Ketamine Infusion Therapy for Depression and Suicidal Ideation

Can ketamine infusion therapy work for depression?

 

What are the advantages?

Ketamine is a medication that has been traditionally used to induce and maintain anesthesia. This drug is often used off-label for conditions such as pain relief, conscious sedation, and depression.

Ketamine has addictive properties and is a popular drug of abuse. The drug is available as white powder, liquid, and tablets and is known as “K”, “Vitamin K”, and “Special K” on the street. Ketamine can cause hallucinations, out-of-body experiences and temporary paralysis. The user may be awake but unable to move or even talk. These effects have led to ketamine being referred to as a “date rape drug.”

In March 2020, SpavatoTM (Esketamine) nasal spray was approved for adults with treatment-resistant depression. This is an important milestone in paving the way for this drug to be used more commonly in depressed and suicidal patients who have tried other treatments without benefit.

Ketamine is not just another antidepressant. It begins to work right away. Other treatments for depression take weeks to work. 

The popular selective serotonin reuptake inhibitors (SSRI’s) must be slowly titrated to the effective dose due to side effects. We must be sure the patient can tolerate the drug and wait weeks to determine effectiveness. 

The same is true for other antidepressants currently available.

This post will describe the use of ketamine infusion therapy for the treatment of depression.  

Suicide

Suicide rates have increased over the past two decades and are one of the top three causes of mortality worldwide for those between the ages of 15-44.1 

This has occurred despite efforts to reduce suicide.2

We know that approximately 90% of those who commit suicide suffer from a treatable mood disorder.3

Our current treatment options for those with suicidal ideation consist mostly of hospitalization, psychotherapy, and pharmacotherapy.  

Although dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), and treatment with clozapine and lithium have been shown to decrease suicide deaths,4

5

6

 

as well as attempts,7

8

They take time to work and have not shown effectiveness acutely. This leads us to a search for an antidepressant that can take effect quickly. 

 

Is ketamine a solution? 

Ketamine for Suicidal Ideation and Mood Disorders

There have been studies showing that ketamine infusions are effective in treating suicidal ideation and depression in the acute setting. A meta-analysis published in the American Journal of Psychiatry in February 2018 came to the following conclusions:9

  • Ketamine significantly reduced suicidal ideation. This occurred within one day and continued for one week after the treatment.
  • The change in the severity of depressive symptoms was strongly correlated with the decrease in suicidal ideation.
  • Ketamine’s effect on suicidality is only partially due to its antidepressant effects.
  • 54.9% of patients had no suicidal ideation 24 hours after a single ketamine infusion, and 60% remained free of suicidal thoughts one week after the infusion.

Are you thinking of Getting a Ketamine Infusion?

If you are considering utilizing ketamine infusions to treat depression or suicidal thoughts, here is what to expect:

  1. You may receive the infusions as an outpatient or inpatient. Several facilities offer ketamine infusions as an outpatient procedure.
  2. You may be asked to fill out a questionnaire to determine your depression level before the procedure.
  3. You will need to arrange for transportation as you will be unable to drive after the infusion.
  4. The following conditions may exclude you from receiving the ketamine infusion:
    • History of schizophrenia, bipolar disorder, or schizoaffective disorder.
    • Dementia.
    • Delirium within the last seven days.
    • Uncontrolled hypertension.
    • Pregnancy.
    • Certain heart conditions.
    • Positive urine drug screen showing substances of abuse or a previous history of substance abuse.
    • An allergy or previous adverse reaction to ketamine.

It is important to note that various facilities will have different protocols. Check with your facility of choice to get their specific guidelines. Here is a few typical guidelines used:

  1. The ketamine infusion will likely last about 40 minutes.  
  2. Vital signs (heart rate, blood pressure, oxygen blood levels, etc) will be monitored during the infusion.
  3. As with any medication, you may experience side effects. Some of these include:
    • Confusion
    • Delirium
    • Dream-like state
    • Excitement
    • Hallucinations
    • Irrational behavior
    • Vivid Imagery
    • Change in heart rate
    • Change in blood pressure
    • Seizure-like movements
    • Rash
    • Nausea and vomiting
    • Double vision
    • Others

Ketamine infusions will normally be given on a pre-determined schedule. A typical schedule may be:

  1. Twice a week for 2-3 weeks (not less than three days apart)
  2. After 2-3 weeks, the infusions should be weekly to every three weeks with a goal to extend the infusions to an interval if possible. This will vary based on patient response.
  3. Ketamine infusions should be tapered when discontinued.
  4. Ketamine infusions range from $400-$800 per infusion, and there may also be an initial consultation fee. These prices are for outpatient procedures. It is important to note that most health insurance plans do not cover these infusions. Inpatient treatment can cost substantially more.

I am a huge proponent of using ketamine infusions for treatment-resistant depression. I have spent many years caring for psychiatric patients, and some do not respond to conventional therapies.  

 

Depression is a devastating mood disorder that can rob an individual of a fulfilling life. It can ruin careers, relationships, and even result in death.

 

If you have any thoughts of ending your life or are depressed, GET HELP. Call someone! There are many resources available to help you. You can get better. We can help! 

