Mental Health Solutions Blog

The common thinking of the cause of Depression in the last 15-20 years has been that it is due to a chemical imbalance. Recently, it is found to be more complicated than that.
It is true that many people’s symptoms are improved with the use of antidepressants. Whether it be by a selective serotonin reuptake inhibitor (SSRI), or selective norepinephirine reuptake inhibitor (SNRI, tricyclic antidepressant or another class, they all are helpful for many people. But it is also believed that close to 50% of people do not benefit from antidepressants. Personally, I question that number when I think about my own practice and how many people have improved. In my own experience, I see 70-80% improving with antidepressants. The prior low numbers may be due to a person getting their meds from a general practitioner than from a specialist who is more adequately prepared to choose the correct type of medication. It could also be that in my practice, I follow my patients much closer than the typical GP who gives psychiatric meds to their patients. Additionally, most of my patients also receive from me some type of counseling or therapy and other health counseling so that should surely be a factor in my better outcomes.
Other factors that appear to be related to depression are genetic predisposition, other illnesses like Diabetes, heart disease, Parkinsons and Cancer, lifestyle factors such as substance abuse, exercise and nutrition. In the last few years there has also been much research directed toward inflammation and its influence on depression which is also showing a lot of promise.

Considering the complexity of issues related to Depression, in my practice I have a multidimensional holistic approach to target Depression.  In my practice, I use a combination of therapy, lifestyle counseling, nutritional counseling, spirituality, and medication prescribing if appropriate and the patient is interested. I have helped many many people overcome the terrible delibitating disease of Depression.

Tags: cause, chemical imbalance, Depression, genetics, lifestyle counseling, medication, spirituality

Obesity is sadly at epidemic proportions. Most of us  are very aware of the devastating health consequences of obesity: diabetes and other metabolic syndromes, heart disease, stroke, even Cancer.  So many are trying to fight the battle of the budge whether it be Weight Watchers, Jenny Craig, Nutrisystem, Atkins and others. There is numerous studies identifying the pros and cons of these programs.
This month I read a very interesting article  in the journal of “Diabetes, Obesity and Metabolism” (December)  This article reported a very intriguing study not normally looked at in weight loss studies. The study looked at how different weight loss programs effected weight loss success. There were three groups. (1) standard nutrition counseling; or (2) the Department of Veterans Affairs (VA) weight loss program called “MOVE” ;, or (3) methylphenidate treatment plus the MOVE program together. The intervention was for 6 months (26 weeks). The last group targeted decreasing apathy. They did this by administering a medication that decreased apathy (Methylphenidate. ) The results showed all groups to lose weight but it was observed that those in the group that targeted the symptom of apathy lost the most weight. This is no surprise to me.
In my practice I see many people who present with the symptom of apathy, a state of being where this a lack of interest or caring in the things around them. Often a patient will have no motivation or energy to eat healthy, to exercise, to address a health problem or do those things that will help them feel better or be in a healthier state. Many of these patients are depressed but others have anxiety, psychotic illness or sometimes ADHD. Interestingly, I will notice after treatment which may include Cognitive Behavivoral Therapy, nutritional supplements, goal setting, and for some, the use of medication that has an added effect in decreasing apathy, that many report  they lose weight.  They notice a higher engagement in healthy habits that wasn’t there before. They may notice less binge behavior.

While I don’t advocate the use of medication for everyone,  for some people with diagnosable mental health conditions medication may be quite helpful in losing or preventing weight gain through the mechnism of decreasing apathy.  Psychotherapy, particularly CBT, is also very useful in helping with weight issues. Anything that will help a person be more mentally healthy I believe will contribute to healthy weight.

Now, I know it is the holiday season, but please do not pass the eggnog!

