Mark Myers Expert Answer to:I'm extremely depressed and angry about being unemployed for some time. How do I go on without having a mental breakdown?

In today's economy, I am sure you are not alone. There are many people who share your plight. The fear you face is understandable. Individuals could experience the following feelings: worry, unproductive, boredom, self defeated, and pessimistic, to name a few emotions. It is important that you take steps to try to take control over areas of your life that you can. Click for more

Antidepressants For Older Adults? Be Careful!

A study published in The British Medical Journal this month raises questions about the risks of antidepressant medications for adults 65 and older who have been diagnosed with depression. The major conclusion of the article -- that care should be taken in prescribing and in selecting which antidepressant medication to prescribe for older adults -- is unquestionably correct and is nothing new. However, the specific findings of this study -- that taking antidepressants was associated with increased death rates and other adverse consequences, and that the new antidepressants (SSRIs ) may have greater serious risks than those associated with previous generations of antidepressants -- are provocative, important and uncertain.

The study's two major findings are frightening on their face.

Compared with older primary care patients who had diagnoses of depression in their records but who did not take antidepressants, those who did take antidepressants had higher rates of death, attempted suicide, falls, fractures, upper gastro-intestinal bleeding and heart attacks.

Those who took SSRIs (which are the most commonly prescribed antidepressants) had higher rates of death, stroke, falls, fractures and seizures than those who took tricyclics or other earlier forms of antidepressant.

Because of possible implications for current standards of practice, the importance of this research and of doing prospective future research to resolve questions that this study leaves unanswered cannot be overstated.

In recent years, much research has indicated that older adults who are depressed -- especially those who also have a chronic physical condition -- and who are not treated for depression are at increased risk for disability and premature mortality. Specifically, previous studies have linked depression to greater functional decline, increased risk of falls and greater cardiovascular mortality among older persons who are not taking antidepressants. As a result, there has been a push to screen for depression and to treat it, using both psychotherapy and antidepressants. This study seems to call this standard approach to depression into question.

In addition, it is known that SSRIs have fewer side effects (e.g., dry mouth, constipation and cardiovascular complications) than earlier forms of antidepressants. Are they also safer? The findings of this study suggest that they may not be. Should preferences regarding antidepressants for older adults therefore change?

Carol Coupland and her colleagues, the authors of this new study, are modest in their conclusions and recommendations, saying only, "The potential risks and benefits of different antidepressants ... need careful consideration when these drugs are prescribed for older adults."

Why not issue an alarm about the use of antidepressants, and particularly about the use of SSRIs, by older adults? First, this study examines patient records in ways that identify associations of facts but do not reveal causation. The standard way to establish causation would involve random selection of depressed patients prescribed antidepressants. In the BMJ study, the decision was not made randomly, raising the possibility that an unidentified factor led physicians to prescribe antidepressants, and particularly SSRIs, to their depressed patients who were at greatest risk for adverse outcomes.

Similar studies have demonstrated that antidepressants are associated with reduced risks of suicide and reduced risks of death from conditions such as strokes and cardiac disease.

Second, this study does not adequately distinguish between older adults with major depressive disorder (MDD) and those with other mood problems, and it does not adequately examine those with moderate or severe MDD compared to those with mild disorders. Clinical research regarding the use of antidepressant medications indicates that they are more effective for people with disorders that meet the threshold for a clinical diagnosis, particularly if moderate to severe . It would be useful to repeat this study leaving out people with mild depression or without depression at all, keeping in mind that a diagnosis of depression in a patient's chart is not necessarily accurate.

Third, this study does not clearly distinguish between those who began the study with a serious physical condition and those who did not. It would be useful to follow patients with serious physical illnesses and depression to see whether -- as other studies suggest -- treatment for depression brings down their risk of death and other adverse consequences.

Despite these reservations, the findings of this study are very important both with regard to overall risks of antidepressants for older adults and with regard to the possibility that SSRIs have more adverse consequences than earlier generations of antidepressants.

Are antidepressant medications dangerous for older adults? Would it be preferable to treat depression only with psychotherapy despite evidence that the combination of psychotherapy and medication is generally more effective than either alone? Should earlier-generation antidepressants be used more frequently than SSRIs despite evidence that the SSRIs have fewer side effects? This study does not give definitive answers, but it does reinforce the fact that the use of antidepressants by older adults is not risk-free. Physicians and their patients should clearly exercise caution.