 

The Suicide Hotline can be reached at:

 

800-273-8255

 

With the recent approval of SpavatoTM, my hope is that some of the stigma associated with ketamine will dissipate. Many drugs we use every day have the potential of being abused. The fact is ketamine can help some of our most vulnerable people.

 

As a society, we have the responsibility to care for our sick individuals. This includes those with mental disorders. Anyone can become depressed!  I pray that we will embrace the potential of ketamine infusions. After other treatments have failed, those who need ketamine should have access to it. 

Insurance companies should pay for it!

 

It is more costly to hospitalize someone for weeks while our traditional treatments take effect. One of ketamine’s most important benefits is that it begins to work right away. This can be the difference between life and death!

Ketamine is a subject I have wanted to write about for some time. We are unable to use ketamine infusions in our facility due to a perceived danger.  It is possible to refer those patients who might benefit from ketamine to an alternative facility. I plan to continue to lobby for its use within our facility. I believe we owe it to our patients.

If you have any questions about ketamine or any other medication, health issue, or nutraceutical, please contact me.

I am happy to help whenever I can.  That is why I started Sunshine Nutraceuticals in the first place.

Have a great week, everyone, and stay safe!!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Ideas for Limiting Screen Time for Tweens

Do your children spend too much time on electronic devices?  

Are they tuned out of everything besides their phones, tablets, and Television?

What can you do to stop this?

What effects may too much screen time have on your kids?

My wife and I have struggled with this issue for many years. If you let your children spend too much time on their devices, you feel like they aren’t interacting enough with the outside world. They are also at risk of viewing inappropriate information and even can become victims of predators

If you limit their screen time too much, they have a tendency to drive you crazy. Although electronics should not be used for “babysitting,” most of us have become dependent on them for a little reprieve at times. This post is designed to give you some ideas on how to limit screen time effectively.

What are Tweens?

Tween is short for tweenager. A tween is a child between 9 and 12 years of age. These kids are in a transition period between small children and teenagers. Many challenges occur during this period, including:

  • Puberty may start resulting in body changes and mood swings.
  • Peer pressure to engage in dangerous activities often occurs during this time. 
  • Tweens are often coerced into using illegal drugs or having sex. 
  • The increased workload at school occurs. Homework can take many hours per week to complete.
  • Tweens become more concerned with their appearance and social standing.

These kids are also very fond of their electronic devices. 

I am sure you are aware that they begin using them at earlier ages as time progresses. If left unchecked, these kids will likely spend most of their time staring at a screen.

Harmful Effects of Too Much Screen Time

There is much debate as to the effects of too much screen time on our developing children. It is beyond the scope of this post to go into all of the studies regarding this topic. My philosophy is anything that interferes with basic human needs can be detrimental. 

These basic needs include:

  • Social interaction.
  • Adequate sleep.
  • A healthy, well-balanced diet.
  • Exercise.

It is clear that too much screen time can have a negative effect on all of these. In addition, other problems can arise based on what the child is watching on the screen. 

My opinion is that screen time should be limited to keep our kids from missing out on the basic needs listed above. 

I am writing this post to help parents with this daunting task.

Ideas to Limit Screen Time

I have researched this topic and will list what I believe to be the best techniques to limit screen time. Please remember that these are not the only options, but ones that I believe are the best.  

Identify time periods where electronic devices are not allowed

The first step in limiting screen time is to identify “blackout periods.” These can be whatever you, as a parent, decide. Some examples are.

Meal periods – I believe meals should be family time. We have a rule in our house prohibiting electronic use during dinner. 

This should be a time to discuss what happened during the day. Remember to role model this behavior. If you are talking on the phone or texting during dinner, it is hard to convince your children not to do the same.  

Before Sleeping – You have probably heard that using electronic devices just prior to sleep decreases sleep quality.1

My suggestion is to take the devices away from your children at least one hour before bedtime. There are several reasons for this.

  • Evening exposure to LED-backlit screens has been shown to decrease melatonin levels and decrease daytime alertness and cognitive performance.2
  • Having a phone or tablet close by while sleeping increases the risk of nocturnal awakening. Phones may ring at night, and tablets may produce sounds due to various apps.
  • The fact that the device is available to the child may result in them waking up earlier to begin using it.

Family time – Holidays and special occasions should be a time to interact with family and friends. This may also include vacation time. Make specific rules around screen time during these periods and stick to them.  

Encourage Exercise and Outdoor Activities

One way to limit screen time is to send the kids outside to play. My family invested in a full-size trampoline to help with this. You could also have them help in the garden or play sports with them. This also helps with exercise.   

Playdates with other kids is also an option. 

Anything that gets them moving works. 

Use Electronic Devices as Rewards

If your children believe they can use their electronics whenever they choose, it can be difficult to limit screen time. 

Change the rules and only allow screen time after homework, chores, and physical activities are completed. 

Remember, you are in charge, not them. 

They may squawk at first, but they will survive.

Not only will this result in less screen time, but it will also incentivize your children to get their work done.

Consider Third Party Programs to Help

There are programs available at reasonable prices to help parents keep their children safe on-line. One such product is bark. This program can:

  • Monitor texts, email, YouTube, and 30+ apps and platforms
  • Get alerts for issues like cyberbullying, on-line predators, suicidal ideation, and more
  • Manage screen time
  • Filter which websites your kids can visit
  • Keep up with kids with location check-ins

Another product is Net Nannytm This program also manages screen time and can block inappropriate content from reaching your children.

