getting your sweat on during the day should make for a much easier lights out.

Metabolic boost: Not only does cardio speed up your heart rate, but it also increases the rate of different processes throughout the body…your metabolism being one. The more intense your cardio session is, the more noticeable increase you’ll see in your metabolic rate. An increased metabolism also means an easier time maintaining your weight or losing weight.

In general, people who exercise regularly are more mindful of their health and their bodies. They tend to smoke and drink less and to live longer, more functional lives. 

I subscribe to the KISS method when starting out a new exercise program. Keep it Simple Stupid. Don’t think that a boot camp type workout is a good place to start. You’ll just end up pulling something and hurting yourself, and that will set you way back. The number one rule in exercising is not to get hurt. KISS would be the number two rule. If you break the number one rule, then see number two.

So if you want to get in better shape or to lose a few pounds, start a little program at home. Start slowly and take baby steps and you’ll surely see a return on your physical investment. 

January 6, 2018 THE RIGHT APPROACH TO THE OPIOD CRISIS

As a practicing doctor with certification in psychiatry and having worked in Palm Beach County for the past 25 years, my views on the current opioid epidemic are the result of my daily contact with addicts, their families, the medical community, law enforcement and the judicial system. My work has taken me from the E.R. to the inpatient treatment centers and rehabs to the courts to our psychiatric hospitals and to our coroners offices. I have watched this epidemic from its earliest stages to its current existential threat status. As a result I have come to the following conclusions about this tragic situation our community and communities across the country find themselves faced with. WE MUST CHANGE THE WAY WE THINK ABOUT THIS AND TREAT THIS PLAGUE.
1.) Move away from the concept of a war on drugs. Move towards providing an aid package for these vulnerable and impaired individuals.
2.) Move away from concepts of criminalization, imprisonment, and that they are deserving of severe punishment. Move towards treatment and therapeutic interventions. View individuals with OUD as impaired and of need of help.
3.) The concept of opiate-dependent individuals as merely addicts that are weak, self-indulgent, hedonistic, and who are scorned by all is not helpful in resolving this national issue. There certainly is a volitional component to this illness. While personal responsibility and accountability is the only path to a healthy life, opiate-dependent individuals need a support system and tools to help get them on that path. Individuals suffering from OUD hate themselves, the behaviors in which they engage, and the resulting consequences. People with OUD are reckless with their lives because they feel their lives have little or no value. The mind-set of the opiate-dependent individual is one in which it doesn’t matter if they live or die. These vulnerable individuals are also prone to abuse and exploitation.
4.) Society must track these individuals and intervene when necessary.
5.) Society as a whole must be educated about opiates and all aspects of drug dependency, starting in grade school. Opiates come in pill form, patches, lollipops, and can be snorted and inhaled. Drug dependency can begin after one dose. Five days of continued use of opiates can result in drug dependency. Individuals who are genetically predisposed to dependency are more affected.

Like many drugs, over time the same amount of opiates has less and less affect which results in individuals increasing the drug dose and decreasing time between doses. This is the concept of drug tolerance. People spend more time getting the drug and doing the drug, and it becomes a vicious cycle. OUD individuals start to live a life of lies to cover their drug use. They spend a majority of their time planning to get money and make time to use drugs. They become psychologically consumed by thoughts of procuring opiates, using opiates, and disregarding everything else, including family, friends, job, health, and finances. All that matters to them now is getting high. When in withdrawal, these individuals can become very desperate and dangerous. They will go to great lengths to get high.

What can we do in terms of how society should deal with the problem? When treating an OUD patient, both incentives and consequences need to be geared towards keeping them off the drug of abuse. These five areas are conceptual changes needed towards resolving the national opiate use crisis and treating patients with Opiate Use Disorder:

