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Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterized by unreasonable thoughts and fears (obsessions) that lead to do repetitive behaviors (compulsions)

Mental Health and Grief

Grief and Mental Health – When the Two Merge

Grief is something that we all experience at one time, or another.  The stages of grief – sometimes explained as 3, 5 or 7 different stages – are pretty well known and include shock, denial, anger, sadness, acceptance in some order.  Most people will struggle but eventually come to some resolution with no prediction as to how long that will take.

Resolution of deep sorrow can be made much more difficult when a pre-existing mental illness is imposed.  A severe loss can trigger a relapse of virtually any mental illness, even when the illness was well treated, and the patient was stable.  Patients may relapse into severe depression, bipolar episodes, panic attacks or a return of obsessive compulsive behavior.  If the patient was not well stabilized, the whole apple-cart can be upset.

Depressed and Suicidal GirlEven the most mentally healthy person can become unstable if unable to resolve the feelings caused by painGrief has been known to result in clinical depression, lasting for a long period which can lead to extreme difficulties and even death in the case of suicide.  The problem comes in a case where one becomes “stuck” at a certain point – usually during the agitation period.

There is a saying;   “depression is anger turned inward.”  The existence of anger over an extended period can cause depression.

Anger allows us to have a heightened response to a threatening situation.  Anger fuels energy, giving us a false sense of power, but over time, the brain and the body run out of that same energy.  This can result in fatigue, emotional lability, and symptoms of depression.  In some cases, depression caused by grief may be resolved with grief counseling.

In other cases, however, depression may have become severe enough that medication may be warranted.  Clinical depression is characterized by:

•    Fatigue and decreased energy
•    Cloudy thinking
•    Feelings of guilt, worthlessness or helplessness
•    Insomnia or excessive sleeping
•    Irritability
•    Loss of interest in pleasurable activities
•    Body pain or digestive problems
•    Persistent sad or empty feelings
•    Thoughts of suicide

How different is this from grief – not much.  The only difference would be in how long it lasts.  Depression carries a high risk of suicide and if symptoms last longer than what would be considered “normal” – for any reason – you should seek treatmentMental Health ChaosDepression that is severe enough to interfere with normal activities for longer than four to six weeks should be treated – even if life circumstances explained it.  Counseling may work – or you may need medication for a short period.

If you have some known mental disorder, stay in contact with your mental health professional.  Most – and I did not say “all”, but most mental health patients find it difficult to self-assess, some find it difficult to be openly honest.  The only way to ensure that an episode of grief is resolved without severe consequences of going “off track” is to allow someone else to help assess your mental state.

Whether you are or are not a mental health patient, know that grief can cause mental illness and can worsen an existing illness – even if only for a short time.  It is not something to be dismissed or ignored as the risks are high.

Melissa Lind

Depression is Anger Turned Inward

Obsessive Compulsive Disorder – OCD

Collecting, Organizing, Checking, Washing…. Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder.

OCD - Bug ObsessionIt is composed of two parts: Obsession and Compulsion.  Obsession is the portion of OCD that occupies your thoughts such as excessive concerns about cleanliness (my kids call this germophobia), extreme social fear, fear of harming someone, preoccupation with organization or other intrusive thoughts that create anxiety.  Compulsion is the physical manifestation of needing to do something about the obsessionsCompulsion results in behaviors such as ritualistic behaviors like excessive hand washing, repeatedly checking to make sure the stove is off, counting steps and other extreme behaviors such as hoarding.

OCD the Good
Once I while participating in a wedding, I was attending the rehearsal dinner at the home of the bride whose mother made the appetizers for over 200 people.  I was amazed at her management skills that made her capable of preparing appetizers from a single kitchen – right up until the time that when looking for the restroom adjacent to the laundry, I opened the pantry door.

There, staring at me were over 100 spice containers, of all the same brand, all the same size and all angled at a precise 45-degree angle so that the labels were all pointed exactly at my head.  I was so dumbfounded that I continued to stare and found that on the other shelves there were precise pyramids of 5 cans each of various vegetables – all the same brand, all the same size, with all the labels facing exactly the same direction.

