What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational—but even so, you feel unable to resist them and break free.

Like a needle getting stuck on an old record, obsessive-compulsive disorder (OCD) causes the brain to get stuck on a particular thought or urge. For example, you may check the stove 20 times to make sure it’s really turned off, or wash your hands until they’re scrubbed raw.

Understanding OCD obsessions and compulsions

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessions and compulsions are irrational—but even so, you feel unable to resist them and break free.

Understanding obsessions and compulsions

Obsessions are involuntary thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas, but you can’t stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.

Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away.

For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive rituals and behaviors often end up causing anxiety themselves as they become more demanding and time-consuming. This is the vicious cycle of OCD.

Signs and symptoms of obsessive-compulsive disorder (OCD)

Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time, and interfere with your daily life and relationships. For example, you may check the stove 20 times to make sure it’s really turned off, or wash your hands until they’re scrubbed raw.

Most people with obsessive-compulsive disorder (OCD) have both obsessions and compulsions, but some people experience just one or the other.

Obsessive thoughts

Common obsessive thoughts in obsessive-compulsive disorder (OCD) include:

• Fear of being contaminated by germs or dirt or contaminating others
• Fear of losing control and harming yourself or others
• Intrusive sexually explicit or violent thoughts and images
• Excessive focus on religious or moral ideas
• Fear of losing or not having things you might need
• Order and symmetry: the idea that everything must line up “just right”
• Superstitions; excessive attention to something considered lucky or unlucky

Compulsive behaviors

Common compulsive behaviors in obsessive-compulsive disorder (OCD) include:

• Excessive double-checking of things, such as locks, appliances, and switches
• Repeatedly checking in on loved ones to make sure they’re safe
• Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
• Spending a lot of time washing or cleaning
• Ordering or arranging things “just so”
• Praying excessively or engaging in rituals triggered by religious fear
• Accumulating “junk” such as old newspapers or empty food containers

The link between hoarding and OCD

The compulsive behavior of hoarding—collecting and keeping things with little or no use or value—is a common symptom of people with OCD. However, people with hoarding symptoms are more likely to also be suffering from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.

Self-help for OCD tip 1: Invest in self care

Your lifestyle plays a big role in how you feel; it can help you manage your anxiety and function better.

Exercise regularly

Exercise is a natural and can be a highly effective anti-anxiety treatment. It can help control OCD symptoms by strengthening your nervous system helping you to refocus your mind when obsessive thoughts and compulsions arise. For maximum benefit, try to get 30 minutes or more of aerobic activity on most days. Ten minutes several times a day can be as effective as one longer period especially if you pay mindful attention to the movement process.

Stay connected to family and friends

Obsessions and compulsions can consume your life to the point of social isolation. In turn, social isolation will aggravate your OCD symptoms. It’s important to invest in relating to family and friends. Talking face-to-face about your worries and urges can make them feel less real and less threatening.

Get enough sleep

Not only can anxiety and worry cause insomnia, but a lack of sleep can also exacerbate anxious thoughts and feelings. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety disorders such as OCD.

Practice relaxation techniques

Stress can trigger symptoms or make them worse. Mindful meditation, yoga, deep breathing, and other relaxation techniques can help lower your overall stress and tension levels and help you manage your urges. For best results, practice a relaxation technique regularly.

Recognize the role trauma may play in your OCD

In some people, OCD symptoms such as compulsive washing or hoarding are ways of coping with trauma. If you have post-traumatic OCD, cognitive approaches may not be effective until underlying traumatic issues are resolved.

Self-help for OCD tip 2: Learn how to resist OCD rituals

If you have obsessive-compulsive disorder (OCD), there are many ways you can help yourself. One of the most powerful strategies is to eliminate the compulsive behaviors and rituals that keep your obsessions going.

Don’t avoid your fears

It might seem smart to avoid the situations that trigger your obsessive thoughts, but the more you avoid them, the scarier they feel. Instead, expose yourself to your OCD triggers, then try to resist or delay the urge to complete your relief-seeking compulsive ritual. If resistance gets to be too hard, try to reduce the amount of time you spend on your ritual. Each time you expose yourself to your trigger, your anxiety should lessen and you’ll start to realize that you have more control (and less to fear) than you think.

Refocus your attention

When you’re experiencing OCD thoughts and urges, try shifting your attention to something else.

• You could exercise, jog, walk, listen to music, read, surf the web, play a video game, make a phone call, or knit. The important thing is to do something you enjoy for at least 15 minutes, in order to delay your response to the obsessive thought or compulsion.
• At the end of the delaying period, reassess the urge. In many cases, the urge will no longer be quite as intense. Try delaying for a longer period. The longer you can delay the urge, the more it will likely change.

Anticipate OCD urges

By anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.

• Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”
• When the urge to check arises later, you will find it easier to re-label it as “just an obsessive thought.”

Self-help for OCD tip 3: Challenge obsessive thoughts

Like a needle getting stuck on an old record, obsessive-compulsive disorder (OCD) causes the brain to get stuck on a particular anxiety-provoking thought. The following strategies can help you get unstuck.

Write down your obsessive thoughts or worries

Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you begin to obsess, write down all your thoughts or compulsions.

• Keep writing as the OCD urges continue, aiming to record exactly what you’re thinking, even if you’re repeating the same phrases or the same urges over and over.
• Writing it all down will help you see just how repetitive your obsessions are.
• Writing down the same phrase or urge hundreds of times will help it lose its power.
• Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.

Create an OCD worry period

Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them.

• Choose one or two 10-minute “worry periods” each day, time you can devote to obsessing. Choose a set time and place (e.g. in the living room from 8:00 to 8:10 a.m. and 5:00 to 5:10 p.m.) that’s early enough it won’t make you anxious before bedtime.
• During your worry period, focus only on negative thoughts or urges. Don’t try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts or urges go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions and compulsions.
• When thoughts or urges come into your head during the day, write them down and “postpone” them to your worry period. Save it for later and continue to go about your day.
• Go over your “worry list” during the worry period. Reflect on the thoughts or urges you wrote down during the day. If the thoughts are still bothering you, allow yourself to obsess about them, but only for the amount of time you’ve allotted for your worry period.

Create a tape of your OCD obsessions

Focus on one specific worry or obsession and record it to a tape recorder, laptop, or smartphone.

• Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.
• Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.
• By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession.

Treatment for obsessive-compulsive disorder (OCD)

The treatment for OCD with the most research supporting its effectiveness is cognitive-behavioral therapy. Cognitive-behavioral therapy for obsessive-compulsive disorder involves two components: 1) exposure and response prevention, and 2) cognitive therapy.

Exposure and response prevention for OCD

Exposure and response prevention involves repeated exposure to the source of your obsession. Then you are asked to refrain from the compulsive behavior you’d usually perform to reduce your anxiety.

For example, if you are a compulsive hand washer, you might be asked to touch the door handle in a public restroom and then be prevented from washing up. As you sit with the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way, you learn that you don’t need the ritual to get rid of your anxiety—that you have some control over your obsessive thoughts and compulsive behaviors.

