Monday, May 8, 2017

Diet & Depression

Diet and Depression

Depression diets were first described in the 2nd millennium BCE. Special diets (including donkey’s milk!) were prescribed in ancient Greece and Rome; and nutritionists have since been looking for possible links between diet and depression. With 350 million sufferers globally; the search for effective treatment and prevention of depression is still on. 

Link between diet and depression

Many people with moderate and severe depression are known to consume food of poor nutritional quality. This is often due to the symptoms of depression itself; such as the loss of appetite; lack of interest in day to day activities; and lack of motivation for self-care. Age, living alone, irregular and hectic work schedules, socio-economic status, cultural and religious taboos may further affect the quality of the diet.
The food we eat is broken down to its simplest forms in the intestines. The nutrients are then used to provide energy for the body and brain; and to synthesize essential compounds. Among them are the hormones and neurotransmitters which act as messengers in the brain. A lack of supply in the diet will therefore certainly affect production of these chemicals.
Bacteria present in our gut help in the breakdown, absorption and even in the synthesis of some of these essential compounds. The type of food we eat, in turn, affects the type of microbes in the gut Thus, there seems to be an important link between what we eat; the microbes in our gut, and all aspects of our health, including mental health.

What are the essential elements of the depression diet?

A diet including whole grains, leafy and colourful vegetables, fruits, nuts and legumes, high quality protein in the form of seafood, chicken and lean meats has been found to be positively correlated to mental health.

  • Whole grains contain complex carbohydrates, which are linked to the mood boosting neurotransmitter serotonin. Complex carbohydrates break down slowly in the body, lead to steady levels of glucose in the blood and thus avoid mood fluctuations.
  • Proteins of high quality as in egg whites, chicken, fish, milk products, soy products, beans and legumes are the source of the amino acid tryptophan, which is the precursor of serotonin. Trace minerals - selenium, chromium, and zinc, present in beans, legumes, lean meats, dairy products and whole grains are also linked to the brain and mental health.
  • Anti-oxidants combat the free radicals which cause cell damage in the brain. Rich sources of anti-oxidants are coloured vegetables such as pumpkin, carrots, spinach(containing beta carotene), citrus fruits, tomato, potato, guava (containing Vit C); nuts, seeds and vegetable oils (having Vit E)
  • Omega 3 fatty acids play an important role in mental health and may be used as a supplement in depression. Mammals do not synthesize omega 3 fatty acids and depend on dietary sources which include fatty fish, flaxseeds, and nuts (especially walnuts).

Vitamin D and Depression

Low Vitamin D levels are often seen in depression, but no definite causal association has yet been found. Depression itself may cause low Vitamin D levels, as people with depression are less likely to go outdoors. It would be sensible to correct Vitamin D levels and include fish oils, fish and dairy products in the diet, but use supplements with caution.

In conclusion

Depression cannot be prevented or cured by a special diet. However, a sensible diet including whole grains, proteins, fresh fruits and vegetables will keep you looking and feeling good. Limiting refined starches (the so-called “beige diet” pasta, pizza, bread, baked goods), caffeine, and alcohol also has a beneficial effect on mood. Do not go for any extreme or ‘fad’ diet. It will only add further to your stress and anxiety. A recent study of depression patients shows that diet does not prevent, cure or relieve depression, but diet may have a significant role in recovery and prevention of depression
Diet and dietary supplements are never a substitute for a therapist.
References:
  1. Democritus Junior (Robert Burton). Anatomy of Melancholy (1652). Project Gutenberg release date January 13, 2004. Accessed 08-May-2017
  2. Rashmi Nemade, Natalie Staats Reiss, Mark Dombeck. Historical Understandings Of Depression. Sep 19, 2007. Accessed 08-May-17
  3. Rao TSS, Asha MR, Ramesh BN, Rao KSJ. Understanding nutrition, depression and mental illnesses. Indian Journal of Psychiatry. 2008;50(2):77-82. doi:10.4103/0019-5545.42391. Accessed 08-May-2017
  4. Drew Ramsey. Prescribing a Diet to Treat Depression. February 03, 2017. Accessed 08-May-2017
Did you know? Many celebrities and historical figures have suffered from depression. Writer JK Rowling, musicians and singers Lady Gaga, Bruce Springstein, Sheryl Crow, actors Robin Williams, Jim Carey, Gwyneth Paltrow, astronaut Edwin ‘Buzz’ Aldrin suffered from depression. Abraham Lincoln, also a sufferer, once said “If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth.”