1.) There needs to be a massive education campaign similar to the education campaign against tobacco including the danger of opiates and treatment options for OUD individuals. Explain the dangers of opiates, what opiates are, how they affect our brains, and, importantly, how easily it is to become dependent. The potential of overdose and death needs to be underscored. For example, the opiate called fentanyl, in amounts barely visible to the human eye, can cause individuals to stop breathing. Fentanyl is measured in micrograms. There are 100 milligrams in a gram. There are 1000 micrograms in a milligram. There are 100,000 micrograms in a gram. Two hundred micrograms or maybe less is lethal, which hardly covers the tip of a needle.
2.) The streets must be flooded with Narcan inhalers. One to three sprays in a nostril can revive an opiate overdose.
3.) The streets must be flooded with test kits to determine what is in the drugs and how much is in them. People make better decisions when they know what is in the drug they are taking. For example, if someone makes a street purchase of a drug with fentanyl or methadone in it, they need to be extra careful because those drugs can easily kill you. Methadone is dangerous not only because it is so potent but because it lasts so long. There is an even more dangerous drug on the street called carfentanyl which is 100 times more potent than fentanyl! Note: methadone has been useful in the treatment of OUD, however, it is so dangerous that the dose must be given out on a daily basis. While methadone blocks cravings, it provides a high so can still be abused and lead to an overdose. Buprenorphine is another drug used in treating OUD, and it has been found to be safe enough to prescribe on a monthly basis. The negatives and stigma associated with methadone should not be associated with buprenorphine.
4.) Laws need to be changed. Instead of charging people with accessory to murder when a friend overdoses and dies, give them immunity. Give complete immunity to people in the presence of someone who overdoses if they call 911 during the overdose. Encourage people to call 911 and save lives, not run and hide fearing prosecution.
5.) The court system for individuals with OUD must change. Once in the system, these individuals must be tracked with drug testing and given treatment when needed. Criminal records for possession or use can be wiped away if the individual stays sober. Incarceration should be a last resort. Charging people with felonies for drug possession scars people for life. Once labeled a felon, re-entering society becomes very difficult. OUD individuals are not sociopaths or criminals, they are ill with a disease. Treat the illness and there are no criminal problems.
This perspective demands basic changes in our societal and individual thinking about opioid dependency. Equally as important is the way the established medical community regards and treats this diagnosis and it is just that….a medical condition.

I have many thoughts for my peers and given the opportunity, I would welcome the chance to share them.

No matter what our circumstances in life, we are all touched by this epidemic in some way. We all have skin in this game. Time is precious, costly and limited. Soon may become later and it is already too late to wait.
More comprehensive explanations about how to deal with addictions in my book Tales From The Couch on amazon.com

Mark Agresti, M.D.

The Agresti Addiction Scale

The Agresti Addiction Quiz is designed to provide you an idea of whether a drug addiction or drug abuse problem exists. The drug addiction quiz is not perfect and the drug addiction quiz should only be seen as a guide.

Florida Flights Opioid Epidemic with Narxcare Tracking

In response to the opiate epidemic and the pill mill phenomenon, the state of Florida instituted a prescription tracking system under Rick Scott. The system is called NarxCare. It tracks the pharmacy, the physician, and the patient when they fill a prescription for a controlled substance.

Depression…What can you do to help yourself?

Let’s talk about depression. First, understand that like most things in life, depression is a spectrum; it is not black and white. Some people have situational depression or very mild depression and do really well with therapy and making some simple life changes. Others might need medication to assist them. Some unfortunately suffer from major depression and find it hard to cope with life.

Depression – What Can You do to Help Yourself?

Let’s talk about depression. First, understand that like most things in life, depression is a spectrum; it is not black and white. Some people have situational depression or very mild depression and do really well with therapy and making some simple life changes. Others might need medication to assist them. Some unfortunately suffer from major depression and find it hard to cope with life. No matter where on the spectrum people fall, the following information is helpful to anyone who has experienced depression.

Handling Clinical Depression Symptoms

Individuals often speak of feeling depressed. Indeed, it is common to feel periodic sadness due to life’s
disappointments. Clinical depression, on the other hand, is quite different from those times when we experience
unhappiness or despair.

Clinical depression is a serious disease caused by a brain disorder, and its effects on the individual’s ability
to perform in daily situations is profound. The condition can impact moods, thoughts, habits, and physical
wellness.

According to the National Institute of Mental Health (NIMH), depression strikes about 17 million American adults
every year. This is more than the amount of cases related to cancer, AIDS, or coronary heart disease. What makes
it even worse is that an estimated 15 percent of people dealing with depression ends in suicide.