Studies show that exposure and response prevention can actually “retrain” the brain, permanently reducing the occurrence of obsessive-compulsive disorder symptoms.

Cognitive therapy for OCD

The cognitive therapy component for obsessive-compulsive disorder (OCD) focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior.

Helping a loved one with obsessive-compulsive disorder (OCD)

The way you react to your loved one’s OCD symptoms has a big impact. Negative comments or criticism can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment. Try to be as kind and patient as possible.

Tips for helping a friend or family member with OCD

• Avoid making personal criticisms. Remember, your loved one’s OCD behaviors are symptoms, not character flaws.
• Don’t scold someone with OCD or tell them to stop performing rituals. They can’t comply, and the pressure to stop will only make the behaviors worse.
• Do not play along with your loved one’s OCD rituals. Helping with rituals will only reinforce the behavior. Support the person, not their rituals.
• Keep communication positive and clear. Communication is important so you can find a balance between supporting your loved one and standing up to the OCD and not further distressing your loved one.
• Find the humor. Laughing together over the funny side and absurdity of some OCD symptoms can help your loved one become more detached from the disorder. Just make sure your loved one feels respected and in on the joke.

Medication for ADD / ADHD: What you need to know

Making ADD/ADHD medication decisions can be difficult, but doing your homework helps. The first thing to understand is exactly what the medications for ADD and ADHD can and can’t do. ADHD medication may help improve the ability to concentrate, control impulses, plan ahead, and follow through with tasks. However, it isn’t a magic pill that will fix all of your or your child’s problems. Even when the medication is working, a child with ADD/ADHD might still struggle with forgetfulness, emotional problems, and social awkwardness, or an adult with disorganization, distractibility, and relationship difficulties. That’s why it’s so important to also make lifestyle changes that include regular exercise, a healthy diet, and sufficient sleep.

Medication doesn’t cure ADD/ADHD. It can relieve symptoms while it’s being taken, but once medication stops, those symptoms come back. Also, ADD/ADHD medication works better for some than for others. Some people experience dramatic improvement while others experience only modest gains. Because each person responds differently and unpredictably to medication for ADHD, its use should always be personalized to the individual and closely monitored by a doctor. When medication for ADD/ADHD is not carefully monitored, it is less effective and more risky.

Stimulant medications for ADD / ADHD

Stimulants are the most common type of medication prescribed for attention deficit disorder. They have the longest track record for treating ADD/ADHD and the most research to back up their effectiveness. The stimulant class of medication includes widely used drugs such as Ritalin, Adderall, and Dexedrine.

Stimulants are believed to work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter associated with motivation, pleasure, attention, and movement. For many people with ADD or ADHD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors.

Short-acting vs. long-acting stimulants for ADD / ADHD

Stimulants for ADD/ADHD come in both short- and long-acting dosages. Short-acting stimulants peak after several hours, and must be taken 2-3 times a day. Long-acting or extended-release stimulants last 8-12 hours, and are usually taken just once a day.

The long-acting versions of ADD/ADHD medication are often preferred, since people with ADHD often have trouble remembering to take their pills. Taking just one dose a day is much easier and more convenient.

Stimulant medications may also cause personality changes. Some people become withdrawn, listless, rigid, or less spontaneous and talkative. Others develop obsessive-compulsive symptoms. Since stimulants raise blood pressure and heart rate, many experts worry about the dangers of taking these ADD/ADHD drugs for extended periods.

ADD / ADHD Stimulant safety concerns

Beyond the potential side effects, there are a number of safety concerns associated with the stimulant medications for ADD/ADHD.

• Effect on the developing brain – The long-term impact of ADD/ADHD medication on the youthful, developing brain is not yet known. Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development.
• Heart-related problems – ADD/ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. An electrocardiogram is recommended if the person has a history of heart problems.
• Psychiatric problems – Stimulants for ADD/ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.
• Potential for abuse – Stimulant abuse is a growing problem, particularly among teens and young adults. College students take them for a boost when cramming for exams or pulling all-nighters. Others abuse stimulant meds for their weight-loss properties. If your child is taking stimulants, make sure he or she isn’t sharing the pills or selling them.

Non-stimulant medications for ADD / ADHD

In addition to the traditional stimulant drugs, there are several other medications used to treat ADD/ADHD, including Strattera, atypical antidepressants, and certain blood pressure medications. In most cases, non-stimulant medications are considered when stimulants haven’t worked or have caused intolerable side effects.

Strattera

Strattera, also known by its generic name atomoxetine, is the only non-stimulant medication approved by the FDA for ADD/ADHD treatment. Unlike stimulants, which affect dopamine, Strattera boosts the levels of norepinephrine, a different brain chemical.

Strattera is longer-acting than the stimulant drugs. Its effects last over 24 hours—making it a good option for those who have trouble getting going in the morning. Since it has some antidepressant properties, it’s also a top choice for those with co-existing anxiety or depression. Another plus is that it doesn’t exacerbate tics or Tourette’s Syndrome.

On the other hand, Strattera doesn’t appear to be as effective as the stimulant medications for treating symptoms of hyperactivity.

Common side effects of Strattera include:

Straterra can also cause insomnia and appetite suppression, but these side effects are more common in stimulants.

Other ADD / ADHD medication options

The following medications are sometimes used “off-label” in the treatment of attention deficit disorder, although they are not FDA approved for this purpose. They should only be considered when stimulants or Strattera aren’t viable options.

• High blood pressure medication for ADD/ADHD – Certain blood pressure medications can be used to treat ADD/ADHD. Options include clonidine (Catapres) and guanfacine (Tenex). But while these medications can be effective for hyperactivity, impulsivity, and aggression, they are less helpful when it comes to attention problems.
• Antidepressants for ADD/ADHD – For people suffering from both ADHD and depression, certain antidepressants, which target multiple neurotransmitters in the brain, may be prescribed. Wellbutrin, also known by the generic name bupropion, is most widely used. Wellbutrin targets both norepinephrine and dopamine. Another option is the use of tricyclic antidepressants.

ADD / ADHD medications and your child

Even when armed with all the facts, deciding whether or not to let your child take ADD/ADHD medication isn’t always easy. If you’re unsure, don’t rush the decision. Sometimes other medical conditions—or even normal childhood behavior—can be mistaken for ADD/ADHD symptoms, so be sure to eliminate all other possible causes before considering medication for your child. Take your time to weigh the options and get your child’s input in the decision-making process.

Most importantly, trust your instincts and do what feels right to you. Don’t let anyone—be it your physician or the principal at your child’s school—pressure your child into medication if you’re not comfortable with it. Remember: medication isn’t the only treatment option. For young children especially, medication should be viewed as a last resort, not the first course of treatment to try.

Questions to ask an ADD / ADHD specialist

Consulting with an ADD/ADHD specialist or an experienced psychiatrist can help you understand the pros and cons of medication. Here are some questions to ask:

• What ADD/ADHD treatments do you recommend?
• Can my child’s symptoms be managed without medication?
• What medications do you recommend and what are the side effects?
• How effective is medication for my child’s ADD/ADHD?
• How long will my child have to take medication?
• How will the decision be made to stop medication?

