On: Mood, Medications & Habits (Lifestyle)

Feeling Better: Medications &/or “Better Habits”

Not every sadness is depression and not every depression needs medications. Accurate assessment of need for medications is an important step before prescription.

If sadness persists for two weeks and if it interferes with a person’s ability to work or have fun, it may be a MOOD DISORDER.

In some cases, medications can save lives. On the other hand they are not a solution to every problem andare usually best used as a last resort after natural methods have been tried. Even if medications are used, lifestyle changes can be made which will be beneficial.

How will I Know if I need medications?

When you visit a therapist they may determine that a problem (like depression or anxiety) is enough of a problem that therapy alone won’t be enough. Then that person will request that you see an M.D. (or another M.D.) for a Medication Evaluation. This involves an assessment of current problems and an assessment of lifelong predispositions. Sometimes written questionnaires are used to make these assessments more comprehensive. The better the assessment, the less chance that something will be missed.

If you are prescribed medications, the following information may be helpful.

Often asked Questions: What if...?

If you have a headache, it’s OK to take Tylenol, Motrin Advil or aspirin as you ordinarily would.

If you feel sleepy after taking the medication, take it at night before bed.

If you get an upset stomach, take it with food.

If you forget a dose, do not take double the amount .

Medications may take 3-6 weeks for full effect. Please be patient even if you don’t feel any different at first; it is a slow process but you’ll be glad when it starts to work. You may feel up at first and then down again. The first few weeks can be difficult; it may get worse before it gets better. Sometimes those close to you will notice improvement before you do, especially if you were having problems with energy, eating or crying spells.

Don’t share your medications with anyone. They are prescribed for you& there may be a good reason why another person shouldn’t take them. They may have a different problem, an allergy or a medical condition which could make the medication dangerous to them, even though it is safe for you.

Driving is ok while on medications, but for the first few doses, wait & see how the medication affects you before driving or operating any machinery.

It is best to avoid alcohol while on medications. If you do drink, avoid having more than one glass of wine/beer etc within a three hour period. If alcohol has been a problem in the past (like you’ve had DUI’s or blackouts) don’t drink at all.

Drugs & alcohol can cause depression, anxiety & insomnia. Symptoms can persist for 30 days after last use. If you feel you can’t quit or people have complained about your drinking, consider a 12-step program. For questions about this, ask your therapist, doctor, or call AA. 619-265-8762 (or 760-758-2514 North County)If someone that you love has a problem with Alcohol or addiction, you may find that the situation is more than you can handle by yourself, and you may benefit from the Al-Anon Family Groups 619-296-2666.

If you’re thinking of giving up smoking, tell your doctor. Nicotine withdrawal can cause severe depression. Cutting back to 5-10 per day is ok , but quitting completely should be coordinated with your doctor.

If you are a sexually active woman, use birth control, congenital defects are theoretically possible withany medication. If you do get pregnant, don’t panic, discuss your options & risks with DrB.

Getting off the medications requires teamwork with your doctor, this is not something to do on your own. Two questions need to be answered carefully: When to get off, and How. After 6-9 months of stable, healthy mood, you will have the option to slowly get off of the medication (if you want to). Remeber, each person is different. Whether you’ll be able to get off depends on 1) family history (predisposition) 2) if you relapse or become depressed again3) lifestyle changes (habits).

Some habits of thinking and behavior increase the probability of becoming depressed, others protect from it.

You can change your habits (lifestyle) in ways that will make the improvements from the medications more permanent and increase the odds that you’ll be able to get off the medications eventually (or minimize the number of meds &/ordose) . Lifestyle changes that you make will result in important changes in your brain chemistry. The sooner that you are able to make these changes, the better. The habits that matter most are; sleeping, eating, exercising, exposure to light and attitude.

Lifestyle & Habits

Do Good Things (even if we don’t feel like it). If we follow the “if it feels good do it” principle, we will regret it. Our bodies may get into a “Psycle” of excess. Sleeping too much can make us feel lethargic and sleepy. Eating too much can make us heavy and increase our appetite. Not exercising can make us feel low in energy. Exercising gives us energy.

A major component of Maturity (generally a good thing), is to do what is most appropriate even when we don’t feel like it. Between ages 2-6, kids usually learn that they can’t eat only dessert, that they can’t hit other people if they are angry with them, that they must go to sleep, get up and get out of bed, even if they don’t feel like it. Sometimes even the best of us need to remember these basics.

A happy medium between extremes of discipline and laissez-faire may be better than either. Regimen can help add structure, and by balancing flexibility with scheduling the best of both can be obtained.

By establishing a reasonable routine, a person can prevent important decisions about eating, sleeping and exercise to be influenced by ups and downs in motivation and mood. One of the most important skills of adulthood is to protect moderation from the tendency to extremes.