Dealing with depression could appear like a daunting task. Some people don’t even comprehend the real nature of
the disease. “Many people still believe that depression is a character defect, or caused by bad parenting”, says
Mary Rappaport, a spokeswoman for the National Alliance for the Mentally Ill. It needs to be noted that taking
care of depression does not merely involve willpower. It requires proper medical attention.

The good news is that depression is treatable. In fact, among the initial steps of taking care of depression,
consists of making use of either of the two major treatment options available; medication or therapy. First, a
proper medical diagnosis must be obtained before one can go on with dealing with depression.

When identifying and dealing with depression, it is necessary to keep in mind that that there are three primary
classifications of the condition. These are major depression, dysthymia, and bipolar depression (otherwise known
as manic depression).

The symptoms for each category of depression can differ, depending upon the person. And there are numerous
factors that serve to increase the risk of depression. According to the American Psychiatric Association’s
Diagnostic and Statistical Manual, the following are the typical symptoms of depression as noted in the DSM-IV:
depressed mood, loss of interest or pleasure in nearly all activities, changes in appetite or weight,
interrupted sleeping patterns, slowed or restless movements, fatigue, loss of energy, feelings of worthlessness
or extreme guilt, difficulty thinking, focusing, or making decisions, and even recurrent thoughts of death or
suicide.

Antidepressant medicines are often prescribed as a step in dealing with depression. These medicines, such as
tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin re-uptake inhibitors, work by
modifying particular chemicals in the brain, such as serotonin. This leads to improved symptoms of depression,
and can assist in taking care of depression.

Alternatively, persons dealing with severe depressive episodes may not be responsive to medication alone. In
order to offer long term relief, psychiatric therapy is required.

Managing A Depressive Disorder

At some point in our lives we might experience depression. Depression is described as a feeling of unhappiness,
dissatisfaction, loneliness, or having negative thoughts towards oneself or to other people. Nonetheless, if the
feelings become overwhelming and continue to appear, which can substantially impact your health and your
everyday routine, immediate care and attention needs to be sought.

In fact, the level of depression that every person experiences might range from mild, moderate, to serious,
depending upon the symptoms related with each condition and the degree the condition disrupts everyday
activities. Managing depression is also, like the level of depression, different from one person to another.
Some individuals might realize the condition to be really disabling, and that they cannot seem to overcome it,
while others manage to undergo effective treatment. It is very difficult to comprehend exactly how extreme the
feelings of a depression sufferer.

We may be able to understand if we know what the possible causes are, and the symptoms of the depression.
Dealing with depression might not be as easy as you think, but, we can offer help to depressive individuals by
letting them know that we always have an ear to listen to their problems. Loss of something or somebody
essential. Loss of control over your own life or things around you.

Most likely, the person who feels this, in some way, senses that nothing can be done to alter the undesirable
events in life, and that handling depression is an impossible job. I should state this one is a great factor why
an individual feels depressed in the first place, as a negative attitude can cause self-defeat.

Here are some of the typical symptoms of depression, mostly grumbled by depression victims. A person with
depression might feel a strong sense of unhappiness, anxiety, guilt, anger, hopelessness, mood swings, and
helplessness.

An individual having depression might commonly sleep too much or too little, experience loss of hunger or
overeating, constipation, irregular monthly period, lose interest in sex, and experience weight loss or gain.

Considering that a depressive person deals with down feelings, crying without reason can occur. Also, withdrawal
from other people or the world in general, irritability, loss of interest in activities, and loss of interest in
physical appearance, no set objectives, and resorting to abuse via drugs and alcohol are simply some of the
things you’ll notice with a depressive person.

Clinical Depression, Mood Disorder Symptoms

Depression is a mood disorder that manipulates every part of daily life. The illness impacts all sectors of the
population in each socio-economic group, from kids, adults, and the elderly. This frustrating illness controls
the mind, behavior, body, emotional state, and can even conclude the ability to maintain relationships. Clinical
depression is a medical finding, and is different from the common connotation of being depressed. According to
the DSM-IV-TR criterion for identifying a major depressive disorder or clinical depression, two aspects need to
be present, which is depressed mood or anhedonia.

It is satisfactory to have either of these clinical depression symptoms in combination with five other clinical
depression signs over a two-week period, which includes; mental or physical fatigue and loss of energy feelings
of guilt, hopelessness, stress and anxiety, fear, or helplessness, decreased amount of interest or enjoyment in
all, or almost all, day-to-day activities practically every day, changing appetite and visible weight-loss or
gain, psychomotor agitation or retardation nearly every day, feelings of overwhelming sadness, or the seeming
inability to feel emotion.