Talking to your child about ADD / ADHD medication

Many kids and teens with ADD/ADHD don’t take their medication correctly—or stop taking it without talking to their parents or doctor—so if your child is on ADD meds, make sure that he or she understands how to take the medication correctly and why following prescription guidelines are important.

Encourage your child to come to you with any medication-related concerns so you can work together to solve the problem or find another treatment option. It’s also important to remember that ADD/ADHD medication should never have a numbing effect on a child’s energy, curiosity or enthusiasm. A child still needs to behave like a child.

Medication alone is not enough

Treatment for attention deficit disorder isn’t just about seeing doctors or taking medication. There is a lot you can do to help yourself or your child tackle the challenges of ADD/ADHD and lead a calmer, more productive life. With the right tips and tools, you can manage many of the symptoms of your ADD/ADHD on your own. Even if you choose to take medication, healthy lifestyle habits and other self-help strategies may enable you to take a lower dose.

• Exercise regularly. Exercising is one of the most effective ways to reduce the symptoms of ADD/ADHD. Physical activity boosts the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. Try walking, skateboarding, hiking, dancing or playing a favorite sport. Encourage your child to put down the video games and play outside.
• Eat a healthy diet. While diet doesn’t cause ADD/ADHD, it does have an effect on mood, energy levels, and symptoms. Set regular snack and meal times. Add more omega-3 fatty acids to your diet and make sure you’re getting enough zinc, iron, and magnesium.
• Get plenty of sleep. Regular quality sleep can lead to vast improvement in the symptoms of ADD/ADHD. Simple changes to daytime habits go a long way toward resting well at night. Have a set bedtime and stick to it. Avoid caffeine later in the day.
• Try therapy. ADD/ADHD professionals can help you or your child learn new skills to cope with symptoms and change habits that are causing problems. Some therapies focus on managing stress and anger or controlling impulsive behaviors, while others teach you how to manage time, improve organizational skills, and persist toward goals.
• Maintain a positive attitude. A positive attitude and common sense are your best assets for treating ADD/ADHD. When you are in a good frame of mind, you are more likely to be able to connect with your own needs or your child’s.

Guidelines for taking ADD / ADHD medication

If you decide to take medication for ADD/ADHD, it’s important to take the drug as directed. Following your doctor and pharmacist’s instructions will help you maximize the effectiveness of medication for ADD/ADHD and minimize the side effects and risks. Here are some guidelines for safe use:

• Learn about the prescribed medication. Find out everything you can about the ADD/ADHD medication you or your child is taking, including potential side effects, how often to take it, special warnings, and other substances that should be avoided, such as over-the-counter cold medication.
• Be patient. Finding the right medication and dose is a trial-and-error process. It will take some experimenting, as well as open, honest communication with your doctor.
• Start small. It’s always best to start with a low dose and work up from there. The goal is to find the lowest possible dose that relieves you or your child’s symptoms.
• Monitor the drug’s effects. Pay close attention to the effect the medication is having on your or your child’s emotions and behavior. Keep track of any side effects and monitor how well the medication is working to reduce symptoms.
• Taper off slowly. If you or your child wants to stop taking medication, call the doctor for guidance on gradually decreasing the dose. Abruptly stopping medication can lead to unpleasant withdrawal symptoms such as irritability, fatigue, depression, and headache.

Dealing with the side effects of ADD / ADHD medication

Most children and adults taking medication for ADD/ADHD will experience at least a few side effects. Sometimes, side effects go away after the first few weeks on the medication. You may also be able to eliminate or reduce unpleasant side effects with a few simple strategies.

Tips for minimizing side effects

• Loss of appetite – To deal with reduced appetite, eat healthy snacks throughout the day and push dinner to a later time when the medication has worn off.
• Insomnia – If getting to sleep is a problem, try taking the stimulant earlier in the day. If you or your child is taking an extended-release stimulant, you can also try switching to the short-acting form. Also avoid caffeinated beverages, especially in the afternoon or evening.
• Stomach upset or headaches – Don’t take the medication on an empty stomach, which can cause nausea, stomach pain, and headaches. Headaches can also be triggered by medication that’s wearing off, so switching to a long-acting drug may help.
• Dizziness – First, have you or your child’s blood pressure checked. If it’s normal, you may want to reduce your dose or switch to a long-acting stimulant. Also make sure you’re drinking enough fluids.
• Mood changes – If medication is causing irritability, depression, agitation, or other emotional side effects, try lowering the dose. Moodiness may also be caused by the rebound effect, in which case it may help to overlap the doses or switch to an extended-release medication.

If troublesome side effects persist despite your best efforts to manage them, talk to your doctor about adjusting the dose or trying a different drug. Many people respond better to the long-acting or extended release formulations of ADHD medication, which build gradually in the bloodstream and then wear off slowly. This minimizes the ups and downs caused by fluctuating medication levels and causes less of a rebound effect, where symptoms return, often worse than before, as the drug wears off.

Medication is a tool, not a cure for adult ADHD

When you think about treatment for ADD/ADHD, do you immediately jump to Ritalin? Many people equate ADD/ADHD treatment with medication. But it’s important to understand that medication for ADD/ADHD doesn’t work for everyone, and even when it does work, it won’t solve all problems or completely eliminate symptoms.

In fact, while medication for ADD/ADHD often improves attention and concentration, it typically does very little to help symptoms of disorganization, poor time management, forgetfulness, and procrastination—the very issues that cause the most problems for many adults with ADD/ADHD.

What you need to know about medication for ADD / ADHD

• Medication for ADD/ADHD is more effective when combined with other treatments. You will get much more out of your medication if you also take advantage of other treatments that address emotional and behavioral issues and teach you new coping skills.
• Everyone responds differently to ADD/ADHD medication. Some people experience dramatic improvement while others experience little to no relief. The side effects also differ from person to person and, for some, they far outweigh the benefits. Because everyone responds differently, finding the right medication and dose takes time.
• ADD/ADHD medication should always be closely monitored. Medication treatment for ADD/ADHD involves more than just taking a pill and forgetting about it. You and your doctor will need to monitor side effects, keep tabs on how you’re feeling, and adjust the dosage accordingly. When medication for ADD/ADHD is not carefully monitored, it is less effective and more risky.

If you choose to take medication for ADD/ADHD, that doesn’t mean you have to stay on it forever. Although it isn’t safe to bounce off and on any drug repeatedly, you can safely decide to stop treating your ADD/ADHD with medication if things aren’t going well. If you want to stop taking medication, be sure to let your doctor know your plans and work with him or her to taper off your medication slowly.

Regular exercise is a powerful treatment for adult ADHD

Exercising regularly is one of the easiest and most effective ways to reduce the symptoms of ADD/ADHD and improve concentration, motivation, memory, and mood.

