All Posts in Category: Mental Health

Man affected by Winter Blues is looking out of the window

How to Avoid Winter Depression?

Psychotherapist, Stelios Kiosses explores how natural light, and the lack of it in the winter, can affect our psychological health

Do you feel slowed down and have difficulty waking up in the morning?

Do you feel you want to eat more through the dark days of winter, and do you find it hard to focus at work and socialise while at the same time feeling depressed?

If you answered yes to one or more of these questions you may be one of the millions of people around the world who have problems with the changing seasons and you may suffer from a condition now widely accepted by the medical community and the public at large as Seasonal Affective Disorder or SAD.

Seasonal Affective Disorder is a depression brought on by a lack or deficit of natural light (i.e. sunlight). According to the Diagnostic and Statistical Manual of Mental Disorders DSM-5, criteria for depression with a seasonal pattern include having depression that begins and ends during a specific season every year (with full remittance during other seasons) for at least two years and having more seasons of depression than seasons without depression over a lifetime.

The term ‘Seasonal Affective Disorder’ was coined in the 1980s by Norman Rosenthal, MD, a psychiatrist and research scientist who studied mood and biological rhythm disorders at the National Institutes of Mental Health. In his best-selling book Winter Blues, he revealed his struggle with SAD.

Many of us now recognise that our moods change with the revolving years and seasons. However, the effect of the seasons on our moods has long been a subject of discussion through the centuries with artists, poets, and philosophers. As in the classic Shakespearean writing remark “a sad tale is best for winter”.

My favourite myth is how the Greek Gods suffered during the winter months: Persephone was banished to the underworld every winter, while Boreas ushered in the cool winter winds and his nasty temper.

The human body responds to daylight: we rise when the sun comes up and we go to bed once it’s gone down. And this is not just in our modern times. As humans, we are attuned to the patterns of light and dark to maintain our circadian rhythms. (Circadian rhythms regulate many of our body’s functions, including our appetites and our moods).

It is thought that insufficient sunlight has a direct effect upon the part of the brain that contains the hypothalamus. The hypothalamus is a region of the forebrain that controls the body’s autonomic nervous system and the pituitary gland. This, in turn, may affect the production of the hormone melatonin in the body.When working normally, this hormone makes us feel tired, but when it is sunlight-deprived, more melatonin than usual may be produced, making us feel more tired, more often. The production of serotonin may also be affected by insufficient sunlight. This hormone affects mood, sleep patterns and appetite and if our bodies do not produce enough serotonin, we often begin to feel depressed. Lower levels of sunlight exposure affects the natural rhythm of our bodies and any disruption to your body’s clock can result in suffering some symptoms of SAD.

Further, with less outdoor exposure to sunlight on the skin in winter, people with SAD may produce less Vitamin D. As Vitamin D is believed to play a role in serotonin activity, Vitamin D deficiency and insufficiency have been associated with clinically significant depressive symptoms. Causal links between serotonin, melatonin, circadian rhythms, Vitamin D, and SAD have not yet been confirmed. However, associations among these key factors are present and are continuing to be researched.

Who is affected by SAD?

Depression can strike anyone at any time, but some groups are more susceptible to developing SAD than others. These groups can be categorised as follows:

1. 20-40 year old age group;
2. women in their 20s and 30s;
3. and women rather than men.

Some individuals may experience a milder form of SAD known as subsyndromal or S-SAD, or most commonly known as ‘winter blues’.

Those living farthest from the equator in Northern latitudes are most susceptible. For example, in the United States, 1% of those who live in Florida and 9% who live in Alaska experience SAD. In Canada, 15% of the population experience winter blues and 2 to 6% experience SAD. In the United Kingdom, 20% experience winter blues and 2% experience SAD.

However, pinpointing prevalence is difficult as the disorder may go unreported and consequently under- diagnosed. Furthermore, SAD can cooccur with other depressive issues like bipolar, attention deficit, alcoholism, and eating disorders, making it difficult to diagnose. The symptoms of SAD tend to be the typical symptoms of depression, including:

• increased sleep,
• increased appetite and carbohydrate cravings,
• weight gain,
• irritability,
• interpersonal difficulties (especially rejection sensitivity),
• a heavy, leaden feeling in the arms or legs,
• feelings of despondency and hopelessness characteristic of depression,
• lack of energy, and difficulty carrying out a normal routine; inactivity,
• increased appetite and a tendency to overeat, leading to weight gain,
• withdrawal from friends, family and social activities,
• feelings of anxiety and an inability to cope,
• difficulties in concentration; frustration and irritability,
• and feelings of worthlessness and guilt.