Friday, January 20, 2017

Forgetfulness and Memory Loss at Work

Forgetfulness and Memory Loss

Forgetfulness or failure to remember information, is a common complaint. All of us have at some time or the other forgotten to make that important call, to pick up some items from the store, an anniversary or birthday, or a colleague’s name. Students forget what they have “learnt” during exams. We often can’t remember where we have left our car keys, our wallet or that important document. Is it normal? And more importantly; when do we need to seek help?

Forgetfulness or memory loss and difficulty concentrating are common symptoms of mental health disorders. This is specially so in depression, anxiety disorders, ADHD (Attention Deficit Hyperactivity Disorder), and dementias as shown in the examples below.
A young working professional seeks help for increased forgetfulness and poor ability to focus at work. Further probing reveals decreased interest in doing things at work and home. She is also irritable, depressed and her sleep is disturbed. These symptoms of low mood can exist in the background of memory loss and problems with focus.
A student during exams has high anxiety causing memory loss. She cannot recall the answer to a certain question. She gets nervous. This causes her to make mistakes in the next question. She tends to panic; fail to recall what she studied. This vicious cycle is common in anxiety disorders and can manifest as problems with concentration, memory and forgetfulness.
An older person does not just forget the name of his neighbour (something that may happen to any of us); but also who she is. He has problems using money, and with shopping. Difficulties at work manifest towards the end of the career. Dementias affect the aged; cause memory loss and affect the context of the memory. 
A young professional person has problems organising and completing projects at work. There may be a history of attention and academic problems in school. Working memory gaps are common in this group. ADHD is a common cause of this problem in adults.

Memory Processing in the Brain

To understand further, it helps to know in brief how memory works. It is a 3 stage process
Encoding
The stage when sounds, images and other sensations are given meaning is called encoding. Sensations are coded electrically for access by other brain areas. (We hear a catchy song from a new movie).
Storage
The process of association or tagging the input with other bits of data to make it persist. The song thus gets stored in our long term memory. Initially, the song remains for a very short while. At this point it is in our working or short term memory. It is encoded. However, we forget the song as the next scene unfolds on screen. The song is repeated at the end of the movie; someone hums the song as we leave the hall. The visuals of the song, and the feelings evoked, the fact that it was a famous actor, then reinforce the memory and makes it persist.
Retrieval
When we need to use this stored data, the brain fishes it out from its long term memory. The more the associations or tags we formed earlier, the more easily the brain can access the information.
Problems in memory can therefore occur at any of these stages. Many of these occur at the stage of encoding because we are simply not paying attention; and many other distractions are vying for our focus at the same time. (e.g checking our FB messages while studying). The brain does not multi-task, it can only do one thing at a time.

Repetition, rehearsal and organisation help in fixing and storage of long term memory. The more widespread and elaborate the connections, and the more data available about an input, the more the connections formed by the brain, and the easier it is for the brain to retrieve the information when required. Many cases of forgetting are due to retrieval failures. The information is there in long term memory but we are unable to access it. This is why we can recall certain things at a later date.
Depression affects memory in many ways. Being unable to concentrate is a symptom of depression. Repeated depressive thoughts also block the learning process through distraction. This affects the stage of encoding. Disturbed sleep which is a common symptom in depression hampers fixing into long term memory.
Forgetfulness is common in ADHD of adults. ADHD lowers the power to focus. The person is easily distracted. The attention span is reduced. This impairs short term or working memory. ADHD persists in up to 40% of aduts.
Anxiety gives rise to pointless thoughts (“my father will be so angry if I don't crack this exam”) which frustrates attempts to retrieve the matter learned. The anxiety provoking thoughts distract from the text which is being studied and impedes the  encoding process.
In dementia there is destruction and loss of brain cells. Dementia blocks all stages of the memory and learning process. The process is not reversible.