Coupland, Carol et al. "Antidepressant use and risk of adverse outcomes in older people: population based cohort study" in BMJ, August 2, 2011. http://www.bmj.com/content/343/bmj.d4551

Harrison, Pam. "Depression in Older Adults Increases Mortality Risk". Medscape News, February 26, 2010. http://www.medscape.com/viewarticle/717663

Fergueson, James. "SSRI Antidepressant Medications: Adverse Effects and Tolerability" Journal of Clinical Psychiatry, February 2001. http://www.ncbi.nlm.nih.gov/pubmed/14514497http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/

Jorge, Ricardo et al. "Mortality and Post-Stroke Depression: A Placebo-Controlled Trial of Antidepressants" in American Journal of Psychiatry, October 2003. http://www.ncbi.nlm.nih.gov/pubmed/14514497

Glassman, Alexander et al. "Psychiatric Characteristics Associated with Long-term Mortality Among 361 Patients Having an Acute Coronary Syndrome and Major Depression: Sever-Year Follow-up of SADHART Participants" in Archives of General Psychiatry, September 2009. http://archpsyc.ama-assn.org/cgi/content/abstract/66/9/1022

Fournier, Jay et al. "Antidepressant Drug Effects and Depression Severity: A Patient Level Meta-Analysis" in Journal of the American Medical Association, January, 2010. http://jama.ama-assn.org/content/303/1/47.full

Bartels, Stephen et al. Evidence-Based Practices in Geriatric Mental Health in Psychiatric Services, November 2002. http://www.ps.psychiatryonline.org/cgi/content/full/53/11/1419

Why Laughter May Be the Best Pain Medicine

Laughing with friends releases feel-good brain chemicals, which also relieve pain, new research

indicates.

Until now, scientists haven't proven that like exercise and other activities, laughing causes a release of so-called endorphins.

"Very little research has been done into why we laugh and what role it plays in society," study researcher Robin Dunbar, of the University of Oxford, said in a statement. "We think that it is the bonding effects of the endorphin rush that explain why laughter plays such an important role in our social lives."

Pet Owners and Mental Health

 There is significant research that keeping pets can improve your physical health, but did you also know that caring for pets also improves mental health? A study published by the APA, American Psychological Association, found that pet owners rated themselves as happier, healthier, and better adjusted than non-pet owners. The key element that made the difference was the perception on the part of pet owners that their pets gave them a sense that their social needs were met, a sense of belonging, and higher reported self-esteem. Pets decrease our sense of loneliness or isolation. Also, pets require individuals to step out of their own thoughts and feelings to consider the needs of another being, thus encouraging engagement in the world around you. McConnell, et. al. Journal of Personality and Social Psychology 2011, Vol. 101, No. 6, 1239-1252

Depression linked to stroke, vitamin D may help both

By David Liu, Ph.D.

Saturday, Aug 13, 2011 (foodconsumer.org) -- Being chronically depressed may be a sign of higher risk of stroke, according to a study in Stroke: Journal of the American Heart

Association.

The study led by Kathryn Rexrode, M.D.at Brigham and Women's Hospital in Boston, Mass found women who had a history of depression was at 29 percent higher risk of total stroke.

The study also found women who used anti-depressant medications particularly selective serotonin reuptake inhibitors were associated with a 39 percent increased risk of stroke. Anti-depressant drugs included Prozac, Celexa and Zoloft.

But the researchers speculated that it is not the medications that cause a higher risk of stroke. Instead use of the drugs only indicates that depression in the patients was more severe.

The study involved in 80,574 women ages 54 to 79 years in the Nurses' Health Study. Participants had no history of stroke at baseline. During the six-year follow-up, prevalence of depression at baseline was 22 percent in the participants and 1,033 strokes were identified.

Depressed women were often those who were single, smoking, and less physically active, according to the study. They were also more likely to have a higher body mass index, and diseases like heart disease, diabetes and high blood pressure, compared to women without a history depression.

A healthy observer said the study suggests what increases the risk of depression may also increase the risk of stroke and vitamin D can be the missing link between the two.

One study in the American Journal of Clinical Nutrition found men who had intake of 600 IU or more of vitamin D per day were 28 percent less likely to suffer stroke and heart attack, compared with those who had an intake of only 100 IU or less per day. In women, the risk reduction was 16 percent.

The study was conduced by Qi Sun of the Harvard School of public Health in Boston MA.

Another study published in 2008 in the journal Circulation linked low serum vitamin D levels with 60 percent higher risk for heart attack, stroke and heart failure, compared with those who had high levels of vitamin D.