Tags: ADHD, anxiety, Apathy, Cognitive Behavior Therapy, Depression, motivation, psychosis, weight loss

There has been very interesting research over the years discussing what types of personality traits effect the perception of happiness. There is evidence that suggests that extroverted people are happier than introverted people. This makes sense as it has been found that extroverted people are more likely to surround themselves with people, which we know is recommended to depressed people to help improve mood. Isolated people tend to be more depressed than more social people in my experience working with the mentally ill. Other studies attribute happiness with the quality of optimism

There is another study that I found that I find very interesting. It is found in the Journal of Affective Disorders in January of this year. “Personality and the perception of health and happiness” Cloninger CR, Zohar AH.  In this study they found that the traits of Self-directedness was strongly associated with all aspects of well-being. Additionally, Cooperativeness was strongly associated with perceived social support which we know is strongly associated with well-being. Another personality trait of Self-transcendence was associated with positive emotions.
Can these personallity traits be developed? The research is not clear but I believe it can. Cognitive behavioral therapy is one way. Another way I forsee in developing these qualities would be through the development of spirituality. I regularly see patients in my practice who have been able to develop these qualities to help them be more happy people. That is why I regularly engage my patients in CBT and also have discussions of spirituality to those patients who are open to it. Many have been able develop these personality traits and others that have helped them improve their perceptions of happiness.

Tags: CBT, Depression, happiness, mental health, personality, spirituality, well-being

There have been numerous articles extolling both the benefits and harmfulness of caffeine. Less often has there been research on the effects on mental health. What’s my opinion? I advise caution in its usage.

There has been insufficient studies showing any benefit of caffeine on mental health. A few studies have suggested caffeine has a positive effective on depression and ADHD. This may due to caffeine increasing alertness, attention and cognitive functioning and by possibly elevating mood. There is also preliminary evidence of caffeine benefiting some people struggling with Obsessive Compulsive Disorder which I thought was interesting because OCD is a subset of an anxiety disorder and my experience has seen caffeine making anxiety worse. Neveretheless, the research is compelling.

But do the benefits outweigh the negative side effects? We know that caffeine can increase heart palpitations and contribute to stomach problems such as Gerd. These are annoying troublesome physical side effects. What do we know about its mental health downside? We do know that caffeine is addicting and may encourage other types of addictions like cigarette smoking. We also know that caffeine in large amounts can bring out psychosis and manic behavior as well as exascerbate general anxious states, panic disorder or social anxiety disorder.

My advice is to keep caffeine to a minimum. If you struggle with Depression, OCD or ADHD, see your primary care mental health provider to investigate safer, healthier treatment for your mental health conditions. There are other things less harmful and that can do the job more effectively than caffeine.

Coming out this month in the British Journal of Pharmacoloy is an interesting article about the links between selective serotonin reuptake inhibitor (SSRI) usage and the risks of myocardial infarction. It has been believed for awhile that a SSRI, which is a particular class of antidepressant, acts immediately to prevent future heart attacks presumably by its anticoagulant properties. In this study they concluded there was something else in SSRI’s that works long-term to prevent heart attacks.
I am wondering if it is related to inflammation? In recent months, SSRI’s have been found to decrease inflammation. Perhaps that is the same mechanism that prevents future heart attacks? Or is there something yet undiscovered?

This is yet another example of how the body and brain effect each other. When one improves the condition and health of the body, the brain also is effected for the positive! It also works the other way around. If one improves brain health, the health of the body will improve also! If you have had a heart attack or are at high risk, you might want to discuss with your nurse practitioner or doctor the possible treatment of a SSRI.  Your heart and brain will thank you!

Tags: antidepressants, body and mind connection, myocardial infarction

There is a very interesting study out of the journal of Child Psychiatry and Human Development out this month. It was a study of children with Autism Spectrum Disorders who suffered from anxiety. The purpose of the study was to try out Cognitive Behavioral Therapy (CBT) for 16 weeks with these children to see if anxiety could be reduced. This therapy was also compared with a Social Recreational program.
Results were significant. Children in both groups showed lessened anxiety levels at 6 month follow-up.
This study also made suggestions to make programs successful. Factors such as regular sessions in a structured setting, social exposuire, the use of autism-friendly stategies and consistent therapists were mentioned as components of effective management of anxiety in children and adolescents with ASD.

