Let your emotions out affirmations

Posted on June 29, 2016 by JmaC
Present Tense Affirmations
I always express my emotions
I let others know how I am really feeling
I always speak my mind
I show the world who I truly am
I allow others to see the real me
I stand up for myself and tell people how I feel
I am in touch with my deepest emotions
I stand up for what I believe in
I am comfortable confronting others and telling them how I feel
I show my true self to family and friends

 

Future Tense Affirmations
I will let my emotions out
I am transforming into someone who is unafraid of being their true self
I will always express my opinion
I am finding it easier to tell others how I am feeling
I will always stand up for myself
I am developing the courage to show people the real me
It is becoming easier to say what I want
I will always tell others what I really think
Letting my emotions out is starting to feel normal
I will show people the real me

 

Natural Affirmations
Expressing my emotions comes naturally to me
I love sharing my feelings with others
Telling others what I think is important to me
Letting out my emotions is healthy
Expressing my emotions is improving the way I feel
I am the kind of person who just tells others how I feel and what I want
It is important that I voice my opinion
It feels good to show people the real me
I have the courage to be myself at all times
I stand up for what I believe in
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Guidelines for choosing a Cognitive Behavioral Therapist

Posted on June 29, 2016 by JmaC
After the decision to seek therapy has been made, an individual may feel unsure about how to choose a therapist. People seeking therapy often find that they have no standards to use in evaluating potential therapists. There are many competent therapists practicing therapy using different approaches.

The purpose of this guide is to provide you with information that might be useful in selecting a cognitive-behavior therapist. No guideline can provide strict rules for selecting the best therapist for a particular individual. We can, however, suggest questions you might ask and areas of information you might want to cover with a cognitive-behavior therapist you are considering seeing before you make a final decision.

What Is Cognitive-Behavior Therapy?

There is no single definition of cognitive-behavior therapy. Although some common points of view are shared by most cognitive-behavior therapists, there is wide diversity among those people who call themselves cognitive therapists, behavior therapists, or cognitive-behavior therapists. The therapists themselves may say they practice cognitive therapy, or behavior therapy, or cognitive-behavior therapy, or some other approach, all of which fall under the umbrella of CBT. The definition that follows is meant to give you a general idea of what cognitive-behavior therapy is. It is not, however, an absolute definition.

CBT is typically a short-term, problem-focused therapy that relies of scientific research. The focus is on the difficulties in the present, although in understanding these difficulties occasionally early life experiences are discussed. The goal of therapy is to teach the individuals to be their own therapists by providing strategies to evaluate their thinking and manage problematic behaviors. The emphasis is on providing you with the tools you need to make progress towards the goals you set.

Qualifications and Training Necessary for Particular Mental Health Professionals

Cognitive-behavior therapy can be done by a number of different mental health professionals. Competent cognitive-behavior therapists are trained in many different disciplines, and the distinction between different types of mental health professionals can sometimes be confusing. Therefore, we have listed below a brief description of the training received by different types of professionals who offer cognitive behavior therapy. Keep in mind that the emphasis on CBT during training will vary between the disciplines listed below.

Psychologists

Psychologists have doctoral degrees (Ph.D., Ed.D., Psy.D.) from graduate programs approved by the American Psychological Association and, soon, the Canadian Psychological Association. Clinical psychologists also have a one-year clinical internship, and one to two years of supervised postdoctoral experience is generally required to receive a license. Licensing or certification procedures vary and are the responsibility of state or provincial governing bodies.

Clinical Social Workers

A clinical social worker must have a college degree plus at least two years of graduate training in a program accredited by the Council on Social Work Education.

Certified social workers have a master’s or doctoral degree in Social Work (MSW, DSW, or Ph.D.) from a program approved by the Council on Social Work Education, have had two years of post-degree experience in the practice of social work, and must have passed an examination given by the Academy of Certified Social Workers (ACSW). Licensing procedures vary from state to state and province to province.

Psychiatrists

A psychiatrist must have a medical degree. Although, technically, an individual can practice psychiatry having had four years of medical school and a one-year medical internship, most psychiatrists continue their training in a five-year residency program in psychiatry. Psychiatrists who have Board certification have had two years of post-residency experience practicing psychiatry and must have passed an examination given by the American Board of Psychiatry and Neurology. But please note that the board certification for psychiatrists does not include any specifics about their training in or knowledge of CBT.

Professional Counselors

Professional counselors usually have master’s (M.E.D., M.A.E., M.A., or M.S.), specialist (Ed.S.), or doctoral (Ph.D. or Ed.D.) degrees from an accredited university. Certified counselors typically have graduate training in counseling, and must have passed an examination given by the National Board of Certified Counselors. Licensing procedures vary from state to state and province to province.

Practical Information About the Training

The degrees and training described above give some sense of what is required to get that degree, but no information at all about how the therapists approach their clients or treat their clients’ problems. That is covered a little below, but, it bears repeating: ask questions.

Practical Information About Therapists

You have the right to obtain the following information about any potential therapist. This information may be obtained from the referral person, over the phone with the therapist, or at your first visit with the therapist. Although you may not feel that all this information is relevant, you will need a substantial amount of it to evaluate whether a particular therapist would be good for you.

Your first session with a cognitive-behavioral therapist should always be a consultation. This session does not commit you to working with the therapist. The therapist will likely ask a number of questions to get a clear idea of the problem. The goals in the first session should be to find out whether this particular therapist is likely to be helpful to you and if you feel comfortable and confident with the therapist. During this session you may want to discuss the therapist’s approach to treating you, your goals for treatment, possible timetables, and potential pitfalls to these goals.

Questions to Ask When Deciding on a Therapist

A cognitive-behavior therapist will devote the first few sessions to assessing the extent and causes of the concerns you have. Generally, your therapist will be asking quite specific questions about the concerns or problems causing you distress and about when and where these occur. As the assessment progresses, you can expect that you and your therapist will arrive at mutually agreeable goals for how you want to change. If you can’t agree on the goals of therapy, you should consider finding another therapist.

The following are things you need to know about a prospective therapist:

  • Training and Qualifications

 

You should find out whether the individual therapist is licensed or certified by your state. If the person is not licensed or certified by your state or province, you may want to ask whether the person is being supervised by another mental health professional. Some clinicians will be certified in cognitive behavior therapy.

The emphasis on cognitive-behavior therapy varies within each discipline. As such, the amount of training or type of professional discipline will not provide information on the therapist’s familiarity and experience with CBT. Therapists with a strong foundation in CBT will not mind being asked questions about their qualifications and will freely give you any professional information that you request. If a therapist does not answer your questions to your satisfaction, or refuses to answer your questions, you should consult another therapist.

  • Fees

 

Many people feel uncomfortable asking about fees. However, it is important information that a good therapist will be willing to give a potential client. The following are financial questions you may want to cover with a therapist. This information may be obtained over the phone or during your first visit. You will want to know:

  • How much does the therapist charge per session?
  • Does the therapist charge according to income (sliding scale)?
  • Does the therapist charge for the initial session? (Since many therapists do charge for the initial session, you should get this information before your first visit.)
  • Is there a policy concerning vacations and missed or canceled sessions? Is there a charge?
  • Will your health insurance cover you if you see this therapist?
  • Will the therapist want you to pay after each session, or will you be billed periodically?

  • Other Questions

 

The following are other questions you may want to ask a therapist:

  • How many times a week will the therapist want to see you?
  • How long will each session last?
  • How long does the therapist expect treatment to last? (Some therapists only do time-limited therapy, whereas others set no such limits.)
  • What are some of the treatment approaches likely to be used?
  • Does the therapist accept phone calls at the office or at home?
  • When your therapist is out of town or otherwise unavailable, is there someone else you can call if an emergency arises?
  • Are there any limitations on confidentiality?

As Therapy Proceeds

Once the initial goals are decided upon, you can expect the therapist to discuss with you one or more approaches for helping you reach your goals. Central to cognitive behavior therapy is home-based work. Many other forms of therapy do not involve exercises between sessions but it is an important part of CBT. As CBT is a skills-based therapy, people will be required to practice these skills. This practice occurs at a pace that is individual to you. As you continue therapy, you can expect your therapist to consistently evaluate your progress toward the previously established goals. If you are not progressing, or if progress is too slow, your therapist will most likely suggest modifying or changing the treatment approach. At each of these points you may want to ask yourself the following questions:

  • Do you understand what the therapist has asked you to do?
  • Do the therapist’s instructions seem relevant to your objectives?
  • Do you believe that following these instructions is likely to help you make significant progress?
  • Has the therapist given you a choice of alternative therapy approaches?
  • Has the therapist explained possible side effects of the therapy?

What to Do If You Are Dissatisfied With Your Therapist

 

  • Talk With Your Therapist

 

People can feel angry or frustrated at times about their therapy. If you do, you should discuss these concerns, dissatisfactions, and questions with the therapist. A good therapist will be open to hearing them and discuss your dissatisfaction with you.

 

  • Get a Second Opinion

 

If you feel that the issues and problems you have raised with your therapist are not being resolved, you may want to consider asking for a consultation with another professional. Usually the therapist you are seeing can suggest someone you can consult. If your therapist objects to your consulting another professional, you should change to another therapist who will not object.

 

  • Consider Changing Therapists

 

Many people feel that it is never acceptable to change therapists once therapy has begun. This is simply not true. Good therapists realize that they might not be appropriate for every person.

The most important thing you need to ask yourself when deciding to continue with a particular therapist is, “Am I changing in the direction I want to change?” If you do not feel that you are improving, and if, after discussing this with your therapist, it does not appear likely to you that you will improve with this therapist, you should consult another therapist.