Dr. Thomas Wang of Harvard Medical School in Boston, Massachusetts and colleagues who conducted the study also reported that the association was even stronger among those with high blood pressure.

For the study, Wang et al. followed up 1,739 people at an average age of 59 in the Framingham Heart Study for five years.

Now low serum vitamin D is also associated with high risk of depression.

Nanri A and colleagues from International Medical center of Japan in Shinjuku-ku, Tokyo, Japan reported on Aug 19, 2009 in the European Journal of Clinical Nutrition that people who had highest levels of vitamin D were 49 percent less likely to feel depressed.

In winter, high levels of vitamin D were found associated with lower risk of depression, particularly severe depression.

Many other studies also suggest that vitamin D can be the cause for depression.

Pre-Bed Booze May Effect Sleep.

People often turn to wine, beer or cocktails to unwind at the end of the day. These drinks might seem to be relaxing and to aid sleep. But research has shown that people who drink alcohol in the evenings actually get less REM sleep and have less restful nights.

Now a study demonstrates that late-night alcohol might decrease the amount of necessary overnight repair work that the body can do.

Subjects in the study drank strong, weak or alcohol-free beverages an hour-and-40-minutes before going to bed. The more booze the volunteers imbibed, the higher their overnight heart rate. These rapid beats were an indication that their bodies were not in the most productive rest mode, say the researchers. The work appears in the journal Alcoholism: Clinical & Experimental Research. [Yohei Sagawa et al., "Alcohol Has a Dose-Related Effect on Parasympathetic Nerve Activity During Sleep"]

The findings might help explain why those who frequently drink often suffer from insomnia at night and sleepiness during the day, as well as more long-term health effects.

So if you're looking for better, more healthful sleep, maybe avoid the nighttime nightcap.

—Katherine Harmon

The Science Behind Dreaming.

For centuries people have pondered the meaning of dreams. Early civilizations thought of dreams as a medium between our earthly world and that of the gods. In fact, the Greeks and Romans were convinced that dreams had certain prophetic powers. While there has always been a great interest in the interpretation of human dreams, it wasn’t until the end of the nineteenth century that Sigmund Freud and Carl Jung put forth some of the most widely-known modern   click for more

Anger Management

Walking away or changing topics are effective delay tactics. Also, when we recognize the physical buildup of anger, techniques such as relaxation, visualization, and deep breathing could be very effective. We cannot escape from anger. This is a natural human emotion. However we are able to control anger. If you have continual problems in managing your anger, discuss this with your therapist.

Anger is one of our most common and misunderstood emotions. We experience situations where we become on a regular basis. Getting angry is not necessarily unhealthy or bad. In some situations it could be healthy and productive. Anger has both a physical and psychological response and process. It is seen in babies as well as adults. Anger exists in all cultures, (although it may be displayed differently in each one). Anger is an emotion that could present itself in many different ways. It is our expression of anger that could become a problem. 

The following are indicators that someone is having trouble managing their anger.

· Frequent use of sarcasm or criticism

· Explosive outbursts

· Impaired relationships due to anger

· Withdrawing when angry

· Feeling guilty over anger

· Have hurt people emotionally and

physically) when angry

· Feeling out of control when angry

· Have a difficult time calming yourself

down when angry

· Significant others complain about

your anger

· Physical problems such as: ulcers,

hypertension, heart disease, gastritis,

and colitis.

· Complaints at work about anger

episodes

Consequences of Anger

When anger is mismanaged, the problems it can create could vary. Often physical problems such as ulcers, high blood pressure, and gastro problems could occur. Other problems such as social and relationship problems, occupational problems, and law problems could also present themselves.

Functions of Anger

When trying to figure out destructive anger, it is important to realize that anger could serve many functions for us. Examples include: getting our way through anger episodes, feeling superior to others, feeling powerful, expressing thoughts (especially hurt), discharging excessive energy, remaining a victim (not taking action but focusing on what is making you angry), and increasing production and motivation. In order to change the way

you deal with your anger, you need to be willing or motivated to change. This would involve giving up the advantages you experience when angry.

How Anger Works

Anger may be the result of a sudden situation we encounter, such as a traffic incident, or a chronic buildup of events.Often times when we find ourselves getting angry, we are reacting to a stressful situation as threat, real or perceived. This is often referred to as the Fight or Flight response. This response lies in the primitive part of

the brain. Our bodies react as if in a state of emergency. Increased hormonal production, adrenaline, blood

and oxygen flow to the major muscle groups, and increased heart rate, are among the many physiological

responses we have when angry and stressed.Our interpretations of events are important factors in determining anger outcomes. 

