Recommitting is the Key to Long-Term Recovery from Alcoholism

By Sarah Allen Benton, M.S., L.M.H.C.


Recovery is an ongoing process and those fortunate to have long-term recovery have one thing in common- an ability to recommit themselves. It has been observed that people often get sober and as a result expect that life should go their way-a reward, in a sense, for their “good” behavior. However, that is not generally what happens. In fact, many sober high-functioning alcoholics, in particular, report that their lives often get worse before better. While this may seem unfair, it is actually a blessing in disguise- for it can ensure that the motivation to remain sober becomes internal and not based solely on external rewards. For example, a person gets sober and then receives a new job, a romantic relationship and everything external in their life takes a positive turn. Inevitably a negative situation will arise and the individual may struggle to cope and feel that there is no point to being sober because life is not going their way. In contrast, when a person is staying sober despite difficult circumstances initially, they are able to increase their distress tolerance and to realize that recovery is about slow internal growth and not dramatic external rewards. It does not matter what the conditions are in early sobriety for an individual-positive or negative, for over time difficulties will arise. It is imperative to learn how to deal with the good, bad and indifferent waves that life will inevitably bring forth.

Initially, getting sober may feel exciting, new and fresh-the world suddenly appears different and a person may feel better mentally and physically. However, this “pink cloud”, as many have labeled it, will wear off and “reality” of this lifelong venture will set in. At this time it is crucial to have a social support system in place as well as outside help for co-occurring mental health issues such as anxiety, depression, etc. (i.e., individual therapy and medication management-as needed). Getting through a difficult time while staying sober builds their “muscle” and makes the next challenge feel possible to work through. Recovery itself may start to feel mundane and tedious and it is up to the individual to take a look at all facets of their lives to see what actions they need to take in order to get back on track. This is the process of “re-committing” and it involves acknowledgement of weakness in an area(s) of recovery and then self-correcting.

There are many aspects involved in having stable recovery. Some common areas in which sober alcoholics may lose their commitment over time are:
• Attending individual therapy as recommended
• Exercising
• Obtaining proper sleep
• Maintaining balanced nutrition
• Attending regular mutual-help meeting (A.A., SMART Recovery, Women for Sobriety)
• Attending group therapy
• Staying in contact with sober peers
• Not engaging in other addictive behaviors (i.e., shopping, sex, gambling)
• Taking prescribed medication that has been assessed as necessary
• Being honest
• Pursuing spiritual practice
• Following through with daily responsibilities (i.e., work, paying bills, chores)
• Giving back to others
• Involvement in healthy relationships (friendships, family and romantic)

One pattern that can lead to relapse is, for example, not attending mutual-help meetings for a period of time and then feeling discouraged about this pattern, giving up all effort in other areas of recovery and possibly relapsing. Instead of viewing this break from an aspect of recovery as a temporary lull and then recommitting, many individuals use “black and white” thinking to judges themselves in a negative way and as a result may “give up” on sobriety. However, no one is perfect, and everyone with long-term recovery has had a time when they were lacking motivation in one area or another. The key is to observe what aspect of life is out of balance and to work on making adjustments without giving up completely. Sometimes creating small and obtainable daily goals can help a person to get back into their routine. It is important to reach out for help and to talk with others in their support network about these challenges-for no one has to be alone on this path.

Source Psychology Today

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Brain Pacemaker Holds Promise for Untreatable Depression

By RICK NAUERT PHD


According to experts, nearly 10 percent of all cases of depression are so severe that patients do not respond to any established treatment method. But stimulating targeted brain areas with a type of “brain pacemaker” has shown promising results.

According to initial studies, half of patients with the most severe depression treated with deep brain stimulation see a significant improvement in mood.

Now, physicians from the University of Bonn in Germany, together with colleagues from the U.S., have suggested a new target structure for this intevention which they hope will achieve an even better success rate with fewer side effects.

In deep brain stimulation, physicians implant electrodes in the brain. Then, using an electrical pacemaker implanted under the patient’s clavicle, physicians can influence the function of certain areas of the brain.

The method was originally developed for treating patients with Parkinson’s disease to treat its typical movement problems.

For several years, the method has also been investigated in the treatment of the most severe cases of depression, with striking and completely unexpected success. In patients who had undergone many years of unsuccessful treatment, the symptoms sometimes significantly resolved.

The most striking aspect: “Depression does not return in patients who responded to the stimulation,” said Professor Dr. Thomas Schläpfer from the Bonn Hospital for Psychiatry and Psychotherapy.

“The method appears to have lasting effects – and this is in the case of the most treatment-resistant patient group described in the literature. This has never before happened.”

Deep brain stimulation has been tested to date in three different areas of the brain: the nucleus accumbens, the internal capsule, and a structure known as cg25.