It is important for the health and aesthetic practitioner, if they suspect that a patient may suffer from SAD, that they do an initial screen of the patient using the Seasonal Pattern Assessment Questionnaire (SPAQ). The SPAQ is a retrospective, self- administered tool that screens for the existence of SAD and S-SAD.

It is freely available in the public domain and can be downloaded from http://www.guilford.com/add/forms/ rosenthal2.pdf. No training is required to use the tool.

How to Avoid Winter Depression – Light therapy

woman using light therapy

Treatment approaches typically include combinations of antidepressant medication, light therapy, Vitamin D, and counselling.

There are some self-care steps you can take all year long that may help reduce your risk of SAD, too. They include exercising regularly, maintaining healthy sleep habits and a predictable sleep/wake cycle, eating a healthy diet and limiting the amount of sugary foods you eat.

Also, going outside on sunny days can make a difference. Exposure to natural sunlight can help ease SAD. Light box therapy is also particularly useful. Light boxes mimic outdoor light by emitting a broad-spectrum ultraviolet light. The most common prescription is 30 minutes of light box use at the beginning of every morning, with the box 12 to 24 inches away.

The intensity of the light box is recorded in lux, which is a measure of the amount of light you receive at a specific distance from a light source. The recommended intensity of the light typically is 10,000 lux.

For light therapy to work, the light must enter a patient’s eyes indirectly – this does not mean staring directly into a light box, rather the box must be facing the person while they work, read, or relax.

Sunrise alarm clocks have become increasingly popular in recent months, especially among people who experience SAD. The clocks come with gentle sunrise and sunset features, allowing users to wake up and go to sleep in a setting that mimics natural light.

How to Avoid Winter Depression – Psychotherapy

A combination of lig and CBT has been shown to significantly reduce symptoms in sufferers, both in the short and long-term. Cognitive Behavioural Therapy (CBT) is a psychological treatment which helps to change the way you think, feel and behave.

Although SAD has been shown to have a biological basis, it is often accompanied by negative automatic thoughts, pessimistic attitudes, withdrawal from social activities, and rumination; thus, CBT can be particularly helpful in targeting these negative thoughts and behaviours.

Finally. there are some simple steps anyone can try that may help improve symptoms:

• Get as much natural sunlight as possible.
• Make your work and home environments as light and airy as possible.
• Sit near the windows when you’re indoors.
• Take plenty of regular exercise, particularly outdoors and in daylight.
• Eat a healthy, balanced diet.
• Manage your stress levels.
• A winter holiday to a sunny location can also do wonders for your state of mind, and some people suffering from SAD truly consider it a health requirement.
• Some SAD sufferers manage their symptoms with vitamin D supplements in the autumn and winter months.
• Snacking on the right kinds of carbohydrates can relieve some of the symptoms of SAD such as popcorn, shredded wheat squares or low-fat biscuits.
• Research has suggested that SAD is less common in those

who consume more omega-3 fatty acids. Take a supplement with a high concentration of fish oil.

The good thing is that winter isn’t forever and, the moment spring returns, the symptoms of SAD fade away.

Furthermore, there is no need to suffer in silence. If SAD is impacting the quality of your life, make lifestyle changes to ease symptoms and consider seeking out a treatment that helps you manage your symptoms and continue living your life. Managing Seasonal Affective Disorder is possible.

