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By Dr. Cheryl Lane, Wed, December 02, 2015

benzodiazepines

By Dr. Cheryl Lane, PhD

Benzodiazepines are a type of fast-acting medication primarily used to treat anxiety symptoms and insomnia. They are also used in the treatment of muscle spasms, agitation, acute mania, alcohol withdrawal symptoms, and seizures. These sedative-hypnotic drugs are also referred to as anxiolytics and minor tranquilizers.

Popular medications that fall in this category include Xanax, Valium, Ativan, and Klonopin. Because of their high potential for addiction, benzodiazepines are typically prescribed for short term use (usually no longer than 4 weeks).

When taken as prescribed, benzodiazepines quickly produce a sedating, calming effect. They provide relatively fast relief for individuals who suffer from acute anxiety and panic attacks. For individuals with insomnia, benzodiazepines help induce sleepiness.
How Benzodiazepines Work

Benzodiazepines work by targeting the receptors of a neurotransmitter known as GABA (which stands for gamma-aminobutyric acid). GABA helps keep the nerve cells in the brain from becoming overexcited. By enhancing GABA’s function, benzodiazepines bring about a state of clam as they reduce any over-activity in the brain. Because of this effect, they are classified as a “central nervous system depressant”.
Two Types of Benzodiazepines

There are two primary types of benzodiazepines: short-acting and long-acting. This is based on how fast and how long they act, how quickly they are eliminated from the body, and whether or not they accumulate when taken in multiple dosages.
Short-acting benzodiazepines include:

Restoril (temazepam)
Dalmane (flurazepam)
ProSom (estazolam)
Halcion (triazolam)
Versed (midazolam)

Long-acting benzodiazepines include:

Xanax (alprazolam)
Valium (diazepam)
Ativan (lorazepam)
Klonopin (clonazepam)
Librium (chlordiazepoxide)
Paxipam (halazepam)
Centrax (prazepam)
Tranxene (clorazepate)
Serax (oxazepam)
Doral (quazepam)

However, like all medications, there are potential side effects. The most common side effect is sedation or drowsiness, which is why benzodiazepines should never be taken while (or shortly before) driving a vehicle or operating any kind of machinery.
Other common side effects of benzodiazepines include:

Impaired coordination
Dizziness or light-headedness
Muscle weakness
Headache
Fatigue
Changes in appetite
Dry mouth
Abuse and Addiction

All benzodiazepines have a high risk for abuse and addiction. This is largely because they produce such a quick sense of calm and relaxation. If you take these medications for longer than prescribed or at higher or more frequent doses than prescribed, you may develop a tolerance to and dependence upon them. If this occurs it can be dangerous to abruptly stop taking the medication. Gradual tapering of the dose, under the supervision of a physician, is advised in order to prevent withdrawal symptoms which may include seizures, muscle cramps, and nausea.
Related Reading

Some commonly prescribed benzodiazepines

Alprazolam Intensol
Alzapam
Ativan
BuSpar
Centrax
Equanil
Inderal
Inderal-LA
Inderide [CD]
Inderide LA [CD]
Ipran
Klonopin
Lexapro ( Lexaprotm )
Libritabs
Librium
Lipoxide
Loraz
Lorazepam Intensol
Luvox
Meprospan
Miltown
Neuramate
Novo-Alprazol
Romazicon
Paxil
Paxipam
Serax
T-Quil
Tranxene
Tranxene – SD
Tranxene T

Valium
Valrelease
Versed
Xanax

Sensationalist coverage and our brains contribute to misunderstandings about mental health

Several common errors of reasoning make all of us susceptible to certain misconceptions about psychological health. For instance, the availability heuristic is a mental shortcut by which we gauge the frequency of an event by the extent to which it is fresh in our mind. For example, the mistaken belief that most children of divorced parents display poor psychological adjustment probably stems from the fact that when a child experiences serious problems after a divorce, we often hear about it. Conversely, when a child adapts well to a divorce—as most do—his or her resilience is almost never discussed. As a result, we may think of divorce as more closely tied to psychological problems than it actually is [see “Is Divorce Bad for Children?”; March/April 2013].
Another common logical error is post hoc, ergo propter hoc, meaning “after this, therefore because of this.” Our minds are continually on the lookout for connections between incidents, which may lead us to conclude that an event preceding the emergence of a psychological condition caused the condition. For instance, many people continue to believe that childhood vaccines (especially those containing the preservative thimerosal) cause autism because the usual time for vaccinating children—soon after they turn one—comes just before the first signs of autism typically become evident. This connection in time is apparently more persuasive to many than the multiple, large epidemiological studies that have debunked the link [see “Autism: An Epidemic?”; April/May 2007].
In addition, many misconceptions about mental illness contain a kernel of truth that can lead us to false conclusions. For example, just because dogs, horses and some other domesticated animals provide emotional warmth that can temporarily relieve anguish does not mean that animal-assisted therapy alleviates the main symptoms of major mental disorders such as autism, schizophrenia and anorexia nervosa [see “Can Animals Aid Therapy?”; June/July 2008].
MISLED BY THE MESSENGER