I am not affiliated with these companies in any way but believe their products are useful. You can find these and other products by doing a simple Google search.

Kids love electronics. I remember how excited my brother and I were when we opened our first video game console back in the dark ages. Pong was a game where each person had a flat paddle and moved it up and down the screen, trying to hit the moving square.  

Video games are much more sophisticated these days. 

They are designed to keep players engaged for hours. I am sure if these were available when I was younger, I would have been hooked as well.

As parents, we must protect our kids from all threats. Too much screen time can rob our children from some of their basic needs. It is essential to model the behavior we want our kids to display. I spend a lot of time on my phone, but it is almost entirely work-related. Even though this is the case, what my kids see is me on my phone most of the time. It is difficult to make them stop doing something that you are doing yourself.

Try to spend time with your kids doing things that don’t involve screens.  

  • Play board or card games.
  • Take a hike in the woods.
  • Visit the beach.
  • Play sports with them.
  • Bake goodies with them.
  • Read a book to them.

There are many activities that can be done without electronics.  

Finally, if you are worried about what your children are being exposed to or want some help managing their screen time, consider purchasing a program like bark or Net Nannytm. These can

filter out damaging content and alert you when your kids are doing inappropriate activities on-line.  

Electronics are not going away any time soon. These are just a few ideas to help your children grow up happy and healthy. If you have any comments about this or any other post, please send me an email.

Until next week, be happy, healthy, and safe!

 

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Malignant Narcissistic Personality Disorder

Although malignant narcissistic personality disorder (MNPD) is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), it is used by many clinicians to describe a subtype of narcissistic personality disorder (NPD).

Campbell’s Psychiatric Dictionary states that MNPD combines characteristics of Narcissistic Personality Disorder (NPD), Antisocial Personality Disorder (APD), aggression, sadism and paranoia.

Let’s take a look at these separately.

What is Narcissistic Personality Disorder (NPD)?

A person with a narcissistic personality disorder is one who has a desire for admiration and has an over-inflated sense of worth, knowledge, power, or identity. They must possess at least five of the following characteristics.

  • Has feelings of entitlement.
  • Seeks admiration.
  • Has an exaggerated sense of self-importance.
  • Appears outwardly arrogant.
  • Is preoccupied with beauty, success, power, or brilliance.
  • Lacks empathy. Is unable to identify with the feelings of others.
  • Exploits others for personal gain.
  • Wishes to only associate with others who are successful.
  • Is envious of others and may believe others are envious of him/her.

NPD patients depend on positive feedback from others. If they don’t receive admiration, these individuals may become angry, anxious, or depressed.

It is common for those with NPD to be controlling. They often detach emotionally from others and have minimal or no concern regarding the impact of their behavior.

The opinions and views of others are ignored if they differ from their own. They do not respond well to change and are insecure and vulnerable. These people tend to have a difficult time managing their emotions and responding to stress.

It can be challenging to diagnose this condition because of the difference in presentation between individuals. Some may be shy and avoid contact with people, while others are grandiose and outgoing.

The critical thing to remember is these people have little self-esteem and have problems regulating their emotions.

Antisocial Personality Disorder (APD)

People with Antisocial personality disorder have little to no empathy. They often abuse others both physically and emotionally. Diagnosis of APD is made after at least three of the following are present:

  • Inability to follow through on commitments or obligations.
  • Use of deceit, seduction or charm to achieve goals
  • Inability to conform to cultural norms or lawful, ethical behavior.
  • Lack of remorse for others suffering.
  • Persistent or frequent anger or aggressive behavior.
  • Seeks immediate gratification and is impulsive.
  • Engages in risky, dangerous, and self-damaging activities.

 

Aggression

Aggression is not a condition but a behavior. It generally occurs in response to anger. Aggression is a hostile or violent behavior or attitude directed toward another person. Many factors may contribute to aggression, including mental health, family structure, relationships, environment, and family structure.

Sadism

Sadism is the tendency to derive pleasure from inflicting pain, suffering, or humiliation on others. This pleasure is often sexual in nature.

How is NPD Treated?

The first-line treatment of all personality disorders is psychotherapy. For MNPD, cognitive therapy is the starting point. The recommendation is to offer group-based cognitive and behavioral interventions to target impulsivity, antisocial behaviors, and interpersonal weaknesses.

The use of medication is reserved for specific behaviors related to cluster B personality disorders:

Anticonvulsants/mood stabilizers – These may be used for impulsive and violent behavior, although there is limited data to support their use.

Lithium 1200 mg/day (target level = 0.6-1.5 mEq/L)

Phenytoin 300 mg/day

Divalproex 750 mg/day

Carbamazepine 450 mg/day

Stimulants such as methylphenidate have been used for inattention, impulsivity, and irritability. There is a high risk of abuse, so these medications are rarely used.

SSRI’s can be useful for aggression, hostility, and impulsivity.

Sertraline – 25-50 mg/day titrated slowly to 150-200 mg/day.

Fluoxetine – 20 mg/day slowly titrated to 60-80 mg/day.

Benzodiazepines should only be used in crisis situations due to abuse potential and an increased risk of suicide in these individuals.