Physical activity immediately boosts the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. In this way, exercise and medications for ADD/ADHD such as Ritalin and Adderall work similarly. But unlike ADD/ADHD medication, exercise doesn’t require a prescription and it’s side effect free.

• Try to exercise on most days. You don’t have to go to the gym. A 30-minute walk four times a week is enough to provide benefits. Thirty minutes of activity every day is even better.
• Pick something enjoyable, so you’ll stick with it. Choose activities that play to your physical strengths or that you find challenging yet fun. Team sports can be a good choice because the social element keeps them interesting.
• Get out into nature. Studies show that spending time in nature can reduce the symptoms of ADD/ADHD. Double up on the benefits by combining “green time” with exercise. Try hiking, trail running, or walking in a local park or scenic area.

The importance of sleep in adult ADHD treatment

Many adults with ADD/ADHD have sleep difficulties. The most common problems include:

• Trouble getting to sleep at night, often because racing thoughts are keeping you up.
• Restless sleep. You may toss and turn throughout the night, tear the covers apart, and wake up at any little noise.
• Difficulty waking up in the morning. Waking up is a daily struggle. You may sleep through multiple alarms and feel groggy and irritable for hours after getting up.

Poor quality sleep makes the symptoms of ADD/ADHD worse, so getting on a regular sleep schedule is essential. Improving the quality of your sleep can make a big difference in your attention, focus, and mood.

Eating right can help you regulate adult ADHD symptoms

When it comes to diet, managing ADD/ADHD is more a matter of how you eat than what you eat. Most of the nutritional problems among adults with ADD/ADHD are the result of impulsiveness and poor planning. Your goal is to be mindful of your eating habits. That means planning and shopping for healthy meals, scheduling meal times, preparing food before you’re already starving, and keeping healthful, easy snacks on hand so you don’t have to run to the vending machine or grab dinner at Burger King.

• Schedule regular meals or snacks no more than three hours apart. Many people with ADD/ADHD eat erratically—often going without a meal for hours and then binging on whatever is around. This isn’t good for your symptoms of ADD/ADHD or your emotional and physical health.
• Make sure you’re getting enough zinc, iron, and magnesium in your diet. Consider a daily multivitamin if you’re unsure.
• Try to include a little protein and complex carbohydrates at each meal or snack. These foods will help you feel more alert while decreasing hyperactivity. They will also give you steady, lasting energy.
• Add more omega-3 fatty acids to your diet. A growing number of studies show that omega-3s improve mental focus in people with ADD/ADHD. Omega-3s are found in salmon, tuna, sardines, and some fortified eggs and milk products. Fish oil supplements are an easy way to boost your intake.

Relaxation techniques: An effective treatment for adult ADHD

Many of the symptoms of ADD/ADHD can be mitigated by relaxation techniques such as meditation and yoga. When practiced consistently, these calming therapies work to increase attention and focus and decrease impulsivity, anxiety, and depression.

Meditation

Meditation is a form of focused contemplation that relaxes the mind and the body and centers your thoughts. Researchers say that in the long run, meditation increases activity in the prefrontal cortex, the part of the brain responsible for attention, planning, and impulse control.

In a way, meditation is the opposite of ADD/ADHD. The goal of meditation is to train yourself to focus your attention with the goal of achieving insight. So it’s a workout for your attention span that also might help you understand and work out problems.

Yoga

Yoga and related activities such as tai chi combine the physiological benefits of exercise with the psychological effects of meditation. You learn deep breathing and other relaxation techniques that help you become centered and mentally aware. By holding different postures for extended periods, you can cultivate balance and stillness. When you feel overwhelmed or out of control, you can turn to yoga techniques to refresh you and put you back in mental balance.

Therapy for adult ADHD can teach you better coping skills

Treatment for ADD/ADHD can also mean seeking outside help. Professionals trained in ADD/ADHD can help you learn new skills to cope with symptoms and change habits that are causing problems.
Some therapies focus on managing stress and anger or controlling impulsive behaviors, while others teach you how to handle time and money better and improve your organizational skills.

Therapy treatment options for adults with ADD / ADHD

• Talk therapy. Adults with ADD/ADHD often struggle with issues stemming from longstanding patterns of underachievement, failure, academic difficulties, job turnover, and relationship conflict. Individual talk therapy can help you deal with this emotional baggage, including low self-esteem, the feelings of embarrassment and shame you may have experienced as a child and teenager, and resentment at the nagging and criticism you receive from people close to you.
• Marriage and family therapy. Marriage and family therapy addresses the problems ADD/ADHD can create in your relationships and family life, such as conflicts over money problems, forgotten commitments, responsibilities in the home, and impulsive decisions. Therapy can help you and your loved ones explore these issues and focus on constructive ways of dealing with them and communicating with each other. Therapy can also improve your relationships by educating your partner and family members about ADD/ADHD.
• Cognitive-behavioral therapy. Cognitive-behavioral therapy encourages you to identify and change the negative beliefs and behaviors that are causing problems in your life. Since many individuals with ADD/ADHD are demoralized from years of struggle and unmet expectations, one of the main goals of cognitive-behavioral therapy is to transform this negative outlook into a more hopeful, realistic view. Cognitive-behavioral therapy also focuses on the practical issues that often come with ADD/ADHD, such as disorganization, work performance problems, and poor time management.

Coaches and professional organizers for adult ADHD

In addition to physicians and therapists, there a number of other professionals who can help you overcome the challenges of adult ADD/ADHD.

Behavioral coaching for adult ADD/ADHD

Coaching is not a traditional form of therapy, but it can be a valuable part of ADD/ADHD treatment. In contrast to traditional therapists who help people work through emotional problems, coaches focus solely on practical solutions to problems in everyday life. Behavioral coaches teach you strategies for organizing your home and work environment, structuring your day, prioritizing tasks, and managing your money. ADD/ADHD coaches may come to your home or talk with you on the phone rather than meet with you in an office; many coach-client relationships are long-distance.

Professional organizers for adult ADD/ADHD

A professional organizer can be very helpful if you have difficulty organizing your belongings or your time. Organizers can help you reduce clutter, develop better organizational systems, and learn to manage your time efficiently. A professional organizer comes to your home or workplace, looks at how you have things organized (or not organized), and then suggests changes. In addition to helping you to organize your paperwork and bill paying, a professional organizer has recommendations for memory and planning tools, filing systems, and more. A professional organizer also helps with time-management: your tasks, your to-do list, and your calendar.

Understanding ADD / ADHD in adults

Attention deficit disorder is not just a problem in children. If you were diagnosed with childhood ADD/ADHD, chances are, you’ve carried at least some of the symptoms into adulthood. But even if you were never diagnosed with ADD/ADHD as a child, that doesn’t mean you can’t be affected by it as an adult.

ADD / ADHD: It’s not just for kids

Attention deficit disorder often goes unrecognized throughout childhood. This was especially common in the past, when very few people were aware of ADD/ADHD. Instead of recognizing your symptoms and identifying the real issue, your family, teachers, or other parents may have labeled you a dreamer, a goof-off, a slacker, a troublemaker, or just a bad student.