As the saying goes, all good things must come to an end. For more than eight years, we have authored this column on facts and fictions in mental health, an opportunity for which we are profoundly grateful. Nevertheless, because of growing commitments and other pursuits, we have decided that this will be our last column.
We have written these articles for a simple reason: we live in a world in which mental health literacy is more important than ever. According to survey data published in 2010 by psychiatrist Mark Olfson of Columbia University and psychologist Steven Marcus of the University of Pennsylvania, about 3 percent of Americans are in psychotherapy, with most of them also receiving medication. Moreover, as psychiatrist Thomas Insel, director of the National Institute of Mental Health, observed in a 2014 strategic plan, the incidence of a number of mental health conditions, including autism spectrum disorder and major depression, has soared in recent years, although the significance of these rising rates remains a matter of controversy.
Despite its pervasiveness, many people are woefully misinformed about mental illness. This fact is worrisome because inaccurate notions about mental illness can be harmful. For example, the erroneous belief that people with schizophrenia are prone to violence can lead to unjustified stigma [see “Deranged and Dangerous?”; July/August 2011]. And the unsupported assumption that antidepressants are more effective than cognitive-behavior therapy for the long-term treatment of depression can dissuade individuals from seeking the most beneficial interventions for their illness [see “The Best Medicine?”; October/November 2007].
In this concluding column, we look back at our past contributions and extract some of their most important lessons. We hope to leave readers with a user-friendly kit for sorting fact from fiction about mental health and illness.
A MISUNDERSTANDING MIND

Several common errors of reasoning make all of us susceptible to certain misconceptions about psychological health. For instance, the availability heuristic is a mental shortcut by which we gauge the frequency of an event by the extent to which it is fresh in our mind. For example, the mistaken belief that most children of divorced parents display poor psychological adjustment probably stems from the fact that when a child experiences serious problems after a divorce, we often hear about it. Conversely, when a child adapts well to a divorce—as most do—his or her resilience is almost never discussed. As a result, we may think of divorce as more closely tied to psychological problems than it actually is [see “Is Divorce Bad for Children?”; March/April 2013].
Another common logical error is post hoc, ergo propter hoc, meaning “after this, therefore because of this.” Our minds are continually on the lookout for connections between incidents, which may lead us to conclude that an event preceding the emergence of a psychological condition caused the condition. For instance, many people continue to believe that childhood vaccines (especially those containing the preservative thimerosal) cause autism because the usual time for vaccinating children—soon after they turn one—comes just before the first signs of autism typically become evident. This connection in time is apparently more persuasive to many than the multiple, large epidemiological studies that have debunked the link [see “Autism: An Epidemic?”; April/May 2007].
In addition, many misconceptions about mental illness contain a kernel of truth that can lead us to false conclusions. For example, just because dogs, horses and some other domesticated animals provide emotional warmth that can temporarily relieve anguish does not mean that animal-assisted therapy alleviates the main symptoms of major mental disorders such as autism, schizophrenia and anorexia nervosa [see “Can Animals Aid Therapy?”; June/July 2008].
MISLED BY THE MESSENGER

About 3,500 self-help books appear every year, but few are based on research or are subjected to scientific scrutiny [see “Do Self-Help Books Help?”; October/November 2006]. Likewise, many psychology Web sites are replete with misinformation. In a 2012 survey of the sites of eight national autism associations, special education professor Jennifer Stephenson and her co-authors at Macquarie University in Australia found that most of them provided misleading information about the effectiveness of interventions. For example, of 33 autism treatments suggested on these sites, solid empirical support exists for only three. (Those three are grounded in the principles of behavior modification, a technique that reinforces adaptive activities.)
The mainstream media can also spread distortions, whether because of mistakes rising from deadline pressure, misunderstanding of source material or an overzealous desire to appeal to the public. As psychologist Thomas Gilovich of Cornell University observed in his 1991 book, How We Know What Isn’t So, reporters almost always sharpen the central point of an article and leave out peripheral details. They also routinely exaggerate claims in the service of a good story. On October 7, 2013, the front page of The Sun, a popular British tabloid, trumpeted: “1,200 killed by mental patients.” The headline implied that psychiatric patients had murdered 1,200 people in the U.K. Yet that figure included not only patients in the mental health system but also individuals who were judged retrospectively by researchers to be experiencing symptoms of mental illness, a judgment that is highly subjective.
Even when a story is more nuanced, the headline may still hold sway in people’s minds. Psychologist Ullrich Ecker of the University of Western Australia and his colleagues collected data last year showing that deceptive headlines, such as “Fears of Fluoride in Drinking Water” (which topped an article emphasizing the safety of fluoride in water), can provoke biased inferences about the story, leading to misconceptions. Thus, readers must not only continue past the headline but must also carefully encode any details in a story that contradict or add nuance to its title. We should beware, too, of misguided attempts to create balance in stories. Journalists sometimes feel obligated to present both sides of an issue even when the scientific consensus is clearly on one side.
We hope that this column and the more than 50 that came before it have helped educate readers about psychological health in ways that matter for both individuals and society. The tips and analyses we have offered over the years are hardly panaceas, but they can serve as a guide through the increasingly complicated maze of claims about mental health.