We can learn to exercise when we don’t feel energetic, eat the right amount of food and stop even if still hungry, and to get up even when we feel like laying in bed. Change doesn’t happen all at once, progress may be slow with two steps forward & one step back. Keep going, continue, persist, do it again. Do it a different way, regroup and get creative. Look for a new approach, do it again

Sleep: 7-9 hours, no naps, wake up at the same time every day Avoid caffeine for 6 hours before sleep. Noise interferes with sleep, if you can’t eliminate it, get & use ear plugs. Avoid other activities in bed except sleeping & sex. Studies have shown that eating, watching T.V. etc makes getting to sleep more difficult. Too much sleep may cause low energy. If you feel sleepy during the day, reduce sleep to 7 hours, if you feel like you don’t need much sleep or have excess energy, sleep 9 hours.

Eat: small amounts of good food, more fruits & vegetables, less sugar. With both sleep & food, moderation & discipline are vital, the signals from the body will sometimes be misleading (that is, if you sleep too much you may feel more tired & then sleep more, etc) Too much food or sleep may make your body ask for more food or sleep. It is up to you to decide what signals to listen to. Seek moderation.

Vitamin Minerals, & Supplements can be very helpful. The most important is Fish Oil (four capsules per day has also been shown to help mood, heart and brain function..

Folic Acid (1200-2400mcg/day) or Methylfolate (Deplin or Cerefolin) helps to detoxify the brain increasing blood flow and the synthesis of dopamine, norepinephrine and serotonin as well as removing homocysteine (which sometimes accumulates causing anxiety, insomnia and impaired concentration).

5-HTP 100mg (3 at bedtime) or Tryptophan 500mg (3 at bedtime) helps with sleep, mood and reduces carb craving.

DHEA 25mg (4-6 in AM) can help with stress and balancing cortisol but check with your doctor first.

A multivitamin (with Iron for women), Vitamin C (500-1000 twice per day), Vitamin D (1000 iu per day), and vitamin E (400-100iu per day) can all be beneficial and are ok to take but numerous studies of large populations have shown them to be inert. Magnesium 250mg at bedtime and Melatonin 3-10mg can help sleep.

Keep in mind, that there seems to be no end to the vitamins & supplements that are marketed by the sellers. The biggest improvement some of these ‘natural’ supplements make is in the wealth of the makers not in the health of the takers.

Exercise: 3 types of exercise that should be a part of every week include Stretch, Stamina & Strength. Stretch is often just a part of warm up routines. Stretching is taken seriously and combined with some form of relaxation, yoga or meditation. Stamina is well studied (regarding brain function). You need about 20 minutes per day, three times per week at 60-80% of your maximum heart rate. Aerobic instructors & health clubs have programs to participate in. Even brisk walking can be helpful. Strength can be worked on several ways including free weights or exercise machines. Increase in strength affects growth hormone & several other growth factors which are associated with improvement in mood, thinking, memory and mood as well as muscle.

Light: Exposure to light has been studied in people & the benefits are remarkable. Improved energy, mood, digestion & metabolism have been seen. To benefit from natural light you must expose yourself to it. From 10am-3pm the sun is at it’s most intense. To avoid sunburn & increased risk of skin problems go early & always use the appropriate sun screen. Light boxes are available for about $2-300. Ask your doctor for details if interested.

Psychotherapy: Medications may work better & life changes will may be more permanent if they occur in the context of self examination. Psychotherapy can be a life changing experience. There are many kinds of psychotherapy. Different approaches work for different people. Discuss your options with your therapist.

“Cognitive Therapy” has been shown to be as effective as medications (in mild and moderate depression). Many people benefit from books that they can read & work through with their therapist or in addition to their therapy. Examples of cognitive therapy books include“Feeling Good” & “The Feeling Good Handbook” both by David Burns.

“Learned Optimism” by Martin Seligman is a superb book which discusses the way our attitudes are shaped by, and shape our experiences. It has been very helpful to some (formerly) depressed patients.

Books on relaxation are also available and can be very useful if anxiety or insomnia are a problem. “The Relaxation Response” or “Timeless Healing” by Herbert Benson, M.D. (director of Harvard University’s Mind-Body Institute) are good examples.

Other Problems: Depression is often accompanied by other problems like anxiety, obsessions, panic attacks, PMS, eating problems or headaches. Usually these get better as the depression gets better.

If Mood Swings are an underlying cause of the depression, a mood stabilizer may be needed.

Stress Management and anger management are subjects of courses taught by therapists, clinics, hospitals and at community colleges. These can make a big difference in learning about and dealing with these issues. Assertiveness training is also available.

Other resources are also available, including clergy or spiritual counselors and support groups. Some people find 12-step meetings (like AA or NA) help them to recover from addictive behaviors like alcohol, drugs, gambling and overeating.

Overall the odds are very good: Depression is one of the most treatable of conditions. In the first 3-6 months 60-80% of patients get better. By two years the percentage is in the high 90s.

Depression that does not respond at first (two different medications for 8 weeks each) is called Refractory Depression (or treatment resistant depression). Diagnosis is the first step - to be sure that there is no underlying medical condition, or other psychiatric condition that is causing it. Refractory Depression is treated with combinations of medications, antidepressants, mood stabilizers and other treatments. It is the domain of the psychopharmacologist. This is a physician who is a psychiatrist with special training in medications for emotional or behavioral problems.