Surprisingly, the effects are nearly identical – regardless of which of these centers the physicians stimulate. Together with colleagues from Baltimore and Washington, the Bonn researchers have since been able to explain why this is the case. Using a novel tomography method, they were able to make what they call the “cable system” of the three brain centers visible.

“In doing this, we determined that at least two of these three areas – probably even all three – are attached to one and the same cable harness,” said Bonn brain surgeon Professor Dr. Volker Coenen.

This is the so-called medial forebrain bundle, which forms a kind of feedback loop that allows us to anticipate positive experiences. “This circuit motivates us to take action,” said Coenen.

“In patients with depression, it is apparently disrupted. This results in, among other things, an extreme lack of drive – a characteristic symptom of the disease.”

The nucleus accumbens, internal capsule, und cg25 all appear to be connected to the medial forebrain bundle – rather like leaves are connected to the branch from which they arise.

Whoever stimulates one of these regions of the brain simultaneously influences the other components of the motivation circuit to a certain extent.

Coenen, who was the first to anatomically describe the forebrain bundle in humans, now proposes implanting the electrode for deep brain stimulation directly into this structure.

“We would use the electrode to send the current pulses to the base of the network and not to the periphery, as before,” said Schläpfer. “We could thus potentially work with lower currents and yet achieve greater success.”

Observations of patients with Parkinson’s disease appear to support this idea: In this case, a network of brain structures responsible for movements is stimulated.

The more basally (figuratively speaking: near the branch) the electrical stimulation is applied, the greater its effect. At the same time, the risk of adverse side effects is reduced.

By now, more than 80,000 patients with Parkinson’s disease worldwide have a brain pacemaker in their body.

“Experiences to date demonstrate that the brain intervention necessary for this is relatively low-risk,” said Coenen.

“Thus from a medical point of view, there is nothing that argues against also using this method to help people with very severe depression.”

The work is published in the journal Neuroscience and Biobehavioral Reviews.

Source Psych Central

F.D.A. Sees Promise in Alzheimer’s Imaging Drug

By GINA KOLATA


An advisory committee to the Food and Drug Administration recommended unanimously Thursday that the agency approve the first test — a brain scan — that can show the characteristic plaques of Alzheimer’s disease in the brain of a living person. The approval was contingent on radiologists agreeing on what the scans say and doctors being trained in how to read the scans.

The F.D.A. usually follows advice from its advisory committees, and Alzheimer’s experts anticipated that the scans would be approved. The additional requirement would not be a big hurdle, said Dr. Daniel M. Skovronsky, chief executive of the company, Avid Radiopharmaceuticals, that applied to market the scans.

“We don’t know exactly what F.D.A. will want,” Dr. Skovronsky said. “But it should take months to generate this type of data, not years.”

The committee vote is “a very positive thing,” said Maria Carrillo, senior director of medical and scientific relations for the Alzheimer’s Association. “This is nothing but a positive for our families.”

More than five million Americans have Alzheimer’s disease.

Plaques are part of the criteria for having Alzheimer’s — if a person with memory problems does not have plaques, that person does not have Alzheimer’s. But without the scan, the only way to know if plaques were present is to do an autopsy.

Alzheimer’s specialists said they expected that if the scan were approved it would come into widespread use.

“This is a big deal,” said Dr. Pierre N. Tariot, director of the memory disorders center at the Banner Alzheimer’s Institute in Phoenix. Asked if he would be using the scans, Dr. Tariot replied, “Absolutely.”

Dr. Tariot is an investigator in studies by Avid, now a subsidiary of Eli Lilly & Company, and its competitors.

The approval would be for a dye that homes in on plaque in the brain, making it visible on PET scans. Such scans would be especially valuable in a common and troubling situation — trying to make a diagnosis when it is not clear whether a patient’s memory problems are a result of Alzheimer’s disease or something else. If a scan shows no plaque, the problems are not caused by Alzheimer’s and could be from tiny strokes or other diseases.

If a person has Alzheimer’s, though, there is as yet no treatment that can slow or reverse the disease, although new drugs are being tested that are intended to reduce plaque.

Nonetheless, doctors said, having a diagnosis is important for planning and for understanding what lies ahead. It also is important for family members to know because they are at increased risk if a mother or father, sister or brother has the disease. And people, they say, often want to know what is wrong with them, even when the news is bad.

The panel’s vote “has moved us a monumental step forward,” said Dr. Reisa Sperling, adding that with the scans “we will not just be guessing clinically.”

Dr. Sperling, director of the Center for Alzheimer’s Research and Treatment at Brigham and Women’s Hospital in Boston, is an unpaid consultant to Avid Radiopharmaceuticals, which makes the dye, and said she paid her own way to speak at the F.D.A. meeting in White Oak, Md.

