Nostalgia

Remember that sepia-tinted class photo someone posted in your social media group? The flurry of comments, the almost-audible laughter, the warm fuzzy feeling, and the wistfulness that followed? You were indulging in a spot of nostalgia – that bittersweet feeling of pleasure mixed with sadness as you think of happy times in the past.

Nostalgia, literally meaning ‘ache for home’, was described in the 17th century and was considered an illness - a form of melancholy. While it’s true that we tend to indulge in nostalgia when we are unhappy, lonely or anxious; and during times of change and uncertainty; we also know that this yearning for the past is a universal human experience. Across cultures, we experience and indulge in nostalgia, and researchers now understand that it can serve many useful purposes.

• It helps us overcome negative emotions. 
• The positive emotions evoked by our nostalgic memories help us overcome feelings of sadness or anxiety we may be experiencing currently. 
• It helps us connect to our past and unifies our sense of identity. 
• We see our own journey through life - as we were, as we changed and adapted to circumstances, right through to who we are today. 
• It connects us to others and strengthens social bonds. Even when we are alone, our memories include and involve others, making us feel connected to them. This helps to dispel loneliness, especially in these difficult pandemic times. 
• Nostalgia is a good coping mechanism. The knowledge that we have overcome difficult situations in the past helps us cope with current situations; and gives us the perspective that the present, like the past, is temporary. 
• Nostalgia encourages feelings of empathy with others, even when they may not concern our own personal memories. It may serve to build bonds across generations and connect us our roots. 

However, there is a flip side too. Our forays into nostalgia may cause us to dwell on negative aspects of our past - the times when we were lonely, cold, hungry or rejected. Nostalgia may worsen feelings of sadness if we are depressed or going through a difficult phase in life. 

Nostalgia can alienate, rather than connect. Idealizing a particular time can cause resentment among those whose experiences were sharply divergent. Not everyone has had a happy childhood, and no period in history has been free of pain, anguish or injustice. 

It is also sobering to realise that nostalgia is often fuelled by dissatisfaction with the present, be it in our personal lives or in the wider socio-political climate. We tend to revert to memories of a simple, uncomplicated childhood, or to an imagined golden era in history to escape the demands of the present and anxieties relating to the future. 

‘Monetizing’ nostalgia 

Nostalgia can be deliberately triggered; and an entire industry cashes in on this very human frailty. While most of it is harmless and enjoyable, we must guard against the tendency to idealize and romanticise the past excessively. Nor should we allow ourselves to be manipulated by canny politicians who promise us ‘the good ol’ days’, in a bid to detract attention from current realities. 

You can’t have a better tomorrow if you are thinking about yesterday all the time

(Charles Kettering)

References

1. Krystine Batcho. Speaking of Psychology: Does nostalgia have a psychological purpose? (apa.org) 
2. Lottie Miles. The Psychology of Nostalgia: Why Do We Feel a Longing for the Past? - Learning Mind (learning-mind.com)

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.”

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.

Bipolar disorder and hypomania - irritability and depression

Chronic unstable mood with irritability and superimposed bouts of depression is a common form of bipolar II disorder or hypomania. Persons with this pattern of illness tend to have an unstable course and stormy interpersonal relationships. They also have more irritable and hostile hypomanic episodes. The classical Bipolar II disorder or hypomania of mild elevation of mood, sharpened and positive thinking, and increased energy and activity levels is less disruptive.

Persons with this irritable type of hypomania and bipolar illness have unrealistically high expectactions of those with whom they interact; whether at the workplace, at home, or other casual day-to-day interactions. When these expectations are not met they pass on their irritation and negative mood to unsuspecting others.

There is usually a grain of truth in their version of the incident, but the growing number of incidents with various people at all levels reduces their credibility. At the workplace they are frequently in search of a new job and personally they have problems sustaining meaningful relationships.

Anger management alone is usually not effective. It needs to be combined with specific treatment for the bipolar illness. At the clinic couples and individuals come in for anger and interpersonal issues that are not resolved with counselling.

"I never realised how much my moods controlled my actions"

Treatment for bipolar disorder including hypomania hinges on medication and psychotherapy. Treatment requires patience by all parties in the therapy. Relapses are frequent when medication is stopped.

"I can see the difference when he stops his medication;

help me get him back, doctor"

It takes time for the affected person to accept he or she has hypomania or bipolar illness. The degree of realisation fluctuates during the course of therapy. Regular psychiatric review is essential to prevent relapse in bipolar illness and hypomania

Treating Depression

Depressed mood or sadness lasting two weeks or more requires treatment. We all feel depressed, sad, or ‘blue’ occasionally. Moods and feelings change in response to events in our external environment. Usually depressive feelings or sadness last for a day or two; longer in case of loss or bereavement. However, if these feelings of sadness and hopelessness persist for more than 2 weeks and interfere with daily life, it indicates a clinical depression.