Alternately, you may have been able to compensate for the symptoms of ADD/ADHD when you were young, only to run into problems as your responsibilities increase. The more balls you’re trying to keep in the air—pursuing a career, raising a family, running a household—the greater the demand on your abilities to organize, focus, and remain calm. This can be challenging for anyone, but if you have ADD/ADHD, it can feel downright impossible.

The good news is that, no matter how it feels, the challenges of attention deficit disorder are beatable. With education, support, and a little creativity, you can learn to manage the symptoms of adult ADD/ADHD—even turning some of your weaknesses into strengths. It’s never too late to turn the difficulties of adult ADD/ADHD around and start succeeding on your own terms.

Signs and symptoms of adult ADD / ADHD

In adults, attention deficit disorder often looks quite different than it does in children—and its symptoms are unique for each individual.

The following categories highlight common symptoms of adult ADD/ADHD. Do your best to identify the areas where you experience difficulty. Once you pinpoint your most problematic symptoms, you can start to work on strategies for dealing with them.

Trouble concentrating and staying focused

Adults with ADD/ADHD often have difficulty staying focused and attending to daily, mundane tasks. For example, you may be easily distracted by irrelevant sights and sounds, quickly bounce from one activity to another, or become bored quickly. Symptoms in this category are sometimes overlooked because they are less outwardly disruptive than the ADD/ADHD symptoms of hyperactivity and impulsivity—but they can be every bit as troublesome. The symptoms of inattention and concentration difficulties include:

• “zoning out” without realizing it, even in the middle of a conversation
• extreme distractibility; wandering attention makes it hard to stay on track
• difficulty paying attention or focusing, such as when reading or listening to others
• struggling to complete tasks, even ones that seem simple
• tendency to overlook details, leading to errors or incomplete work
• poor listening skills; hard time remembering conversations and following directions

Hyperfocus

While you’re probably aware that people with ADD/ADHD have trouble focusing on tasks that aren’t interesting to them, you may not know that there’s another side: a tendency to become absorbed in tasks that are stimulating and rewarding. This paradoxical symptom is called hyperfocus.

Hyperfocus is actually a coping mechanism for distraction—a way of tuning out the chaos. It can be so strong that you become oblivious to everything going on around you. For example, you may be so engrossed in a book, a TV show, or your computer that you completely lose track of time and neglect the things you’re supposed to be doing. Hyperfocus can be an asset when channeled into productive activities, but it can also lead to work and relationship problems if left unchecked.

Disorganization and forgetfulness

When you have adult ADD/ADHD, life often seems chaotic and out of control. Staying organized and on top of things can be extremely challenging—as is sorting out what information is relevant for the task at hand, prioritizing the things you need to do, keeping track of tasks and responsibilities, and managing your time. Common symptoms of disorganization and forgetfulness include:

• poor organizational skills (home, office, desk, or car is extremely messy and cluttered)
• tendency to procrastinate
• trouble starting and finishing projects
• chronic lateness
• frequently forgetting appointments, commitments, and deadlines
• constantly losing or misplacing things (keys, wallet, phone, documents, bills)
• underestimating the time it will take you to complete tasks

Impulsivity

If you suffer from symptoms in this category, you may have trouble inhibiting your behaviors, comments, and responses. You might act before thinking, or react without considering consequences. You may find yourself interrupting others, blurting out comments, and rushing through tasks without reading instructions. If you have impulse problems, being patient is extremely difficult. For better or for worse, you may go headlong into situations and find yourself in potentially risky circumstances. You may struggle with controlling impulses if you:

• frequently interrupt others or talk over them
• have poor self-control
• blurt out thoughts that are rude or inappropriate without thinking
• have addictive tendencies
• act recklessly or spontaneously without regard for consequences
• have trouble behaving in socially appropriate ways (such as sitting still during a long meeting)

Emotional difficulties

Many adults with ADD/ADHD have a hard time managing their feelings, especially when it comes to emotions like anger or frustration. Common emotional symptoms of adult ADD/ADHD include:

Hyperactivity or restlessness

Hyperactivity in adults with ADD/ADHD can look the same as it does in kids. You may be highly energetic and perpetually “on the go” as if driven by a motor. For many people with ADD/ADHD, however, the symptoms of hyperactivity become more subtle and internal as they grow older. Common symptoms of hyperactivity in adults include:

Effects of adult ADD / ADHD

If you are just discovering you have adult ADD/ADHD, chances are you’ve suffered over the years for the unrecognized problem. People may have labeled you “lazy” or “stupid” because of your forgetfulness or difficulty completing tasks, and you may have begun to think of yourself in these negative terms as well.

Untreated ADD/ADHD has wide-reaching effects

ADD/ADHD that is undiagnosed and untreated can cause problems in virtually every area of your life.

• Physical and mental health problems. The symptoms of ADD/ADHD can contribute to a variety of health problems, including compulsive eating, substance abuse, anxiety, chronic stress and tension, and low self-esteem. You may also run into trouble due to neglecting important check-ups, skipping doctor appointments, ignoring medical instructions, and forgetting to take vital medications.
• Work and financial difficulties. Adults with ADD/ADHD often experience career difficulties and feel a strong sense of underachievement. You may have trouble keeping a job, following corporate rules, meeting deadlines, and sticking to a 9-to-5 routine. Managing finances may also be a problem: you may struggle with unpaid bills, lost paperwork, late fees, or debt due to impulsive spending.
• Relationship problems. The symptoms of ADD/ADHD can put a strain on your work, love, and family relationships. You may be fed up with constant nagging from loved ones to tidy up, listen more closely, or get organized. Those close to you, on the other hand, may feel hurt and resentful over your perceived “irresponsibility” or “insensitivity.”

The wide-reaching effects of ADD/ADHD can lead to embarrassment, frustration, hopelessness, disappointment, and loss of confidence. You may feel like you’ll never be able to get your life under control. That’s why a diagnosis of adult ADD/ADHD can be an enormous source of relief and hope. It helps you understand what you’re up against for the first time and realize that you’re not to blame. The difficulties you’ve had are symptoms of attention deficit disorder—not the result of personal weakness or a character flaw.

Self-help for adult ADD / ADHD

Armed with an understanding of ADD/ADHD’s challenges and the help of structured strategies, you can make real changes in your life. Many adults with attention deficit disorder have found meaningful ways to manage their symptoms, take advantage of their gifts, and lead productive and satisfying lives. You don’t necessarily need outside intervention—at least not right away. There is a lot you can do to help yourself and get your symptoms under control.

