Navigating Your Depression Relapse

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Like many other common medical conditions, such as high blood pressure, depression is highly treatable, but there is also a risk that the symptoms will return. According to Dr. William Marchand, a clinical associate professor of psychiatry at the University of Utah School of Medicine, the risk of recurrence, or a relapse after a full remission, for a person who has had one episode is 50%. For a person who has had two episodes, the risk is about 70%. For someone with three episodes or more, the risk rises to around 90%. This is why having a prevention plan in place is critical. “Depression is often a chronic illness, but with a good prevention plan in place, it is often possible to prevent recurrences entirely or limit the severity and duration if depression does return.” A prevention plan must include maintenance treatment, which is “treatment that is continued after symptoms are in remission to prevent recurrence.” It is also important to understand what might be triggering a possible relapse, and how you can prevent or minimize the influence of those triggers. Here are three common triggers that could cause a relapse:

  • Not Following Treatment: “The biggest issue regarding relapse has to do with children and adults not following through on their treatment plan,” said Deborah Serani, Psy.D, a clinical psychologist. This can include anything from skipping therapy sessions to missing doses of your medications to ending your therapy too soon.
  • Ruminating: Those who suffer from depression tend to dwell on their supposed flaws and failures. These negative self-referential ruminations play a major role in relapse.
  • Not Knowing Your Personal Vulnerabilities: Since we are all unique, triggers can be specific to each individual’s situation. To identify your triggers, learn how to recognize the who, what, whys and whens of your emotional and physical life,” Serani said.

Sometimes it is not possible to prevent yourself from a relapse. However, by knowing the early signs and getting treatment right away, you can prevent a full blown episode or lessen its severity and length.



Managing ADHD in the College World

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Heading off to college is a big adjustment for anyone, but students with ADHD may need to prepare themselves even more. ADHD affects learning and function, not intelligence, which is why if you have ADHD and are off to college you might have to approach learning, studying, and organizing in a different way. Some students may never know they have ADHD until they get to college, since it is not uncommon for signs to surface late in a student’s education. Here are some ADHD symptoms that could be a sign that you are struggling:

  • Substance Use: People struggling with ADHD tend to make poor choices when it comes to alcohol and drugs and may not know when to say no. Drinking too often and too much could be signs that you are struggling.
  • Difficulty Working in a Group: Group projects are common assignments in college. People who have unmanaged ADHD symptoms may not contribute to the work, be late to meetings, and function ineffectively.
  • Inability to make friends: Going to college is a time for meeting new people and experiencing new things; however, ADHD can definitely affect social interactions and friendships. It can be difficult for students to make new friends and maintain friendships.
  • Suffering in School: If you are finding yourself unable to concentrate during a lecture, taking poor notes, feeling disorganized or having problems reading, your ADHD symptoms may need better control.

If you are starting to notice any of these symptoms, head to the student health center on your campus for an ADHD evaluation. If you are diagnosed with ADHD, it is important for you to establish a relationship with an on-campus mental health professional who can teach you coping and life-management strategies. To help you manage your ADHD in college, here are some strategies:

  • Look for a school with good ADHD resources, and make sure to take advantage of them.
  • Alert any counselors, administrator, and professors that you have ADHD and that you may need some classroom accommodations, including class notes and more time for tests.
  • Sit at the front of the classroom and record lectures.
  • Create a daily schedule that has all of your classes, study times and other responsibilities.
  • Learn time management skills by meeting with a counselor or taking a class.


What Happens When You Have a Migraine

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Many migraine sufferers find it frustrating when they suffer from the agonizing head pain of migraines, and the nausea and sensitivity to light that can accompany them, while others don’t suffer. They wonder why.

The answer, unfortunately, basically comes down to their brains simply being more sensitive to outside stimuli than other people’s brains.

Before, migraines were blamed on blood vessels in the brain dilating. Now, the newer thinking is that the expansion of blood vessels is the result of some other event, not the cause. The cause may in part be the excitation of a nerve responsible for sensation in the face.

