Get Rid Of Depression

Are you blue, anxious, irritable, tired, inundated or emotionally delicate? These forms of mood disorders have become shockingly common, and in a lot of cases, may easily be resolved.

Depression and anxiety particularly have become so prevalent that it’s exceedingly common for individuals to be taking medication for one or even both of these mood disorders. As a matter of fact, the incidence of depression and anxiety has tripled since 1990 and more than twenty-five percent of the adult population in the U.S. suffers from one or more mood troubles.

Occasionally depression or a blue mood might have no evident cause and occasionally it might be caused by a number of elements. Keeping a journal is among the most potent tools available for personal growth and emotional mending. It may and should be a day-to-day ritual. Putting down our views lets us view them as separate from ourselves.

A wellness checklist ought to handle the needs of mind, body, and soul by rendering honest daily goals. It's meant to encourage you as you battle depression, not drown you, so keep it easy.

Beneficial nutrition is crucial when you need to battle depression. This is tricky, as depression tends to cut off the appetite. In order to battle depression, you need to take up enough calories and nutrients to provide your body and brain strength.

Sleep furnishes the armor you require to battle depression. Without enough rest, you're more susceptible to those damaging messages twirling around in your brain, and less able to do beneficial things on your own behalf. 

Depression might be among the worst illnesses we know, but it's highly treatable. Discovering what works might involve weeks or months - and occasionally even years - of frustration and heartbreak, but with the range of options we now have, your prospects are excellent. Furthermore, we're not helpless bystanders. The decisions we make affecting our lifestyles can dramatically better the odds in our favor. To those of you, who are depressed, please look for help - you shouldn't have to hurt one day longer than you have to. For those of you fighting with your treatments don't give up hope. A more brilliant future lies ahead. 

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New PTSD Program Answers Nee

|by Capt. Bryan Lewis

LANDSTUHL REGIONAL MEDICAL CENTER, Germany - Symptoms of combat stress and post-traumatic stress disorder include continual nightmares, avoidance behaviors, denial, grief, anger and fear.

Some Soldiers, battling these and other symptoms, can be treated successfully as an outpatient while assuming their normal duties. For others, however, returning to work and becoming their old selves again were challenges recognized by several mental health professionals across the European theater.

"We were looking at how we can best meet the needs of our clientele, and we were identifying that a lot of the Soldiers needed more than once-a-week outpatient, individual therapy and probably needed more than once- or twice-a-week group therapy," said Joseph Pehm, chief of Medical Social Work at Landstuhl Regional Medical Center.

The solution came in the creation of an intensive eight-week therapeutic Post-Traumatic Stress Disorder Day Treatment Program called "evolution" that began in March 2009 at LRMC. During the eight-hour days, patients enrolled in the program participate in multiple disciplines and interests, including art therapy, yoga and meditation classes, substance abuse groups, anger and grief management, tobacco cessation, pain management and multiple PTSD evidence-based practice protocols.

"I am a great believer in the kitchen sink, meaning I throw everything, including the kitchen sink, and something will stick," said Dr. Daphne Brown, chief of the Division of Behavioral Health at LRMC. "And so we've come with all the evidence-based treatment for PTSD that we know about ... We've taken everything that we can think of that will be of use in redirecting symptoms for these folks and put it into an eight-week program."

Brown, Pehm and Sharon Stewart, a Red Cross volunteer who recently received a doctorate in psychology, said the program is designed from research into the effects of traumatic experience and mirrors successful PTSD programs at Walter Reed Army Medical Center and the Department of Veterans Affairs, as well as programs run by psychologists in the U.S.

"We are building on the groundbreaking work that some of our peers and colleagues have done and just expanding it out," said Brown.

During treatment, patients begin the day with a community meeting where they discuss how well they feel and any additional issues or concerns since their last meeting. The remainder of the day depends on the curriculum scheduled for that week.

The first few weeks focus on learning basic coping skills such as how to reduce anxiety and fight fear, as well as yoga and meditation for relaxation. Eye Movement Desensitization and Reprocessing, or EMDR, an evidence-based practice for treating PTSD, is also conducted during the early phases of the treatment program.

"The concept behind EMDR is that, essentially, memories become fixed in one part of our brain and they maintain their power and control over our emotions as long as they are fixed there," said Brown. "And if we can activate a different part of the brain while we're experiencing that memory, we can help to remove some of that emotional valence from it. So we use physiological maneuvers to activate both sides of the brain."

The goal at the beginning of the PTSD program is to provide patients with a number of tools they can use to help them calm down when feeling overwhelmed, especially before more intense therapy begins in the latter weeks. Cognitive processing therapy is used throughout the program. EMDR and prolonged exposure therapy are also available on an individual basis at the Soldier's request. All three techniques are research-based treatments.