Depression is the fourth highest contributor to the global burden of disease. 

Clinical depression is a treatable illness. Many people never seek treatment due to lack of awareness, lack of access to mental health care, ignorance, or shame.

Signs and Symptoms

The hallmark of Clinical Depression is a pervasive depressed mood. This depressed mood is not responsive to positive events. There is associated slowness of thinking and movement; and there are thoughts related to guilt, self-blame, hopelessness and suicide . These features of constitute the classical triad of symptoms for the diagnosis of Clinical Depression. For a more formal diagnosis some or all of the symptoms below are used

1. Persistent sadness. Frequent crying, irritability, ‘emotional outbursts’
2. Slowing of movement and thoughts
3. Feelings of guilt - ‘I shouldn’t have done that’, ‘it is all my fault’
4. Worthlessness - ‘I haven’t achieved anything’, ‘I let my parents down’, ‘what I do has no value’
5. Hopelessness - ‘What’s the point?’, ‘I don’t see things getting better’
6. Thoughts of dying and suicide - ‘I would be better off dead’
7. Loss of interest in activities and hobbies that were once pleasurable
8. Difficulty concentrating, remembering details, making decisions
9. Insomnia, early morning wakefulness, excessive sleeping.
10. Change in appetite – appetite loss or overeating.
11. Fatigue, lethargy, decreased energy
12. Headache, cramps or digestive problems that are not relieved by treatment

How is depression treated?

The first step to treatment is to visit a psychiatrist. Your psychiatrist is the only mental health professional qualified to prescribe medication and provide psychotherapy. Your psychiatrist will take a detailed history of your symptoms, and will ask you to complete some questionnaires to assess their severity. He will also do a physical examination and may get some tests done (thyroid disorders and blood glucose related problems can cause similar symptoms).

The treatment of depression rests on two pillars

1. Pharmacotherapy (medication)
2. Psychotherapy (counselling, CBT)

Medication (pharmacotherapy) is required for moderate and severe depressions. Formal psychotherapy is started later once concentration and thinking improve. Your psychiatrist will prescribe an appropriate antidepressant. Antidepressants are not addicting. Side effects if any occur during the initial phase of treatment, they should not make you feel worse. Antidepressants must be taken for 4-6 weeks before they have a full effect. Later you should continue the medication even if you are feeling better to prevent a relapse. Suddenly stopping antidepressants can precipitate a relapse. Medication should be tapered gradually under your doctor’s supervision. If you follow your doctor's advice regarding follow up visits your treatment will be optimal.

Psychotherapy alone may be used in mild depression. Usually it is combined with medication for moderate and severe depressions. Psychotherapy is of two types:

1. Cognitive Behaviour Therapy (CBT) identifies self-defeating, ‘negative thoughts’ and behaviours that perpetuate clinical depression in a vicious cycle. Your therapist then works with you to replace these thoughts and behaviours with ‘positive’ ones to help you recover from the illness.
2. Interpersonal Therapy (IPT) helps people understand and work through troubled relationships that may be at the root of depression or making it worse.

How can I help a friend or family member who is depressed?

1. Listen carefully.
2. Offer support, understanding and encouragement.
3. Never dismiss feelings, but point out realities and offer hope.
4. Encourage them to go out for walks, outings and other simple activities. Don’t push too hard but keep trying.
5. Make sure they keep appointments with the psychiatrist and stay in therapy.
6. Never ignore suicide comments
• Gently correct blatantly ‘negative’ thoughts. Help the person form an action plan to resolve the problem
• DON'T LEAVE THEM ALONE until they OK the plan. 
• Accompany them to a known responsible person or a doctor or mental health professional. You could save a life.

What can I do when I am depressed?

1. Stay active. Exercise; go out for a movie, or any event you previously enjoyed.
2. Eat regular meals. Don’t skip them even if you are not hungry.
3. Go to bed at a regular time. Don’t wait until you are extremely tired so you can get sleep. Insomnia is the first symptom to respond to antidepressant medication
4. Set realistic goals for yourself.
5. Break up large tasks into smaller ones and do what you can.
6. Spend time with others, confide in a trusted friend or relative.
7. Postpone important decisions such as getting married/divorced, changing jobs until you are feeling better.
8. Do not wait too long to get treatment.
9. Expect your mood to improve gradually. Sleep and appetite will improve before your mood changes.
10. Keep your appointments with your psychiatrist and do not stop your medication suddenly.

Reference