How to Get the Names of Cognitive-Behavior Therapists

If you don’t already have the name of a therapist, you might try some of the following suggestions:

  • Call us, the Association for Cognitive and Behavioral Therapies. ABCT is not a certifying organization, but ABCT provides lists of all full members by state and, in Canada, by province, including information on specialties and populations served. You might call persons listed to ask for a referral. Our referral is found at www.findcbt.org.
  • Each state or province will have a list of mental health providers separated by discipline (e.g., social workers, clinical counselors, psychiatrists and psychologists). Many of these professional organizations have a referral service.
  • Call the university psychology, social work, or medical school psychiatry departments in your area and ask for a referral. Ask to speak with someone in clinical or counseling psychology, or the chairperson of the department of psychiatry.
  • Call your local community mental health clinic. The clinic may have a cognitive-behavior therapist on the staff or be able to give you a referral.
  • Look in the National Register of Health Service Providers in Psychology, published by the Council of National Health Service Providers in Psychology, 1120 “G” Street, NW, Suite 330, Washington, DC 20005. Persons listed might be able to give you a referral.
  • Look in the National Association of Social Workers Register of Clinical Social Workers published by the National Association of Social Workers, 750 1st Street, NE, Suite 700, Washington, DC 20002. Persons listed might be able to give you a referral.
  • Ask for recommendations from your family physician, friends, and relatives.
  • Look at the American Board of Professional Psychology (click on Cognitive and Behavioral Psychology). This can be found at http://www.abpp.org.
  • Look at the Academy of Cognitive Therapy, which can be found at
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Stress

Posted on June 29, 2016 by JmaC
Everyone experiences stress. Stress can come from anywhere: day-to-day activities, relationships, work, life changes, illness, even from fun events.

Everyone reacts differently to it. Many people don’t even know they are stressed until they begin to experience serious symptoms. Symptoms can be psychological, physical, or both.

What Are the Symptoms of Stress?

Symptoms can include irritability, lack of concentration, worrying, minor headaches, eating too much or too little, not sleeping well, lower back pain, rashes, an upset stomach or ulcers, migraine or tension headaches, high blood pressure, and chest pains, to name a few. Stress can also make physical problems worse, lower your resistance to disease, and affect how well your body responds to sickness and how well you recover from minor setbacks.

Stress affects us all in one way or another. Some people deal well with their stress. Some people have learned to identify their stressors (those things that cause people to feel stress) and deal with them appropriately. Unfortunately, many of us do not deal effectively with the stressors in our lives.

Stress Management Techniques

Things I Can Do on My Own

Do you work too much? Do you get so busy with the kids that you are too tired to go out and have fun or relax? Do you put things off until the last minute? Do you avoid dealing with problems? Do you feel stuck in your life? Do you plan too much but feel ineffective?

People can manage their own stressors by taking time out of their busy lives and identifying potential conflicts, changes, worries, or time constraints that they have. First, figure out what your stressors are; then, see if the stressor is within or outside of your control.

For example, if your job is based on deadlines, unless you decide to change jobs, the stressor is outside of your control. In this case, while you can’t control the stressors, you may be able to do things to make them more manageable. For instance, in a job with tight deadlines, you might schedule 5-minute breaks, just to catch your breath and relax. Also, you might try to get to bed earlier so that you are more refreshed and less tired; you might even try to delegate more or see if the work flow can be rearranged to make things move more smoothly. A key is to determine what is within your control to change and what isn’t, and then try to affect those things that are within your control.

What is within your control is what you do for yourself to help get rid of the stress on a regular basis. Some people work out at a gym, others meditate. So you can influence how stressors affect you. A lot of times it is something we are doing to ourselves that makes something even more stressful. In the example we just discussed, perhaps you did not take a break to eat a healthy lunch, or you are really mad that a co-worker left extra work for you, but feel there is nothing you can do about it. In the first example, you could try to schedule a break or eat more healthy snacks; in the second example, you could talk with your colleague about the extra work.

We all know about eating healthy, sleeping enough, exercising, relaxing, enjoying friends and family, and taking care of our bodies. However, many of us don’t do these things and, consequently, we add to our stress level. Some people can figure out what to do on their own, but many of us require a behavioral psychologist to help us put together our own unique program that matches our individual needs.

There are several techniques that can be taught by trained behavior therapists or cognitive behavior therapists to help you identify and effectively deal with your stress.

Therapy Techniques I Can Learn

There are many techniques available to manage stress. Below are some that are commonly used by behavior therapists to help their patients reduce stress. You and your therapist must thoroughly assess which of these would be most useful for your life and your unique stressors.

1. Progressive Relaxation Training and Controlled Breathing Techniques effectively reduce physical tension, anxiety, and overall stress level. Progressive Relaxation Training involves a series of exercises that train your body and mind to become gradually more relaxed. It requires an initial time investment, but, with practice, can be effective in reducing stress. Controlled Breathing requires less time at first, and works well with people who can clear their mind and learn to regulate their breathing, thus relaxing the rest of the body. Sometimes this is harder to do because many people who are used to being stressed tend to breath in a shallow and quick manner. Your therapist is trained to determine which individuals respond better to which treatment, and can also help determine which technique is likely to benefit you most. Some therapists may use biofeedback techniques to help determine which techniques work best for you.

2. Cognitive Restructuring works very well with accumulated stress and for people who tend to overreact or underreact to situations. In cognitive restructuring, your therapist will help you look at situations to see when you might be incorrectly viewing a problem and help you see the problem for what it is. For instance, many of us make assumptions or have unnecessary worries that go far beyond what the situation calls for. Your therapist can help you identify when your thoughts and feelings are inappropriate to the situation and when they actually contribute to your stress. They can teach you a method to catch yourself when you do it, and teach you how to use logic to revise your reaction to a level appropriate to the situation. This treatment works well for people feeling stuck in their lives, who fly off the handle, and who get upset even with little things. Because this technique teaches you to question how you think about things (or how you feel about things), this also helps people feel more comfortable standing up for themselves and about their ability to be effective in their own lives.

3. Assertiveness Training and Communication Skills Training can be used jointly with one of the above techniques or may be effective when used alone. Both techniques teach you how to deal with difficulties in a fair and tactful way, where everyone’s rights are considered. Many people avoid dealing with stressful situations, such as asking for more money or asking the *neighbors to keep their cat away from the bird feeder. They feel they have no right to ask for what they want, fear they will make matters worse, or fear rejection. Learning how to approach others, speak up for oneself, and use good speaking and listening skills can be extremely effective in reducing the stress that results from interacting— or the mere prospect of interacting—with others.

4. Problem-Solving Techniques are extremely helpful in combination with the above or on their own to help people, couples, groups, and families reduce stress. You learn techniques that help you focus on solutions instead of focusing on the problem. Because we often focus on the problem, rather than thinking of solutions, we increase stress and feel hopeless, helpless, or out of control. The therapist can teach you how to use these techniques and discover ways to focus on solutions, which will help overcome the stressors or, at least, minimize their effects.

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Health Anxiety what is it

Posted on June 29, 2016 by JmaC
Health Anxiety: What Is It?

Anxiety is the body’s natural response to the perception of threat. Because most people consider their physical health to be of great importance, it is not surprising that most people experience anxiety about their health from time to time. Most people’s health anxiety is fleeting, in that reassurance from a medical professional alleviates any distress and worry.

Other people, however, experience anxiety about their health that is intensely distressing, frequent, and persistent. Such “clinical health anxiety” is especially common for people with psychological disorders such as illness anxiety disorder (IAD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), panic disorder, or somatic symptom disorder (i.e., hypochondriasis, pain disorder). In health anxiety (which is not an official diagnosis itself), the person experiences excessive, unreasonable fears of, and a preoccupation with, having or acquiring a serious illness such as heart disease, cancer, or some other physical malady. The fear and anxiety is usually based on a misinterpretation of a harmless (or minor) bodily sensation (e.g., heart fluttering, dizziness, headache) and it persists in spite of appropriate medical evaluation and determination that no medical problem is present.

People with health anxiety typically engage in a number of behaviors to try to reduce their distress. Examples include frequently visiting doctors, excessively researching diseases and their symptoms on the Internet, repeatedly seeking reassurance from loved ones, and excessively checking and inspecting aspects of their body (e.g., lumps, moles) and its by-products (e.g., smell or color of excrement). Although medical reassurance and checking may temporarily reduce the health-related concerns, these behaviors do not usually quell the anxiety in the long run.

An alternative fear-reduction strategy used by some people with health anxiety is to avoid information related to illnesses (e.g., news segments about global pandemics) because of the intense distress that such information causes. They may also avoid hospitals and other important aspects of medical care (e.g., giving self-breast exams) out of fears of catching a disease or confirming their worst fears that a disease is present.

Health anxiety is not the same as “faking,” nor are those with health anxiety necessarily “crying wolf” to seek attention. Health anxiety exists on a continuum from mild to extremely severe. In the most severe instances, people with health anxiety cannot hold a job or sustain meaningful relationships. They might relocate to live close to medical centers, fearing that a serious illness or death could befall them at any point.

As mentioned above, health anxiety might be related to a number of psychological or medical conditions, including:

• GAD. People with GAD struggle with worries about many aspects of their life, often seeking reassurance to make life more bearable. Health is one of the possible areas of concern in this condition.

• OCD. OCD may include fears of contamination and illnesses similar to health anxiety. The two problems might also overlap in terms of checking and reassurance-seeking rituals.

• Panic disorder. People with panic disorder suffer panic attacks and thereafter have a tendency to misinterpret physical sensations (e.g., racing heart) as the symptoms of a serious medical problem (e.g., heart attack). The fears in panic disorder are usually of acute, immediate bodily sensations associated with physiological arousal, whereas worries in health anxiety tend to include a broader range of bodily sensations and diseases.

• Conversion disorder. People with conversion disorder usually report a loss of physical functioning (e.g., loss of movement and/or feeling in a limb) and other unexplained physical symptoms that can lead to fears regarding health status.

• Delusional disorder, somatic type. People with health anxiety may express strong conviction that they have medical maladies (even despite medical reassurance to the contrary), but at other times are able to consider the possibility that they are mistaken. People with delusional disorder, however, are more convinced that their health-related fears are realistic and are unable to consider alternatives. Somatic delusions, which are those focused on the body and its functions, also tend to be more bizarre (e.g., believing the body is infested with parasites) than the typical concerns in health anxiety.

• Depression. Some people with depression worry about their health and experience unexplained physical symptoms. These health concerns most often occur when depressive episodes are at their worst.

• Underlying medical condition. Just because someone has severe health anxiety does not automatically mean that they do not have any medical illnesses. Consequently, health care professionals should assess for underlying medical conditions (e.g., neurological or endocrine disorders) that may be causing the distressing physical symptoms. However, no more than routine medical assessment is necessary. Care should be taken not to fall into the trap of excessive medical reassurance seeking (and reassurance giving) as mentioned above.

Who Is Affected by Health Anxiety?

Lifetime prevalence rates of clinically severe health anxiety in the general population vary widely, ranging from .02% to 7.7%. This wide range is the result of the fact that estimates come from different types of samples. Prevalence rates are highest in primary care settings and among those who already have a bona fide medical condition (e.g., Crohn’s disease). Clinical levels of health anxiety affect men and women about equally and generally have an onset sometime in adulthood.