Malignant narcissistic personality disorder is a condition brought about by emotional dysregulation. They have a fragile ego and must receive positive feedback from others. These individuals can be dangerous when things don’t go their way. Many have little regard for the feelings of others and often are controlling. They often exploit others for their own personal gain.

Unfortunately, most of these people will not seek treatment because they believe the problem stems from others. They have an exaggerated sense of self-worth and prefer to be surrounded by influential people. They are shallow when evaluating others and often put too much emphasis on looks.

Personality disorders are the most difficult psychiatric conditions to treat because they are the result of coping mechanisms created over many years. The only hope is to retrain these individuals to react to their environment in a healthy way. Group therapy is often the best method of achieving this.

Medications can be helpful for specific symptoms, but I have observed little success of medications used for personality disorders.

If you are in a relationship with a narcissist, be sure to protect yourself. These individuals can be dangerous and may get gratification from hurting you. Follow your instincts. If you feel threatened, get out of the relationship.

Remember, people with mental illnesses are no different than those with heart disease, diabetes, or cancer. They have a disorder that affects the brain. As a society, it is our responsibility to take care of them. If we don’t, we will all suffer the consequences.

If you have any questions, please send me an email. This is a difficult but important subject. Be healthy, be happy, and most importantly, be safe!

 

 

 

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Is Aspartame Sweetener Bad for You

What is aspartame?

Is it bad for you?

My favorite soft drink is Diet Coke. Diet Coke is sweetened by a substance called aspartame. I have been trying to improve every aspect of my life regarding health choices. One thing I plan to change is what I choose to drink. 

Not surprisingly, water is going to be my main drink going forward. Water can be flavored using fruit for a different taste. Stay tuned for a future blog post on different ways to enjoy the healthiest drink on the planet!  

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

What is Aspartame?

Aspartame is an artificial sweetener marketed under the following names:

  • NutraSweetTMCanderelTM
  • EqualTM

This substance is found in over 6,000 food items and is consumed by millions of Americans daily.1

 

2

 

3

Aspartame is found in many diet soft drinks, chewing gum, and vitamin supplements. It is not a good sweetener for baking because it breaks down and loses most of its sweetness when heated.  

Aspartame is a dipeptide of two natural amino acids, L-aspartic acid, and L-phenylalanine. After ingested, aspartame is broken down into-

  • Aspartic acid
  • Phenylalanine
  • Methanol4
  • Formaldehyde5
  • Formic acid

Aspartame and your Health

Aspartame has been a subject of controversy for years. Many believe that this sweetener is hazardous to one’s health. We will take a look at some of the available studies.

Effects on the Brain

The metabolism of aspartame mentioned above may lead to the following effects on the brain.

  • Phenylalanine acts as a regulator of neurotransmission.6

  • Aspartic acid is an excitatory neurotransmitter 7

Studies have shown a decrease in the production of dopamine and serotonin following aspartame ingestion. 

This is believed to be caused by an increase in aspartic acid and phenylalanine.

8

 

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We know that aspartame also increases the permeability of the blood-brain-barrier altering concentrations of some substances such as dopamine in the brain. This change in dopamine concentration may lead to the pathogenesis of some mental disorders.10

Other researchers have concluded that these adverse effects of aspartame only occur at very high concentrations not generally achieved by typical aspartame consumption.

11

A study published in April of 2014 tested the effects of high-aspartame meals (25 mg/kg/day) vs. low-aspartame meals (10 mg/kg/day) on spatial orientation, working memory, mood (irritability), depression and headaches.

This study was double-blind, and the subjects served as their own controls. They received either the high-aspartame diet or low-aspartame diet followed by a two-week washout period. During this washout period, they consumed their regular diet. After the washout period, they received the other aspartame diet (high or low).  

The treatment periods were eight days in length.

The results are shown in Table 1 below.

 

 

This study found that subjects showed weaker spatial orientation and an increased frequency of irritability and depression when consuming the high-aspartame diet 12

Another study by Walton et al. in 1993 also found high aspartame diets caused more irritability and depression. This study was not completed due to adverse reactions experienced by the study subjects.13

 

Aspartame and Cardiometabolic Health

An analysis of 7 trials (1003 subjects) was published in 2017. These subjects were obese, overweight, or hypertensive. This study found that artificial sweeteners, including aspartame, may be associated with increased body mass index (BMI) and cardiometabolic risk.14

More experimental studies are needed to compare different sweeteners with regard to BMI and cardiometabolic effects. At the current time, research does not support a benefit of artificial sweeteners for weight management.

 

 

 

Other Health Concerns Regarding Aspartame

Aspartame has been a controversial substance for many years. Here are some of the other risks reported with its use.

  • Lupus
  • Cancer
  • Multiple Sclerosis
  • Alzheimer’s Disease
  • Dizziness
  • Seizures
  • ADHD
  • Erectile Dysfunction (ED)

Some people have also reported headaches after ingesting aspartame. 

My recommendation for anyone suffering from headaches is to keep a journal. Keep track of what you eat and drink daily. When you have a headache, write down the time and severity in the journal.

Determine if patterns exist.

Are certain foods a possible trigger? 

If you are taking medications for psychosis or suffer from phenylketonuria, you should avoid aspartame.  

Please see my blog post on low glycemic sweeteners by clicking here. 