What someone’s eyes can tell you about what they’re thinking.

They’ve existed for 540 million years and most of us have a pair, but aside from giving us sight, what can we tell from looking at someone’s eyes?

People say that the eyes are a “window to the soul” – that they can tell us much about a person just by gazing into them. Given that we cannot, for example, control the size of our pupils, body language experts can deduce much of a person’s state by factors relating to the eyes.

The Pupils
The pupils are a part of our body language that we practically have no control over.

As well as adjusting the amount of light taken in the process of sight (Dilation: pupil size increasing; Contracting: pupil size decreasing), Eckhard Hess (1975) found that the pupil dilates when we are interested in the person we’re talking to or the object we’re looking at.

As an indicator, check a friend’s pupil size when you’re talking to them about something interesting, then change the subject to something less interesting and watch their pupils contract!

Eye Contact
For making contact and communicating with a person, effective eye contact is essential to our every day interaction with people, and also to those who want to be effective communicators in the public arena:

Persistent eye contact

Look, Don’t Stare.
Staring

Look, don’t stare. Over-powering eye contact can make the recipient uncomfortable.

Generally in Western societies and many other cultures, eye contact with a person is expected to be regular but not overly persistent. Constant eye contact is often considered to be an attempt at intimidation, causing the person who’s the object of a person’s gaze to feel overly studied and uncomfortable.

Even between humans and non-humans, persistent eye contact is sometimes unadvisable: the New Zealand Medical Journal reported that one reason so many young children fall victim to attacks by pet dogs is their over-poweringly regular eye contact with pets, which causes them to feel threatened and defensive.

Overly persistent eye contact is also a sign of a person’s over-awareness of the messages they are emmiting. In the case of a person who is try to deceive someone, they may distort their eye contact so that they’re not avoiding it – a widely recognised indicator of lying.

Avoiding Eye Contact

Evasive Eye Contact
Evasive Eye Contact

Evasive eye contact: a sign of discomfort.

Why do we avoid looking at a person? It may be because we feel ashamed to be looking at them if we’re being dishonest of trying to deceive them. However, Scotland’s University of Stirling found that, in a question-and-answer study among children, those who maintained eye contact were less likely to come up with the correct answer to a question than those who looked away to consider their response.

Eye contact, as a socialising device, can take a surprising amount of effort to maintain when this energy could be spend on calculating, as opposed to perceptive, tasks.

Crying
Did You Know?
Humans are believed to be the only species on Earth to cry, though there is emerging evidence of it in elephants and gorillas.1

most cultures around the world, crying is considered to be caused by an extreme experience of emotion; usually, it’s associated with sadness or grief, though often extreme experiences of happiness, and through humor, can cause us to cry. Often, forced crying in order to gain sympathy or deceive others is known as “crocodile tears” – an expression from myths of crocodiles ‘crying’ when catching prey.

Blinking
Aside from our instinctive need to blink, our emotions and feelings towards the person we’re talking to can cause us to subconciously alter our blink rate.

www.healthline.com/health/bipolar-disorder/best-videos-of-the-year?utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=bipolar#3

False beliefs about mental illness can cause significant problems. Learn what you can do about stigma.
By Mayo Clinic Staff :

Stigma is when someone views you in a negative way because you have a distinguishing characteristic or personal trait that’s thought to be, or actually is, a disadvantage (a negative stereotype). Unfortunately, negative attitudes and beliefs toward people who have a mental health condition are common.