What Are Its Effects on the Sufferers and Their Loved Ones?

As mentioned, health anxiety causes significant distress and impairment in social, occupational, and other daily functioning. Those with overwhelming preoccupations about health status might frequently visit doctors to perform laboratory tests (e.g., echocardiogram) or seek medical reassurance (i.e., have the doctor tell them they are healthy), which can be quite costly over time. Significant others of those with health anxiety, such as friends, romantic partners, and family members, may also be affected. For instance, they may have to leave work in the middle of the day to take loved ones to medical appointments, contribute personal income to medical expenses, or experience relationship distress related to accommodating health-related requests (e.g., constantly providing reassurance, assisting with excessive decontamination rituals in the home).

Who Can Diagnose Health Anxiety?

It is important to consider health anxiety as a diagnosis when frequent and intense preoccupation with unexplained physical symptoms persists despite a thorough medical examination that fails to identify any disease or abnormality. In these instances, general practitioners may recommend seeing a psychiatrist, psychologist, or other mental health professional. These individuals will conduct a diagnostic assessment that may include certain questionnaires or an interview as well as a review of one’s medical records. Although many people referred for psychological assessment may understandably become frustrated, or even upset, that their doctor believes the problem is “all in their head,” it is important to remember that health anxiety is a valid—and treatable—condition.

What Treatment Options Exist for Health Anxiety?

Certain antidepressant medications can be helpful in reducing health anxiety symptoms, but the reasons that these medications work are presently not clear. Advantages of medication treatment include general safety and ease of use, as well as minimal time required for follow-up (i.e., one only needs to coordinate with prescribers for refills). Disadvantages of medication include limited expectations for improvement, the need to remain on these agents continuously, incurred financial costs over the long run, and possible short- and long-term side effects.

The first-line psychological treatment for health anxiety is cognitivebehavioral therapy (CBT). CBT is a skills-based approach that helps people learn to adopt different ways of thinking and behaving in response to health anxieties. CBT may involve education about how the body works, how diseases and illnesses affect the body, and how behaviors—such as checking, avoidance, and reassurance seeking—are not solutions to the problem. CBT also helps people with health anxiety to identify and challenge misinterpretations of benign bodily sensations as well as more deeply held maladaptive beliefs about health, illness, and medicine more generally. Exposure—a technique commonly used in CBT for health anxiety—also helps people to reintroduce feared or avoided stimuli (e.g., body sensations, places) and refrain from engaging in maladaptive health-related behaviors (e.g., body checking). In essence, CBT teaches the person to better manage their fear, which often leads to long-term fear reduction and improvement in life functioning.

Advantages of CBT include its general long-term effectiveness and relatively brief duration (usually 12 to 20 sessions). This treatment has been well studied and shown to improve health anxiety in the majority of people (although not all) who receive it. The main disadvantage of CBT is that it requires more effort than taking a medication. CBT asks clients to learn and practice alternative ways of thinking and behaving in response to their health anxiety, which takes some level of motivation and effort. A qualified mental health professional should be able to describe the advantages and disadvantages of each treatment approach in greater detail.

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Mindfullness

Posted on June 28, 2016 by JmaC

Mindfulness is a way of paying attention to whatever is happening in our lives, inside and out, in the present moment. When we connect with the present, we become aware of habitual patterns of thought, emotion and behaviour.

With mindfulness, we train ourselves to pay close attention to what is going on in the present moment; just as it is. Much of our suffering is a result of regrets about the past, worries about the future or judgments about the present. When we are mindful we become aware of and explore these habitual thought patterns and ways of reacting. This attitude of curiosity allows us to create new and healthier ways of responding to life’s challenges.

Mindfulness is not a religion—anyone, with any belief system, can enjoy its benefits, many of which are based in research.

Mindfulness is the awareness that emerges from intentionally training to regulate our attention and emotion and a willingness to encounter, at least temporarily, whatever is arising so we can come to fully know our direct experience.Dr. Patricia Rockman

what_is_mindfulness

How is mindfulness practised?

Mindfulness practice, like physical exercise, requires repetition and time to produce noticeable changes in everyday life. Over time, thanks to neuroplasticity, practising mindfulness can change the physical structure of one’s brain.

Mindfulness is practised mainly through consciously focusing one’s attention on a particular object, such as the breath, body, emotions, thoughts, or sounds, or by bringing an open and receptive attention to the coming and going of thoughts, emotions, and physical sensations.

The opposite of mindfulness is forgetfulness, wandering attention, or autopilot. A Harvard study found people’s minds are wandering an average of 47% of the time, and that “a wandering mind is an unhappy mind.”

When practising mindfulness, the attention will naturally be pulled to stimuli that are greater than our capacity to stay focused on a chosen object (e.g. breath or body sensations). This will happen again and again. At some point, we notice or wake up to the fact that our attention has moved into such places as daydreaming, our to-do list or a recent argument with a friend. This is the crucial moment when one crosses over from automatic pilot to mindful awareness. Only then can we bring our attention back to our intended object of focus. This act of returning our attention, over and over again, is the central practice, the thing that builds our mindfulness.

Is there evidence supporting the benefits of mindfulness?

The beneficial effects of meditation and mindfulness-based therapies are supported by a growing body of evidence. Over two decades of clinical research has shown that it can benefit people suffering from anxiety, recurrent depression, chronic pain, substance abuse and other conditions. Benefits include:

  • Stress reduction
  • Reduced rumination
  • Decreased negative affect (e.g. depression, anxiety)
  • Less emotional reactivity/more effective emotion regulation
  • Increased focus
  • More cognitive flexibility
  • Improved working memory
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Electroconvulsive therapy

Posted on June 28, 2016 by JmaC

Electroconvulsive therapy (ECT) uses an electric current to treat depression and some other mental illnesses.

Description

During ECT, the electric current triggers a seizure in the brain. Doctors believe that the seizure activity may help the brain “rewire” itself, which helps relieve symptoms. ECT is generally safe and effective.

ECT is most often done in a hospital while you are asleep and pain-free (general anesthesia):

  • You receive medicine to relax you (muscle relaxant). You also receive another medicine (short-acting anesthetic) to put you briefly to sleep and prevent you from feeling pain.
  • Electrodes are placed on your scalp. Two electrodes monitor your brain activity. The other two electrodes are used to deliver the electric current.
  • When you are asleep, a small amount of electric current is delivered to your head to cause seizure activity in the brain. It lasts for about 40 seconds. You receive medicine to prevent the seizure from spreading throughout your body. As a result, your hands or feet move only slightly during the procedure.
  • ECT is usually given once every 2 to 5 days for a total of 6 to 12 sessions. Sometimes more sessions are needed.
  • Several minutes after the treatment, you wake up. You do not remember the treatment. You are taken to a recovery area. There, the health care team monitors you closely. When you have recovered, you can go home.
  • You need to have an adult drive you home. Be sure to arrange this ahead of time.

Why the Procedure is Performed

ECT is a highly effective treatment for depression, most commonly severe depression. It can be especially helpful for treating depression in patients who:

  • Are having delusions or other psychotic symptoms with their depression
  • Are pregnant and severely depressed
  • Are suicidal
  • Cannot take antidepressant drugs
  • Have not responded fully to antidepressant drugs

Less often, ECT is used for conditions such as mania, catatonia, and psychosis that do not improve enough with other treatments.

Risks

ECT has received bad press, in part because of its potential for causing memory problems. Since ECT was introduced in the 1930s, the dose of electricity used in the procedure has been decreased significantly. This has greatly reduced the side effects of this procedure, including memory loss.

However, ECT can still cause some side effects, including:

  • Confusion that generally lasts for only a short period of time
  • Headache
  • Low blood pressure (hypotension) or high blood pressure (hypertension)
  • Memory loss (permanent memory loss beyond the time of the procedure is much less common than it was in the past)
  • Muscle soreness
  • Nausea
  • Rapid heartbeat (tachycardia) or other heart problems

Some medical conditions put patients at greater risk for side effects from ECT. Discuss your medical conditions and any concerns with your doctor when deciding whether ECT is right for you.

Before the Procedure

Because general anesthesia is used for this procedure, you will be asked not to eat or drink before ECT.

Ask your health care provider whether you should take any daily medicines in the morning before ECT.

After the Procedure

After a successful course of ECT, you will receive medicines or less frequent ECT to reduce the risk of another depression episode.

Outlook (Prognosis)

Some people report mild confusion and headache after ECT. These symptoms should only last for a short while.

Alternative Names

Shock treatment; Shock therapy; ECT

References

Welch CA. Electroconvulsive therapy. In: Stern TA, Rosenbaum JF, Fava M, et al., eds.Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Mosby Elsevier; 2008:chap 45.

Update Date 9/2/2014

Updated by: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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Brain Stimulation Therapies

Posted on June 28, 2016 by JmaC

Overview

Brain stimulation therapies can play a role in treating certain mental disorders. Brain stimulation therapies involve activating or inhibiting the brain directly with electricity. The electricity can be given directly by electrodes implanted in the brain, or noninvasively through electrodes placed on the scalp. The electricity can also be induced by using magnetic fields applied to the head. While these types of therapies are less frequently used than medication and psychotherapies, they hold promise for treating certain mental disorders that do not respond to other treatments.

Electroconvulsive therapy is the best studied brain stimulation therapy and has the longest history of use. Other stimulation therapies discussed here are newer, and in some cases still experimental methods. These include:

  • vagus nerve stimulation (VNS)
  • repetitive transcranial magnetic stimulation (rTMS)
  • magnetic seizure therapy (MST)
  • deep brain stimulation (DBS)

A treatment plan may also include medication and psychotherapy.Choosing the right treatment plan should be based on a person’s individual needs and medical situation, and under a doctor’s care.

Electroconvulsive Therapy

artist depiction of electroconvulsive therapyElectroconvulsive therapy (ECT) uses an electric current to treat serious mental disorders. This type of therapy is usually considered only if a patient’s illness has not improved after other treatments (such as antidepressant medication or psychotherapy) are tried, or in cases where rapid response is needed (as in the case of suicide risk and catatonia, for example).

ECT: Why it’s done

ECT is most often used to treat severe, treatment-resistant depression, but it may also be medically indicated in other mental disorders, such as bipolar disorder or schizophrenia. It also may be used in life-threatening circumstances, such as when a patient is unable to move or respond to the outside world (e.g., catatonia), is suicidal, or is malnourished as a result of severe depression.