• Exercise and eat right. Exercise vigorously and regularly—it helps work off excess energy and aggression in a positive way and soothes and calms the body. Eat a wide variety of healthy foods and limit sugary foods in order to even out mood swings.
• Get plenty of sleep. When you’re tired, it’s even more difficult to focus, manage stress, stay productive, and keep on top of your responsibilities. Support yourself by getting between 7-8 hours of sleep every night.
• Practice better time management. Set deadlines for everything, even for seemingly small tasks. Use timers and alarms to stay on track. Take breaks at regular intervals. Avoid piles of paperwork or procrastination by dealing with each item as it comes in. Prioritize time-sensitive tasks and write down every assignment, message, or important thought.
• Work on your relationships. Schedule activities with friends and keep your engagements. Be vigilant in conversation: listen when others are speaking and try not to speak too quickly yourself. Cultivate relationships with people who are sympathetic and understanding of your struggles with ADD/ADHD.
• Create a supportive work environment. Make frequent use of lists, color-coding, reminders, notes-to-self, rituals, and files. If possible, choose work that motivates and interests you. Notice how and when you work best and apply these conditions to your working environment as best you can. It can help to team up with less creative, more organized people—a partnership that can be mutually beneficial.

When to seek outside help for adult ADD / ADHD

If the symptoms of ADD/ADHD are still getting in the way of your life, despite self-help efforts to manage them, it may be time to seek outside support. Adults with ADD/ADHD can benefit from a number of treatments, including behavioral coaching, individual therapy, self-help groups, vocational counseling, educational assistance, and medication.

Treatment for adults with attention deficit disorder, like treatment for kids, should involve a team of professionals, along with the person’s family members and spouse.

What is seasonal affective disorder (SAD)?

Seasonal affective disorder (SAD) is a form of depression that occurs at the same time each year, usually in winter. Otherwise known as seasonal depression, SAD can affect your mood, sleep, appetite, and energy levels, taking a toll on all aspects of your life from your relationships and social life to work, school, and your sense of self-worth. You may feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love. While a less common form of the disorder causes depression during the summer months, SAD usually begins in fall or winter when the days become shorter and remains until the brighter days of spring or early summer.

SAD affects about 1% to 2% of the population, particularly women and young people, while a milder form of winter blues may affect as many 10 to 20 percent of people. Since the amount of winter daylight you receive changes the farther you are from the equator, SAD is most common in people who live at least 30 degrees latitude north or south (north of places such as Jacksonville, Florida, Austin, Texas, Cairo, Egypt, and Hangzhou, China, or south of Perth, Australia, Durban, South Africa, and Cordoba, Argentina). No matter where you live, though, or how dark and cold the winters, the good news is that, like other forms of depression, SAD is treatable. The more you understand about seasonal depression, the better equipped you’ll be to manage or even prevent the condition.

Signs and symptoms of seasonal affective disorder

The signs and symptoms of seasonal affective disorder are the same as those for major depression. SAD is distinguished from depression by the remission of symptoms in the spring and summer months (or winter and fall in the case of summer SAD).

Common symptoms of seasonal depression include:

• Depressed mood, low self-esteem
• Loss of interest or pleasure in activities you used to enjoy
• Feelings of sadness, hopelessness, and despair
• Feeling angry, irritable, stressed, or anxious
• Unexplained aches and pains
• Changes in sleeping pattern
• Appetite and weight changes
• Difficulty concentrating
• Fatigue and lack of energy; reduced sex drive
• Use of drugs or alcohol for comfort

As with depression, the severity of SAD symptoms can vary from person to person—often depending on genetic vulnerability and geographic location. For many, the symptoms usually begin mildly at the start of fall and get progressively worse through the darkest days of winter. Then, by spring or early summer, the symptoms lift until you’re in remission and feel normal and healthy again.

To be clinically diagnosed with seasonal affective disorder, you need to have experienced these cyclical symptoms for two or more consecutive years. Regardless of the timing or persistence of your symptoms, if your depression feels overwhelming and is adversely affecting your life, it’s time to seek help.

Seasonal changes in bipolar disorder

The changes in seasons can trigger mood changes in some people with bipolar disorder. Spring and summer may trigger symptoms of mania or hypomania, while the onset of fall and winter can bring on symptoms of depression. While the depression symptoms of SAD and bipolar disorder can look alike, there are significant differences, especially when it comes to treatment. To learn more about bipolar disorder, see Bipolar Disorder Signs and Symptoms.

Causes of seasonal affective disorder

While the exact causes of seasonal affective disorder are unclear, most theories attribute the disorder to the reduction of daylight hours in winter. The shorter days and reduced exposure to sunlight that occurs in winter are thought to affect the body by disrupting:

• Circadian rhythms. Your body’s internal clock or sleep-wake cycle responds to changes between light and dark to regulate your sleep, mood, and appetite. The longer nights and shorter days of winter can disrupt your internal clock—leaving you feeling groggy, disoriented, and sleepy at inconvenient times.
• Production of melatonin. When it’s dark, your brain produces the hormone melatonin to help you sleep and then sunlight during the day triggers the brain to stop melatonin production so you feel awake and alert. During the short days and long nights of winter, however, your body may produce too much melatonin, leaving you feeling drowsy and low on energy.
• Production of serotonin. The reduced sunlight of winter can lower your body’s production of serotonin, a neurotransmitter that helps to regulate mood. A deficit may lead to depression and adversely affect your sleep, appetite, memory, and sexual desire.

As with any form of depression, there can be many different causes and contributing factors for seasonal affective disorder. Always consult your doctor for an accurate diagnosis and see the lifestyle changes outlined below for help to boost your mood and manage your depression symptoms.

Risk factors

Seasonal affective disorder can affect anyone but is most common in people who live far north or south of the equator. This means you’ll experience less sunlight in the winter months and longer days during the summer. Other risk factors include:

• Your gender. While 3 out of 4 sufferers of SAD are women, men often experience more severe symptoms.
• Your age. In most cases, winter SAD is first diagnosed in people aged 18 to 30 and is less likely to occur as you get older.
• Your family history. Having relatives who’ve experienced SAD or another type of depression puts you at greater risk.

Self-help tips for seasonal affective disorder

Seasonal depression can make it hard to motivate yourself to make changes, but there are plenty of steps you can take to help yourself feel better. Recovery takes time but you’ll likely feel a little better each day. By adopting healthy habits and scheduling fun and relaxation into your day, you can help lift the cloud of seasonal affective disorder and keep it from coming back.

Tip #1: Get as much natural sunlight as possible—it’s free!

Whenever possible, get outside during daylight hours and expose yourself to the sun without wearing sunglasses (but never stare directly at the sun).

• Take a short walk outdoors, have your coffee outside if you can stay warm enough.
• Increase the amount of natural light in your home and workplace by opening blinds and drapes and sitting near windows.
• Some people find that painting walls in lighter colors or using daylight simulation bulbs also helps combat winter SAD.

Tip #2: Exercise regularly—it can be as effective as medication

Regular exercise is a powerful way to fight seasonal depression, especially if you’re able to exercise outside in natural daylight.

• Regular exercise can boost serotonin, endorphins, and other feel-good brain chemicals. In fact, exercise can treat mild to moderate depression as effectively as antidepressant medication.
• Exercise can also help to improve your sleep and boost your self-esteem.
• Aim for 30 to 60 minutes of activity on most days. Even something as simple as walking a dog, for example, can be good exercise for you and the animal, as well as a great way to get outdoors and interact with other people.