Stigma can lead to discrimination. Discrimination may be obvious and direct, such as someone making a negative remark about your mental illness or your treatment. Or it may be unintentional or subtle, such as someone avoiding you because the person assumes you could be unstable, violent or dangerous due to your mental health condition. You may even judge yourself.
Some of the harmful effects of stigma can include:
Reluctance to seek help or treatment
Lack of understanding by family, friends, co-workers or others you know
Fewer opportunities for work, school or social activities or trouble finding housing 
Bullying, physical violence or harassment
Health insurance that doesn’t adequately cover your mental illness treatment
The belief that you’ll never be able to succeed at certain challenges or that you can’t improve your situation
Steps to cope with stigma

Here are some ways you can deal with stigma:
Get treatment. You may be reluctant to admit you need treatment. Don’t let the fear of being labeled with a mental illness prevent you from seeking help. Treatment can provide relief by identifying what’s wrong and reducing symptoms that interfere with your work and personal life.
Don’t let stigma create self-doubt and shame. Stigma doesn’t just come from others. You may mistakenly believe that your condition is a sign of personal weakness or that you should be able to control it without help. Seeking psychological counseling, educating yourself about your condition and connecting with others with mental illness can help you gain self-esteem and overcome destructive self-judgment.
Don’t isolate yourself. If you have a mental illness

an illness. So instead of saying “I’m bipolar,” say “I have bipolar disorder.” Instead of calling yourself “a schizophrenic,” say “I have schizophrenia.”
Join a support group. Some local and national groups, such as the National Alliance on Mental Illness (NAMI), offer local programs and Internet resources that help reduce stigma by educating people with mental illness, their families and the general public. Some state and federal agencies and programs, such as those that focus on vocational rehabilitation or the Department of Veterans Affairs (VA), offer support for people with mental health conditions.
Get help at school. If you or your child has a mental illness that affects learning, find out what plans and programs might help. Discrimination against students because of a mental health condition is against the law, and educators at primary, secondary and college levels are required to accommodate students as best they can. Talk to teachers, professors or administrators about the best approach and resources. If a teacher doesn’t know about a student’s disability, it can lead to discrimination, barriers to learning and poor grades.
Speak out against stigma. Consider expressing your opinions at events, in letters to the editor or on the Internet. It can help instill courage in others facing similar challenges and educate the public about mental illness.

Others’ judgments almost always stem from a lack of understanding rather than information based on the facts. Learning to accept your condition and recognize what you need to do to treat it, seeking support, and helping educate others can make a big difference.

Mayo Clinic

Part 1 of 4
Testing for bipolar disorder
People with bipolar disorder go through intense emotional changes that are very different from their usual mood and behavior. These changes affect their lives on a day-to-day basis.

Testing for bipolar disorder isn’t as simple as taking a multiple choice test or sending blood to the lab. While bipolar disorder does show distinct symptoms, there is no single test to confirm the condition. Often, a combination of methods is used to make a diagnosis. 

Part 2 of 4
Medical tests
If you experience extreme shifts in mood that disrupt your daily routine, you should see your doctor. They will perform a physical exam and may also order lab tests, including blood and urine analyses. These tests can help determine if other conditions or factors could be causing your symptoms.

Sometimes, certain thyroid issues cause symptoms that are similar to those of bipolar disorder. Symptoms may also be a side effect of other medications. After other possible causes are ruled out, your doctor will likely refer you to a mental health specialist.

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Part 3 of 4

Mental health evaluation
A psychiatrist or psychologist will ask questions to assess your overall mental health. Testing for bipolar disorder involves questions about symptoms, how long they’ve occurred, and how they may disrupt your life. The specialist will also ask you about certain risk factors for bipolar. This includes questions about family medical history and any history of drug abuse.

Bipolar disorder is a mental health condition that is known for its periods of both mania and depression. The diagnosis for bipolar requires at least one depressive and one manic or hypomanic episode. Your mental health specialist will ask about your thoughts and feelings during and after these episodes. They will want to know if you feel in control during the mania and how long the episodes last. They might ask your permission to ask friends and family about your behavior. Any diagnosis will take into account other aspects of your medical history and medications you have taken.

To be exact with a diagnosis, doctors use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM provides a technical and detailed description of bipolar disorder. Here’s a breakdown of some of the terms and symptoms used to diagnose the condition.