One individual may perceive a situation as a threat while another may not. This perception could be based on several factors including: previous life experiences, behavior patterns learned while growing up, coping abilities, and current life situation. These past experiences shape our reactions to events today.

Environmental factors could impact upon our anger management. Peer groups and cultural factors are

influences we need to consider. If people around us mismanage their anger, we may find it harder to control

ours. Other life challenges such as depression or stress are considerations we need to take into account as well.

Managing Anger

One of the first tasks involved in managing anger is developing awareness of anger patterns. By keeping an anger record, we develop more insight into our anger patterns. The more awareness we develop regarding

our anger, the more opportunity we have to intervene in the anger process. This awareness would include recognizing physical warnings of anger build ups, thought processes that contribute to anger, and a

lifestyle that contribute to anger problems.

Anger Thought

Thought processes contribute to anger. We need to begin to develop alternative ways to look at situations. It is helpful to identify beliefs that contribute to our anger states. This allows us to use other thoughts to interpret the event differently and provide a different, more rational thought process to take over. It is also important to incorporate humor into your life. If you take events less seriously, you may find yourself viewing a lot of situations with a lighter frame of mind.

Lifestyle Changes

By maintaining a healthy lifestyle, we are promoting a positive environment for ourselves enabling us to focus more on our anger problems. This would include: good sleep habits, supportive relationships, good nutrition, and regular exercise. Communication skills are important tools to use with anger problems. Learning to communicate our thoughts in less destructive ways not only derails anger blowups, but also improves the quality of our relationships. When we become more aware of our anger buildup, we could utilize delay tactics.

Hearing Loss and Depression

Hearing loss could affect many different people and age groups. It could be caused by hereditary factors, natural aging, injury to head, earwax build up, ear infections, or exposure to noise. As we age our sensory abilities diminish. Hearing loss is the third most common long-term health problem in older Americans and affects up to 40 out of 100 people age 65 and older, and up to 80 out of 100 people older than 85 (National Institute of Health). Hearing loss can cause sufferer’s to feel isolated, anxious, self conscious, lonely, and disconnected. If someone is experiencing hearing loss it could certainly make life less enjoyable.

This problem is not just confined to older adults. Children as young as three weeks old could be diagnosed as having a hearing deficit. About 2 to 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing and approximately 15 percent (26 million) of Americans between the ages of 20 and 69 have high frequency hearing loss due to exposure to loud sounds or noise at work or in leisure activities(National Institute on Deafness and Other Communication Disorders ). Hearing loss in children could affect grades, self confidence, and peer relations. Since children are not always able to articulate their problems, identifying the problem makes it more challenging. In a 2010 study published in the Journal of the American Medical Association, researchers found a 31 percent increase in teenage hearing loss. The study compared teens in 2005 and 2006 to teens tested from 1988 to 1994. According to the research, called the Third National Health and Nutrition Examination Survey, the results show that "one in five U.S. adolescents 12 to 19 years old demonstrated hearing loss." (Deafness research Foundation).

For older adults, certain settings for them may provide challenges. Rooms with particular

structures may make it more difficult to hear (acoustics). Background noise could also factor

into ability to hear others. Lastly, certain pitches in voices (usually higher ones) are hard to

decipher. The impact could be felt at work (business meetings), social, and family relations

(being able to communicate with children or grandkids).

There are preventive measures individuals can do in avoiding hearing loss. For some, it may not

be avoidable (hereditary factors and aging). Here are some suggestions:

Children should have periodic hearing exams (once every few years).

Avoid exposure to loud noises

Avoiding long exposure to music listening devices(IPods, MP3 players, I phones)

When exposed to settings with loud noise, wear ear wax, if possible.

Be conscious when buying items such as dishwashers, washers, and dryers. There is a

difference in products when it comes to amplitude.

If exposed to loud noises and it is unavoidable, try to limit time that you are exposed it.

If you experience hearing loss, let others know about it. Accommodations could be made

that would increase your ability to hear others. Time of day (visiting restaurant in non

busy time), locations (acoustics) and seating arrangements (face to face) could greatly

increase communications.

Talk with your doctor or audiologist. Hearing aids can make a tremendous difference in

hearing impaired lives. There are many advances in technology and hearing aids are less

intrusive and noticeable as they once were.

Hearing loss may open new challenges in life. For the elderly it may mean another loss they

experience. Discussing your concerns with others could develop the support you are looking for.