Other symptoms include difficulty concentrating or making decisions, or a generalized slowing of cognition
consisting of memory, disrupted sleeping patterns such as excessive sleep or hypersomia, insomnia, or loss of
REM sleep. Repeated thoughts of death, not simply the fear of dying, but persistent suicide ideation with a
specific plan, or a specific plan of committing suicide or suicide attempt.

Various other clinical depression symptoms sometimes reported but not usually taken into account in medical
diagnosis consist of inattention to personal hygiene, fear of going mad, decrease in self-esteem, change in
perception of time, sensitivity to noise, physical pains and aches with the belief that these may be indications
of a severe illness.

Clinical depression symptoms in youngsters are not as apparent as in grownups. Some of the signs that children
may reveal are irritability, loss of appetite, learning or memory problems where none existed in the past, sleep
problems such as reoccurring nightmares, and substantial behavioral changes such as social isolation,
aggression, and withdrawal.

An additional indicator could be the excessive use of alcohol or drugs, where depressed teenagers are at a
particular risk of further critssical behavior such as eating disorders and self-harm.

Among the most extensively used instruments for measuring the extent of depression is the Beck Depression
Inventory, which has twenty-one multiple-choice questions. For people who have not experienced clinical
depression, either personally or by regular exposure to individuals who struggle with it is hard for them to
comprehend the emotional impact and seriousness. It could be similar to as having the blues or feeling down.

Sorts of Depression Medicine

There are a bunch of different sorts of depression medicines which are now available for the treatment of
depression. More recent depression medicines have become accessible that are safer and more effective than the
older depression medicines, and have fewer adverse effects. It is essential to take note though, that all types
of depression medicines, even the newest and most well-known, present specific risks, and can still trigger
unpleasant negative effects. It is smart to educate oneself in order to find suitable alternatives such as Selective Serotonin Reuptake Inhibitors (SSRI).

These sorts of depression medicines are the newest and most popular, and works by increasing the levels of a
mood-related neurotransmitter called serotonin, in the brain. These medications normally present a lesser risk
of side effects than other types of depression medications, but it does not imply that they are completely safe
or free of negative effects.

The most difficult adverse effects caused by SSRI depression medications are sexual dysfunction and weight gain.
It is not unusual for men taking this medication to end up being nearly impotent, and females to gain thirty
pounds. A lot of people look to natural options to prescription depression medicine in order to eliminate these
nasty negative effects. The first SSRI medicine introduced in the United States in 1988 was Prozac (fluoxetine),
since then, numerous SSRI medications have been released, including Paxil (paroxetine), Lexapro (escitalopram),
Luvox (fluvoxamine), Celexa (citalopram), Zoloft (sertraline) and Tricyclic Antidepressants (TCA).

These types of depression medicines are the older group, and due to the fact that they can cause adverse effects
such as constipation, dry mouth, bladder issues, blurred vision, sexual dysfunction, drowsiness, and
lightheadedness. They are no longer frequently prescribed, and have fallen out of favor. Some TCAs consist of
Tofranil (imipramine), Anafranil (clomipramine), Elavil (amitriptyline) and Monoamine Oxidase Inhibitors (MAOI).
These depression medications are currently the rarest sorts of depression medications, due to the fact that they
pose serious safety risks, can cause extreme side effects, and require a restricted diet plan.

Because of the expensive cost and negative effects of depression medicines, people in the United States are
increasingly more turning to natural depression medicines. Nonetheless, numerous natural supplements are of poor
quality, and do not work as well as prescription medicine. Some high-quality natural depression supplements do
exist though, and the best natural depression supplements include ingredients that have actually been proven to
work as well as depression medication, but with fewer side effects.

In a natural antidepressant medication called Amoryn, the major ingredient is hyperforin, which is an effective
treatment for anxiety and depression. Scientific research reveals that it eases depression as successfully as a
great deal of prescription medicine, but the good thing is, it has fewer negative effects.