Tip #3: Reach out to family and friends—and let them help

Close relationships are vital in reducing isolation and helping you manage SAD. Participate in social activities, even if you don’t feel like it. It may feel more comfortable to retreat into your shell, but being around other people will boost your mood. Even if you’ve retreated from relationships that were once important to you, make the effort to reconnect or start new relationships.

• Call or email an old friend to meet for coffee. Or reach out to someone new—a work colleague or neighbor, for example. Most of us feel awkward about reaching out, but be the one to break the ice.
• Join a support group for depression. Sometimes, just talking about what you’re going through can help you feel better. Being with others who are facing the same problems can help reduce your sense of isolation and provide inspiration to make positive changes.
• Meet new people with a common interest by taking a class, joining a club, or enrolling in a special interest group that meets on a regular basis. Whatever you choose, make sure it’s something that’s fun for you.
• Volunteer your time. Helping others is one of the best ways to feel better about yourself, expand your social network, and overcome SAD.

Tip #4: Eat the right diet

Eating small, well-balanced meals throughout the day, with plenty of fresh fruit and vegetables, will help you keep your energy up and minimize mood swings.

• While the symptoms of SAD can make you crave sugary foods and simple carbohydrates, such as pasta and white bread, complex carbohydrates are a better choice. Foods such as oatmeal, whole grain bread, brown rice, and bananas can boost your feel-good serotonin levels without the subsequent sugar crash.
• Foods rich in certain omega-3 fats—such as oily fish, walnuts, soybeans, and flaxseeds—can also improve your mood and may even boost the effectiveness of antidepressant medication.

Tip #5: Take steps to deal with stress—by making time for fun

Whatever the time of year, too much stress can exacerbate or even trigger depression. Figure out the things in your life that stress you out, such as work overload or unsupportive relationships, and make a plan to avoid them or minimize their impact.

• Practicing daily relaxation techniques can help you manage stress, reduce negative emotions such as anger and fear, and boost feelings of joy and well-being. Try yoga, meditation, or progressive muscle relaxation.
• Do something you enjoy every day. Having fun is a great stress buster, so make time for leisure activities that bring you joy, whether it be painting, playing the piano, working on your car, or simply hanging out with friends.

Treatment for seasonal affective disorder

While your doctor may also suggest treatment such as medication or psychotherapy, the mainstay of winter SAD treatment is light therapy, otherwise known as phototherapy. Light therapy aims to replace the missing daylight of winter by exposing you to bright light that mimics natural outdoor light. Daily exposure can suppress the brain’s secretion of melatonin to help you feel more awake and alert, less drowsy and melancholy.

Light therapy has been shown to be effective in up to 85 percent of SAD cases. However, the timing and length of exposure needed can vary according to your symptoms and circadian rhythm, so you’ll need guidance from your doctor or mental health professional to find the right dosage. Your doctor or therapist can also help you choose a light therapy product that’s both effective and safe.

Light therapy has to be continued daily throughout the winter months to be effective. Starting light therapy before the onset of symptoms in the fall may even help prevent seasonal affective disorder.

There are two different ways of administering light therapy.

• A light box delivers light that with up to ten times the intensity of normal domestic lighting. In most cases, you simply sit about 12 inches in front of a 10,000 lux light box for 15 to 30 minutes each morning. The light box emits a controlled amount of white light, with harmful ultraviolet (UV) rays filtered out. While the light needs to enter the eyes, you shouldn’t stare directly at the light box, but rather continue your morning routine, such as eating breakfast, reading the newspaper or working at the computer. Most people notice an improvement in their SAD symptoms after a few days and experience the full antidepressant effect in about two weeks.
• A dawn simulator is a device that gradually increases the amount of light in your bedroom in the morning to simulate the rising sun and wake you up. The light gradually increases, just as natural sunlight does, over a period of 30 to 45 minutes. Instead of waking in darkness, you wake to what looks like a sunny morning. This can help reset your circadian rhythm and improve your mood. While light boxes may trigger hypomania or mania in those with bipolar disorder, there is no such risk with a dawn simulator.

While tanning beds generate sufficient light, they should never be used to treat SAD as the UV rays they produce can be harmful to the skin and eyes.

Medication and psychotherapy for seasonal affective disorder

While light therapy is often a highly effective treatment for SAD or the winter blues, it doesn’t work for everyone. If that’s the case, don’t despair, there are other effective treatment options available and plenty of self-help techniques to help you feel better.

• Cognitive behavioral therapy (CBT) can be highly beneficial for people with seasonal depression.The right therapist can help you curb negative thoughts, attitudes, and behaviors that make the disorder worse and help you learn how to manage symptoms and deal with stress in healthy ways. For many people, CBT can be as effective at treating seasonal affective disorder as light therapy or antidepressants, but without any risky side-effects.
• Medication. If light therapy doesn’t work for you, your doctor may suggest antidepressant medication. SSRI antidepressants work by acting on serotonin levels in the brain to reduce SAD symptoms. In the U.S., the FDA has specifically approved the drug bupropion (Wellbutrin) to treat seasonal affective disorder. However, as with all antidepressants, there may be adverse side effects, including a number of safety concerns specific to children and young adults. It’s important to weigh the benefits against the risks before starting on medication.

Whatever treatment plan you settle on, it’s important to combine it with self-help techniques to help manage your depression symptoms and even help prevent seasonal affective disorder returning next year.

Do antidepressants cure a chemical imbalance in the brain?

You’ve seen it in television ads, read it in newspaper articles, maybe even heard it from your doctor: depression is caused by a chemical imbalance in the brain that medication can correct. The truth is that there is very little—if any—research to support this theory. It’s a triumph of pharmaceutical marketing over science.

While antidepressant drugs increase serotonin levels in the brain, this doesn’t mean that depression is caused by a serotonin shortage. After all, aspirin may cure a headache, but that doesn’t mean headaches are caused by an aspirin deficiency.

When it comes to depression, serotonin is just one small part of the story

Mental health researchers agree that the causes of depression are much more complex than the chemical imbalance theory suggests. A growing body of research points to other physiological factors, including inflammation, elevated stress hormones, immune system suppression, abnormal activity in certain parts of the brain, nutritional deficiencies, and shrinking brain cells. And these are just the biological causes of depression. Social and psychological factors⎯such as loneliness, lack of exercise, poor diet, and low self-esteem⎯also play an enormous role.

How effective are antidepressants?

So now we know that depression isn’t simply a matter of having too little serotonin. But that doesn’t mean that antidepressants don’t work. Going back to our aspirin analogy, even though headaches aren’t caused by an aspirin deficiency, they still go away when you pop a couple of pills. Is the same true with antidepressant and depression? Again, the evidence may surprise you.

When depression is severe, medication may be helpful—even lifesaving. However, research shows that very few people become symptom-free on antidepressants, and some become worse. Furthermore, many who respond initially to medication soon slip back into depression, despite sticking with drug treatment.