If you or someone else is experiencing hearing loss and having a hard time with it, consider

joining a support group or seeing a therapist. This could not only provide additional support, but

some coping strategies as well.Hearing loss could affect many different people and age groups. It could be caused by hereditary factors, natural aging, injury to head, earwax build up, ear infections, or exposure to noise. As we age our sensory abilities diminish. Hearing loss is the third most common long-term health problem in older Americans and affects up to 40 out of 100 people age 65 and older, and up to 80 out of 100 people older than 85 (National Institute of Health). Hearing loss can cause sufferer’s to feel isolated, anxious, self conscious, lonely, and disconnected. If someone is experiencing hearing loss it could certainly make life less enjoyable.

This problem is not just confined to older adults. Children as young as three weeks old could be diagnosed as having a hearing deficit. About 2 to 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing and approximately 15 percent (26 million) of Americans between the ages of 20 and 69 have high frequency hearing loss due to exposure to loud sounds or noise at work or in leisure activities(National Institute on Deafness and Other Communication Disorders ). Hearing loss in children could affect grades, self confidence, and peer relations. Since children are not always able to articulate their problems, identifying the problem makes it more challenging. In a 2010 study published in the Journal of the American Medical Association, researchers found a 31 percent increase in teenage hearing loss. The study compared teens in 2005 and 2006 to teens tested from 1988 to 1994. According to the research, called the Third National Health and Nutrition Examination Survey, the results show that "one in five U.S. adolescents 12 to 19 years old demonstrated hearing loss." (Deafness research Foundation).

For older adults, certain settings for them may provide challenges. Rooms with particular

structures may make it more difficult to hear (acoustics). Background noise could also factor

into ability to hear others. Lastly, certain pitches in voices (usually higher ones) are hard to

decipher. The impact could be felt at work (business meetings), social, and family relations

(being able to communicate with children or grandkids).

There are preventive measures individuals can do in avoiding hearing loss. For some, it may not

be avoidable (hereditary factors and aging). Here are some suggestions:

Children should have periodic hearing exams (once every few years).

Avoid exposure to loud noises

Avoiding long exposure to music listening devices(IPods, MP3 players, I phones)

When exposed to settings with loud noise, wear ear wax, if possible.

Be conscious when buying items such as dishwashers, washers, and dryers. There is a

difference in products when it comes to amplitude.

If exposed to loud noises and it is unavoidable, try to limit time that you are exposed it.

If you experience hearing loss, let others know about it. Accommodations could be made

that would increase your ability to hear others. Time of day (visiting restaurant in non

busy time), locations (acoustics) and seating arrangements (face to face) could greatly

increase communications.

Talk with your doctor or audiologist. Hearing aids can make a tremendous difference in

hearing impaired lives. There are many advances in technology and hearing aids are less

intrusive and noticeable as they once were.

Hearing loss may open new challenges in life. For the elderly it may mean another loss they

experience. Discussing your concerns with others could develop the support you are looking for.

If you or someone else is experiencing hearing loss and having a hard time with it, consider

joining a support group or seeing a therapist. This could not only provide additional support, but

some coping strategies as well.Hearing loss could affect many different people and age groups. It could be caused by hereditary factors, natural aging, injury to head, earwax build up, ear infections, or exposure to noise. As we age our sensory abilities diminish. Hearing loss is the third most common long-term health problem in older Americans and affects up to 40 out of 100 people age 65 and older, and up to 80 out of 100 people older than 85 (National Institute of Health). Hearing loss can cause sufferer’s to feel isolated, anxious, self conscious, lonely, and disconnected. If someone is experiencing hearing loss it could certainly make life less enjoyable.

This problem is not just confined to older adults. Children as young as three weeks old could be diagnosed as having a hearing deficit. About 2 to 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing and approximately 15 percent (26 million) of Americans between the ages of 20 and 69 have high frequency hearing loss due to exposure to loud sounds or noise at work or in leisure activities(National Institute on Deafness and Other Communication Disorders ). Hearing loss in children could affect grades, self confidence, and peer relations. Since children are not always able to articulate their problems, identifying the problem makes it more challenging. In a 2010 study published in the Journal of the American Medical Association, researchers found a 31 percent increase in teenage hearing loss. The study compared teens in 2005 and 2006 to teens tested from 1988 to 1994. According to the research, called the Third National Health and Nutrition Examination Survey, the results show that "one in five U.S. adolescents 12 to 19 years old demonstrated hearing loss." (Deafness research Foundation).