ECT can be effective in reducing the chances of relapse when patients undergo follow-up treatments. Two major advantages of ECT over medication are that ECT begins to work quicker, often starting within the first week, and older individuals respond especially quickly.

ECT: How it works

Before ECT is administered, a person is sedated with general anesthesia and given a medication called a muscle relaxant to prevent movement during the procedure. An anesthesiologist monitors breathing, heart rate and blood pressure during the entire procedure, which is conducted by a trained medical team, including physicians and nurses. During the procedure:

  • Electrodes are placed at precise locations on the head.
  • Through the electrodes, an electric current passes through the brain, causing a seizure that lasts generally less than one minute. Because the patient is under anesthesia and has taken a muscle relaxant, it is not painful and the patient cannot feel the electrical impulses.
  • Five to ten minutes after the procedure ends, the patient awakens. He or she may feel groggy at first as the anesthesia wears off. But after about an hour, the patient usually is alert and can resume normal activities.

A typical course of ECT is administered about three times a week until the patient’s depression improves (usually within 6 to 12 treatments). After that, maintenance ECT treatment is sometimes needed to reduce the chances that symptoms will return. ECT maintenance treatment varies depending on the needs of the individual, and may range from one session per week to one session every few months. Frequently, a person who undergoes ECT also takes antidepressant medication or a mood stabilizing medication.

ECT Side Effects

The most common side effects associated with ECT include:

  • headache
  • upset stomach
  • muscle aches
  • memory loss

Some people may experience memory problems, especially of memories around the time of the treatment. Sometimes the memory problems are more severe, but usually they improve over the days and weeks following the end of an ECT course.

Research has found that memory problems seem to be more associated with the traditional type of ECT called bilateral ECT, in which the electrodes are placed on both sides of the head.

In unilateral ECT, the electrodes are placed on just one side of the head—typically the right side because it is opposite the brain’s learning and memory areas. Unilateral ECT has been found to be less likely to cause memory problems and therefore is preferred by many doctors, patients and families.

Vagus Nerve Stimulation

artist depiction of vagus nerve stimulationVagus nerve stimulation (VNS) works through a device implanted under the skin that sends electrical pulses through the left vagus nerve, half of a prominent pair of nerves that run from the brainstem through the neck and down to each side of the chest and abdomen. The vagus nerves carry messages from the brain to the body’s major organs (e.g. heart, lungs and intestines) and to areas of the brain that control mood, sleep, and other functions.

VNS: Why it’s done

VNS was originally developed as a treatment for epilepsy. However, scientists noticed that it also had favorable effects on mood, especially depressive symptoms. Using brain scans, scientists found that the device affected areas of the brain that are involved in mood regulation. The pulses appeared to alter the levels of certain neurotransmitters (brain chemicals) associated with mood, including serotonin, norepinephrine, GABA and glutamate.

In 2005, the U.S. Food and Drug Administration (FDA) approved VNS for use in treating treatment-resistant depression in certain circumstances:

  • If the patient is 18 years of age or over; and
  • If the illness has lasted two years or more; and
  • if it is severe or recurrent; and
  • if the depression has not eased after trying at least four other treatments

According to the FDA, it is not intended to be a first-line treatment, even for patients with severe depression. And, despite FDA approval, VNS remains an infrequently used because results of early studies testing its effectiveness for major depression were mixed. But a newer study , which pooled together findings from only controlled clinical trials, found that 32% of depressed people responded to VSN and 14% had a full remission of symptoms after being treated for nearly 2 years.

VNS: How it works

A device called a pulse generator, about the size of a stopwatch, is surgically implanted in the upper left side of the chest. Connected to the pulse generator is an electrical lead wire, which is connected from the generator to the left vagus nerve.

Typically, 30-second electrical pulses are sent about every five minutes from the generator to the vagus nerve. The duration and frequency of the pulses may vary depending on how the generator is programmed. The vagus nerve, in turn, delivers those signals to the brain. The pulse generator, which operates continuously, is powered by a battery that lasts around 10 years, after which it must be replaced. Normally, people do not feel pain or any other sensations as the device operates.

The device also can be temporarily deactivated by placing a magnet over the chest where the pulse generator is implanted. A person may want to deactivate it if side effects become intolerable, or before engaging in strenuous activity or exercise because it may interfere with breathing. The device reactivates when the magnet is removed.

Please Note: VNS should only be prescribed and monitored by doctors who have specific training and expertise in the management of treatment-resistant depression and the use of this device.

VNS treatment is intended to reduce symptoms of depression. It may be several months before the patient notices any benefits and not all patients will respond to VNS. It is important to remember that VNS is intended to be given along with other traditional therapies, such as medications, and patients should not expect to discontinue these other treatments, even with the device in place.

VNS: Side Effects

VNS is not without risk. There may be complications such as infection from the implant surgery, or the device may come loose, move around or malfunction, which may require additional surgery to correct. Some patients have no improvement in symptoms and some actually get worse.

Other potential side effects include:

  • Voice changes or hoarseness
  • Cough or sore throat
  • Neck pain
  • Discomfort or tingling in the area where the device is implanted
  • Breathing problems, especially during exercise
  • Difficulty swallowing

Long-term side effects are unknown.

Repetitive Transcranial Magnetic Stimulation

artist depiction of repetitive transcranial magnetic stimulationRepetitive transcranial magnetic stimulation (rTMS) uses a magnet to activate the brain. First developed in 1985, rTMS has been studied as a treatment for depression, psychosis, anxiety, and other disorders.

Unlike ECT, in which electrical stimulation is more generalized, rTMS can be targeted to a specific site in the brain. Scientists believe that focusing on a specific site in the brain reduces the chance for the types of side effects associated with ECT. But opinions vary as to what site is best.

rTMS: Why it’s done

In 2008, rTMS was approved for use by the FDA as a treatment for major depression for patients who do not respond to at least one antidepressant medication in the current episode. It is also used in other countries as a treatment for depression in patients who have not responded to medications and who might otherwise be considered for ECT.

The evidence supporting rTMS for depression was mixed until the first large clinical trial , funded by NIMH, was published in 2010. The trial found that 14% achieved remission with rTMS compared to 5% with an inactive (sham) treatment. After the trial ended, patients could enter a second phase in which everyone, including those who previously received the sham treatment, was given rTMS. Remission rates during the second phase climbed to nearly 30%. A sham treatment is like a placebo, but instead of being an inactive pill, it’s an inactive procedure that mimics real rTMS.

rTMS: How it works

A typical rTMS session lasts 30 to 60 minutes and does not require anesthesia.

During the procedure:

  • An electromagnetic coil is held against the forehead near an area of the brain that is thought to be involved in mood regulation.
  • Then, short electromagnetic pulses are administered through the coil. The magnetic pulses easily pass through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region.

Because this type of pulse generally does not reach further than two inches into the brain, scientists can select which parts of the brain will be affected and which will not be. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan. Generally, the person feels a slight knocking or tapping on the head as the pulses are administered.

Not all scientists agree on the best way to position the magnet on the patient’s head or give the electromagnetic pulses. They also do not yet know if rTMS works best when given as a single treatment or combined with medication and/or psychotherapy. More research is underway to determine the safest and most effective uses of rTMS.

rTMS: Side Effects

Sometimes a person may have discomfort at the site on the head where the magnet is placed. The muscles of the scalp, jaw or face may contract or tingle during the procedure. Mild headaches or brief lightheadedness may result. It is also possible that the procedure could cause a seizure, although documented incidences of this are uncommon. Two large-scale studies on the safety of rTMS found that most side effects, such as headaches or scalp discomfort, were mild or moderate, and no seizures occurred. Because the treatment is relatively new, however, long-term side effects are unknown.

Magnetic Seizure Therapy

MST: How it works

Magnetic seizure therapy (MST) borrows certain aspects from both ECT and rTMS. Like rTMS, MST uses magnetic pulses instead of electricity to stimulate a precise target in the brain. However, unlike rTMS, MST aims to induce a seizure like ECT. So the pulses are given at a higher frequency than that used in rTMS. Therefore, like ECT, the patient must be anesthetized and given a muscle relaxant to prevent movement. The goal of MST is to retain the effectiveness of ECT while reducing its cognitive side effects.

MST is in the early stages of testing for mental disorders, but initial results are promising. A recent review article that examined the evidence from eight clinical studies found that MST triggered remission from major depression or bipolar disorder in 30-40% of individuals.

MST: Side Effects

Like ECT, MST carries the risk of side effects that can be caused by anesthesia exposure and the induction of a seizure. Studies in both animals and humans have found that MST produces

  • fewer memory side effects
  • shorter seizures
  • allows for a shorter recovery time than ECT

Deep Brain Stimulation

artist depiction of deep brain stimulationDeep brain stimulation (DBS) was first developed as a treatment for Parkinson’s disease to reduce tremor, stiffness, walking problems and uncontrollable movements. In DBS, a pair of electrodes is implanted in the brain and controlled by a generator that is implanted in the chest. Stimulation is continuous and its frequency and level are customized to the individual.

DBS has been studied as a treatment for depression or obsessive compulsive disorder (OCD). Currently, there is a Humanitarian Device Exemption for the use of DBS to treat OCD, but its use in depression remains only on an experimental basis. A review of all 22 published studies testing DBS for depression found that only three of them were of high quality because they not only had a treatment group but also a control group which did not receive DBS. The review found that across the studies, 40-50% of people showed receiving DBS greater than 50% improvement.

DBS: How it works

DBS requires brain surgery. The head is shaved and then attached with screws to a sturdy frame that prevents the head from moving during the surgery. Scans of the head and brain using MRI are taken. The surgeon uses these images as guides during the surgery. Patients are awake during the procedure to provide the surgeon with feedback, but they feel no pain because the head is numbed with a local anesthetic and the brain itself does not register pain.

Once ready for surgery, two holes are drilled into the head. From there, the surgeon threads a slender tube down into the brain to place electrodes on each side of a specific area of the brain. In the case of depression, the first area of the brain targeted by DBS is called Area 25, or the subgenual cingulate cortex. This area has been found to be overactive in depression and other mood disorders. But later research targeted several other areas of the brain affected by depression. So DBS is now targeting several areas of the brain for treating depression. In the case of OCD, the electrodes are placed in an area of the brain (the ventral capsule/ventral striatum) believed to be associated with the disorder.