Mania
The DSM defines mania as a “distinct period of abnormally and persistently elevated, expansive, or irritable mood.” The episode must last at least a week. The mood must have at least three of the following symptoms:

high self-esteem
little need for sleep
increased rate of speech (talking fast)
flight of ideas
easily distracted
an increased interest in goals or activities
psychomotor agitation (pacing, hand wringing, etc.)
increased pursuit of activities with a high risk of danger

Depression
The DSM states that a major depressive episode must have at least four of the following symptoms. They should be new or suddenly worse, and must last for at least two weeks:

changes in appetite or weight, sleep, or psychomotor activity
decreased energy
feelings of worthlessness or guilt
trouble thinking, concentrating, or making decisions
thoughts of death or suicidal plans or attempts
Suicide preventionIf you think someone is at immediate risk of self-harm or hurting another person:
Call 911 or your local emergency number.
Stay with the person until help arrives.
Remove any guns, knives, medications, or other things that may cause harm.
Listen, but don’t judge, argue, threaten, or yell.
If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.
Sources: National Suicide Prevention Lifeline • Substance Abuse and Mental Health Services Administration

Bipolar I disorder
Bipolar I disorder involves one or more manic episodes or mixed (mania and depression) episodes and at least one major depressive episode. The episodes are not due to a medical condition or substance use.

Bipolar II disorder
Bipolar II disorder has one or more severe major depressive episodes with at least one hypomanic episode. There are no manic or mixed episodes. Hypomania is a lesser form of mania. It doesn’t disrupt your ability to function as much as bipolar I disorder. The symptoms must cause a lot of distress or problems at work, school, or with relationships. It’s common for those with bipolar II disorder to not remember their manic episodes.

Cyclothymia
Cyclothymia is characterized by changing low-level depression along with periods of hypomania. The symptoms must be present for at least two years in adults or one year in children before a diagnosis can be made. Adults have symptom-free periods that last no longer than two months. Children and teens have symptom-free periods that last only about a month.

Rapid-cycling bipolar disorder
This category is a severe form of bipolar disorder. It occurs when a person has at least four episodes of major depression, mania, hypomania, or mixed states within a year. Rapid cycling affects more women than men.

Not otherwise specified (NOS)
This category is for bipolar symptoms that do not clearly fit into other types. NOS is diagnosed when multiple bipolar symptoms are present but not enough to meet the label for any of the other subtypes. This category can also include rapid mood changes that don’t last long enough to be true manic or depressive episodes. Bipolar disorder NOS includes multiple hypomanic episodes without a major depressive episode.

Part 4 of 4
Misdiagnosis
Bipolar disorder is most often misdiagnosed in its early stages, which is frequently during the teenage years. When it’s diagnosed as something else, symptoms of bipolar disorder can get worse. This usually occurs because the wrong treatment is provided. Other factors of a misdiagnosis are inconsistency in the timeline of episodes and behavior. Most people don’t seek treatment until they experience a depressive episode.

According to a 2006 study published in Psychiatry, around 69 percent of all cases are misdiagnosed. One-third of those are not being properly diagnosed for 10 years or more.

Bipolar disorder is often misdiagnosed as unipolar depression, anxiety, OCD, ADHD, an eating disorder, or a personality disorder. The condition shares many of the symptoms associated with other mental disorders. Some things that may help doctors in getting it right are a strong knowledge of family history, fast recurring episodes of depression, and a mood disorder questionnaire.

Start a conversation about mental health when there is an open window of time to have an in-depth discussion, and neither you or the person you’re talking to will have to cut the conversation short to take care of other obligations. Plan to set aside at least 30 minutes to an hour.
If you aren’t sure how to bring up the topic of your mental health, here are a few ways to get started:

Start with a text if a face-to-face talk is too intimidating.  It could be a plain old text message with a note that says, “I have some important things on my mind and need to make time to talk to you about them.”

Find & share info. Find important information online that might help you explain what you’re going through. Print it and bring it with you when you’re ready to talk.

Take the Youth Screen at mhascreening.org. Print out your results to share with the person you plan to talk to.

Still Stumped About How To Get Started?
Use the letter below and fill in the blanks. Pick from the options we’ve listed or use your own words.
Dear _________,

For the past (day/week/month/year/__________), I have been feeling (unlike myself/sad/angry/anxious/ moody/agitated/lonely/hopeless/fearful/overwhelmed/ distracted/confused/stressed/empty/restless/unable to function or get out of bed/__________).

I have struggled with (changes in appetite/changes in weight/loss of interest in things I used to enjoy/ hearing things that were not there/seeing things that were not there/ feeling unsure if things are real or not real/ my brain playing tricks on me/ lack of energy/increased energy/ inability to concentrate/alcohol or drug use or abuse/self-harm/skipping meals/overeating/overwhelming focus on weight or appearance/feeling worthless/ uncontrollable  thoughts/guilt/paranoia/nightmares/ bullying/not sleeping enough/ sleeping too much/risky sexual behavior/overwhelming sadness/losing friends/unhealthy friendships/unexplained anger or rage/isolation/ feeling detached from my body/feeling out of control/ thoughts of self-harm/cutting/thoughts of suicide/plans of suicide/abuse/sexual assault/death of a loved one/__________).