“It’s called the trigeminal nerve,” explains Larry Newman, MD, director of the Headache Institute at St. Luke’s-Roosevelt Hospital Center in New York City. When this nerve is stimulated, it causes the release of a variety of neurotransmitters, which in turn cause the blood vessels that surround the brain to expand and inflame. “Those blood vessels are attached to nerve fibers which transmit the pulsations from the blood vessels back into the brain, where you then perceive it as pain,” says Dr. Newman. Although some people experience a pre-attack aura, a typical migraine occurs in two steps:

  • The Trigeminal Nerve is Activated: When the nerve gets excited, the most common first symptom is pain around the eye and temple. If that pain is treated quickly, a sufferer can shut down the migraine relatively quickly.
  • The Central Nervous System is Triggered: If the pain is left untreated, another mechanism will trigger in the central nervous system itself. When this happens, that pain mechanism becomes very difficult to turn off. It is as if the pain has become independent of the original source at the trigeminal nerve, where medications are less likely to work.

“Once it goes beyond a certain point, cutting off the source is no longer sufficient because the pain of the headache reverberates in the central nervous system,” says Dr. Cutrer. “A different set of neurons has now become irritable and activated—and getting them back to normalcy is not easy. They can continue to be reactivated and reactivated and the headache becomes harder to treat.” That is the dreaded migraine phase that can go on for hours or days. Since it is very important to catch migraines in the early phase, doctors advise patients to monitor triggers and symptoms to prevent excitation of the trigeminal nerve and to try to get the jump on treatment to calm it down. Missed triggers and medications delayed are a recipe for prolonged suffering.



ADHD May Lead to Obesity in Boys

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While ADHD has been linked to struggles with drugs and alcohol, less schooling and more arrests, a study shows that it may also be linked to weight problems.  In this study published in Pediatrics, researchers connected the impulsive behavior that can characterize ADHD with overeating that contributes to calorie overload. The 33-year study tracked boys with attention deficit hyperactivity disorder into adulthood. They found that men who were hyperactive as children were twice as likely to have higher body-mass-index readings and rates of obesity than men who didn’t have the condition as children. Of the men who were diagnosed with ADHD as kids, 41% were obese compared with 22% of men who didn’t have ADHD as children. The average rate of obesity for me in this age group was 24%.

The study was first designed to investigate new insights into brain-structure differences among people with ADHD, but when researchers received a grant to perform brain MRI scans on the men to evaluate their psychiatric health, many of the study participants were too large to fit in the scanner. “One of these gentlemen really wanted to help out, but we had to squeeze him in, inch by inch,” says Dr. Francisco Xavier Castellanos, the study’s senior author. The scientists began asking the men for height and weight measurements to see if they would fit inside the MRI machine. They found that nearly three times as many men from the childhood hyperactivity group couldn’t fit in the scanner. Curious, the study researchers decided to systematically collect data on the men’s weight. “There had been suggestions in the past that ADHD might be related to obesity,” says Castellanos. “There were a lot of checks to make sure this was not due to other conditions. We were able to confirm that this risk seemed really related to childhood diagnosis of ADHD.”

It is not clear why this disorder would lead men with ADHD to weigh so much more than their peers. However, the researchers suspect that impulsivity and poor decision making skills played a role. “We live in a society with supersized amounts of food,” says Castellanos. “If someone has less than the average amount of self-control because of the ADHD, they are less able to withstand the temptations of food.” The results suggest that among the other behavioral issues that children with ADHD may face, maintaining a healthy weight might be an additional concern and struggle for them.



Get Outside with ADHD

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For kids who have ADHD, getting outside in the great outdoors can be really good for them. Research suggests that being outside in natural environments reduces the severity of ADHD symptoms in kids. “Being outside provides ADHD children with a more open environment to appropriately express their energy,” says Roberto Olivardia, Ph.D, a clinical psychologist and clinical instructor in the department of psychiatry at Harvard Medical School. Psychotherapist Terry Matlen, ACSW, agreed. “Children who are hyperactive and impulsive can release tension far easier being outside running, jumping, swinging and playing sports than sitting indoors.” It also gives kids the opportunity to get their bodies moving and heart pumping, which also helps to reduce ADHD symptoms, according to Stephanie Sarkis, Ph.D, a psychotherapist and author of several books on ADHD. “Exercise increases dopamine levels in the brain, and these levels are naturally low in the ADHD brain.” Here are some fun ideas and engaging outdoor activities that can get your child with ADHD moving outside:

  • Structured and Simple Activities: “Structured, organized activities with simplified instructions such as art or creative activities, playing tag and yoga can be helpful for children with ADHD,” said Sarkis.
  • Team Sports: Healthy competition can be engaging and stimulating for your child. Try to get him or her involved in team sports such as soccer, baseball, basketball, volleyball, football or tennis.
  • Individual Activities: Some kids might thrive in team sports, however there are many that “have problems with social skills and poor motor skills (clumsiness),” said Matlen. They might not enjoy team sports, so activities such as running, swimming or biking might be best suited for them.
  • Natural Activities: “Children with ADHD are curious and most love nature,” Matlen said. She suggests everything from gardening to setting up bird feeders could be great activities for kids with ADHD. This way they can, for example, quietly wait for birds to feed, which is a great skill for them to develop.
  • Yard Work: Matlen also suggests “activities like painting the fence, raking leaves [and] hauling things in the wheelbarrow.” These types of activities are effective since it forces kids to use their bodies against resistance which offers a calming effect, much like some therapeutic activities occupational therapists use.



Endometriosis Fact Sheet


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Endometriosis is a problem that many women can have during their childbearing years. It means that a type of tissue that lines your uterus is also growing outside your uterus. This does not always cause symptoms and isn’t usually dangerous, but it can cause pain and other problems. Your uterus is lined with a type of tissue called endometrium, and each month, your body releases hormones that cause the endometrium to thicken and prepare for an egg. When you do not become pregnant, the endometrium breaks down, and your body sheds it as blood. When you suffer from endometriosis, the implants of tissue outside your uterus act like the tissue lining your uterus. During your menstrual cycle, they thicken, then break down and bleed. However, since the implants are outside your uterus, the blood can’t flow out of the body. The implants can get irritated and painful. Sometimes they form scar tissue or cysts. The most common symptoms of endometriosis are:

  • Pain, which can be:
    • Pelvic Pain
    • Severe menstrual cramps
    • Low backache 1 or 2 days before the start of the menstrual period
    • Pain during sexual intercourse
    • Rectal pain
    • Pain during bowel movements
  • Abnormal bleeding, which can include:
    • Blood in the urine or stool
    • Some vaginal bleeding before the start of the menstrual period
    • Vaginal bleeding after sex
  • Infertility:
    • Trouble getting pregnant
    • May be the only sign that you have endometriosis

Endometriosis varies between individuals, and some women are unaware they have it until they see a doctor. Some will only have mild cramping which might seem normal for them, while for others, the pain and bleeding are more severe, affecting their ability to work or attend school. If you are noticing any of these symptoms or abnormality in your menstrual cycle, speak with your doctor right away.



Surprising Ways to Prevent Migraines

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If you suffer from migraines, chances are you have tried a variety of different treatments to prevent them and ease your pain. If you haven’t had any success, don’t give up just yet. Here are some remedies you might not have tried and may not be aware of:

  • Getting Injections: In 2010, Botox was FDA-approved to prevent chronic migraines. It is a recommended treatment for those who suffer migraines for more than 15 days a month. It is covered by insurance if you have a diagnosis of chronic migraines and get the shots from a neurologist.
  • Dropping Some Weight: According to a 2009 Drexel University College of Medicine Study, women with greater amounts of belly fat are 37% more likely to get migraines than those who have trimmer torsos. Losing 10 pounds can make a difference for your head.
  • Curbing Your Allergies: Almost a third of people with allergies also have migraines. “When you have an allergic reaction, your body releases chemicals such as histamine and other substances that can trigger a headache,” explains Vincent Martin, MD, professor of medicine at the University of Cincinnati College of Medicine. His research found a 50% reduction in migraines among people who got allergy shots.
  • Checking the Forecast: When there is a 5-degree-Celsius rise in temperature, the risk of having a severe migraine goes up 7.5%, according to a report in the Harvard Gazette. Migraine sufferers are also a third more likely to get a headache on days lightning strikes within 25 miles of their home, says a University of Cincinnati study. Try to stay inside in air-conditioning during heat waves, and if you know a storm is coming, try to keep your other known triggers to a minimum.