My research shows the most likely adverse effects resulting from aspartame consumption are weaker spatial orientation and an increased frequency of irritability and depression. These only seem to be a concern when consuming higher amounts of aspartame.  

Although aspartame has been blamed for many other negative health effects, the available research doesn’t support this.

I look at aspartame as a risk vs. benefit situation. 

Since there are other sweeteners available, I am going to limit my intake of aspartame. My goal will be to consume black coffee, water (flavored and plain), and AXIO.

I don’t feel the risk of consuming aspartame is currently worth the benefit.

As always, if you have any questions or comments, please let me know.

Have a great week, and be happy and healthy!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

How to Handle a Combative Dementia Patient

There are many challenges involved in caring for a patient with dementia. At times these patients may become combative. This is a regular aspect of the disease and may happen even in patients who were not aggressive earlier in their lives. 

How do you deal with combative dementia patients? 

I work as a pharmacist in a geriatric psychiatric unit. We care for these patients when caregivers are unable to. Our goal is to stabilize them and return them into the community.  

This post will give you pointers on what to do when faced with aggression from a dementia patient. 

Be Prepared and Keep Calm

It is essential to be prepared for unusual behaviors from dementia patients. Due to damage occurring in the brain, these patients often display unexpected behaviors.  

Be calm when they become aggressive and speak to them in a soft, comforting tone. Always remember that this is part of the disease process and not a personal attack against you. 

Although your instincts may lead you to retaliate when dealing with an aggressive dementia patient, this can make the situation worse. Try to learn from each situation and keep yourself and the patient safe. 

Try to Identify Possible Causes of the Aggression

There are some basic things to rule out when patients begin to act out. Be sure basic needs are met. These include: 

 Pain – uncontrolled pain can cause individuals to lash out. They often are not able to communicate. It is vital to look for non-verbal signs of distress, including: 

  • Facial grimacing. 
  • Moaning. 
  • Guarding certain areas or withdrawing from touch. 
  • Writhing or constant movement. 
  • Increase in blood pressure or respiratory rate. 

 

 Constipation-this can make anyone uncomfortable, including dementia patients. Be sure they follow a toileting schedule and pay attention to the frequency of bowel movements. 

 

Urinary tract infections– These can be a cause of pain and discomfort and are more common in elderly patients. Monitor the patient for smelly, cloudy, or discolored urine. If these signs appear and the patient is acting differently, they should be seen by a medical professional for an evaluation. 

Try to keep the patient comfortable. Maintain a reasonable room temperature and create a good place for the patient to relax.  

 

Sleep – We all can become grumpy if we don’t get enough sleep.  Follow the basic sleep hygiene guidelines listed below. 

 

  • Follow a sleep schedule. Try to get the patient to sleep at the same time each night. 
  • Avoid letting the patient take long naps during the day. 
  • Do not give the patient large amounts of fluid close to bedtime. This can increase nighttime awakening. 
  • Be sure the room where the patient sleeps is dark, quiet, cool, and comfortable.  

It is important to note that sleeping pills other than melatonin are not appropriate for dementia patients. Drugs such as diphenhydramine (BenadrylTM) and other sedating antihistamines make dementia worse. Read my blog post on anticholinergics and dementia for more information. 

 

 

Calm the Environment

Excessive noise and activity can agitate patients.  

The nurses on our unit are quick to ask staff to quiet down when it becomes noisy or hectic.

Keep music soft, and try to have people speak quietly.

If too many people are around the patient, ask some of them to relocate temporarily. If the patient is starting to act out, try moving them to a different room.

Keep track of what works and doesn’t.

Every patient is different. 

 

Redirect

Many times you can calm a dementia patient by merely redirecting them. Read them a story, show them pictures or watch a TV show with them. Avoid activities that demand too much thought or concentration. Most dementia patients will become frustrated if they are asked to participate in activities that are too difficult for them to perform. Find activities that the person enjoys. Redirection is one of the best tools available to you. 

Smile and be Kind

Sometimes a simple smile can do wonders—all of us like people to smile at us.

A gentle touch can also help.

Avoid startling the patient. Approach them from the front so they can easily see you coming.

Show them you care.   

Give Them Time Alone

If nothing seems to be working, consider giving the patient some time alone.

Be sure the patient is safe and keep an eye on them.

They may just need to cool down.

Some alone time in a quiet place may be what is necessary.  

Take Care of Yourself First

If you are taking care of a dementia patient, you will likely be under a lot of stress.

The most important thing for you to do is keep healthy, both physically and mentally.

You will not be an effective caregiver if you get burned out or become sick yourself.  

If you need a break, find help!  

Taking care of these patients often causes one to be up in the middle of the night. Try to find a family member or friend to help when needed.

We all need a break at times. 

Know Your Limits

In some cases, you may be unable to care for the patient yourself.

If the situation becomes unsafe for either you or them, it is time to consider placement into a memory care facility.

This is not a sign of failure on your part. We all have our limits. Memory care facilities are staffed with individuals who know how to care for your loved one. They take care of these patients every day.

Caregivers in these facilities are trained to recognize behaviors that require medication.

Remember, your health and well-being are important too. 

I have spent the last four years working on a unit that cares for geriatric patients with psychiatric issues. Many of these patients have dementia. There are several forms of this disease, but all of these patients become dependent on others for their care eventually.   