Tags: adolescents, anxiety, Autistic Spectrum Disorders, behavioral management, CBT, children

Attention parents out there! Have you noticed that your children from the very earliest ages display male or female type of behavior no matter how hard you try to “unbias” them and give them the full spectrum of experiences of cars and balls, baby dolls and barbies? As a mother of five I remember a particular daughter from babyhood who only liked frilly pink and purple dresses and baby dolls but never pants, cars and balls.  I deliberately tried to get her to wear blue clothing as I was never dressed in pink as a child and was never attracted to that ultra-feminine frilly look. I also never liked sports as a child and tried to introduce her to something I never had like soccer and soft ball with the hope of making her a more-rounded individual. No such luck! She hated sports, she hated pants, desired only to wear pink and purple with frills, and played dolls and barbies having no interest in balls or cars. She was so rigid in her ways that she often drove me to the brink of parental craziness!

Yesterday, there was an article in my local Bend, Oregon newspaper about gender neutral parenting being on the rise. This is really concerning to me with my personal and professional experience and what I know about brain science. I believe while it sounds like a good idea in reality is harmful to our kids. The article quoted a person in a Social Work program who stated that sex was determined at birth and that gender is socially learned. This is a politically correct philosophy but it doesn’t match up with current brain science. Boys and girls brains are different and are used differently by each sex. There is a learning difference that  isn’t recognized in a majority of education curriculum. This is why I believe that we have many more diagnosed ADHD boys out there. Teachers aren’t engaging them in the way they need to be engaged and the boys are bored, restless, distracted, even physically aggressive. I am a professional that works regularly with ADHD kids and their families. I prescribe medication often per parent request which is sometimes unfortunate as we really don’t know the long term effects of stimulant medication. I feel the problem needs to be partly remedied in teaching methods that recognize sex differences and not one size fits all. Boys learn by games, challenge even competition. That has been largely removed from school with a preference of touchy feely types of teaching which works great with girls but not boys. Until our school’s teaching methods match up to current brain science, I am afraid our children will not learn up to their full potential.

Tags: ADHD, gender neutral parenting, School curriculum, sex differences

04/20/11

Many experts now believe that plastics are hurting our brains. Teenage boys today have lower testosterone levels than their grandfather’s did 30 years ago. Teenage boys are also suffering more ADHD symptoms: lack of motivation, drive, ambition, ability to plan and follow-through as well as increased rates of depression. Gender confusion has escalated in recent years. Girls are developing way earlier than they did even 15 years ago. Many researchers now believe that this may all be due to the increased use of plastics (or bisphenol A) in our society. Another cause may be herbicides and pesticides which I will not address in this article and will save for another time.

Recently, the FDA has come out with a statement that basically reverses a previous statement they made claiming that low levels of bisphenol A (BPA-the chemical in polycarbonates) does not have long term health consequences in humans. Please note: they now believe that it is harmful to humans! There have been a plethora of research supporting this view in recent months. Frankly, I am surprised it isn’t more prominent in the news given the enormity of research and the severity of BPA effects. Please note that BPA release estrogenic chemicals that are endocrine disrupters.

In the January 27, 2011 edition of the Brain Development journal it claimed that prenatal and lactational exposure to low-doses of BPA alters adult behavior.

In the April 23, 2011 journal of Current Opinion Pediatrics it found that there was a relationship between prenatal BPA exposure and increased hyperactivity and aggression in 2 year old female children.

The Mar 22, 2011 edition of Reproductive Biomed Online found that BPA effects reproductive health by interfering with the process of implantation of endometrial stromal fibroblasts.

There are many more human and animal studies that cannot be ignored that I don’t have room or time to address. One such animal study from China reports that rats exposed to BPA take longer than control rats in figuring out how to get through a maze. The FDA also recognizes that these animal studies cannot be ignored and they are calling out for more research and more comments by the public. In the meantime, they have preliminarily warned the public about BPA in baby products such as baby formula, which cans are often lined with BPA and baby bottles and pacifiers. It is believed that babies are particularly vulnerable to the effects of BPA. They advise to use BPA free types of plastic.

The problem is, there have been other research showing that virtually all plastics have BPA in them, even those claiming to be BPA free. What is one to do?

My advice? Get rid of as much plastics in your house as possible. I threw out all my plastic tupperware and now use glass containers. I use wax paper instead of plastic. I try and use food products that have not been packaged in plastic or tin cans. (Tin cans are often lined with BPA.) Also, do not drink out of water bottles or juice bottles! We have no idea how long these bottles have sat in a warm truck somewhere leaching its BPA into the product. Studies show that by eating more fresh, unpackaged, unprocessed foods, BPA levels can be lowered.