The question about interpreting the scans arose because in the Avid study, radiologists did not establish a firm cutoff point that would say whether a person had significant amounts of plaque. Instead they did a graded analysis. What is needed in practice is a set level that would say yes or no, and distinguish significant plaque accumulation from insignificant amounts. And the company must show that its cutoff points are accurate and that different radiologists assess the same scan in the same way.

Some people have plaque without having Alzheimer’s, so if a scan shows plaque, doctors will have to use their clinical judgment, taking into account a patient’s symptoms, in deciding what the scan results mean, noted Dr. P. Murali Doraiswamy, an Alzheimer’s researcher at Duke University and a clinical investigator in the Avid trial. But if a scan shows no plaque, the situation is simpler, Dr. Doraiswamy said. It means the doctor should focus on other causes for the symptoms.

“This technique will allow family doctors to feel confident ruling out Alzheimer’s,” he said. “Until now we had to guess whether someone had plaques.”

In 2008, an advisory committee to the F.D.A. said that in order for the dye to be approved for amyloid imaging, the company would have to show that the scans were detecting the same plaques as were found on autopsy.

Avid did that, using people at the end of life who agreed to be scanned and then to have brain autopsies. The company also tested young healthy people who, presumably, would not have amyloid plaque in their brains. The scans found no plaque in those younger subjects.

At the meeting Thursday, a parade of medical experts testified about the need for the scans. Dr. Norman Foster, a professor of neurology at the University of Utah, came at his own expense even though he is a consultant to GE Healthcare, which is developing its own brain scan for plaque, to urge approval of the Avid scan.

“Physicians currently have little confidence in their ability to determine the cause of dementia, and as a result they often don’t even try,” Dr. Foster said. As a result, he said, families are left in limbo, unable to plan for the future if it is Alzheimer’s and, if it is not, delaying getting treatment.

“The preventable costs are enormous,” Dr. Foster said. “The emotional toll is incalculable.”

He told of three patients he had seen in the past two weeks who would have benefited from a scan. One is a 70-year-old man with memory problems and depression. He was given a diagnosis of depression, but only after he continued to get worse over two years did it become clear that he most likely had Alzheimer’s.

“I wish I had had the ability to do an amyloid PET scan to allow an earlier diagnosis,” Dr. Foster said. Approval of the scan, he said, “would be a historic advance in neurology and in the daily management of patients with memory complaints.”

With the committee’s vote, Dr. Doraiswamy said, “It’s a landmark day for our field.”

Web Source: http://www.nytimes.com/2011/01/21/health/21alzheimers.html?_r=1&partner=rss&emc=rss

Long-Term Antidepressant Treatment Contributes To Significant Increases In Weight Gain And Obesity

On January 18, 2011, in Depression, Medication, by Christopher Fisher, PhD


This study demonstrates that patients using antidepressant medication continuously, mostly serotonin-selective reuptake inhibitors (SSRIs), show significantly more (abdominal) overweight and obesity than those using them intermittently or not at all. Compared with SSRIs, other types of antidepressant medication used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures (i.e., measurement of of human physical variations).

In a study published in the last 2010 issue of Psychotherapy and Psychosomatics, a group of researchers of the University of Amsterdam presents new findings on the relationship between weight and recurrent depression.

The literature on the relation between obesity and the recurrent type of major depressive disorder (MDD-R; having had at least 2 major depressive episodes) is limited and equivocal. Most studies on depression and obesity did not distinguish between single and recurrent episodes. However, this distinction may be important because depression is increasingly considered a chronic recurrent disorder with various levels of interepisodic functioning, and evidence is growing that the recurrent type is a distinct one.

Most studies on the relation between depression and obesity did not control for antidepressant (AD) medication use, although a substantial part (20 – 60%) of the recurrently depressed patients use ADs for lengthy periods of time. This study elaborates on their findings by focusing on the relation between obesity and MDD-R and the association between long-term use of ADs and obesity.

To be eligible for this study, patients had to meet the following criteria: (a) at least 2 major depressive episodes in the past 5 years (DSM IV), (b) current remission status, according to DSM-IV criteria, for longer than 10 weeks and no longer than 2 years before, and (c) Hamilton Rating Scale for Depression of <10.

At 2 years, follow-up assessment anthropomorphic parameters were collected of 134 subjects.

To assess relapse/recurrence, the Structured Clinical Interview for DSM-IV (SCID-I) was used. Regarding the use of ADs, two groups were distinguished: those who used Ads throughout the entire 2-year study period (n = 46) and those who did not use ADs continuously, but intermittently (n = 49) or not at all (n = 39). Differences between these groups in BMI, waist circumference, and waist-to-hip ratio were tested stratified by gender.

Overweight and obesity occurred more often in patients with recurrent depression than in the reference group, although statistical significance was reached in women only (74% of this sample). Within the MDD-R patient group, serotonin-selective reuptake inhibitors (SSRIs) were the most commonly used type of AD among the continuous AD users. Compared with SSRIs, other types of ADs used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures.