After the electrodes are implanted and the patient provides feedback about their placement, the patient is put under general anesthesia. The electrodes are then attached to wires that are run inside the body from the head down to the chest, where a pair of battery-operated generators are implanted. From here, electrical pulses are continuously delivered over the wires to the electrodes in the brain. Although it is unclear exactly how the device works to reduce depression or OCD, scientists believe that the pulses help to “reset” the area of the brain that is malfunctioning so that it works normally again.

DBS Side Effects

DBS carries risks associated with any type of brain surgery. For example, the procedure may lead to:

  • Bleeding in the brain or stroke
  • Infection
  • Disorientation or confusion
  • Unwanted mood changes
  • Movement disorders
  • Lightheadedness
  • Trouble sleeping

Because the procedure is still being studied, other side effects not yet identified may be possible. Long-term benefits and side effects are unknown.

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Psychotherapies

Posted on June 28, 2016 by JmaC

Psychotherapies

What is psychotherapy?

Psychotherapy, or “talk therapy”, is a way to treat people with a mental disorder by helping them understand their illness. It teaches people strategies and gives them tools to deal with stress and unhealthy thoughts and behaviors. Psychotherapy helps patients manage their symptoms better and function at their best in everyday life.

Sometimes psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Other times, psychotherapy is combined with medications. Therapists work with an individual or families to devise an appropriate treatment plan.

woman in front of window looking depressed

What are the different types of psychotherapy?

Many kinds of psychotherapy exist. There is no “one-size-fits-all” approach. In addition, some therapies have been scientifically tested more than others. Some people may have a treatment plan that includes only one type of psychotherapy. Others receive treatment that includes elements of several different types. The kind of psychotherapy a person receives depends on his or her needs.

This section explains several of the most commonly used psychotherapies. However, it does not cover every detail about psychotherapy. Patients should talk to their doctor or a psychotherapist about planning treatment that meets their needs.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a blend of two therapies: cognitive therapy (CT) and behavioral therapy. CT was developed by psychotherapist Aaron Beck, M.D., in the 1960’s. CT focuses on a person’s thoughts and beliefs, and how they influence a person’s mood and actions, and aims to change a person’s thinking to be more adaptive and healthy. Behavioral therapy focuses on a person’s actions and aims to change unhealthy behavior patterns.

CBT helps a person focus on his or her current problems and how to solve them. Both patient and therapist need to be actively involved in this process. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.

CBT can be applied and adapted to treat many specific mental disorders.

CBT for depression

Many studies have shown that CBT is a particularly effective treatment for depression, especially minor or moderate depression. Some people with depression may be successfully treated with CBT only. Others may need both CBT and medication. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help a person recognize things that may be contributing to the depression and help him or her change behaviors that may be making the depression worse.

CBT for anxiety disorders

CBT for anxiety disorders aims to help a person develop a more adaptive response to a fear. A CBT therapist may use “exposure” therapy to treat certain anxiety disorders, such as a specific phobia, post traumatic stress disorder, or obsessive compulsive disorder. Exposure therapy has been found to be effective in treating anxiety-related disorders.1 It works by helping a person confront a specific fear or memory while in a safe and supportive environment. The main goals of exposure therapy are to help the patient learn that anxiety can lessen over time and give him or her the tools to cope with fear or traumatic memories.

A recent study  sponsored by the Centers for Disease Control and Prevention concluded that CBT is effective in treating trauma-related disorders in children and teens.

CBT for bipolar disorder

People with bipolar disorder usually need to take medication, such as a mood stabilizer. But CBT is often used as an added treatment. The medication can help stabilize a person’s mood so that he or she is receptive to psychotherapy and can get the most out of it. CBT can help a person cope with bipolar symptoms and learn to recognize when a mood shift is about to occur. CBT also helps a person with bipolar disorder stick with a treatment plan to reduce the chances of relapse (e.g., when symptoms return).2

CBT for eating disorders

Eating disorders can be very difficult to treat. However, some small studies have found that CBT can help reduce the risk of relapse in adults with anorexia who have restored their weight.3 CBT may also reduce some symptoms of bulimia, and it may also help some people reduce binge-eating behavior.4

CBT for schizophrenia

Treating schizophrenia with CBT is challenging. The disorder usually requires medication first. But research has shown that CBT, as an add-on to medication, can help a patient cope with schizophrenia.5 CBT helps patients learn more adaptive and realistic interpretations of events. Patients are also taught various coping techniques for dealing with “voices” or other hallucinations. They learn how to identify what triggers episodes of the illness, which can prevent or reduce the chances of relapse.

CBT for schizophrenia also stresses skill-oriented therapies. Patients learn skills to cope with life’s challenges. The therapist teaches social, daily functioning, and problem-solving skills. This can help patients with schizophrenia minimize the types of stress that can lead to outbursts and hospitalizations.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT), a form of CBT, was developed by Marsha Linehan, Ph.D. At first, it was developed to treat people with suicidal thoughts and actions. It is now also used to treat people withborderline personality disorder (BPD). BPD is an illness in which suicidal thinking and actions are more common.

The term “dialectical” refers to a philosophic exercise in which two opposing views are discussed until a logical blending or balance of the two extremes—the middle way—is found. In keeping with that philosophy, the therapist assures the patient that the patient’s behavior and feelings are valid and understandable. At the same time, the therapist coaches the patient to understand that it is his or her personal responsibility to change unhealthy or disruptive behavior.

DBT emphasizes the value of a strong and equal relationship between patient and therapist. The therapist consistently reminds the patient when his or her behavior is unhealthy or disruptive—when boundaries are overstepped—and then teaches the skills needed to better deal with future similar situations. DBT involves both individual and group therapy. Individual sessions are used to teach new skills, while group sessions provide the opportunity to practice these skills.

Research suggests that DBT is an effective treatment for people with BPD. A recent NIMH-funded study found that DBT reduced suicide attempts by half compared to other types of treatment for patients with BPD.6

Interpersonal Therapy

Interpersonal therapy (IPT) is most often used on a one-on-one basis to treat depression or dysthymia (a more persistent but less severe form of depression). The current manual-based form of IPT used today was developed in the 1980’s by Gerald Klerman, M.D., and Myrna Weissman, M.D.

IPT is based on the idea that improving communication patterns and the ways people relate to others will effectively treat depression. IPT helps identify how a person interacts with other people. When a behavior is causing problems, IPT guides the person to change the behavior. IPT explores major issues that may add to a person’s depression, such as grief, or times of upheaval or transition. Sometimes IPT is used along with antidepressant medications.

IPT varies depending on the needs of the patient and the relationship between the therapist and patient. Basically, a therapist using IPT helps the patient identify troubling emotions and their triggers. The therapist helps the patient learn to express appropriate emotions in a healthy way. The patient may also examine relationships in his or her past that may have been affected by distorted mood and behavior. Doing so can help the patient learn to be more objective about current relationships.

woman and man in therapy session

Studies vary as to the effectiveness of IPT. It may depend on the patient, the disorder, the severity of the disorder, and other variables. In general, however, IPT is found to be effective in treating depression.7

A variation of IPT called interpersonal and social rhythm therapy (IPSRT) was developed to treat bipolar disorder. IPSRT combines the basic principles of IPT with behavioral psychoeducation designed to help patients adopt regular daily routines and sleep/wake cycles, stick with medication treatment, and improve relationships. Research has found that when IPSRT is combined with medication, it is an effective treatment for bipolar disorder. IPSRT is as effective as other types of psychotherapy combined with medication in helping to prevent a relapse of bipolar symptoms.8

Family-focused Therapy

Family-focused therapy (FFT) was developed by David Miklowitz, Ph.D., and Michael Goldstein, Ph.D., for treating bipolar disorder. It was designed with the assumption that a patient’s relationship with his or her family is vital to the success of managing the illness. FFT includes family members in therapy sessions to improve family relationships, which may support better treatment results.

Therapists trained in FFT work to identify difficulties and conflicts among family members that may be worsening the patient’s illness. Therapy is meant to help members find more effective ways to resolve those difficulties. The therapist educates family members about their loved one’s disorder, its symptoms and course, and how to help their relative manage it more effectively. When families learn about the disorder, they may be able to spot early signs of a relapse and create an action plan that involves all family members. During therapy, the therapist will help family members recognize when they express unhelpful criticism or hostility toward their relative with bipolar disorder. The therapist will teach family members how to communicate negative emotions in a better way. Several studies have found FFT to be effective in helping a patient become stabilized and preventing relapses. 9,10,11

FFT also focuses on the stress family members feel when they care for a relative with bipolar disorder. The therapy aims to prevent family members from “burning out” or disengaging from the effort. The therapist helps the family accept how bipolar disorder can limit their relative. At the same time, the therapist holds the patient responsible for his or her own well being and actions to a level that is appropriate for the person’s age.

Generally, the family and patient attend sessions together. The needs of each patient and family are different, and those needs determine the exact course of treatment. However, the main components of a structured FFT usually include:

  • Family education on bipolar disorder
  • Building communication skills to better deal with stress, and
  • Solving problems together as a family.

It is important to acknowledge and address the needs of family members. Research has shown that primary caregivers of people with bipolar disorder are at increased risk for illness themselves. For example, a 2007 study based on results from the NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial found that primary caregivers of participants were at high risk for developing sleep problems and chronic conditions, such as high blood pressure. However, the caregivers were less likely to see a doctor for their own health issues.12 In addition, a 2005 study found that 33 percent of caregivers of bipolar patients had clinically significant levels of depression.13

Are psychotherapies different for children and adolescents?