I am concerned about the children…I hope you are too.

Tags: Bisphenol A, BPA, children, mental health, plastic

1.5 CEUs available

For reservation information, cost, location, and time, see below.

+++++++++ And Next Month +++++++++

April 15, 2011

The Tender Loving Care and Feeding of the Brain:
Current evidence based research incorporating health habits, therapy techniques, psychopharmacology and spirituality in caring for our clients with mental health issues

Presented by: Satu Woodland, PMHNP

In this very practical presentation, I will discuss my practice as a psychiatric mental health nurse practitioner and what I have learned in my 25 years of research/practice in the areas of mental health. I will discuss medical conditions/deficiencies that can create mental health symptoms that are often missed, when to refer for psychopharmacology, why we must be concerned about our clients health habits, key elements of psychotherapy that must be present in any psychotherapeutic relationship, and why it is important to engage the patient’s own spiritual belief systems in providing care. Clinicians will be able to incorporate this information into their own practices and know when to refer out for help with their clients where there is a deficit in knowledge or practice parameters.

Learning objectives:

1) Recognize possible medical conditions that could be contributing to a client’s mental health issues.

2) Understand when referral for psychopharmacology is warranted.

3) Become familiar with current research in health habits that a client needs to be aware of for good mental health.

4) Introduce some current research regarding which therapies work for which types of problems.

5) Identify reasons of why and how to engage a client’s spiritual belief system in his care.

Satu H. Woodland PMHNP is a psychiatric mental health nurse practitioner in private practice in Bend. She has been working in the medical and mental health fields working with adults, teens and children since 1984. She has practiced mostly in the San Francisco Bay Area, California in various in-patient and out-patient settings with the last 5 years in private practice in Bend. Undergraduate work at Brigham Young University and California State University Dominguez Hills. Graduate school at University of California San Francisco. Married for 29 years to local mortgage broker David Woodland, mother of 5 highly productive children and 1 grandchild (with one on the way!), she has extensive practical experience working with children and families. For more information, please visit her website at http://www.bendmentalhealth.com

1.5 CEUs available pending approval

RESERVATIONS: to D’Arcy Swanson: darcys@bendbroadband.com or 419-3947 by Wednesday, two days before the Luncheon. Reservations made after Wednesday will be charged an additional $5. Specify vegetarian meal if desired. 24-hour notice of cancellation is required or you will be charged for your lunch. Visit our website for the latest news, questions and events at www.CliniciansNetwork.com.

These luncheons are held the third Friday of the month, September through June, at Touchmark from 12:00 Noon to 2:15 PM
Cost (includes lunch): $15.00 members; $20.00 non-members; CEU’s add $10 (if available);

Touchmark is at 19800 SW Touchmark Way in Bend. It is on the west side of the Bill Healy Memorial Bridge, just south of the roundabout at Reed Market Road and Mt. Bachelor Drive, and very near the Athletic Club of Bend. Click here for a detailed, interactive map: Touchmark Bend

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Tags: brain, health habits, mental health, presentation, psychopharmacology, spirituallity

I read with interest the article written by Gardiner Harris on the Sunday, March 6th of the Bend Bulletin. “Since talking doesn’t pay, psychiatrist simply write prescriptions.” http://bit.ly/eIhDoh I’d like to mention another option to see for your mental health issues which seemed to be neglected in the article. I am a Psychiatric Mental Health Nurse Practitioner (PMHNP) in private practice in Bend. Http://bendmentalhealth.com Advanced practice nurses, who have Masters or Doctoral degrees in their specialty, are independent providers in most states of the Union. In the specialty of psychiatry, we do psychiatric evaluations, order and interpret lab work, prescribe medications and do psychotherapy. Most of my patients I see for 45 minutes and many I see once or twice weekly. Most insurances will reimburse my fees. Many patients prefer us to psychiatrists as we spend more time with them listening to them. In fact, because I spend more time with my patients I feel I can be more effective in medication management and am more satisfying to the patient. I do not believe good medication management or any psychiatric care can be done in 15 minutes! For more information about PMHNP services in general please feel free to contact the American Psychiatric Nurses Association.

Tags: advanced practice nurse, APRN, PMHNP, psychiatrist