Lining the floor were plastic bins, spaced 2 inches apart…exactly, containing 3 bags each of a variety of pasta, flour, rice…. all of course the same brand, carefully placed in the bin, with the label in exactly the same location.

This is OCD at its best – at least for others.  She had an obsession and a compulsion that created this superbly organized pantry.  Likely though, even this “good” OCD manifestation took up a lot of her time – and had a negative impact on her daily life and that of her family’s.

OCD is not always at its best however and can result in the opposite – hoarding.  I don’t have to go into this but if you haven’t seen it, you should watch “Hoarders” or “Hoarding, Buried Alive” for some insight.

OCD the Bad
In addition to situations like hoarding, OCD can also interfere with life in other ways.  I have a cousin with OCD, who before he was medicated, found himself unable to leave his driveway due to fears that he would back over a child with his car.  This caused him to spend hours – literally hours every morning starting the car, looking in the rear view mirror, getting out of the car to look behind it, getting back in the car, looking in the rear view mirror, getting out of the car….  He eventually found himself unable to work.

Obsessive Compulsive Disorder - OCD Confused MindOthers have found that OCD has limited their lives in similar ways.  Howie Mandel, a well-known comic, has talked about his Obsessive Compulsive Disorder.  It prevented him from appearing in public for many years, in part due to social fear but also due to fear of infection.  Even today, while his disease is “under control,” he does not ever shake hands or allow others to touch him.

How do I know if I have OCD?
A lot of people have rituals – such as specific routines before bed.  A lot of people have extreme concerns which may consume thoughts for a while – such as excessive concerns over money.  The difference in “normal” rituals and “normal” concerns is that they don’t typically impair normal life and they don’t become paralyzing.

Thoughts and behaviors that might indicate OCD:
•    Repeated thoughts or mental pictures about things such as
o    Germs
o    Dirt
o    Intruders
o    Violence
o    Hurting others
o    Embarrassment
o    Disorganization
o    Religious beliefs
•    Repeated behaviors such as:
o    Washing hands
o    Disinfecting surfaces
o    Locking and unlocking doors
o    Counting
o    Repeating steps over and over
o    Keeping unneeded things
o    Excessive grooming
•    Lack of ability to control or stop unwanted thoughts and behaviors
•    Repeated behaviors provide temporary relief from anxiety that is caused by obsessive thoughts
•    Repeated behaviors don’t provide any pleasure other than temporary relief
•    Spending at least 1 hour a day on thoughts and behaviors, creating a negative impact on daily life

The International OCD foundation reports that it takes around 15 years for most people to be diagnosed.  This may be due to hiding of symptoms – but it may also be due to lack of awareness of both the public and health professionals.

What can be done about OCD?
OCD can be treated – it usually cannot be cured but can be controlled.  First line treatment for OCD includes working with a properly trained therapist – most beneficially, one who is trained in cognitive behavioral therapy (CBT).  CBT uses “exposure to” unpleasant stimuli, carried on to the “what if” stage.  “What if” I touch that faucet without disinfecting it?  “What if” I get into the elevator without opening the door 10 times?  The “exposure” period is followed by “response prevention” where the patient chooses NOT to perform the behavior that the “exposure” usually causes.  Over time, the obsession and compulsive thoughts and behaviors become more manageable.
In other cases, medication may be needed – usually given in combination with CBT.  Some antidepressants (not all) will help with OCD.  Anti-depressants that have been shown to help include:
o    Luvox (fluvoxamine)
o    Prozac (fluoxetine)
o    Zoloft (sertraline)
o    Paxil (paroxetine)
o    Celexa (citalopram)
o    Lexapro (escitalopram)
o    Effexor (venlafaxine)

Other medications may also help but have not been “approved” to treat OCD.  Doctors who have found them helpful may use them regardless of whether they are officially approved to treat OCDMedications such as Cymbalta (duloxetine) have been reported to be helpful – and some patients may benefit from short-term use of anti-anxiety agents.

It is important to know that all medications may cause side effects and you should tell your doctor about any other medications you are taking.

Melissa Lind

Obsessive Compulsive Disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety and by repetitive behaviors aimed at reducing that anxiety.