Psychotherapies can be adapted to the needs of children and adolescents, depending on the mental disorder. For example, the NIMH-funded Treatment of Adolescents with Depression Study (TADS) found that CBT, when combined with antidepressant medication, was the most effective treatment over the short term for teens with major depression.14 CBT by itself was also an effective treatment, especially over the long term. Studies have found that individual and group-based CBT are effective treatments for child and adolescent anxiety disorders.15 Other studies have found that IPT is an effective treatment for child and adolescent depression.16,17

Psychosocial treatments that involve a child’s parents and family also have been shown to be effective, especially for disruptive disorders such as conduct disorder or oppositional defiant disorder. Some effective treatments are designed to reduce the child’s problem behaviors and improve parent-child interactions. Focusing on behavioral parent management training, parents are taught the skills they need to encourage and reward positive behaviors in their children.18 Similar training helps parents manage their child’s attention deficit/hyperactivity disorder (ADHD). This approach, which has been shown to be effective, can be combined with approaches directed at children to help them learn problem-solving, anger management and social interaction skills. 19

group of five people sitting in therapy session

Family-based therapy may also be used to treat adolescents with eating disorders. One type is called the Maudsley approach, named after the Maudsley Hospital in London, where the approach was developed. This type of outpatient family therapy is used to treat anorexia nervosa in adolescents. It considers the active participation of parents to be essential in the recovery of their teen. The Maudsley approach proceeds through three phases:

  • Weight restoration. Parents become fully responsible for ensuring that their teen eats. A therapist helps parents better understand their teen’s disease. Parents learn how to avoid criticizing their teen, but they also learn to make sure that their teen eats.
  • Returning control over eating to the teen. Once the teen accepts the control parents have over his or her eating habits, parents may begin giving up that control. Parents are encouraged to help their teen take more control over eating again.
  • Establishing healthy adolescent identity. When the teen has reached and maintained a healthy weight, the therapist helps him or her begin developing a healthy sense of identity and autonomy.

Several studies have found the Maudsley approach to be successful in treating teens with anorexia.20,21Currently a large-scale, NIMH-funded study  on the approach is under way.

What other types of therapies are used?

In addition to the therapies listed above, many more approaches exist. Some types have been scientifically tested more than others. Also, some of these therapies are constantly evolving. They are often combined with more established psychotherapies. A few examples of other therapies are described here.

Psychodynamic therapy. Historically, psychodynamic therapy was tied to the principles of psychoanalytic theory, which asserts that a person’s behavior is affected by his or her unconscious mind and past experiences. Now therapists who use psychodynamic therapy rarely include psychoanalytic methods. Rather, psychodynamic therapy helps people gain greater self-awareness and understanding about their own actions. It helps patients identify and explore how their nonconscious emotions and motivations can influence their behavior. Sometimes ideas from psychodynamic therapy are interwoven with other types of therapy, like CBT or IPT, to treat various types of mental disorders. Research on psychodynamic therapy is mixed. However, a review of 23 clinical trials involving psychodynamic therapy found it to be as effective as other established psychotherapies.22

Light therapy. Light therapy is used to treat seasonal affective disorder (SAD), a form of depression that usually occurs during the autumn and winter months, when the amount of natural sunlight decreases. Scientists think SAD occurs in some people when their bodies’ daily rhythms are upset by short days and long nights. Research has found that the hormone melatonin is affected by this seasonal change. Melatonin normally works to regulate the body’s rhythms and responses to light and dark. During light therapy, a person sits in front of a “light box” for periods of time, usually in the morning. The box emits a full spectrum light, and sitting in front of it appears to help reset the body’s daily rhythms. Also, some research indicates that a low dose of melatonin, taken at specific times of the day, can also help treat SAD.23

Other types of therapies sometimes used in conjunction with the more established therapies include:

  • Expressive or creative arts therapy. Expressive or creative arts therapy is based on the idea that people can help heal themselves through art, music, dance, writing, or other expressive acts. One study has found that expressive writing can reduce depression symptoms among women who were victims of domestic violence.24 It also helps college students at risk for depression.25
  • Animal-assisted therapy. Working with animals, such as horses, dogs, or cats, may help some people cope with trauma, develop empathy, and encourage better communication. Companion animals are sometimes introduced in hospitals, psychiatric wards, nursing homes, and other places where they may bring comfort and have a mild therapeutic effect. Animal-assisted therapy has also been used as an added therapy for children with mental disorders. Research on the approach is limited, but a recent study found it to be moderately effective in easing behavioral problems and promoting emotional well-being.26
  • Play therapy. This therapy is used with children. It involves the use of toys and games to help a child identify and talk about his or her feelings, as well as establish communication with a therapist. A therapist can sometimes better understand a child’s problems by watching how he or she plays. Research in play therapy is minimal.

What research is underway to improve psychotherapies?

Researchers are continually studying ways to better treat mental disorders with psychotherapy, and many NIMH-funded studies are underway. For more information about NIMH-funded clinical trials involving psychotherapies, see the NIMH Clinical Trials page.

woman entering door of National Institute of Mental Health clinic

How do I find a psychotherapist?

Your family doctor can help you find a psychotherapist. Other resources for locating services are available here.

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Mental Health Medications

Posted on June 28, 2016 by JmaC

Overview

Medications can play a role in treating several mental disorders and conditions. Treatment may also include psychotherapy (also called “talk therapy”) and brain stimulation therapies (less common). In some cases, psychotherapy alone may be the best treatment option. Choosing the right treatment plan should be based on a person’s individual needs and medical situation, and under a mental health professional’s care.

The National Institute of Mental Health (NIMH), a Federal research agency, does not provide medical advice or referrals. Resources that may help you find treatment services in your area are listed on ourHelp for Mental Illnesses web page.

NIMH also does not endorse or recommend any particular drug, herb, or supplement. Results from NIMH-supported clinical research trials (What are Clinical Research Trials?) that examine the effectiveness of treatments, including medications, are reported in the medical literature. This health topic webpage is intended to provide basic information about mental health medications. It is not a complete source for all medications available and should not be used as a guide for making medical decisions.

Information about medications changes frequently. Check the U.S. Food and Drug Administration (FDA) website  for the latest warnings, patient medication guides, or newly approved medications. Brand names are not referenced on this page, but you can search by brand name on MedlinePlus Drugs, Herbs and Supplements Drugs website. The MedlinePlus website also provides additional information about each medication, including side effects and FDA warnings.

Understanding Your Medications

If you are prescribed a medication, be sure that you:

  • Tell the doctor about all medications and vitamin supplements you are already taking.
  • Remind your doctor about any allergies and any problems you have had with medicines.
  • Understand how to take the medicine before you start using it and take your medicine as instructed.
  • Don’t take medicines prescribed for another person or give yours to someone else.
  • Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.
  • Report serious side effects to the FDA MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088]. You or your doctor may send a report.

Antidepressants

What are antidepressants?

Antidepressants are medications commonly used to treat depression. Antidepressants are also used for other health conditions, such as anxiety, pain and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, antidepressants are sometimes used to treat ADHD in adults.

The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include:

Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and includevenlafaxine  and duloxetine. 

Another antidepressant that is commonly used is bupropion.Bupropion  is a third type of antidepressant which works differently than either SSRIs or SNRIs.  Bupropion is also used to treat seasonal affective disorder and to help people stop smoking.

SSRIs, SNRIs, and bupropion are popular because they do not cause as many side effects as older classes of antidepressants, and seem to help a broader group of depressive and anxiety disorders. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications.

How do people respond to antidepressants?

According to a research review by the Agency for Healthcare Research and Quality , all antidepressant medications work about as well as each other to improve symptoms of depression and to keep depression symptoms from coming back. For reasons not yet well understood, some people respond better to some antidepressant medications than to others.

Therefore, it is important to know that some people may not feel better with the first medicine they try and may need to try several medicines to find the one that works for them. Others may find that a medicine helped for a while, but their symptoms came back. It is important to carefully follow your doctor’s directions for taking your medicine at an adequate dose and over an extended period of time (often 4 to 6 weeks) for it to work.

Once a person begins taking antidepressants, it is important to not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return. When it is time to stop the medication, the doctor will help the person slowly and safely decrease the dose. It’s important to give the body time to adjust to the change. People don’t get addicted (or “hooked”) on these medications, but stopping them abruptly may also cause withdrawal symptoms

What are the possible side effects of antidepressants?

Some antidepressants may cause more side effects than others. You may need to try several different antidepressant medications before finding the one that improves your symptoms and that causes side effects that you can manage.

The most common side effects listed by the FDA include:

  • Nausea and vomiting
  • Weight gain
  • Diarrhea
  • Sleepiness
  • Sexual problems

Call your doctor right away if you have any of the following symptoms, especially if they are new, worsening, or worry you(U.S. Food and Drug Administration, 2011):

  • Thoughts about suicide or dying
  • Attempts to commit suicide
  • New or worsening depression
  • New or worsening anxiety
  • Feeling very agitated or restless
  • Panic attacks
  • Trouble sleeping (insomnia)
  • New or worsening irritability
  • Acting aggressively, being angry, or violent
  • Acting on dangerous impulses
  • An extreme increase in activity and talking (mania)
  • Other unusual changes in behavior or mood

Combining the newer SSRI or SNRI antidepressants with one of the commonly-used “triptan” medications used to treat migraine headaches could cause a life-threatening illness called “serotonin syndrome.” A person with serotonin syndrome may be agitated, have hallucinations (see or hear things that are not real), have a high temperature, or have unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications. For more information, please see the FDA Medication Guide on Antidepressant Medicines 

Antidepressants may cause other side effects that were not included in this list. To report any serious adverse effects associated with the use of antidepressant medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please see Drugs@FDA .

Anti-Anxiety Medications

What are anti-anxiety medications?

Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind SSRIs or other antidepressants.

Benzodiazepines used to treat anxiety disorders include:

Short half-life (or short-acting) benzodiazepines (such as Lorazepam ) and beta-blockers are used to treat the short-term symptoms of anxiety. Beta-blockers help manage physical symptoms of anxiety, such as trembling, rapid heartbeat, and sweating that people with phobias (an overwhelming and unreasonable fear of an object or situation, such as public speaking) experience in difficult situations. Taking these medications for a short period of time can help the person keep physical symptoms under control and can be used “as needed” to reduce acute anxiety.Buspirone  (which is unrelated to the benzodiazepines) is sometimes used for the long-term treatment of chronic anxiety. In contrast to the benzodiazepines, buspirone must be taken every day for a few weeks to reach its full effect. It is not useful on an “as-needed” basis.

How do people respond to anti-anxiety medications?

Anti-anxiety medications such as benzodiazepines are effective in relieving anxiety and take effect more quickly than the antidepressant medications (or buspirone) often prescribed for anxiety. However, people can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect. Some people may even become dependent on them. To avoid these problems, doctors usually prescribe benzodiazepines for short periods, a practice that is especially helpful for older adults (read the NIMH article: Despite Risks, Benzodiazepine Use Highest in Older People), people who have substance abuse problems and people who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly.

What are the possible side effects of anti-anxiety medications?