The Positive Symptoms of Schizophrenia

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Schizophrenia causes two types of symptoms: negative and positive. However, “positive” doesn’t necessarily mean “good”. Positive symptoms of schizophrenia are things that are “added” or “new” to your personality that significantly impact your life. The most common positive symptoms of schizophrenia include:

  • Hallucinations: You hear voices. The hallucinations will seem real and can involve sight, hearing, taste, smell, and/or touch.
  • Delusions: You believe something that cannot be proven or continue to believe something that has been proven to be false or wrong. A common delusion for those with schizophrenia is to believe you are an important historical or political person, or that there is poison in your food.
  • Confused and Disorganized Speech and Behavior: For example, a person might not make sense when talking or will easily get off the subject of the conversation. They might dress oddly, such as wearing many shirts at once, or wearing winter clothing during the summer. It is also possible that they might exhibit socially inappropriate behavior, such as urinating in public.

Positive signs of schizophrenia usually can be reduced or prevented with medicines. If you or someone you know suffer from schizophrenia and experience any of these “positive” signs, speak with a doctor to find out the best treatment plan for these symptoms.



Symptoms of Schizophrenia

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Schizophrenia is an illness that can affect a person’s ability to think clearly, manage emotions, and interact with others. It can affect each person differently. The symptoms of schizophrenia include:

  • Negative Symptoms: In the case of schizophrenia, “negative” does not mean “bad”. Negative symptoms are things that are “lost” from one’s personality, thus influencing his or her outlook on life. One may act in the following way as a result:
    • Does not care about things
    • Lose interest or drive to do things
    • Not taking care of oneself, such as not bathing regularly
    • Difficulty communicating how he or she feels
    • Become angry with strangers for no reason and react to others in other harmful ways
  • Positive Symptoms:Similar to negative symptoms, “positive” does not mean “good”. Positive symptoms are things “added” or “new” to one’s personality, which influence his or her experience in life. These symptoms include:
    • Hallucinations
    • Delusions
    • Thoughts and speech that are confusing
  • Cognitive Symptoms:These symptoms revolve around how one thinks and are often not obvious to oneself or others. They can include:
    • Memory loss
    • Not being able to understand things well enough to make decisions
    • Having trouble talking clearly to others

Symptoms tend to start during adolescence or young adulthood, but they can also start later in life. They might appear suddenly or develop slowly and one may not be aware of his or her symptoms. The negative symptoms of schizophrenia usually appear first. Positive symptoms can start within days, months or years after the negative symptoms. Some early signs of the disorder may include performing worse in school, thinking that people are trying to do harm, or changes in one’s personality, such as not wanting to see people. These signs are not necessarily indicative of schizophrenia; however, if one is noticing them as well as the symptoms above, he or she should speak with his or her doctor.



Guide to Tweens and Teens with ADHD

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Raising a tween or teen can be a challenge. When the child has ADHD, it can be even more challenging.

A study from Massachusetts General Hospital found that teens with attention deficit hyperactivity disorder are more likely to partake in risky behavior, such as smoking and abusing drugs, than their peers who don’t have the disorder. Other studies have shown that teens with ADHD are not only more likely to experiment with drugs, but more likely to do so at an earlier age, to boot. They are also more prone to depression and suicide.

None of this is inevitable, though. Here is some advice on how to better deal with the issues that parents of tweens and teens, with ADHD, contend with:

  • Educate Yourself: “The first and most important thing I would suggest is that parents educate themselves as much as they can about ADHD and ADHD symptoms,” says Ari Tuckman, PsyD. Knowing what to expect from your child could help to make it easier to deal with issues if and when they arise. If you are better prepared, you will be able to react in ways that will help your child rather than hurt him or her.
  • Educate Your Child: Teens are generally not good at recognizing the consequences of risky behaviors; and for teens with ADHD, they probably are even poorer at understanding cause and effect. Tuckman says, “As a parent, you need to talk to your child about ADHD and about how risky situations are more likely to lead to certain outcomes. That way, your teen may be more likely to understand the consequences of his actions and try to avoid situations that could be riskier.” For example, suppose your teen with ADHD doesn’t get along well with a classmate who takes the same bus to school. Explain that getting in trouble is therefore a lot more likely, if your teen sits near that classmate. Take the time to be clear and thoroughly explain such situations.

Every teenager, with ADHD or not, needs structure and support. As a parent, you can provide the proper support and intervene when necessary. When you know what you are doing and are prepared, you can help your teen with ADHD through this extra-challenging time.