Treatments for Depression

Among the most common mental issues impacting almost everyone, whether on a personal basis or through a family
member dealing with the condition, depression is an illness identified by bouts of melancholia, despair, or
feeling emotionally down in such a way that disrupts the normal functioning of a person. Individuals with
depression might experience problems with work, social and family adjustment. If left without treatment,
depression can be a strong risk factor for suicide.

Luckily, therapies for depression are offered, and the majority of them work in dealing with the condition,
along with its symptoms. The treatments for depression are likewise extremely varied, so to list them all here
would be almost impossible. Suffice to say, that therapies for depression are generally divided into two
significant classifications; medications and therapy. Some individuals with depression respond to therapy
better, while others can go on normally with their lives by routinely taking antidepressant medicine.
Nonetheless, there are also others that can only respond to treatment after taking antidepressants. Hence, the
two methods of treatment for depression may be utilized alternatively or in combination with some health
specialists, depending on the individual response of the patient.

The first thing to remember about depression medicines is that they do not treat depression. Just as aspirin can
lower a fever but without clearing up the infection that causes it, antidepressants only help control the
symptoms, but do not treat the condition itself.

Furthermore, depression medications do not produce the same effect in everybody. Some individuals might
experience side effects, and factors such as age, sex, body size, body chemistry, and so on, can impact exactly
how the drug works on a patient. Many people do however respond well to antidepressants as treatment for
depression. How long the person should take antidepressants depends upon the kind and severity of the
depression.

A different approach to providing treatment for depression is therapy. Therapy is where the depressed individual
is given support in lots of different ways, consisting of supportive counseling, cognitive therapy, and
problem-solving therapy.

This sort of intervention helps alleviate the pain of depression. Among the most common symptoms of depression
is the sensation of hopelessness that a depressed individual experiences. The function of supportive therapy is
to directly address this feeling of hopelessness and despair.

All pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression are
taken care of in this phase of intervention. The key right here is to help the depressed individual recognize
which life problems are important and which are minor. In understanding this, the individual can now develop
more positive life goals.

Depression may be created because of certain troublesome areas in an individual’s life. The purpose of problem-
solving therapy is to directly address these crucial areas that create considerable stress.

Major Depression

Each year, about 9.9 American adults deal with it. That is roughly five percent of the overall adult population,
give or take a few. Extreme depression is unlike the normal feelings of sadness, loss, or passing mood states
that many people have.

The condition is more persistent, and because of that persistence, it might significantly disrupt your thoughts,
habits, mood, activity, and even physical health. According to the World Health Organization (WHO), extreme
depression is set to become the second leading cause of disability in the world, after heart disease. The onset
of severe depression might be gradual, so the symptoms are not obvious right away.

Nonetheless, a few of the indications to keep an eye out for to identify whether you are suffering from severe
depression or not consist of the following: persistently sad state of mind or high irritability,
marked shifts in regular routines, consisting of sleep and appetite. Noticable changes in energy such as
frequently low energy practically daily. Feelings of being slowed down or agitation such as loss of interest in
previously pleasant activities. Relentless sensations of shame, unimportance, hopelessness, and emptiness may
also occur.

Other symptoms that are brought on by depression are reoccurring ideas of death or suicide, consistent physical
signs like headaches, intestinal disorders, and persistent pain without any known cause, and do not respond to
therapy. If you experience a number of of these symptoms of major depression, and they happen at the same time
for approximately longer than two weeks, and in such a way that they interfere with normal functioning, then do
not think twice to ask for expert treatment.

The reasons for severe depression are different, and the events that led to the development of the condition,
are in some cases too numerous to determine a single one as the clear-cut cause. There are typically lots of
aspects involved such as physical, biological, and even environmental aspects that all play a role.

According to scientific research, however, extreme depression is mainly a brain disorder. The problem could be
traced back to three chemicals or neurotransmitters, which function as messengers that transfer electric signals
between brain cells. These are norepinephrine, serotonin, and dopamine.

A person suffering from major depression often exhibits a chemical imbalance between these three
neurotransmitters, thus, producing a clinical state where depression takes place. In order to make up for the
imbalance, antidepressant drugs are introduced. These drugs work by increasing the availability of
neurotransmitters, or by changing the level of sensitivity of the receptors for these chemical messengers.