Working with these patients has been one of the most rewarding aspects of my pharmacy career. Being involved in the final chapter of a patient’s life has a special meaning to me. 

I hope this post has helped if you are caring for a loved one with dementia. I want you always to remember that there is help out there for you if you are struggling.  

Safety is always the most important goal.   

I have listed some resources below if you need help.  

You can always contact me with questions at [email protected].

If I don’t know the answer to your question, I will find it for you. 

 

 

Have a great week, and stay safe. Be sure to read our other blog posts to help you live a happy, healthy life, and please sign up for our newsletter below.   

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Alternatives to ADHD Meds – Dietary Supplements

Are you looking for alternatives to traditional stimulant medications to treat your child’s ADHD?

Is there a more natural way to treat ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopment disorder that is associated with the following symptoms. There are two broad groups.

Inattention that negatively impacts social, occupational, and or academic functioning.

Symptoms in this category include:

  • Forgetfulness
  • Distractibility
  • Inability to listen
  • Frequently loses items
  • Trouble organizing
  • Difficulty in maintaining attention
  • Not able to follow instructions or finish tasks
  • Avoids activities that require attention
  • Fails to focus on details or makes careless mistakes on schoolwork

Hyperactivity and impulsivity

symptoms include:

  • Excessive talking
  • Impulsive (doesn’t wait turn and blurts out answers)
  • Runs and climbs when not appropriate to do so
  • Cannot remain seated
  • Fidgets or squirms in seat
  • Constantly on the go
  • Unable to engage in quiet activities

ADHD was estimated to affect 9.4% of children in the US, according to a national parent survey in 2016. 

Of these children, 77% were receiving treatment. This treatment was as follows:

  • 30% treated with medication alone.
  • 15% received only behavioral treatment.
  • 32% received both medication and behavioral treatment.

NSCH 2016: Redesigned as an online and mail survey, estimate includes children 2-17 years of age. 1

Is there a reasonable alternative to stimulants for these children?

Polyunsaturated Fatty Acids (PUFAs)

Omega-3 fatty acids must be obtained through our diet. The following foods are high in this substance:

  • Fish (salmon, trout, sardines, halibut, herring, albacore tuna)
  • Walnuts
  • Flaxseed oil
  • Canola oil

Other foods that contain omega-3 fatty acids are:

  • Clams
  • Shrimp
  • Catfish
  • Cod
  • Spinach

The Western diet consists of a higher quantity of omega-6 fatty acids. Foods that contain omega-6 are poultry, eggs, cereals, nuts, whole-grain bread, and durum wheat.  

Why is this important in ADHD?

One meta-analysis that contained ten trials, including 699 children with ADHD found that PUFA supplementation produced a small but significant improvement compared to a placebo group.2

A significant relationship was also shown between the eicosapentaenoic acid (EPA) dose within the omega-3 supplements, and the efficacy obtained.3

The mechanism of action of the omega-3 in the treatment of ADHD is likely due to its effect on serotonin and dopamine neurotransmission.4

There have been other systemic reviews that have raised questions about the use of omega-3 supplementation in the treatment of ADHD.5

 

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The methods in these reviews were different, which may have led to altered results.

I believe an omega-3 supplement is worth a try. The possible benefits seem to outweigh the risks involved.

Melatonin

Melatonin is a hormone produced by our bodies to regulate circadian rhythm. Adults and children have used melatonin as a sleep aid. 

As a pharmacist, it is the first-line medication for sleep that I recommend. Melatonin has very few side effects and is non-addictive.  

We know that sleep problems are common in children with ADHD. We also know that a lack of sleep can cause symptoms such as hyperarousal, disinhibition, and executive function problems that mimic ADHD symptoms.

The two studies I located showed melatonin was effective for sleep but had no effect on ADHD symptoms.

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Iron

A meta-analysis published in 2012 found that children and adolescents with ADHD had lower serum ferritin levels than healthy controls.

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A small randomized, placebo-controlled study showed children with ADHD, and low serum ferritin levels demonstrated significant improvement when receiving ferrous sulfate (80 mg/day) compared to placebo.

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More studies with a larger sample size are needed before iron can be recommended as a standard treatment of ADHD.

Pycnogenol

Pycnogenol is an extract obtained from the bark of the French maritime pine. Pycnogenol was the subject of the very first post I made to this blog. You can read this post by clicking here!  

Case reports have shown Pycnogenol can improve ADHD symptoms either alone or in combination with psychostimulants.  

A four week randomized, placebo-controlled trial of 61 children found Pycnogenol significantly improved ADHD symptoms according to the Child Attention Problems (CAP) teacher rating scale.

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A significant improvement was not found using Connor’s Parent and Teacher Ratings, but trends were similar to CAP.

This study also found lower catecholamine levels in the urine of the pycnogenol subjects suggesting a possible effect on catecholamine formation or metabolism.

More studies are needed to determine the safety and efficacy of Pycnogenol in the treatment of ADHD.

Parents are often reluctant to put their children on medications to treat ADHD. At times, this leads to the use of nutritional supplements that are ineffective in the treatment of this disorder.While researching this topic, I discovered supplements such as St. John’s Wort, carnitine, and Gingko Biloba either were ineffective or had minimal evidence to support their use in the treatment of ADHD.

These substances may also produce unwanted side effects.