For older adults, certain settings for them may provide challenges. Rooms with particular

structures may make it more difficult to hear (acoustics). Background noise could also factor

into ability to hear others. Lastly, certain pitches in voices (usually higher ones) are hard to

decipher. The impact could be felt at work (business meetings), social, and family relations

(being able to communicate with children or grandkids).

There are preventive measures individuals can do in avoiding hearing loss. For some, it may not

be avoidable (hereditary factors and aging). Here are some suggestions:

Children should have periodic hearing exams (once every few years).

Avoid exposure to loud noises

Avoiding long exposure to music listening devices(IPods, MP3 players, I phones)

When exposed to settings with loud noise, wear ear wax, if possible.

Be conscious when buying items such as dishwashers, washers, and dryers. There is a

difference in products when it comes to amplitude.

If exposed to loud noises and it is unavoidable, try to limit time that you are exposed it.

If you experience hearing loss, let others know about it. Accommodations could be made

that would increase your ability to hear others. Time of day (visiting restaurant in non

busy time), locations (acoustics) and seating arrangements (face to face) could greatly

increase communications.

Talk with your doctor or audiologist. Hearing aids can make a tremendous difference in

hearing impaired lives. There are many advances in technology and hearing aids are less

intrusive and noticeable as they once were.

Hearing loss may open new challenges in life. For the elderly it may mean another loss they

experience. Discussing your concerns with others could develop the support you are looking for.

If you or someone else is experiencing hearing loss and having a hard time with it, consider

joining a support group or seeing a therapist. This could not only provide additional support, but

some coping strategies as well.

The Two Way Street: Medical Conditions and Mental Health

Studies have shown that a strong relationship between medical conditions/problems and

mental health exists. It is estimated that up to one-third of individuals with a serious medical

condition experience symptoms of depression. Chronic illness can trigger or exacerbate

depressive (feelings of helplessness or despair) or anxiety symptoms (concern about the

future), not to mention both the mental and physical stress of coping with a prolonged illness.

The limitations of the medical condition significantly alter a person’s life, which could create

huge and seemingly overwhelming situations. Self image, independence (or lack of), and social

interactions are obstacles that are put to limits. Lastly, emotional problems could slow down or

prevent full recovery from medical conditions.

The severity of a medical condition typically varies with each person and that person’s

subjective ability in addressing the challenges a chronic or prolonged illness can bring up.

Medical challenges are not limited to the aging population, as hearing loss, vision impairment,

endocrine disorders, gastric issues, surgery, as well as autoimmune diseases could happen to all

age groups. Any one of these could create feelings of loss (loss of mobility, social interaction,

resources, finances, and one’s own mortality). 

The rate for depression occurring with other medical illnesses is quite high:

Heart attack: 40%-65%

Coronary artery disease (without heart attack): 18%-20%

Parkinson’s disease: 40%

Multiple sclerosis: 40%

Stroke: 10%-27%

Cancer: 25%

Diabetes: 25%

Cleveland Clinic: Copyright 1995-2009, The Cleveland Clinic Foundation

The relationship between medical issues and mental health is a two-way street. Mental health

challenges like anxiety, depression, and substance abuse have a strong link to physical ailments.

Sleep and fatigue due to mental health problems affect and stress us, and if we are not given

enough time to replenish our body we become more susceptible to illness. When we are

experiencing symptoms of anxiety and panic attacks our body experience what is referred to as

flight or fight syndrome, which is just one clear example of the stress these mental health issues

have on our body. This would also make our body more prone to illness and breakdowns.

Another factor to consider in addressing medical conditions and mental health is medication.

Some medications have side effects that could amplify emotions such as anxiety or depression.

If a person has substance abuse problems, the risk of abusing prescriptions is greatly increased.

Energy level or lack thereof, creates less ability to socialize and increase feeling of isolation, and

medications can amplify these feelings as well. Also, some medications may have other side

effects such as a change in sexual desire, which could affect self confidence and relationship

issues.

It is important to understand that medical challenges could have a huge impact on a person’s

psyche. Identify emotional issues that may surface or are surfacing, and have a dialogue with

your support group to educate them on what you are currently feeling and what you may

experience later on. Try to develop regular sleep patterns and resist the urge to isolate. Your

doctor can educate you and your loved ones on medications and side effects. Inviting a loved

one or significant other in on such a discussion will only serve to educate them better on what

you are feeling and how best to cope with it. There are some exercise programs out there such

as water aerobics that may be possible for some with doctor approval. Monitoring your diet is

another way to stay both physically and mentally healthy. Lastly, seek out a therapist who has

experience working with individuals with medical conditions to get the best help for your

situation.

Sleep Better!