References

• R. Anglin, Z. Samaan, S. Walter, and S. McDonald, “Vitamin D deficiency and depression in adults: systematic review and meta-analysis,” British Journal of Psychiatry, vol. 202, no. 2, pp. 100–107, 2013.
• American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM- 5), American Psychiatric Association, Arlington, Va, USA, 2013. • S. Penckofer, J. Kouba, M. Byrn, and C. E. Ferrans, “Vitamin D and depression: where is all the sunshine,” Issues in Mental Health Nursing, vol. 31, no. 6, pp. 385–393, 2010.
• D. C. Kerr, D. T. Zava, W. T. Piper, S. R. Saturn, B. Frei, and A. F. Gombart, “Associations between vitamin D levels and depressive symptoms in healthy young adult women,” Psychiatry Research, vol. 227, no. 1, pp. 46–51, 2015.
• M. Kjærgaard, K. Waterloo, C. E. A. Wang et al., “Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial,” British Journal of Psychiatry, vol. 201, no. 5, pp. 360–368, 2012.
• Rohan KJ, Meyerhoff J, Ho SY, Evans M, Postolache TT, and Vacek PM. Outcomes One and Two Winters Following Cognitive- Behavioral Therapy of Light Therapy for Seasonal Affective Disorder. The American Journal of Psychiatry. 2015.

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Common Mental Health Conditions

Common Mental Health Conditions

In a previous blog we discussed depression, anxiety and stress, which are the most commonly recognised mental health conditions. However, there are other mental health conditions that we treat regularly at Dementech Neurosciences.

Bipolar Disorder

Bipolar disorder causes extreme mood swings ranging from highs (mania or hypomania) to lows (depression).

Find out more about bipolar disorder in this short video.

 

Symptoms of bipolar include:

  • Depression – feeling hopeless or sad, losing interest in most activities.
  • Mania/Hypomania (a less extreme type of mania) – irritability, euphoria, feeling energised.

The condition can affect the ability to think clearly as well as affect judgement, behaviour, energy levels, activity and sleep. It cannot be cured however treatments are available that can help you to manage the symptoms.

Treatment options for bipolar disorder:

  • Cognitive behavioural therapy focuses on identifying unhelpful or negative behaviours and beliefs and replacing them with positive and healthy ones. It may be helpful in identifying triggers for episodes of bipolar and developing strategies to help you cope with your condition.
  • Interpersonal and social rhythm therapy aims to stabilise daily routines and create a more consistent pattern of sleep, exercise and diet.
  • Family therapy can help family members to understand more about the condition and how to recognise and manage the early signs.

Chronic Fatigue Syndrome

This is a complex disorder that cannot be explained by an underlying medical condition. The symptoms include extreme fatigue which does not improve with rest. Scientists are unclear what causes chronic fatigue syndrome although it is believed to be triggered by a combination of factors which may include psychological stress and viral infections.

Symptoms include:

  • Extreme exhaustion which does not improve with rest or sleep
  • Loss of memory or concentration
  • Headaches and/or muscular or joint pain

Treatment options:

Cognitive training involves talking to a counsellor to help you feel more in control of your life. This can help as chronic fatigue brings with it many restrictions and uncertainties. You may also benefit from gentle exercises which you can build up gradually.

Phobias

A phobia is a fear of a specific thing, situation or animal. People can have phobias about a whole range of things, from heights to needles and the symptoms of a phobia can occur suddenly and without warning.

Symptoms can include:

  • Breathing difficulties or shortness of breath
  • Rapid heartbeat
  • Pain or tightness in the chest
  • Trembling
  • Sweating
  • Headaches, nausea or dizziness
  • Panic attack

Some of the most common phobias include:

  • Arachnophobia (fear of spiders)
  • Ophidiophobia (fear of snakes)
  • Acrophobia (fear of heights)
  • Aerophobia (fear of flying)
  • Cynophobia (fear of dogs)
  • Social Phobia (fear of being in a social situation)
  • Agoraphobia (fear of public places)
  • Mysophobia (fear of dirt or germs)

Treatment options for phobias:

Phobias produce a fear response which can be extreme and may interfere with daily living, resulting in anxiety and, in some cases, depression. Psychotherapy has been shown to be effective for phobias and panic disorders and may be used alongside prescribed medication and self-help techniques like meditation and mindfulness.

Fibromyalgia

Fibromyalgia is a condition that is characterised by pain throughout the body, accompanied by fatigue, sleep and memory problems and mood swings. It is believed to be caused by a change in the way the brain processes pain signals, leading to pain sensations becoming amplified.

The condition may begin after some kind of physical trauma, psychological stress, infection or surgery. In some people symptoms develop gradually over time.