Zinc can be useful when a deficiency exists, but this is rare in the United States. There have been studies in Israel, Turkey, and Poland demonstrating lower zinc levels in children diagnosed with ADHD. 

Correcting this deficiency of zinc can improve ADHD symptoms.

Magnesium supplementation has been tried, but no randomized, placebo-controlled trials are available to support its use.

Iron supplementation has shown to be effective in one small study. 

Pycnogenol has also shown positive results although more studies are needed to confirm its benefits in the treatment of ADHD.

The most robust evidence available at this time is for omega-3 fatty acid supplementation in the treatment of ADHD and melatonin for sleep-onset insomnia.

The Omega-3 fatty acids are still not as effective as traditional ADHD medications, but they may be beneficial in those with mild symptoms. 

Melatonin is always my first recommendation for patients of all ages for insomnia.

Please feel free to send me an email if you have any questions regarding this post or any other subject regarding medications, diet, fitness, or happiness.  

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Have a great week, and please stay safe out there!

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

N-Acetylcysteine for Anxiety, Depression and other Psychiatric conditions

N-acetylcysteine (NAC) is an over-the-counter supplement that may be used for several conditions. This molecule is a derivative of cysteine, which is an amino acid. In the hospital setting, it is used by the intravenous route for the treatment of acetaminophen overdose.1

NAC is also used in chronic obstructive pulmonary disease to break up mucous. It may also be beneficial in the prevention of contrast-induced nephropathy.2

During the last several years, there has been an interest in using acetylcysteine for other ailments. 

This post will focus on the use of NAC for depression, anxiety, bipolar disorder, schizophrenia  and the treatment of addiction.

Addiction

Acetylcysteine has been studied for its ability to treat several types of addiction. A study conducted on 116 cannabis dependent adolescents and young adults found that those treated with 2.4 grams per day of NAC had a significantly higher incidence of negative urine cannabinoid tests as compared to the placebo group.3

This was a double-blind, randomized controlled trial lasting eight weeks. The NAC group also showed a more considerable decrease in self-reported days of cannabis use than the placebo group, but this was not statistically significant. 

There is a possibility that NAC could increase cannabinoid elimination. This would increase the probability of the NAC group having a negative urine test. 

More studies are needed to investigate the effects of NAC of cannabinoid metabolism.

Several controlled studies have shown NAC to be beneficial for treating cocaine addiction. The most extensive study showed positive effects only in a small subset of subjects that were abstinent at the beginning of the trial.

The studies for using NAC in other types of addiction, including gambling, were inconclusive.

Anxiety

The treatments currently available for anxiety disorder have limited effectiveness. Several studies suggest oxidative stress has a role in the development of anxiety. These findings have led to studies on the use of antioxidants in the treatment of anxiety.4

 

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There has been a case study of a 17-year-old male with generalized anxiety disorder and social phobia who had failed cognitive behavioral therapy and several antidepressants but responded well to NAC. 

Unfortunately, more studies are needed before NAC can be recommended as a treatment for anxiety.

Bipolar Disorder

Bipolar disorder is a mood disorder characterized by periods of depression alternating with periods of mania.

Symptoms of depression include:

  • Feeling sad or hopeless.
  • Loss of interest in pleasurable activities.
  • Sleep disturbances – too much or too little sleep.
  • Inappropriate guilt.
  • Unexplained weight changes.
  • Isolation.
  • Loss of energy or fatigue.
  • Restlessness or lethargy.

Manic symptoms are as follows:

  • Racing thoughts.
  • Distractibility.
  • Euphoria and increased self-confidence.
  • Increased activity and agitation.
  • Participation in risky behaviors.
  • Poor decision making.
  • Unusual talkativeness.

Bipolar disorder can be severe and may also present with psychotic features. Acetylcysteine has been shown to improve depressive symptoms in patients with bipolar disorder significantly.6

Unfortunately, this study was not able to show any significant difference in the frequency of new episodes of either depression or mania in the NAC group compared to the placebo group. More research is necessary to determine the role NAC may have in the treatment of bipolar disorder.

Depression

A randomized-controlled trial of 252 patients with major depressive disorder (MDD) showed NAC improved symptoms more effectively than placebo when added to the patient’s usual treatment regimen for a twelve-week period.7

There is also a case series of two patients who showed successful and sustained improvement of depressive symptoms when NAC was added to their antidepressant regimen.8

Other studies of NAC in the treatment of other disorders have found an improvement in mood and well-being.9

The current evidence suggests NAC may be a valuable treatment option either alone, or in combination with other agents for the treatment of mood disorders.

 

 

Schizophrenia

There have been positive results obtained when utilizing acetylcysteine for the treatment of schizophrenia.

One such study showed patients receiving NAC improved with regards to schizophrenia symptoms and akathesia.10

Other studies have also supported the use of NAC as a viable addition to schizophrenia treatment regimens.11

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Although these results are promising, more studies with larger sample sizes are necessary to determine the true utility of NAC in the treatment of schizophrenia.

Mechanism of Action

The proposed mechanisms of action of NAC are too complicated for the scope of this post. This substance is thought to work as an antioxidant and anti-inflammatory. It is also thought to affect several neurotransmitters and mitochondrial function within cells.  