Telling you this makes me feel (nervous/anxious/hopeful/embarrassed/ empowered/pro-active/mature/self-conscious/guilty/__________), but I’m telling you this because (I’m worried about myself/it is impacting my schoolwork/it is impacting my friendships/I am afraid/I don’t want to feel like this/I don’t know what to do/I don’t have anyone else to talk to about this/I trust you/__________).

I would like to (talk to a doctor or therapist/talk to a guidance counselor/talk to my teachers/talk about this later/create a plan to get better/talk about this more/find a support group/__________) and I need your help.
Sincerely,
(Your name__________)

What if someone talks to you about their mental health?

Listen. Let them finish their sentences and complete thoughts without interrupting. After they have finished you can respond.
Let them know if you understand. If someone has just spilled their guts and and you’ve gone through something similar—tell them. It helps a lot for someone to know they aren’t alone. Make sure you don’t switch the topic of conversation to your struggles though; focus on their needs.

Avoid being judgmental. Don’t tell them they are being weird or crazy; it’s not helpful at all.
Take them seriously. Try not to respond with statements that minimize how they are feeling or what they are going through, such as, “You’re just having a bad week,” or “I’m sure it’s nothing.”

Make yourself available to talk again if needed. While it can be a big relief for someone to share something they have been keeping secret, mental health struggles usually aren’t solved with one conversation.  Let the person who has spoken with you know that they can reach out to you again if they are having a tough time. It’s ok to let them know if there is a time of day or certain days of the week that you aren’t available.  For instance, “I’m here for you if you need to talk, but my parents don’t let me use the phone after 9 on school nights, so call before then.

Don’t turn what you’ve been told into gossip. If someone is talking to you about their mental health, it was probably tough for them to work up the nerve to say something in the first place and you shouldn’t share what they tell you with other students at school. Let them share on their own terms.

If you don’t understand, do some research and learn about what you’ve been told. Make sure that your information is coming from reliable sources like government agencies and health organizations.

Tell an adult if you have to. It’s important to have friends that trust you, but if a friend indicates they have thoughts or plans of hurting themself or another person, have been hearing voices or seeing things that no one else can hear or see, or have any other signs and symptoms that shouldn’t be ignored then you need to tell an adult what is going on. That doesn’t make you a bad friend; it just means that the problem requires more help than you can give. If someone you know is in crisis and needs help urgently, call 1-800-273-TALK (8255), text 741741, go to your local Emergency Room or call 911.

Now what?

If you’ve made the decision to talk to someone about your mental health, you may be nervous about how things will go and what could happen. Check out the list below to find out more about what you can expect.

Things might be a little awkward at first for both people in the conversation. For a lot of people, talking about anything related to their health or body can be kind of tough at first.
You’ll probably feel relieved. Being able to open up and share something you’ve been keeping to yourself for a long time can feel like a weight has been lifted. You might learn that the person you’re talking to has had some personal experience or knows someone in their family who has gone through something similar, which will help you to feel less alone.

You may encounter someone who doesn’t understand. While it’s likely that a person will know someone who has struggled with their mental health, they may not understand what it’s like- especially if they haven’t struggled themselves.
Expect to be asked questions. Some questions might include: How long has this been going on? Did something difficult happen before you started feeling this way? Can you describe what it’s like? You don’t have to answer every question that you’re asked if you don’t want. Remember that the person you’re talking to is probably asking questions to help them better understand what you’re going through.

It’s possible that you might not get the reaction you were hoping for. It can be discouraging if you work up the nerve to speak up and are then told, “you’ve just got the blues” “get over it”“stop being silly” or “you worry too much.” Sometimes this kind of reaction has to do with culture or expectations. Try to explain how it is really having an effect on your ability to live a healthy and happy life and you aren’t sure how to make things better.  If for some reason the person you chose to talk to still isn’t “getting it” someone else will. Think about someone else you could talk to that would give you the help you need. Don’t stop or go back to ignoring your situation or struggling alone.
The conversation is the first step in a process. Congratulations for getting the ball rolling.
If your first conversation isn’t with your parents, you’ll probably need to talk to them at some point. See the following page for tips and common concerns about talking to parents.