Symptoms include:

  • Pain throughout the body that is experienced as a dull ache
  • Fatigue
  • Sleep disorders including sleep apnoea and restless legs syndrome
  • Difficulty concentrating

The condition may be accompanied by other disorders such as irritable bowel syndrome, migraine and cystitis.

Treatment

Fibromyalgia is a painful and distressing condition. There is no single effective treatment. However, doctors may prescribe medication to relieve pain and to help promote sleep. CBT, mindfulness and counselling may also help people to deal more effectively with the stress of the condition.

To find out what the best treatment is for fibromyalgia for you, it is best to speak to a specialist who can assess your symptoms and offer advice on how to manage the condition.

Dementech specialises in diagnosing and treating neurological disorders including all types of mental health conditions. For more information contact our experienced and friendly team.

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patient with mental health problem

Common Mental Health conditions and how to treat them

Mental health problems are becoming increasingly common, but why is this and what can be done about it?

Causes of mental health problems

There is no single cause for the growth in mental health disorders over the last 10 years. We believe there may be many different contributory factors. There are more demands on people now compared to previous generations, fuelled by the pressures of social media and instant news. The pace of life has accelerated to such an extent that people are at greater risk of burnout than ever before. Our cognitive and emotional workload is increasing, and many people are finding it harder and harder to find any downtime or to relax in the short amount of leisure time they may have. The result is rising levels of anxiety, depression and stress.

Why is mental illness on the rise? Mr Stelios Kiosses explains in this video.

 

Depression

Depression is very different to feeling low or unhappy. When someone is depressed it can impact every aspect of their lives and they may feel unable to cope with everyday activities. It may affect their physical and mental health, resulting in a loss of interest in things that previously they enjoyed. They may lose their appetite or find themselves unable to sleep.

Anxiety

Anxiety is a natural human response to a perceived threat. It is what we feel when we are worried or tense about things that might happen, particularly if we are facing stressful events or major life changes.

Anxiety becomes a problem if it starts to have a significant detrimental impact on your life. You may be diagnosed as having anxiety if you have felt anxious for a long time or your fears are disproportionate to the situation. You may be experiencing distressing symptoms such as panic attacks, or you may find it hard to go about your normal life.

Stress

Stress is normally related to our reaction to feeling under pressure. This is very individual and what one person finds stressful, another may take in their stride. Stress can become particularly acute when we feel we don’t have control over what is happening to us or we become overwhelmed. Stress isn’t a psychiatric diagnosis however it can trigger mental health problems like anxiety or depression. Conversely, mental health problems can lead to stress.

Stress can also cause physical symptoms including tiredness, headaches and gastrointestinal problems. When we are stressed our bodies produce high levels of hormones such as cortisol and adrenaline which are responsible for the body’s fight, flight or freeze response. When we are unable to release these hormones as our ancestors would have done (by running away or fighting, for example) they remain in our bodies and can cause unpleasant physical symptoms.

Treatment for anxiety and depression

The right treatment for mental health problems, such as anxiety and depression, varies from one person to the next, depending on the type and extent of the problem and the person’s individual thoughts, beliefs and preferences.

Medication may be prescribed to deal with certain problems, such as anxiety or problems sleeping, but this will not get to the root of the problem. A therapeutic approach such as Cognitive Behavioural Therapy (CBT) can be effective in tackling some of the psychological issues that lie at the heart of a person’s depression.

CBT for mental health

CBT works on a person’s behaviour first. This is because when someone becomes depressed, they may stop doing things that they used to enjoy. They may lose motivation and become tired and listless. The focus of CBT is to try and increase the person’s activity levels first, so they begin to experience some of the things they used to enjoy and start to feel better. Once this is in place, the therapist may help the person to work on any negative thoughts or rumination.

How does mindfulness reduce depression?

Mindfulness-based CBT brings together mindfulness techniques such as meditation, stretching and breathing exercises and combines this with elements of CBT. It can be effective in helping to break the negative thought patterns that are a symptom of recurrent depression.

Evidence suggests that mindfulness-based CBT can reduce the risk of relapse of people who experience recurrent depression by as much as 43%. It is recommended by NICE for the prevention of relapse in such people.

Dementech specialise in diagnosing and treating neurological disorders including mental health conditions and can suggest the best treatment plan for you. For more information contact our experienced and friendly team.

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