Forgetfulness and Memory Loss – when to seek help?

  • When it affects our work, or the quality of our work
  • When the failure to learn and recall affects our daily activities and functioning
  • When there are also problems including sleep, appetite, inter-personal or behaviour changes.
  • When it is strange - leaving keys in the fridge 
  • When it can harm - often leaving cooking burner on, leaving doors unlocked at night
In normal forgetfulness, the person may recall the memory when some cues are given. The memories were encoded, they just needed some reminder to access them. In clinical disorders resulting in memory loss the memories were never laid down in the first place, or the storage structures in the brain are destroyed. Access to these memories may not be possible. 
References
  1. Brydges CR, Ozolnieks KL, Roberts G. Working memory - not processing speed - mediates fluid intelligence deficits associated with attention deficit/hyperactivity disorder symptoms. J Neuropsychol. 2015 Dec 31. doi: 10.1111/jnp.12096. [Epub ahead of print]

Saturday, May 21, 2016

OCD – Obsessive Compulsive Disorder

OCD Obsessive Compulsive Disorder

What is OCD?

OCD – Obsessive compulsive disorder – is a severe type of anxiety disorder involving obsessions and compulsions that affects the day-to-day functioning of a person.

What are obsessions?

Obsessions are thoughts, images, or impulses that occur over and over again; cause severe anxiety; feel outside the person’s control and affect the day to day functioning of a person.

What obsessions are not

Most of us know what it is like to be preoccupied with a thought, idea or even a person sometimes. These are not obsessions. They often give pleasure, usually pass off soon and do not affect our daily routine or work. Certain types of personality are also linked to a fastidious concern for details and “correctness”. However, this is not associated with anxiety and hence not an obsession.

What are compulsions?

Compulsions are repetitive behaviours aimed at decreasing the anxiety associated with the obsessions.

What compulsions are not

Not all repetitive behaviours are compulsions. Bedtime rituals, religious practices, learning new skills involve repeating an activity. Behaviours also depend on the condition and situations of a person’s life. Arranging wares back on shelves are a normal part of a shop assistant’s work and are not compulsions.

Types of obsessions and compulsions in OCD

Contamination
Contamination is among the commonest of obsessions. There is a fear of dirt, germs, waste, toxins or body secretions. A person is afraid of getting an illness or spreading it. Sometimes he/she may just have feeling of “not being clean”. Touching an “unclean” object or even being near it may cause extreme anxiety. This is only eased by repeated washing and cleaning. Often the washing has to be done in a particular way or be repeated many times before he/ she feels clean again. The person also goes through great trouble to avoid or prevent contact with the contaminants. In time, they may become house-bound and force family members to also follow these cleaning rituals.
Pathological doubt
A person worries all the time that he will cause some harm to himself, his family or others due to his own carelessness. ‘Did I lock the door?’; ‘Did I switch off the lights?’; ‘Is the gas turned off?’ This constant questioning, doubt and responsibility leads to a compulsion to check and recheck. He may need to check the gas switch and the locks so many times that he gets late for work or is unable to sleep at night. Though he knows that the task is complete, his compulsive, repetitive behaviour continues.
Perfectionism and need for symmetry
A person has a need to do or arrange things “perfectly”. Items on his desk have to be placed in a certain way; or his shoes may need to be stacked in an exact order. He may need to perform certain actions or behaviours a certain number of times or in a precise order to have a sense of ‘completeness’. A child with OCD may worry that his homework is ‘not quite right’ and spend hours checking, erasing and re-doing his work because his T’s are not crossed properly. A person at work may feel that the day will go badly for him if he does not take a certain number of steps (say in multiples of seven) to his desk.
Concern about illness and disease
A person may have an irrational fear of developing a serious or incurable illness-usually HIV, heart disease or cancer. He may consult doctors and visit hospitals repeatedly. Despite normal medical reports and reassurance he will get investigations done again and again.
Distressing sexual thoughts and images
'Sinful' religious images are other common obsessions. This specially occurs near religious places or during religious rites and rituals. He may feel intense guilt and avoid such places or services in the future.