Like other medications, anti-anxiety medications may cause side effects. Some of these side effects and risks are serious. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include:

  • Nausea
  • Blurred vision
  • Headache
  • Confusion
  • Tiredness
  • Nightmares

Tell your doctor if any of these symptoms are severe or do not go away:

  • Drowsiness
  • Dizziness
  • Unsteadiness
  • Problems with coordination
  • Difficulty thinking or remembering
  • Increased saliva
  • Muscle or joint pain
  • Frequent urination
  • Blurred vision
  • Changes in sex drive or ability (The American Society of Health-System Pharmacists, Inc, 2010)

If you experience any of the symptoms below, call your doctor immediately:

  • Rash
  • Hives
  • Swelling of the eyes, face, lips, tongue, or throat
  • Difficulty breathing or swallowing
  • Hoarseness
  • Seizures
  • Yellowing of the skin or eyes
  • Depression
  • Difficulty speaking
  • Yellowing of the skin or eyes
  • Thoughts of suicide or harming yourself
  • Difficulty breathing

Common side effects of beta-blockers include:

  • Fatigue
  • Cold hands
  • Dizziness or light-headedness
  • Weakness

Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both.

Possible side effects from buspirone include:

  • Dizziness
  • Headaches
  • Nausea
  • Nervousness
  • Lightheadedness
  • Excitement
  • Trouble sleeping

Anti-anxiety medications may cause other side effects that are not included in the lists above. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please see Drugs@FDA. 

Stimulants

What are Stimulants?

As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration (National Institute on Drug Abuse, 2014). Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD.

Stimulants used to treat ADHD include:

Note: In 2002, the FDA approved the non-stimulant medication atomoxetine for use as a treatment for ADHD. Two other non-stimulant antihypertensive medications, clonidine  and guanfacine , are also approved for treatment of ADHD in children and adolescents. One of these non-stimulant medications is often tried first in a young person with ADHD, and if response is insufficient, then a stimulant is prescribed.

Stimulants are also prescribed to treat other health conditions, including narcolepsy, and occasionally depression (especially in older or chronically medically ill people and in those who have not responded to other treatments).

How do people respond to stimulants?

Prescription stimulants have a calming and “focusing” effect on individuals with ADHD. Stimulant medications are safe when given under a doctor’s supervision. Some children taking them may feel slightly different or “funny.”

Some parents worry that stimulant medications may lead to drug abuse or dependence, but there is little evidence of this when they are used properly as prescribed. Additionally, research shows that teens with ADHD who took stimulant medications were less likely to abuse drugs than those who did not take stimulant medications.

What are the possible side effects of stimulants?

Stimulants may cause side effects. Most side effects are minor and disappear when dosage levels are lowered. The most common side effects include:

  • Difficulty falling asleep or staying asleep
  • Loss of appetite
  • Stomach pain
  • Headache

Less common side effects include:

  • Motor tics or verbal tics (sudden, repetitive movements or sounds)
  • Personality changes, such as appearing “flat” or without emotion

Call your doctor right away if you have any of these symptoms, especially if they are new, become worse, or worry you.

Stimulants may cause other side effects that are not included in the list above. To report any serious adverse effects associated with the use of stimulants, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please seeDrugs@FDA. 

Antipsychotics

What are antipsychotics?

Antipsychotic medicines are primarily used to manage psychosis. The word “psychosis” is used to describe conditions that affect the mind, and in which there has been some loss of contact with reality, often including delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not really there). It can be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, bipolar disorder, or very severe depression (also known as “psychotic depression”).

Antipsychotic medications are often used in combination with other medications to treat delirium, dementia, and mental health conditions, including:

Antipsychotic medicines do not cure these conditions. They are used to help relieve symptoms and improve quality of life.

Older or first-generation antipsychotic medications are also called conventional “typical” antipsychotics or “neuroleptics”. Some of the common typical antipsychotics include:

Newer or second generation medications are also called “atypical” antipsychotics. Some of the common atypical antipsychotics include:

According to a 2013 research review by the Agency for Healthcare Research and Quality , typical and atypical antipsychotics both work to treat symptoms of schizophrenia and the manic phase of bipolar disorder.

Several atypical antipsychotics have a “broader spectrum” of action than the older medications, and are used for treating bipolar depression or depression that has not responded to an antidepressant medication alone.

To find additional antipsychotics and other medications used to manage psychoses and current warnings and advisories, please visit the FDA website .

How do people respond to antipsychotics?

Certain symptoms, such as feeling agitated and having hallucinations, usually go away within days of starting an antipsychotic medication. Symptoms like delusions usually go away within a few weeks, but the full effects of the medication may not be seen for up to six weeks. Every patient responds differently, so it may take several trials of different antipsychotic medications to find the one that works best.

Some people may have a relapse—meaning their symptoms come back or get worse. Usually relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel that they don’t need it anymore, but no one should stop taking an antipsychotic medication without talking to his or her doctor.When a doctor says it is okay to stop taking a medication, it should be gradually tapered off— never stopped suddenly. Many people must stay on an antipsychotic continuously for months or years in order to stay well; treatment should be personalized for each individual.

What are the possible side effects of antipsychotics?

Antipsychotics have many side effects (or adverse events) and risks. The FDA lists the following side effects of antipsychotic medicines:

  • Drowsiness
  • Dizziness
  • Restlessness
  • Weight gain (the risk is higher with some atypical antipsychotic medicines)
  • Dry mouth
  • Constipation
  • Nausea
  • Vomiting
  • Blurred vision
  • Low blood pressure
  • Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines)
  • Seizures
  • A low number of white blood cells, which fight infections

A person taking an atypical antipsychotic medication should have his or her weight, glucose levels, and lipid levels monitored regularly by a doctor.

Typical antipsychotic medications can also cause additional side effects related to physical movement, such as:

  • Rigidity
  • Persistent muscle spasms
  • Tremors
  • Restlessness

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements, commonly around the mouth, that a person can’t control. TD can range from mild to severe, and in some people, the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking typical antipsychotic medication. People who think that they might have TD should check with their doctor before stopping their medication. TD rarely occurs while taking atypical antipsychotics.

Antipsychotics may cause other side effects that are not included in this list above. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program . For more information about the risks and side effects for antipsychotic medications, please visit Drugs@FDA .

Mood Stabilizers

What are mood stabilizers?

Mood stabilizers are used primarily to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression.Lithium , which is aneffective mood stabilizer, is approved for the treatment of mania and the maintenance treatment of bipolar disorder. A number of cohort studies describe anti-suicide benefits of lithium for individuals on long-term maintenance. Mood stabilizers work by decreasing abnormal activity in the brain and are also sometimes used to treat:

  • Depression (usually along with an antidepressant)
  • Schizoaffective Disorder
  • Disorders of impulse control
  • Certain mental illnesses in children

Anticonvulsant medications are also used as mood stabilizers. They were originally developed to treat seizures, but they were found to help control unstable moods as well. One anticonvulsant commonly used as a mood stabilizer is valproic acid  (also called divalproex sodium). For some people, especially those with “mixed” symptoms of mania and depression or those with rapid-cycling bipolar disorder, valproic acid may work better than lithium. Other anticonvulsants used as mood stabilizers include:

What are the possible side effects of mood stabilizers?

Mood stabilizers can cause several side effects, and some of them may become serious, especially at excessively high blood levels. These side effects include:

  • Itching, rash
  • Excessive thirst
  • Frequent urination
  • Tremor (shakiness) of the hands
  • Nausea and vomiting
  • Slurred speech
  • Fast, slow, irregular, or pounding heartbeat
  • Blackouts
  • Changes in vision
  • Seizures
  • Hallucinations (seeing things or hearing voices that do not exist)
  • Loss of coordination
  • Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.

If a person with bipolar disorder is being treated with lithium, he or she should visit the doctor regularly to check the lithium levels his or her blood, and make sure the kidneys and the thyroid are working normally.

Lithium is eliminated from the body through the kidney, so the dose may need to be lowered in older people with reduced kidney function. Also, loss of water from the body, such as through sweating or diarrhea, can cause the lithium level to rise, requiring a temporary lowering of the daily dose. Although kidney functions are checked periodically during lithium treatment, actual damage of the kidney is uncommon in people whose blood levels of lithium have stayed within the therapeutic range.

Mood stabilizers may cause other side effects that are not included in this list. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each individual medication, please see Drugs@FDA .

For more information on the side effects of Carbamazepine ,Lamotrigine , and Oxcarbazepine , please visit MedlinePlus Drugs, Herbs and Supplements .

Some possible side effects linked anticonvulsants (such as valproic acid) include:

  • Drowsiness
  • Dizziness
  • Headache
  • Diarrhea
  • Constipation
  • Changes in appetite
  • Weight changes
  • Back pain
  • Agitation
  • Mood swings
  • Abnormal thinking
  • Uncontrollable shaking of a part of the body
  • Loss of coordination
  • Uncontrollable movements of the eyes
  • Blurred or double vision
  • Ringing in the ears
  • Hair loss

These medications may also:

  • Cause damage to the liver or pancreas, so people taking it should see their doctors regularly
  • Increase testosterone (a male hormone) levels in teenage girls and lead to a condition called polycystic ovarian syndrome (a disease that can affect fertility and make the menstrual cycle become irregular)

Medications for common adult health problems, such as diabetes, high blood pressure, anxiety, and depression may interact badly with anticonvulsants. In this case, a doctor can offer other medication options.

For more information about the risks and side effects for each medication, please see Drugs@FDA .

Special Groups: Children, Older Adults, Pregnant Women

All types of people take psychiatric medications, but some groups have special needs, including:

  • Children and adolescents
  • Older adults
  • Women who are pregnant or who may become pregnant

Children and Adolescents

Many medications used to treat children and adolescents with mental illness are safe and effective. However, some medications have not been studied or approved for use with children or adolescents.

Still, a doctor can give a young person an FDA-approved medication on an “off-label” basis. This means that the doctor prescribes the medication to help the patient even though the medicine is not approved for the specific mental disorder that is being treated or for use by patients under a certain age. Remember:

  • It is important to watch children and adolescents who take these medications on an “off-label: basis.
  • Children may have different reactions and side effects than adults.
  • Some medications have current FDA warnings about potentially dangerous side effects for younger patients.

In addition to medications, other treatments for children and adolescents should be considered, either to be tried first, with medication added later if necessary, or to be provided along with medication. Psychotherapy, family therapy, educational courses, and behavior management techniques can help everyone involved cope with disorders that affect a child’s mental health. Read more about child and adolescent mental health research.

Older Adults

People over 65 have to be careful when taking medications, especially when they’re taking many different drugs. Older adults have a higher risk for experiencing bad drug interactions, missing doses, or overdosing.