Your next step might be going to an appointment of some sort. It may start with someone at school like the guidance counselor or school psychologist, a visit to your regular family doctor or psychiatrist, or with another kind of treatment provider like a therapist or social worker. These professionals can help figure out what exactly is going on and how to start getting you the help you need. You might need to talk to more than one person to find someone who can be the most helpful.
It takes time to get better. You could be going through something situational, which can improve with time to process feelings (for example, grief after the death of a loved one or a tough break-up) or adjustments to your environment (like switching lockers to get away from someone who is a bully), or you could have a more long term mental health issue. Mental health issues are common and treatable; however, you may have to try a few different things to find right type of treatment or combination of strategies that works best for you

Yet many on antidepressants may not need them

More than two-thirds of adults with depression don’t receive any treatment for their condition, researchers reported.
In an analysis of data from the Medicare Expenditure Panel Surveys (MEPS), only about 29% of adults who screened positive for depression were being treated for it in 2012-2013, Mark Olfson, MD, MPH, of Columbia University, and colleagues reported online in JAMA Internal Medicine.

At the same time, patients with less serious psychological distress were more likely than those with serious distress to be prescribed antidepressants — and the clinical reasons for that aren’t clear, the researchers said.
The findings suggest there are “problems aligning depression care with patient needs,” Olfson told MedPage Today, and that there is a greater need for “more careful clinical attention to ensure depressed patients receive care their symptoms require.”
Previous work that had indicated that about half of adults with a lifetime medical history of major depressive disorder had never been treated for depression — but there has been a recent spike in antidepressant prescribing over the past few years in the U.S., and more emphasis has recently been placed on depression screening following a recommendation from the U.S. Preventive Services Task Force, the researchers said.
“With the recent increase in prescribing of antidepressants, some physicians may assume that under treatment of depression is no longer a widespread problem,” Olfson said.
To assess depression treatment trends, Olfson and colleagues analyzed data from 46,417 adults who responded to the Medical Expenditure Panel Surveys in 2012 and 2013.

A total of 8.4% screened positive for depression — but only 28.7% reported receiving any treatment for depression, the researchers reported.
Yet among all respondents who were receiving treatment for depression, only about 30% actually screened positive for depression — and only about 22% had serious psychological distress, they found.
“The clinical reasons for this pattern are unclear, but may include a tendency to overestimate the effectiveness of antidepressants in treating mild depression, insufficient time to provide alternative interventions for mild depression, and errors in clinical assessment,” the researchers wrote. “The reported treatment patterns suggest a need to increase routine assessment of depression severity.”
Those with serious psychological distress who were treated for depression were more likely to receive care from psychiatrists (33.4% versus 17.3%, P<0.001) or other mental health specialists (16.2% versus 9.6%, P<0.001) than those with less serious psychological distress.
They were also less likely to receive depression care exclusively from general practitioners.

There’s an absolute link between your emotional health and your physical well-being, so take time to nurture both.

To be completely healthy, you must take care of not only your physical health, but your emotional health, too. If one is neglected, the other will suffer.

Understanding the Physical Health and Emotional Health Connection

There is a physical connection between what the mind is thinking and those parts of the brain that control bodily functions. According to Charles Goodstein, MD, clinical professor of psychiatry, New York University School of Medicine in New York City, and president of the Psychoanalytic Association of New York, the brain is intimately connected to our endocrine system, which secretes hormones or chemicals that can have a powerful influence on your emotional health. “Thoughts and feelings as they are generated within the mind [can influence] the outpouring of hormones from the endocrine system, which in effect control much of what goes on within the body,” says Dr. Goodstein.

“As a matter of fact, it’s very probable that many patients who go to their physician’s office with physical complaints have underlying depression,” he says. People who visit their doctors reporting symptoms of headache, lethargy, weakness, or vague abdominal symptoms often end up being diagnosed with depression, even though they do not report feelings of depression to their doctors, says Goodstein. Depression causes you to be over-aware of physical discomfort.

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While unhappy or stressed-out thoughts may not directly cause poor physical health, they could be a contributing factor and may explain why one person is suffering physically while someone else is not, Goodstein adds.

Physical Health and Emotional Health: Examples of Links

There are many circumstances that support the link between physical health and emotional health, including:

White-coat syndrome. This is a condition in which a person’s blood pressure increases the minute they step into a doctor’s office. In white-coat syndrome, anxiety is directly related to physical function — blood pressure. “If you extrapolate from that, you can say, what other kinds of anxieties are these people having that are producing jumps in blood pressure? What is the consequence of repeated stress?” asks Goodstein.
Personality and heart disease. Some people are more at risk of heart attack because of their personality, specifically those “hard-driving, hard-charging” Type A individuals.
Chronic disease and depression. People who are having a hard time coping with a chronic illness are more likely to become depressed.
Physical symptoms of emotional health distress. People who are clinically depressed often have physical symptoms, such as constipation, lack of appetite, insomnia, or lethargy, among others.
And on the other hand: “Those individuals who have achieved a level of mental health where they can manage better the inevitable conflicts of human life are more likely to prevail in certain kinds of physical illness,” says Goodstein.