OCD Treatment

Treatment of OCD consists of cognitive behaviour therapy (CBT) and medication. OCD treatment is best done as early as possible, as chronic OCD can affect daily life, work and relationships. CBT is essential for all patients with OCD. CBT tackles the obsessive thoughts [Cognitions-C]; the compulsive behaviours [B] in a methodical way [Therapy-T]. CBT by itself can reduce symptoms and delay or prevent relapses.

OCD medication may be required when symptoms are moderate or severe. Medication for obsessive compulsive disorder is usually combined with CBT. The outcome of therapy also depends on family support; and the patient’s own insight, motivation and readiness for change.

Monday, April 18, 2016

ADHD and Me

ADHD and Me

Hi. I’m Jai. I’m 8 years old. This is my story. My doctor says I have an illness. I don’t feel sick. But I do know that grown-ups around me are annoyed with me most of the time. I’m constantly being told, “sit still’’, “stop dreaming”, “pay attention”. I can’t seem to be able to do just that.

In class, I seem to lose track of what the teacher says. I try to listen, I really do. I start doing what she says, then I notice the insect fluttering on the window pane, I see the boy in the row ahead tapping his fingers on the desk, the office boy walking down the corridor and the sound of laughter from the next classroom. I don’t realise I have left my seat till teacher tells me “Jai, return to your seat”.

My parents are frequently called to school to meet my class teacher. They are unhappy with my marks. They think I’m careless and lazy because I take all evening to do my homework. I tell my mother that I try hard. I feel sad and frustrated that she doesn’t understand or believe me. Some of the other children make fun of me specially when I can’t answer in class. Mostly, I haven’t heard the question. They don’t like to play with me as I get excited and can’t wait for my turn.

Things changed about 6 months back. My parents took me to a special doctor. The doctor seemed to understand that I was not being naughty or disobedient. He talked to me, looked at my exercise books and listened to my parents. He told my parents that I had an illness, ADHD. I needed medicines for treatment of ADHD to improve my focus and concentration. I also need structure and routine in my life. It was such a relief to know it was not my fault.

A lady at the doctor’s clinic gave me some puzzles and games to do. I liked her; she spoke slowly and clearly. She explained things one at a time and did not mind repeating herself when I did not get her the first time. She helped us draw up a time-table - we had such fun doing that because she made time for everything I want to do. Now I have a study time, a play time, TV time, all clearly written in the big chart I helped to make. It reminds me of what I have to do and gives me enough time to prepare for it. Mother says I sit quietly for longer periods. Teacher says I pay more attention and don’t disturb other kids in class. She is more patient with me too.

Understanding ADHD and Helping Me

Doctor says there are many children like me. Here’s what you can do to help me and others like me.

  • Help me focus. Make sure I’ve heard you and understood what you want me to do.
  • I sometimes don’t realise I’ve left my seat. Please remind me to stop and think.
  • I need structure and routine in my life.
  • I need to know what comes next.
  • Please give me time to adjust to any changes in my schedule.
  • Please let me learn at my own pace, I get confused and make mistakes when you ask me to hurry up.
  • Please give me instructions one step at a time. Make me repeat them.
  • Please give me short work periods and small goals to start with.
  • Please give me immediate feedback; did I do things the right way?
  • Do give me praise even if I succeed only partially. Please don’t wait till I’m perfect.
  • Don’t always find fault with me. Please praise me and reward me when I do something well.