When life-changing events occur, Brown said perceptions about the world may change. For example, before Soldiers experience combat trauma they may think the world is safe. Following combat, a Soldier's perceptions may change - a majority of the world may now seem unsafe. Cognitive processing therapy attempts to re-address experiences and reshift a Soldier's perceptions.

Prolonged exposure therapy is behaviorally based and addresses a Soldier's fears, which are seen as reflex reactions to a stimulus. To decondition the reactions, a patient is continually exposed to the stimulus by retelling the story repeatedly, minus the negative outcome. Brown compared it to riding a roller coaster over and over again to overcome a fear of roller coasters.

"So they're getting EMDR, they're getting cognitive processing therapy, they're getting individual therapy, they're getting group therapy, they're getting education, anger management, self-esteem, relationship issues, grief and loss, yoga, meditation exercise, skill building -- a little bit of everything across the board," said Brown. "Not everything's going to resonate with everyone who comes through, but something's going to resonate for everyone who comes through."

In addition to the overall core curriculum, Brown and her staff have programs such as pain management, relationship enrichment and tobacco cessation to help individualize treatment.

"The core of the group and individual education is consistent for everyone," said Brown. "But we recognize that every patient is different, and we have to tailor-make it to give an individualized treatment plan. We don't keep people in pain management if they're not in pain. We don't give them tobacco cessation if they're not smoking. So we do try and tailor as much of it as we can."

Spirituality, relationship enrichment and gender-specific issues are also areas of focus.
"The program is holistic," said Pehm. "It looks at people from different spheres, not just the medical model, because everything is impacted when someone has combat stress or PTSD - not just the individual Soldier, but everybody who comes in contact with them."

The intensity, length and "kitchen sink" qualities are not the only aspects that make this program unique, said Brown. It is a joint military and civilian effort accomplished entirely by volunteers. The staff is as diverse as the therapy options, and includes chaplains, social workers, Red Cross volunteers, psychiatrists, a nurse practitioner, enlisted psychiatric technicians, and graduate students. Brown said having a sundry of personnel keeps the program fresh and the staff excited.

"The patients get perspectives from people from a number of different backgrounds," said Brown.

Thus far, the staff outnumbers the program's participants.

"By design we started out small, and we were able to establish a really good working relationship with the local Warrior Transition Unit people ... It's been a wonderful working relationship with them," said Pehm.

Evolution is currently on it second eight-week course, with five patients enrolled. The first class had four. The goal is to keep the class size small in order to benefit from the program's intensity. Thinking small also helps keep the impact large by successfully returning Soldiers to their units, while also expanding access outside the WTUs. However, Pehm said they would like to expand the program to include patients from throughout the European Command.

"Ideally, we'd like to max it at about 10 because it is so intensive," said Brown. "These are folks we hope to remediate and return to the Army to be functional members again. Also, if they go back to their communities and their providers or spouses see the changes that have come about, that will increase the willingness or desire of more people to be here."

Though few have completed this young program, signs of success have already started to surface.

"With the last group, the shift from 'I have to be here' to 'I'm so glad I came' was really phenomenal," said Pehm.

"One of them said that he didn't think he was getting anything out of the program," Brown said. "It was about week six until he saw himself react differently to a situation that came up, and watched himself do it differently using skills that he didn't know he learned. He went 'Wow,' maybe I am getting something out of this."

It is too early, and the numbers are too small, to generalize the early trends, but self-completed PTSD checklists showed a significant decrease in reported symptoms for three of the four patients in the first cohort. Additionally, anxiety and depression symptom measures decreased.

"The whole idea is that we know all the changes aren't going to take place here," said Brown. "But we hope we give them enough learning to send them in a different direction. My hope is that we can build a program to provide valid, effective treatment to folks who have put themselves in harm's way at the request of their country, and help them live happier and better lives."

PTSD and Problems with Alcohol Use

PTSD does not automatically cause problems with alcohol use; there are many people with PTSD who do not have problems with alcohol. However, PTSD and alcohol together can be serious trouble for the trauma survivor and his or her family.

How do PTSD and alcohol use affect each other and make problems worse?

PTSD and alcohol problems often occur together.

People with PTSD are more likely than others with similar backgrounds to have alcohol use disorders both before and after being diagnosed with PTSD, and people with alcohol use disorders often also have PTSD.

Being diagnosed with PTSD increases the risk of developing an alcohol use disorder.

Women exposed to trauma show an increased risk for an alcohol use disorder even if they are not experiencing PTSD. Women with problematic alcohol use are more likely than other women to have been sexually abused at some point in their lives.

Men and women reporting sexual abuse have higher rates of alcohol and drug use disorders than other men and women.