The need for sleep is a vital part of our ability to function.  We spend one third of our lives asleep.  Without the proper rest  we could experience problems in the following areas: difficulties in making decisions, lost productivity, concentration, underachievement, being more accident prone, depression, anxiety, sexual performance, and fatigue.  Our enjoyment of life is hampered if we are not able to get the proper rest we need. It is difficult to determine what impact sleep deprivation may have on your presenting problem.  Often times, it is difficult to know if it’s your problem that is causing sleep difficulties or the sleep difficulties causing problems.

About how many hours did you sleep last night? On the average, eight hours of good sleep is  recommended. This could vary from individual to individual. Some of us need more and some less. Our age is one factor in determining the amount of sleep we need. The older we get, the less sleep we may require.
Included are some tips on better sleep habits.  By using these suggestions, you may find yourself with more energy to address other concerns in your life.

Diet
1.  Cut down or eliminate alcohol consumption.
2. Avoid heavy meals before bedtime.  Also avoid acid producing foods such as spices, onions, and peppers.
3.  Cut down or eliminate caffeine . This would include chocolate, tea, and soda pops.
4. A glass of warm milk 15 minutes before going to bed will soothe your nervous system. Milk contains calcium, which aids in relaxation.
5. Try a cup of hot chamomile, catnip, anise or fennel tea. All contain natural ingredients which may help you sleep. Some blends of herb tea are designed to soothe you and help you get to sleep.
6.  A small, low protein, high carbohydrate bedtime snack, such as juice and cookies, eaten about an hour before bedtime, can help you fall asleep sooner.
7. Studies indicate that foods with large amounts of the amino acid L-tryptophan help us sleep better. These include warm or hot milk (but not cold milk), eggs, cottage cheese, chicken, turkey and cashews.

Environmental Factors
1.  Evaluate your sleep environment. Is there too much noise or light?  You may find it helpful to get some ear plugs or sound machines. There may be new noises introduced into your environment that could be making it more difficult to sleep.
2. Try to keep your room as dark as possible. Night time eye shades  could  be helpful. Also consider your alarm clock.  If it is a particularly luminous one, this can be extremely annoying if you're having a hard time getting to sleep.
3. Fresh air and a cool room temperature  will provide best sleeping conditions. Adjust the temperature inside the bed --with more or fewer blankets.
4. Listen to Music. Music should be soft and soothing. There are cassettes and records designed for that very purpose. Other sounds to try to lull you to sleep could be sounds of waves, wind, or other relaxing sounds.
5. A firm bed will give your entire body the support it needs to really relax. It's better for your spine, too. Sleep on your back. This allows for better passage of air and facilitates easier breathing.  

Sleep Friendly Behaviors
1.  Try to keep your sleep and wake times consistent, even on weekends. If you have had a difficult  time sleeping one night, don’t try to catch up with it by sleeping twice as much.  Your body likes regular routines, even if you don’t.
2.  Avoid day time naps.  This will only further throw off your sleep cycle.
3.  Keep a sleep log.  Look for patterns. If you are having success on one night, find out what you did differently and try to repeat it.
4.  Spend your normal sleep time (i.e. 6,7,8, hours) in bed.  If you are used to sleeping eight  hours a night, spending twelve hours to get that amount of sleep will only frustrate you.
5.  Decrease your activities as you approach your desired sleep time.  The more active you are the  more time it will take to settle down to sleep. Individuals with jobs that require a lot of thinking throughout the day, have far more trouble sleeping than individuals who work in more physical settings.  For these individuals, wind down time is especially important.
6. Regular exercise is helpful. Exercise allows for better oxygen and blood flow which helps you relax more and sleep better. Too much exercise or doing it too close to bedtime would be counterproductive.
7. A warm bath is a great way to relax your body. You could also use ingredients to add to the bath...bath salts, Epsom salts,   baking soda, or bath oils. These will relax you and also help remove toxins from your body.
9. Massages could also aid in the transition to sleep. Have your spouse (or whoever) give you a massage just before going to sleep. Items such as foot or back massagers could be bought from most stores.
If your sleep difficulties persist, let your therapist know. You and your therapist may want to explore this with a more focused approach.

Why do men go through midlife crises?

Throughout our life cycle, both men and women experience specific developmental challenges relative to their age. These challenges start as early as the first few months of life(mastering motor skills) to the end of life(acceptance of diminishing capabilities). Depending on your religion or theoretical orientation, these stages could be broken into anywhere from 4 to 7 stages.