Thank you for being patient with me.

Monday, February 1, 2016

Dealing with Grief

girl dealing with grief
Dealing with grief is a process of acceptance
Grief is the response to losing someone to death. All of us understand that death and loss of a loved one is a part of life. However, the reality of death often leads to feelings of shock, sadness and confusion. Acute grief occurs in the immediate aftermath of the loss. It is intensely painful characterised by sadness, crying, constant thoughts of the deceased, disturbed sleep, appetite and disinterest in one’s own self and others. In a majority of cases, this is followed by integrated or abiding grief in which memories of the loved one mingle with sadness and longing but it does not persistently occupy the mind or disrupt normal day-to day activities.
“Well, everyone can master a grief but he that has it.”
William Shakespeare. Much Ado About Nothing. III.ii.25

Loss through death affects each of us differently. How one feels depends on the nature and circumstances of the loss, one’s beliefs and religion, age, relationships and one’s own physical and mental health. A sudden or violent death, death of a child or loss of a long-time spouse are always more difficult to accept. If the relationship with the departed person was difficult, the grief is more complicated and may take more time to work through.

Stages of grief

5 stages of the grieving process has been described. The stages do not necessarily come in order, nor are all the stages experienced by every person. One may return or go through one or the other stage several times before acceptance of the loss.Grief is a process and not just a state. During the process of grieving and bereavement a person may experience many emotions during the course of bereavement- helplessness, anger, sadness, denial, despair and yearning are common.
Denial
The first stage is the stage of denial ('It's not true’; ‘There must be some mistake.’) This is a normal defence mechanism which helps to cushion the immediate shock.
Anger
Once the reality sinks in, the pain is often redirected and expressed as anger. ‘Why me?’; ‘Its not fair’; ‘How can this happen to me’; are the common reactions in this phase. Anger may be directed towards objects, strangers, the doctors or family members, God; or even towards the deceased person- ‘How could you leave me alone?’
Bargaining
A promise of good behaviour or an attempt to strike a bargain (‘I will always listen to you’, ‘I will never worry you again,)’ is often the reaction at this stage.
Depression
Sadness and regret are mingled and one may often say ‘There is no point in life; - I may as well die too’.
Acceptance
At this stage emotions are stable and calm.

Strategies for dealing with grief 

Though each one copes differently, the following strategies may help you cope with your feelings and come to terms with your loss.
  1. Talking about your loss: It may be difficult for you initially- but in time it helps to talk about your loss and your feelings with a trusted family member or friend or a counsellor.
  2. Accepting your feelings : The anger, guilt, helplessness you may feel are normal and part of the grieving process. There is no guilt or shame in accepting them; and it paves the way for healing.
  3. Taking care of yourself : Establishing a routine with regular meals, exercise and adequate rest is important for your physical and mental health.
  4. Reaching out to others: Working with people less fortunate, or carrying on the legacy of the deceased (teaching, helping in the community) helps to give meaning to life.

When to seek professional help

  • Though different people take different times, intense and persistent grief continuing over a period of six months may require professional help.
  • Loss due to suicide is among the most difficult to bear. In such cases, counselling during the first weeks is both advisable and beneficial.
  • Inability to cope with or resume daily life or work activities, intense sorrow or pain which does not subside with time, inability to maintain or build relationships are indications to consult a mental health specialist.
Recovery from grief is a highly individual process. Each individual works through grief on their own with time, using their own personal ways of coping. Acceptance, rationalisation, humour, distraction, prayer, avoidance of reminders are some of the many ways in which people cope. Social support and healthy habits contribute to recovery which may take a few months or even a year.