The mean AD equivalent correlated positively with both waist circumference (p = 0.006) and waist-to-hip ratio (p = 0.004), but not with BMI. In addition, mean waist circumference and waist-to-hip ratio scores were consistently higher amongst the continuous AD users compared to intermittent and no AD users. Patients using ADs continuously, mostly SSRIs, show significantly more (abdominal) overweight and obesity than those using them intermittently or not at all. Compared with SSRIs, other types of ADs used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures. The authors did find, however, a small association between AD equivalent dosage and waist circumference and waist-to-hip ratio.

In general, a better understanding of the relationship between obesity and depression that includes understanding the beneficial and adverse effect of psychotropics on appetite, eating behaviour, body weight, and metabolism should improve our ability to prevent and treat both obesity and depression. Thereby, ideally persontailored interventions can be developed, including effective nonpharmaceutical preventive strategies for recurrent depression and extra physical activities with – as added benefit – protection against AD-induced weight gain.

Material adapted from Journal of Psychotherapy and Psychosomatics.

Reference
Lok, A.; Visscher, T.L.S.; Koeter, M.W.J.; Assies, J.; Bockting, C.L.H. ; Verschuren, W.M.M. ; Gill, A. ; Schene, A.H. The ‘Weight’ of Recurrent Depression: A Comparison between Individuals with Recurrent Depression and the General Population and the Influence of Antidepressants. Psychother Psychosom 2010;79:386-388.

Web Source: http://www.bmedreport.com/archives/22150?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+TheBehavioralMedicineReport+(The+Behavioral+Medicine+Report)

UNC Researchers Investigate Estrogen Replacement Therapy To Prevent Depression And Cardiovascular Disease

Article Date: 13 Jan 2011 – 2:00 PST


Researchers at the University of North Carolina at Chapel Hill have launched a new clinical trial to determine if estrogen replacement therapy may help prevent depression and cardiovascular illness in women between the ages of 45 and 55.

It’s a move that may raise eyebrows in some quarters, given that a Women’s Health Initiative (WHI) study was halted in 2004 due to findings that estrogen therapy resulted in an increased risk of stroke and blood clots.

But there’s an important difference between the UNC study and the WHI estrogen study, said David Rubinow, MD, UNC’s chair of psychiatry and one of two principal investigators of the new 5-year study, which is funded by a $4.5 million grant from the National Institutes of Health. The other principal investigator is Susan Girdler, PhD, professor of psychiatry.

“The Women’s Health Initiative study led to the mistaken belief that estrogen replacement therapy is bad for all women. And as a result, it has served to deprive some women of a treatment that might greatly and favorably impact their lives. Much of the negative impact of estrogen that they found was related to the fact that most of the women in the Women’s Health Initiative study were far past the menopause and up to 79 years old,” Dr. Rubinow said.

“There are now a large number of studies that demonstrate what has been called the timing hypothesis. That is, giving estrogen within a year or two of menopause has beneficial effects, but giving estrogen in women more than five years beyond the menopause can actually be harmful.

“When the women who were close to menopause were looked at separately, the adverse effects on the heart were not seen and in fact some suggestion of beneficial effects was seen. Perimenopausal women in the Women’s Health Initiative who received estrogen had significantly lower coronary artery calcification compared to the women who didn’t take estrogen.

“That raises the question: Is estrogen potentially beneficial for women in the perimenopause – the years surrounding the menopause? It’s really an unanswered question at this point. Our study is an effort to find out what puts an individual woman at risk for heart disease and depression and what predicts beneficial effects of estrogen replacement during the perimenopause on affective well-being and cardiovascular well-being.”

The study, which began in August 2010 and will be conducted entirely at UNC, seeks to enroll a total of 320 women ages 45 to 55 who are in the menopause transition. All will be randomized to receive treatment with estradiol (estrogen replacement) skin patches or placebo.

Women in the study will be tested three times: before treatment and then again after 6 months and 12 months of treatment. These laboratory tests will measure their cardiovascular and inflammatory responses to mental stress, indicators of cardiovascular health and metabolic markers such as a glucose tolerance test, waist/hip ratio and lipid profiles. In addition, assessments of their moods, vital signs, side effects and compliance with the treatment regimen will be conducted on each participant

“Given the mortality and morbidity associated with depression and heart disease, and the tremendous increase in risk of these disorders during the perimenopause, it is critical that we identify those women who will be helped by estradiol,” Dr. Rubinow said.

The research study is currently enrolling participants. Eligible women will receive free study related medical evaluations and up to $1,200 in monetary compensation for completing all study visits.

Source:
University of North Carolina at Chapel Hill School of Medicine

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