Obsessive Compulsive Disorder can be treated!

Getting Out of Depression

Some tips to get you out of depression

Major depression is the third most common mental disorder in the US.  Nearly 7 percent of the US population is affected in any one year.  Incidentally, if you are keeping track, the two most common mental disorders are Anxiety disorders and Phobia disorders, including Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder.

Major Depression, also called Major Depressive Disorder (MDD) has an average onset of 32 years of age and is more common in women than in men.  It is also called “unipolar depression” by those who are familiar with Bipolar disorder.  It may include a subset of depressive disorders such as Seasonal Affective Disorder (SAD), which affects people yearly – usually in the winter and Dysthymic Disorder, which is a less severe form of depression.

In order to be diagnosed with Major Depression, a person must meet the DSM criteria including at least five of the following for at least two weeks:
•    Depressed mood most of the day
•    Diminished interest in all or most activities
•    Significant, unintentional weight loss or gain
•    Insomnia or sleeping too much
•    Agitation or psychomotor retardation (slow movement) noticeable by others
•    Fatigue
•    Feelings of worthlessness or guilt
•    Diminished ability to think or indecisiveness
•    Suicidal thoughts

In some cases, depression can be relieved by changes in lifestyle or with psychotherapy, but in severe cases – medication may be warranted.  We are fortunate today in that there are a number of effective medications that have fewer side effects than previous treatments, and the category continues to evolve.

Even with medication – that may not begin working for at least several weeks – some lifestyle changes, and habits may help a person “emerge” from their depression and manage symptoms in the future.

Major DepressionLifestyle changes are difficult, particularly when depressed, but the effort it takes to “soldier through” is worth it in the end.  These tips for helping with depression are not easy – especially when you do not have any energy and don’t feel like getting up, but even though they may not provide a cure – they almost always provide some help.

  1. Get up and move – this is the hardest for most people to do.  It may take a tremendous amount of efforts but even simply getting off the couch or out of bed and walking around the house will help.  Getting up and moving around will increase your blood flow and heart rate will help increase blood flow to your brain and may convince your body that “hibernation” is over.
  2. Get dressed – you may have been wearing the same clothes for many days.  Changing into a “daytime” outfit can help regulate your time clock and may help you feel like you can accomplish something.  If you wear makeup or fix your hair, do so – and by all means, take a shower.
  3. Get out in the sun – don’t stay long enough to get a sunburn but studies have shown that bright light helps your brain wake up.  It resets your internal clock by adjusting your melatonin levels (a hormone responsible for inducing sleep).  It also triggers a “springtime” effect – that again tells your brain and body that winter is over, and it is time to come out of hibernation.
  4. Talk to a friend – making a phone call may not be tops on your mind, but even a wordless chat can help you feel like someone else is aware of your existence.
  5. Watch something enjoyable – even if you don’t want to enjoy anything, do something that would normally make you happy.  Just a little bit of happiness peeking through can go a long way.
  6. Go to bed and get out of bed at normal hours – sleep patterns are often destroyed by depression.  Reestablishing those normal patterns will help reset your internal clock to a natural level.
  7. Don’t take naps – again with both the normal sleeping hours and with the “getting up.”  Reinforcing physiologic habits will help establish normal brain functioning.
  8. Eat healthily – you may want to eat everything, nothing, or only certain foods.  Likely, no matter how much or how little you are eating, you are deficient in some of the necessary vitamins and nutrients – so eating a healthy diet and taking a multivitamin mineral supplement is a good idea.  B vitamins are especially helpful to restore nerve cell functioning, C and E are useful for combating inflammation that can cause sluggishness, D vitamins are useful to aid in the “sunlight” phenomenon discussed before, Calcium and Magnesium are good for the brain cells which are malfunctioning.

Most people who are depressed will find a lot of these activities difficult – and you may only be able to do one or two a day.  None of this is meant to be insulting, but there is science behind all of it – and others have been through it before.
With the help from the medication and the lifestyle adjustments – you will feel like you are coming out of the fog – and be able to do all of them – or sometimes, choose not to.  Choosing not to do something is different than feeling like you are unable to do something – and you want to have control of your life.

– Melissa Lind