Regardless of your orientation or religion, certain stages in life present different challenges. Midlife, chronologically, could be anywhere from 40 years of age to 60. During this time, a person may be reflecting on life goals, achievements, disappointment, uncertainty about future coarse of life, and status in life. For some, this contemplation could lead to confusion, uncertainty, anger, or regret. Just as any stage in our development, these thoughts to- feelings experiences could turn negative and destructive.

The reason this developmental stage is given more attention is the level of impact this crisis can have on others. Symptoms of struggles at this age have more impact on family and careers than other stages. There may be more historical references about men having these type of crises but as woman have taken on roles that were once reserved for men, we are seeing similar impact on families these struggles have taken. More attention may be given to a father who makes drastic changes in his life than an adolescent who is rebelling(a common response to a teenagers developmental challenge at that period). Woman may go through their own midlife challenges and present the conflict differently or the impact may be seen differently. It does not mean they are sailing through this period of life carefree.

The causes could be from external events(getting fired from job) to internal reaction to a situation(having a good friend have a heart attack). It is important to understand that some struggles at different stages in life are normal. What we could define it as "crisis" is relative to the situation and how this conflict plays out. Having a support group to use as a reference point or sounding board are often helpful. Talking concerns out with a trained therapist could also help, especially if decisions are being made that have significant implications.

Mark Myers expert answer to: How can I manage my anger?

When anger is mismanaged, the problems it can create could vary. Often physical problems such as ulcers, high blood pressure, and gastro problems could occur. Other problems such as social and relationship problems, occupational problems, and law problems could also present themselves.
When trying to figure out destructive anger, it is important to realize that anger could serve many functions for us. Examples include: getting our way through anger episodes, feeling superior to others, feeling powerful, expressing thoughts (especially hurt), discharging excessive energy, remaining a victim (not taking action but focusing on what is making you angry), and increasing production and motivation. In order to change the way you deal with your anger, you need to be willing or motivated to change. This would involve giving up the advantages you experience when angry.

Managing your anger involves rethinking the way you look at problems, creating more awareness to patterns to your anger, utilizing relaxation techniques, and making lifestyle changes.
We cannot escape from anger. This is a natural human emotion. However we are able to control anger. If you have continual problems in managing your anger, discuss this with a therapist.

How do you know if your teenager needs to see a therapist?

Teenagers are not always able to articulate what they are feeling. At this age they are going through many changes, which include hormonal, psychological, physical, and social. It is common that we may see a child struggle at some point during these years. Complicating matters, teenagers may not verbalize these feelings to peers for fear of being different or to adults because they may feel they will not understand. Therefore, adults may need to look for behaviors that stand out to indicate a youth may be struggling emotionally.

The following are indicators a child may need to see a therapist:
• Extreme or intense anger
• Slip in grades
• Isolating
• Change of friends
• Low opinion of self
• Lack of interest in activities
• Anxiousness
• Change in sleeping habits
• Poor concentration
• Behavior challenges in school
• Talking about death and dying
• Change of eating habits
• Avoiding family
• Change of appearance

These behaviors may not mean there is a problem, but nonetheless would be important to broach the subject with a child. Showing a child you care and want to listen to them go a long way with teenagers. If this discussion does not put you at ease, it would be advisable to introduce them to therapy. Even though a teenager may initially be reluctant to go to therapy, it still would be beneficial. If a teenager establishes a good connection with a therapist, they will understand therapy is a safe place for them to discuss their problems.

Mark Myers expert answer to: What are the signs of Depression?

A person may be depressed for a variety of different reasons including: a life event (death of loved one, divorce), substance abuse, a situation in life (being in an unhappy marriage), a feeling of depression without any noticeable starting point, a medical condition or any combination of the above.

The symptoms of depression include any of the following symptoms: feeling sad for most of day, decrease in pleasurable pursuits, weight gain/weight loss, fatigue, feeling guilty or worthless, isolating, sleep difficulties, difficulties concentrating, and recurrent thoughts of death. Any single one of these symptoms could bring a person to see their doctor or.

Diagnosing depression may not seem as easy as one would think. A person may be depressed but not necessarily identify their symptoms as being the cause. Some one may see a doctor for sleep difficulties, but upon further questioning might have other symptoms of depression. A thorough exam should uncover other symptoms that would lead to a diagnosis of depression. If any of the aforementioned symptoms persist for a while or impact your life, you should seek out help. If you are seeking out help from your doctor, it is important for both patient and doctor to discuss other symptoms or events that are occurring in a person's life as opposed to just looking at the initial symptoms.