Twenty-five to seventy-five percent of those who have survived abusive or violent trauma also report problems with alcohol use.

Ten to thirty-three percent of survivors of accidental, illness, or disaster trauma report problematic alcohol use, especially if they are troubled by persistent health problems or pain.

Sixty to eighty percent of Vietnam veterans seeking PTSD treatment have alcohol use disorders. Veterans over the age of 65 with PTSD are at increased risk for attempted suicide if they also experience problematic alcohol use or depression. War veterans diagnosed with PTSD and alcohol use tend to be binge drinkers. Binges may be in reaction to memories or reminders of trauma.

Alcohol problems often lead to trauma and disrupt relationships.

Persons with alcohol use disorders are more likely than others with similar backgrounds to experience psychological trauma. They also experience problems with conflict and intimacy in relationships.

Problematic alcohol use is associated with a chaotic lifestyle, which reduces family emotional closeness, increases family conflict, and reduces parenting abilities.

PTSD symptoms often are worsened by alcohol use.

Although alcohol can provide a temporary feeling of distraction and relief, it also reduces the ability to concentrate, enjoy life, and be productive.

Excessive alcohol use can impair one's ability to sleep restfully and to cope with trauma memories and stress.

Alcohol use and intoxication also increase emotional numbing, social isolation, anger and irritability, depression, and the feeling of needing to be on guard (hyper-vigilance).

Alcohol use disorders reduce the effectiveness of PTSD treatment.

Many individuals with PTSD experience sleep disturbances (trouble falling asleep or problems with waking up frequently after falling asleep). When a person with PTSD experiences sleep disturbances, using alcohol as a way to self-medicate becomes a double-edged sword. Alcohol use may appear to help symptoms of PTSD because the alcohol may decrease the severity and number of frightening nightmares commonly experienced in PTSD. However, alcohol use may, on the other hand, continue the cycle of avoidance found in PTSD, making it ultimately much more difficult to treat PTSD because the client's avoidance behavior prolongs the problems being addressed in treatment. Also, when a person withdraws from alcohol, nightmares often increase.

Additional Mental Health Issues

Individuals with a combination of PTSD and alcohol use problems often have additional mental or physical health problems. As many as 10-50% of adults with alcohol use disorders and PTSD also have one or more of the following serious disorders:

• Anxiety disorders (such as panic attacks, phobias, incapacitating worry, or compulsions)
• Mood disorders (such as major depression or a dysthymic disorder)
• Disruptive behavior disorders (such as attention deficit or antisocial personality disorder)
• Addictive disorders (such as addiction to or abuse of street or prescription drugs)
• Chronic physical illness (such as diabetes, heart disease, or liver disease)
• Chronic physical pain due to physical injury/illness or due to no clear physical cause

What are the most effective treatment patterns?

Because the existence of both PTSD and an alcohol use disorder in an individual makes both problems worse, alcohol use problems often must be addressed in PTSD treatment. When alcohol use is (or has been) a problem in addition to PTSD, it is best to seek treatment from a PTSD specialist who also has expertise in treating alcohol (addictive) disorders. In any PTSD treatment, several precautions related to alcohol use and alcohol disorders are advised:

The initial interview and questionnaire assessment should include questions that sensitively and thoroughly identify patterns of past and current alcohol and drug use.

Treatment planning should include a discussion between the professional and the client about the possible effects of alcohol use problems on PTSD, sleep, anger and irritability, anxiety, depression, and work or relationship difficulties.

Treatment should include education, therapy, and support groups that help the client address alcohol use problems in a manner acceptable to the client.

Treatment for PTSD and alcohol use problems should be designed as a single consistent plan that addresses both sources of difficulty together. Although there may be separate meetings or clinicians devoted primarily to PTSD or to alcohol problems, PTSD issues should be included in alcohol treatment, and alcohol use ("addiction" or "sobriety") issues should be included in PTSD treatment.

Relapse prevention must prepare the newly sober individual to cope with PTSD symptoms, which often seem to worsen or become more pronounced with abstinence.

Where can you get help?

For a listing of professionals in the USA and Canada who treat alcohol disorders and PTSD, we suggest consulting the membership directories of the International Society for Traumatic Stress Studies or the Association of Traumatic Stress Specialists. For veterans experiencing problems with PTSD and alcohol use, the Department of Veterans Affairs has a network of specialized PTSD and substance use treatment programs. For information on these programs, contact the local VA Vet Center or the Psychiatry Service at a VA Medical Center. (For addresses and telephone numbers, look under the "United States Government" listings in the telephone directory.)

FOR MORE INFORMATION:
EMAIL - ncptsd@va.gov
CALL - THE PTSD Information Line at (802) 296-6300