It is not enough however, to deal with major depression with psychotherapeutic drugs alone. Some individuals may
respond better to cognitive therapy, wherein they are given assistance in managing the problem areas of their
lives that add to depression. Additionally, individuals with severe depression may react to treatment
incorporating both approaches of medication and therapy.

Teenager Depression

Everyone feels down at some time. It’s common to feel sad. If you are feeling sad most of the time, and the
feeling is starting to impact your grades, relationships, and your behavior in many ways, then the issue might
be more than just the blues. It might be teen depression, a major health problem that approximately four out of
a hundred teenagers suffer with each year.

The signs of depression are many, so there is typically no hard and fast guideline to identifying all the
symptoms of teen depression. However, the most vital thing to keep in mind is that there are typically two sorts
of teen depression.

Under the first kind, you will discover two other sorts of depression which differ only in their intensity, as
major depression or clinical depression (severe) and dysthymia or chronic depression (moderate, but lasts for a
longer period).

The second type of teen depression is referred to as bipolar depression, the depressive state of manic-
depressive disorder, a condition wherein the subject suffers periodic bouts of mania or elevated mood and
depression, where the subject is commonly too low in energy that he would not have the ability to move. It would
take a health specialist to distinguish the sort of teen depression.

It is a good idea that you speak with expert assistance when you see any of the following indications of teen
depression. Consistent feelings of sadness or crying a lot for no evident reason is an indication of teen
depression. Consistent feelings of guilt, once again, for no actual reason and the feeling like you are no good
or are worthless are also indications.

Symptoms of depression can include loss of confidence or low self-esteem, you feel as though life is
meaningless, and that absolutely nothing good will ever come out of it. You constantly appear to be tired, and
you do not feel like doing things that you used to take pleasure in a lot, like music, sports, being with pals,
or going out. Most of the time, you simply want to be left alone.

Other symptons consist of you continually getting sidetracked and you can’t seem to focus. You likewise forget
things, or you do things without any recollection of doing them. Little things make you lose your temper. You
get aggravated very easily, or you overreact. Your sleep pattern changes. Either you sleep more or you sleep
less, or you cannot seem to fall asleep or remain asleep. You get up too early most mornings, and have problems
falling back to sleep.

Insomnia (inadequate sleep) or hyposomnia (too much sleep) sets in. Your eating routines likewise change. You
have lost your appetite or you eat a lot more. Weight gain or weight-loss is extreme. You think about death, or
feel like you are dying, or you have thoughts committing suicide, whether or not you have the energy to actually
harm yourself.

Signs of Depression

A very typical condition, depression is believed by numerous professionals to be the leading cause of disability
in the world. In the United States alone, studies show that 17 % of the population will experience the symptoms
of depression eventually in their lives. Currently, there is an estimated 19 million people experiencing
depression in the United States. Additionally, research shows that females are more vulnerable to struggle with
the symptoms of depression than males.

Often classed as a mental condition, depression is as much an illness of the body as it is of the mind. You
cannot wish it away and you can not simply snap out of it. Neither is it a sign of weak character. The good news
about depression is that virtually everyone experiencing the symptoms of depression can be helped with
appropriate therapy. That is why it is essential to identify the signs and symptoms of depression as early as
possible in order to prevent the condition from worsening.

The U.S. National Institute of Mental Health, or NIMH, has developed a list of the primary signs and symptoms of
depression. The following symptoms can be seen on the list; persistent feelings of sadness, anxiety, or
emptiness, feelings of hopelessness, despair, and pessimism, feelings of shame, worthlessness, and helplessness,
loss of interest, even in basic pleasures such as hobbies or activities that were once enjoyed, consisting of
sex, decreased energy, tiredness, being slowed down, difficulty concentrating, remembering or making decisions,
sleeplessness, early-morning awakening, or oversleeping, appetite and/or weight loss or overeating and weight
gain, thoughts of death or suicide, suicide efforts, restlessness, irritability, consistent physical symptoms
that do not respond to therapy, such as headaches, intestinal disorders, and chronic pain.

If you have any of these symptoms of depression, and have been struggling with them for a number of weeks, and
to a degree that they have actually hindered or impacted your life, have a talk with your doctor. She or he can
help you find out whether you are dealing with depression or not, and then help you create a treatment and
recovery strategy.