Physical Health and Emotional Health: Caring for Both

The best way to care for your total health, emotional and physical, is to follow the advice of your mother:

Eat right. A healthy, regular diet is good for the body and mind.
Go to bed on time. Losing sleep is hard on your heart, may increase weight, and definitely cranks up the crankiness meter.
If you fall down, get back up.Resilience in the face of adversity is a gift that will keep on giving both mentally and physically.
Go out and play. Yes, work is a good thing: It pays the bills. However, taking time out for relaxation and socializing is good for your emotional health and your physical health.
Exercise. Exercise is proven to improve your mood and has comprehensive benefits for your physical health.
See the right doctor, regularly. Going to the right doctor can make all the difference in your overall health, especially if you have a complicated condition that requires a specialist. But if your emotions are suffering, be open to seeing a mental health professional….

Finding the best treatment plan for depression can take some trial and error. Here’s how to tell if your current treatment isn’t working and what to do about it.

When it comes to major depression, there’s no one treatment that works for everyone. Because each person may respond differently to treatment, finding the most effective treatment plan for you can sometimes take several attempts. But with time and effort, major depression can be treated successfully.

“People with major depression need to be patient,” says David Schilling, MD, an associate professor of psychiatry at Loyola University Health System in Maywood, Ill. “Serious depression usually requires medication and may need other types of treatment as well.”

Research shows that the combination of medication and talk therapy (psychotherapy) works better than either of these types of treatments alone for treating major depression. However, making lifestyle changes — including eating well, exercising regularly, and maintaining a strong support system — can also be important. Because finding the right combination of depression treatment options can be tricky, it’s important to know the signs of an ineffective treatment regimen so your doctor can recommend alternatives as soon as possible.

5 Signs Your Depression Treatment Isn’t Working

Here are five warning signs that your depression treatment might not be working and what you can do if it isn’t:

1. You’ve been taking an antidepressant medication for four to six weeks, and you’re not feeling better.

Major depression causes a mood so depressed that you can no longer enjoy life. If your treatment is working, you should feel that most depression symptoms — such as changes in sleep, energy, and appetite — are starting to lose their intensity, Dr. Schilling says. “Although antidepressants take time to work, if you’re not starting to feel better within four to six weeks, your doctor may want to increase your dose, change your medication, or add another medication,” he says. “Another option is to add psychotherapy if you’re only taking medication.”

2. You’ve been trying psychotherapy for several weeks, and you’re not feeling better.

Research shows that people with moderate to severe depression can benefit from a type of psychotherapy called cognitive behavioral therapy, especially if a therapist immediately focuses on techniques to help you break out of negative thought patterns and see life events more realistically. But if talk therapy isn’t working for you, it’s important to evaluate why. Be honest with your therapist so together you can figure out what needs to happen to get you where you need to be in your treatment progression. “Your therapist may suggest seeing a psychiatrist who can prescribe an antidepressant,” Schilling says.

3. You feel less depressed, but you’re also feeling very high and excited.

If this happens, you may have bipolar disorder and not major depression. “Most of the time, people with bipolar disorder are depressed, so it’s not uncommon to be misdiagnosed,” Schilling says. “If you start to feel the opposite of depressed, or if you start to feel invincible, you need to let your doctor or therapist know.” Treatment for bipolar disorder also involves a combination of medication and psychotherapy, but it differs from treatment for major depression.

4. Your treatment is reducing some depression symptoms but not others.

Different types of depression may need different types of treatment. For instance, one type of major depression called psychotic depression may cause you to have false beliefs or see, feel, or hear things that aren’t real. Psychotic depression requires more aggressive treatment than antidepressants alone. Other disorders can also exist along with depression, including substance abuse, anxiety, and post-traumatic stress disorder. These conditions may need to be addressed along with depression to enhance your overall treatment.

5. Side effects of antidepressant medication are affecting your overall treatment.

All antidepressants can have side effects, such as nausea, vomiting, diarrhea, sleepiness, weight gain, and sexual problems. “Side effects can keep treatment from going well, and you need to let your doctor know about them,” Schilling says. If you’re plagued by side effects, you might need to switch to a different antidepressant medication. Or your doctor may lower your dose until side effects fade, which is common. Some side effects, like trouble sleeping or sexual difficulties, may be treated with other medications. But you shouldn’t stop taking medication on your own. Always talk to your doctor first.

About Treatment for Major Depression

Treatment for major depression takes time to work, and you may need to change treatments at some point. “Treatment works for most people with major depression,” Schilling says. “But giving up or avoiding treatment leads to longer and more serious depression symptoms.”

To help boost treatment effectiveness for and speed recovery of major depression, learn as much as you can about depression and work closely with your doctor to find the right combination of treatment options for you.