Other studies show that the benefits of antidepressants have been exaggerated, with a growing number of researchers concluding that—when it comes to mild to moderate depression—antidepressants are no more effective than placebos.

I’m depressed and need relief. Where does this leave me?

Medication may be right for you if depression is interfering with your ability to function in an important part of your life—work, school, or in your relationships, for example. However, many people use antidepressants when therapy, exercise, or self-help strategies would work just as well or better—minus the side effects. Even if you decide to take medication, it’s a good idea to pursue therapy and lifestyle changes that can help you get to the bottom of your underlying issues and develop the tools to beat depression for good.

What are the side effects of antidepressant medication?

There are many different types of drugs used in the treatment of depression, including selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Side effects are common in all antidepressants. For many people, the side effects are serious enough to make them stop taking the medication..

Side effects of SSRIs (selective serotonin reuptake inhibitors)

The most widely prescribed antidepressants come from a class of medications known as selective serotonin reuptake inhibitors (SSRIs). The SSRIs include drugs such as Prozac, Zoloft, and Paxil.

The SSRIs act on a chemical in the brain called serotonin. Serotonin helps regulate mood, but it also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions. As a result, the SSRI antidepressants cause a wide range of side effects.

Common SSRI side effects include:

The SSRIs can also cause serious withdrawal symptoms, especially if you stop taking them abruptly.

Side effects of atypical antidepressants

There are a variety of newer depression drugs, called atypical antidepressants, which target other neurotransmitters either alone or in addition to serotonin. Some of the brain chemicals they affect include norepinephrine and dopamine. The atypical antidepressants include:

The side effects vary according to the specific drug. However, many of the atypical antidepressants can cause nausea, fatigue, weight gain, sleepiness, nervousness, dry mouth, and blurred vision.

Side effects of older depression drugs

Tricyclic antidepressants and MAOIs (monoamine oxidase inhibitors) are older classes of antidepressants. Their side effects are more severe than those of the newer antidepressants, so they are only prescribed as a last resort after other treatments and medications have failed.

Antidepressants and suicide risk

There is a danger that, in some people, antidepressant treatment will cause an increase, rather than a decrease, in depression. In fact, the U.S. Food and Drug Administration requires that all depression medications include a warning label about the increased risk of suicide in children and young adults. The suicide risk is particularly great during the first month to two months of treatment.

Anyone taking antidepressants should be closely watched for suicidal thoughts and behaviors. Monitoring is especially important if this is the person’s first time on depression medication or if the dose has recently been changed. Signs that medication is making things worse include anxiety, insomnia, hostility, and extreme agitation—particularly if the symptoms appear suddenly or rapidly deteriorate. If you spot the warning signs in yourself or a loved one, contact your doctor or therapist immediately.

What are the risk factors of antidepressants?

Anyone who takes antidepressants can experience side effects, but certain individuals are at a higher risk:

• People over 65. Studies show that SSRI medications may increase the risk for falls, fractures, and bone loss in older adults.
• Pregnant women. The use of SSRIs late in pregnancy may lead to short-term withdrawal symptoms in newborns after delivery. Typical symptoms include tremor, restlessness, mild respiratory problems, and weak cry.
• Teens and young adults. The U.S. Food and Drug Administration requires all depression medications to include a warning label about the increased risk of suicide in children and young adults.
• People who may have bipolar disorder. Antidepressants can actually make bipolar disorder worse or trigger a manic episode; there are other treatments available for those with bipolar disorder.

Is depression medication right for you?

If you’re considering antidepressants as a treatment option, the following questions may help you make your decision.

Questions to ask yourself and a mental health professional

• Is my depression adversely affecting my life enough to require drug treatment?
• Is medication the best option for treating my depression?
• Am I willing to tolerate unwanted side effects?
• What non-drug treatments might help my depression?
• Do I have the time and motivation to pursue other treatments such as therapy and exercise?
• What self-help strategies might reduce my depression?
• If I decide to take medication, should I pursue therapy as well?

Questions to ask your doctor

• How much mental health care training have you had?
• Are there any medical conditions that could be causing my depression?
• What are the side effects and risks of the antidepressant you are recommending?
• Are there any foods or other substances I will need to avoid?
• How will this drug interact with other prescriptions I’m taking?
• How long will I have to take this medication?
• Will withdrawing from the drug be difficult?
• Will my depression return when I stop taking medication?

Guidelines for taking antidepressants

The more you know about your antidepressant, the better equipped you’ll be to deal with side effects, avoid dangerous drug interactions, and minimize other safety concerns.

Some suggestions:

• See a psychiatrist, not a family physician. Your family physician might help you or your loved one first realize that you may need depression treatment. But although any medical doctor can prescribe medications, psychiatrists are doctors who specialize in mental health treatment. They are more likely to be familiar with the newest research on antidepressants and any safety concerns. Your health depends on your doctor’s expertise, so it’s important to choose the most qualified physician.
• Follow instructions. Be sure to take your antidepressant according to the doctor’s instructions. Don’t skip or alter your dose, and don’t stop taking your pills as soon as you begin to feel better. Stopping treatment prematurely is associated with high relapse rates and can cause serious withdrawal symptoms.
• Beware of drug interactions. You should avoid drinking alcohol when taking SSRIs since it can lessen the effects of the medication. Dangerous drug interactions can occur when SSRIs are taken with antihistamines, found in many over-the-counter cold and allergy medicines and sleep aids, or with prescription painkillers. Always talk to your doctor or pharmacist before combining medications.
• Monitor side effects. Keep track of any physical and emotional changes you’re experiencing and talk to your doctor about them. Contact your doctor or therapist immediately if your depression worsens or you experience an increase in suicidal thoughts. See your doctor on a regular basis.
• Be patient. Finding the right drug and dosage is a trial and error process. It takes approximately four to six weeks for antidepressant medications to reach their full therapeutic effect. Many people try several medications before finding one that helps.

Antidepressant withdrawal

Once you’ve started taking antidepressants, stopping can be tough. Many people have severe withdrawal symptoms that make it difficult to get off of the medication. If you decide to stop taking antidepressants, it’s essential to consult a doctor and taper off slowly.

Antidepressant withdrawal symptoms

When you stop taking antidepressants, you may experience a number of unpleasant—even disabling—withdrawal symptoms, including:

Tips for stopping your antidepressants safely

• Reduce your dose gradually. In order to minimize antidepressant withdrawal symptoms, never stop your medication “cold turkey.” Instead, gradually step down your dose, allowing for at least one to two weeks between each dosage reduction.
• Don’t rush the process. The antidepressant tapering process may take up to several months, and should only be attempted under a doctor’s supervision. Be patient. If, at any time, you experience difficulties, consider spending more time at your current dose before attempting any further reductions.
• Choose a time to stop that isn’t too stressful. Withdrawing from antidepressants can be difficult, so it’s best to start when you’re not under a lot of stress. If you’re currently going through any major life changes or significantly stressful circumstances, you may want to wait until you’re in a more stable place.