The symptoms of depression can differ from person to person. In addition, an individual’s response to various
medicines may also vary. That is why it is rather possible that you may have to check out a number of different
drugs in order to find out which one works best for you.

Your physician can recommend you some anti-depressant medicines. These drugs are relatively quick-acting, so you
may begin to feel better after just a few weeks of taking them. Nonetheless, unless your physician says so, do
not stop taking the drugs. It might be that you are only experiencing the initial impact of the drugs, but the
complete results have yet to take place.

Signs of Depression in Children

If depression is considered a severe condition to adults, exactly how would you think about depression in kids?
Actually, depression in kids is the same as in adults with just a few exceptions. Therefore, this only suggests
one thing, depression in children must be given immediate attention and care, particularly if they can’t make
out the precise words to express their condition. This is why you have to always keep a closer look on the
possible indicators of depression in children in order for you to take specific action about the problem.

To say that children have clinical depression, they need to have five of the 9 most common symptoms of
depression, which can cause disturbance of their functioning or behavior, for a duration of at least two weeks.
Below is a list of some of the symptoms that could be possible signs of depression in children. These signs may
be helpful to you if you sense your youngster or some children you know are dealing with depression.

Irritable mood most of the day, virtually everyday, having problems sleeping or sleeping too much practically
daily, tiredness or loss of energy, decreased ability to think or concentrate, significant loss of appetite
causing loss or gain of weight, loss of interest in things once enjoyed, restlessness, or slowness.

Various other physical symptoms, such as serious headaches, which may not be really common, have actually been
experienced by children for at least once a month. There are actually many other warning signs of depression in
children that you need to know and be aware of. Early indicators of depression in children can easily be missed,
due to the fact that it is typically associated with various other behaviors. Abrupt changes in behavior,
aggressiveness, angry or agitated behavior, increased interest in risk-taking, lower self-confidence, resulting
in withdrawal from other people.

When you hear young people discussing hurting themselves, or even suicide, don’t let it go by. In case you have
no idea, hurting one’s self or suicide is not new to depressive individuals. They have the tendency to commit
suicide because of the many aspects such as feelings of unimportance, unhappiness, helplessness, and many more.
Anyhow, none of the signs of depression in kids should be taken lightly. As soon as indicators of depression in
youngsters are observed, see to it to talk to your child and have him or her talk about what they are feeling.

It’s no use to comfort your kid, so don’t try and seek professional assistance immediately, as physicians are
the only ones who can identify depression. Fortunately, depression is treatable, and can be treated only with
psychotherapy and medicine. Except for depression, you and the whole family, and good friends can still show
your support to other emotional and physical difficulties of your children.

Depression

Victims of depression describe it as a black curtain of despair coming down over their lives. In truth, lots of
people diagnosed with depression have perpetual spells of apathy, where they feel like they have no energy to do
anything, or they can’t concentrate. Others might experience sensations of irritation, although there seems to
be no reason for feeling so.

The symptoms of depression vary from person to person. So, occasionally, it is challenging to diagnose. However,
if you have been feeling down for more than two weeks already, and these emotions are starting to interfere with
your life, it is time for you to see a physician who specializes in mood disorders to identify if you have what
they call clinical depression.

It has been observed that people who have gone through depression have the tendency to experience another
episode sooner or later. It is possible that you have one episode today, and the next few weeks, and then you
experience some of the symptoms once again before the next full-blown episode. If you learn to spot these very
early causes or symptoms, then you might be able to keep the depression from worsening.

Working with your doctor can help you learn how to manage depression. There are lots of medications used to
treat this mood disorder, and you may need to try a few different ones to discover which works best for you. In
addition to that, your doctor may also suggest a specialist for you, and suggest that you make a couple of
lifestyle changes.

Whatever medication you select in the end, always the initial step to improving and remaining better is taking
your medicine precisely as prescribed by your physicians. It might also help if you remember the following
treatment tips.

It takes some time for anti-depressants to work, so do not be impatient. Some antidepressants may start to make
you feel much better in just a few weeks. Nonetheless, the full anti-depressant impact of the drug might not be
seen until the passage of numerous weeks.

Even if you feel much better, keep taking your anti-depressant for as long as your physician tells you to. Your
doctor may suggest that you continue using the anti-depressant in order to help lower your chances of becoming
depressed once again.