Older adults also tend to be more sensitive to medications. Even healthy older people react to medications differently than younger people because older people’s bodies process and eliminate medications more slowly. Therefore, lower or less frequent doses may be needed for older adults. Before starting a medication, older people and their family members should talk carefully with a physician about whether a medication can affect alertness, memory, or coordination, and how to help ensure that prescribed medications do not increase the risk of falls.

Sometimes memory problems affect older people who take medications for mental disorders. An older adult may forget his or her regular dose and take too much or not enough. A good way to keep track of medicine is to use a seven-day pill box, which can be bought at any pharmacy. At the beginning of each week, older adults and their caregivers fill the box so that it is easy to remember what medicine to take. Many pharmacies also have pill boxes with sections for medications that must be taken more than once a day.

For more information and practical tips to help older people take their medicines safely, please see National Institute on Aging’s Safe Use of Medicines booklet and Taking Medicines  on NIHSeniorHealth.gov.

Women who are pregnant or who may become pregnant

The research on the use of psychiatric medications during pregnancy is limited. The risks are different depending on which medication is taken, and at what point during the pregnancy the medication is taken. Decisions on treatments for all conditions during pregnancy should be based on each woman’s needs and circumstances, and based on a careful weighing of the likely benefits and risks of all available options, including psychotherapy (or “watchful waiting” during part or all of the pregnancy), medication, or a combination of the two. While no medication is considered perfectly safe for all women at all stages of pregnancy, this must be balanced for each woman against the fact that untreated serious mental disorders themselves can pose a risk to a pregnant woman and her developing fetus. Medications should be selected based on available scientific research, and they should be taken at the lowest possible dose. Pregnant women should have a medical professional who will watch them closely throughout their pregnancy and after delivery.

Most women should avoid certain medications during pregnancy. For example:

  • Mood stabilizers are known to cause birth defects. Benzodiazepines and lithium have been shown to cause “floppy baby syndrome,” in which a baby is drowsy and limp, and cannot breathe or feed well. Benzodiazepines may cause birth defects or other infant problems, especially if taken during the first trimester.
  • According to research, taking antipsychotic medications during pregnancy can lead to birth defects, especially if they are taken during the first trimester and in combination with other drugs, but the risks vary widely and depend on the type of antipsychotic taken. The conventional antipsychotic haloperidol has been studied more than others, and has been found not to cause birth defects. Research on the newer atypical antipsychotics is ongoing.

Antidepressants, especially SSRIs, are considered to be safe during pregnancy. However, antidepressant medications do cross the placental barrier and may reach the fetus. Birth defects or other problems are possible, but they are very rare. The effects of antidepressants on childhood development remain under study.

Studies have also found that fetuses exposed to SSRIs during the third trimester may be born with “withdrawal” symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (low blood sugar). Most studies have found that these symptoms in babies are generally mild and short-lived, and no deaths have been reported. Risks from the use of antidepressants need to be balanced with the risks of stopping medication; if a mother is too depressed to care for herself and her child, both may be at risk for problems.

In 2004, the FDA issued a warning against the use of certain antidepressants in the late third trimester. The warning said that doctors may want to gradually taper pregnant women off antidepressants in the third trimester so that the baby is not affected. After a woman delivers, she should consult with her doctor to decide whether to return to a full dose during the period when she is most vulnerable to postpartum depression.

After the baby is born, women and their doctors should watch for postpartum depression, especially if a mother stopped taking her medication during pregnancy. In addition, women who nurse while taking psychiatric medications should know that a small amount of the medication passes into the breast milk. However, the medication may or may not affect the baby depending s on the medication and when it is taken. Women taking psychiatric medications and who intend to breastfeed should discuss the potential risks and benefits with their doctors.

Contact FDA MedWatch

About the FDA

The FDA is responsible for protecting the public health by ensuring the safety, efficacy and security of drugs (medications), biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.

FDA is also responsible for advancing public health by helping to speed innovations that make medicines more effective, safer, and more affordable and by helping the public get accurate science-based information they need to use medicines and foods to maintain and improve their health.

Reporting Serious Problems to the FDA

Visit FDA’s MedWatch  to voluntarily report a serious adverse effect, product quality problem, product use error or product failure that you suspect is associated with the use of an FDA-regulated drug, biologic, medical device, dietary supplement or cosmetic. You can also report suspected counterfeit medical products to the FDA through MedWatch . You can also use the contact information provided below:

1-800-332-1088

1-800-FDA-0178 Fax

Report a Serious Problem: MedWatch Online 

Regular Mail: Use postage-paid FDA Form 3500 

Mail to: MedWatch, 5600 Fishers Lane, Rockville, MD 20857

Subscribe to MedWatch Safety Alerts

FDAs MedWatch program offers several ways to help you stay informed about the medical products are prescribed, administered, or dispensed every day. Get safety alerts delivered to your inbox. To subscribe, join the MedWatch email list . Learn more about the MedWatch E-list . You can also follow MedWatch on Twitter by following @FDAMedWatch .

Additional Resources

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Disruptive Mood Dysregulation Disorder

Posted on June 28, 2016 by JmaC

Definition

Disruptive mood dysregulation disorder (DMDD) is a childhood condition of extreme irritability, anger, and frequent, intense temper outbursts. DMDD symptoms go beyond a being a “moody” child—children with DMDD experience severe impairment that requires clinical attention. DMDD is a fairly new diagnosis, appearing for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013 .

Signs and Symptoms

DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18. A child with DMDD experiences:

  • Irritable or angry mood most of the day, nearly every day
  • Severe temper outbursts (verbal or behavioral) at an average of three or more times per week that are out of keeping with the situation and the child’s developmental level
  • Trouble functioning due to irritability in more than one place (e.g., home, school, with peers)

To be diagnosed with DMDD, a child must have these symptoms steadily for 12 or more months.

Risk Factors

It is not clear how widespread DMDD is in the general population, but it is common among children who visit pediatric mental health clinics. Researchers are exploring risk factors and brain mechanisms of this disorder.

Treatment and Therapies

DMDD is a new diagnosis. Therefore, treatment is often based on what has been helpful for other disorders that share the symptoms of irritability and temper tantrums . These disorders include attention deficit hyperactivity disorder (ADHD), anxiety disorders, oppositional defiant disorder, and major depressive disorder.

If you think your child has DMDD, it is important to seek treatment. DMDD can impair a child’s quality of life and school performance and disrupt relationships with his or her family and peers. Children with DMDD may find it hard to participate in activities or make friends. Having DMDD also increases the risk of developing depression or anxiety disorders in adulthood.

While researchers are still determining which treatments work best, two major types of treatment are currently used to treat DMDD symptoms:

  • Medication
  • Psychological treatments
    • Psychotherapy
    • Parent training
    • Computer based training

Psychological treatments should be considered first, with medication added later if necessary, or psychological treatments can be provided along with medication from the beginning.

It is important for parents or caregivers to work closely with the doctor to make a treatment decision that is best for their child.

Medication

Many medications used to treat children and adolescents with mental illness are effective in relieving symptoms. However, some of these medications have not been studied in depth and/or do not have U.S. Food and Drug Administration (FDA)  approval for use with children or adolescents. All medications have side effects and the need for continuing them should be reviewed frequently with your child’s doctor.

For basic information about these and other mental health medications, you can visit the NIMH Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website .

Stimulants

Stimulants are medications that are commonly used to treat ADHD. There is evidence that, in children with irritability and ADHD, stimulant medications also decrease irritability.

Stimulants should not be used in individuals with serious heart problems. According to the FDA , people on stimulant medications should be periodically monitored for change in heart rate and blood pressure.

Antidepressants

Antidepressant medication is sometimes used to treat the irritability and mood problems associated with DMDD. Ongoing studies are testing whether these medicines are effective for this problem. It is important to note that, although antidepressants are safe and effective for many people, they carry a risk of suicidal thoughts and behavior in children and teens. A “black box” warning—the most serious type of warning that a prescription can carry—has been added to the labels of these medications to alert parents and patients to this risk. For this reason, a child taking an antidepressant should be monitored closely, especially when they first start taking the medication.

Atypical Antipsychotic

An atypical antipsychotic medication may be prescribed for children with very severe temper outbursts that involve physical aggression toward people or property. Risperidone  and aripiprazole  are FDA-approved for the treatment of irritability associated with autism and are sometimes used to treat DMDD. Atypical antipsychotic medications are associated with many significant side-effects, including suicidal ideation/behaviors, weight gain, metabolic abnormalities, sedation, movement disorders, hormone changes, and others.

Psychological treatments

Psychotherapy

Cognitive-behavioral therapy, a type of psychotherapy, is commonly used to teach children and teens how to deal with thoughts and feelings that contribute to their feeling depressed or anxious. Clinicians can use similar techniques to teach children to more effectively regulate their mood and to increase their tolerance for frustration. The therapy also teaches coping skills for regulating anger and ways to identify and re-label the distorted perceptions that contribute to outbursts. Other research psychotherapies are being explored at the NIMH.

Parent Training

Parent training aims to help parents interact with a child in a way that will reduce aggression and irritable behavior and improve the parent-child relationship. Multiple studies show that such interventions can be effective. Specifically, parent training teaches parents more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to have a temper outburst and working ahead to avert the outburst. Training also focuses on the importance of predictability, being consistent with children, and rewarding positive behavior.

Computer-based training

Evidence suggests that irritable youth with DMDD may be prone tomisperceiving ambiguous facial expressions as angry. There is preliminary evidence that computer-based training designed to correct this problem may help youth with DMDD or severe irritability .

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. During clinical trials, treatments might be new drugs or combinations of drugs, new psychotherapies or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Please note: Decisions about whether to participate in a clinical trial and which ones are best suited for a given individual are best made in collaboration with your licensed health professional.

Clinical Trials at NIMH/NIH

Scientists at the NIMH campus conduct research on numerous areas of study, including cognition, genetics, epidemiology, and psychiatry. The studies take place at the NIH Clinical Center in Bethesda, Maryland and usually require regular visits. After an initial phone interview to see if any of the clinical trials recruiting subjects are a good match for you, you will come to an appointment at the clinic and meet with a clinician. Visit the NIMH Clinical Trials — Participants or Join a Study: Disruptive Mood Dysregulation Disorder for more information.

How Do I Find a Clinical Trial Near Me?

To find a clinical trial near you, you can visit ClinicalTrials.gov . This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from your health provider.

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