There are some individuals who only become depressed once. However, there are others who have actually been
depressed before, or have a number of risk factors, in which case, they might need long-term treatment with
medicine.

Choosing The Right Separation Anxiety Treatment

Many individuals across the country are looking for an effective separation anxiety treatment to help them deal with severe separation anxiety. Before looking for a treatment method for relief, most of these individuals have experienced numerous instances of separation anxiety, and the condition might be worsening as the days pass.

The selling of separation anxiety treatment has actually become a multimillion dollar industry, and continues to grow each year as more and more treatments are added, and more individuals feel the need to purchase the products.

There are lots of different sorts of treatments for separation anxiety available, developed by several different manufacturers]. A separation anxiety therapy can be natural, consist of medicines, or be a restorative approach that modifies the way the body is working to ease the symptoms of the condition.

The sort of treatment technique chosen depends on the individual’s personal choice, the intensity of their symptoms, and the level of disruption that separation anxiety is causing in their life. Cost may also be a factor in selecting a separation anxiety treatment, as some treatment methods are more costly than others.

The most typical sort of separation anxiety treatment used today is a treatment that contains a drug to help the person manage their separation anxiety. These medications can be bought from a pharmacist at lots of different places with a prescription from the individual’s physician. These medicines can be very strong, so they can only be purchased with a prescription to avoid abuse and dependency to the medication. Lots of people do not want to use a separation anxiety treatment which contains medication, because of the risk of dependency.

A natural separation anxiety treatment will contain natural herbs and minerals found in nature to help individuals handle the stress that occurs with separation anxiety. These treatments are not as strong as the medications, but, they have a decreased danger of dependency, and many individuals believe that they are safer for mild to moderate cases of separation anxiety. A natural separation anxiety treatment can be purchased at locations such as grocery stores, drug stores, or stores that sell natural products.

Therapeutic methods that are utilized as a separation anxiety treatment teaches the person physical techniques to ease the stress that goes along with separation anxiety. These methods have the ability to ease the person’s separation anxiety within a matter of minutes without the person having to take medicine. There are lots of different separation anxiety treatment methods available to assist an individual in easing the symptoms of separation anxiety, and a few of them can be very effective at treating separation anxiety for good.

What Is One of the most Effective Methods To Relieve Separation Anxiety?

If you are attempting to relieve separation anxiety and its accompanying symptoms, there are lots of different alternatives for you to select from. A few of the remedies are natural, while a few of the other treatments are manufactured by companies and sold commercially. So how do you determine which remedies are the most effective method to relieve separation anxiety? There are a few things that you should consider.

When trying to find a treatment that will be utilized to alleviate separation anxiety, you will want to search for a solution that is simple to use. If the procedure for taking the remedy is too complicated, you might resist utilizing the remedy for a longer period of time, allowing the anxiety to gradually worsen as time passes, and you resist taking the remedy. For a remedy to alleviate separation anxiety effectively, you cannot be resistant to making use of the remedy, nor have a remedy that is so complicated to take, that it is much easier to just suffer through the stress and anxiety.

The ease of finding the remedy may likewise be very important for how effective the remedy can be to relieve separation anxiety. Lots of people have home remedies that are constantly available, and can be taken quickly to alleviate separation anxiety before it becomes too bad, while other individuals chose a remedy that is always in their favorite stores for their separation anxiety remedy, because it can quickly be located whenever it is required. If a remedy is too tough to find, people will stop taking it to ease their separation anxiety.

The strength of the separation anxiety remedy is another aspect of how effective the remedy will be to relieve separation anxiety. Prescription remedies are more powerful than nonprescription remedies or home remedies, however, the fact that you require a prescription from a doctor to purchase them make them more difficult to obtain.

The remedies to relieve a separation anxiety disorder that can be acquired over the counter in stores are available in a variety of various strengths, so it is easier for a person to find a strength that is effective, but is not so strong that it might trigger other issues when taken.

The speed at which the remedy can alleviate separation anxiety is essential too. A few of the remedies available work for a longer time frame, but takes longer to work, while some other remedies begin to work within a few minutes, but only last for an hour or two. For immediate relief, the fast acting remedies are normally chosen to stop the separation anxiety fast, and prevent it from worsening in time.