 

Adverse Effects of Acetylcysteine

Acetylcysteine is generally well-tolerated. UpToDateTM lists the following adverse reactions to oral acetylcysteine:

  • Chest tightness
  • Hypotension
  • Rash (with or without fever)
  • Urticarial
  • Nausea and Vomiting
  • Hypersensitivity reaction
  • Bronchospasm
  • Bronchitis

Less than 1%, post-marketing and/or case reports (important or life-threatening only):

  • Angioedema
  • Pruritis
  • Tachycardia

 

Pregnancy and Breast-Feeding

Since acetylcysteine crosses the placenta, it should only be used in pregnancy when the benefits outweigh the risk. This may occur in the case of acetaminophen overdose. 

It is not known whether NAC is excreted into breast milk.  Based on pharmacokinetic data, acetylcysteine should be cleared from the body thirty hours after administration. 

If NAC is consumed while breast feeding, breast milk should be pumped and discarded for thirty hours after ingestion.

NAC should not be used in pregnant women for depression, anxiety, bipolar disorder or the treatment of addiction.

Drug Interactions

There are no known drug interactions.

I became interested in N-Acetylcysteine after speaking to a child psychiatrist at the hospital where I practice. She had ordered it for one of her patients, and I was curious as to her reasoning for its use. She believed in NAC’s ability to improve several psychiatric symptoms in children with minimal risk. She sent me an article which detailed much of what I have covered in this post.

NAC has also been studied for use in Alzheimer’s disease, ADHD, autism, epilepsy, neuropathy, traumatic brain injury (TBI), and several impulse control disorders. It is essential to mention that more studies need to be done in all of these conditions before a recommendation can be made to use NAC.

  I do believe it is worth trying NAC in patients who present with the disease states covered in this post. There is minimal risk, and the benefits could be significant. This is especially true in conditions such as anxiety disorder, where our treatment options are scarce and often ineffective.

Please feel free to contact me if you have any questions regarding acetylcysteine or any other medication or supplement. I would be happy to get an answer for you ASAP.

As always, have a great week, stay healthy, and stay safe!

 

 

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Gratitude Unlocks the Fullness of Life

The COVID-19 virus has changed our way of living. People are tired of being cooped up in their houses. Most of us are used to being able to socialize, go out to dinner, ship our kids off to school and visit friends and family. During this time, I believe it is important to stop, take a deep breath, and think about the positive things we enjoy daily.

This post is about gratitude. One of the keys to happiness. Any situation can be looked at in different ways. Remember, your glass can be half full or half empty. I am going to share some techniques I use to help change my mindset. These are just a few examples. Find what works best for you. The key is to train your mind to look at the positive aspects of a situation rather than concentrating on the negative. It takes work but it is time well spent.

 

The Gratitude Journal

It is easy to forget all the great things about our lives. One of the best ways to keep positive thoughts alive in your mind is to create a gratitude journal. This is a very simple process that anyone can do in just a few minutes per day.

I recommend journaling when you first wake up, right before falling asleep, or both. Starting your day off by counting your blessings will allow you to begin your day on a positive note. This doesn’t have to take a lot of time. Just list different things you are grateful for each day.

Journaling just prior to sleeping helps to calm your mind. It can lead to a better night of sleep. Just write down the things that made you happy during the day. What did you do well? List accomplishments. Review your day and jot the positive aspects down on paper.

 

Take a Break to Appreciate Nature

This has become my number one tool for decreasing anxiety and feeling better about the world we all live in. With everything going on lately, it is very easy to focus on negatives. Please give this a try.

Take a break to go outside and look around at what nature has to offer. Feel the suns warmth on your skin. Listen to birds sing. Actually study a flower or leaf. Pay attention to the details of their beauty.

No matter how your day is going, realizing how spectacular our world is can change your perspective. If you visit nature on a consistent basis, you can actually change how you feel. This is one of the reasons people enjoy hiking so much. The world we live in is truly a beautiful place.

Take pictures of flowers and trees. The photos posted at the beginning of this segment are just a few of the beautiful aspects of nature I have observed this year.

 

Don’t Forget the Gratitude Quotes

I have made a habit of reading positive quotes daily. This started as a strategy to find content for Instagram posts. I learned that this habit changed my perspective on life. It is another way to place positive information in your mind. These quotes can be found on the internet in seconds. You can also find them at least every other day on my Instagram feed @sunshineNTC.

I often share them with my wife and coworkers. It has helped my mindset. Sometimes it is the simplest things that cause the most impact.

 

The Power of Prayer

Do not underestimate the power of prayer. Connecting with your creator on a daily basis can change your life for the better. Take this time to thank God for the life you live and the world you live in. Instead of praying for a better life, consider being thankful for what you have. Your family, friends, job, house and everything you own can bring you joy if you think about things in the right way. If you are not a religious person, this can also be accomplished with meditation.

It is about spending some quiet time to collect your thoughts.

There are many ways to meditate and I plan to write an entire blog post on this subject in the near future. Clearing your mind with meditation has many positive effects on both the mind and body.

 

Celebrate Thanksgiving Everyday

One of our family’s Thanksgiving traditions is to go around the table and explain to the group what we are thankful for.

What if you did this each night at the dinner table?   Start with the youngest and ask them what they enjoyed about their day?

What things made them feel good?

Did they learn anything new?

What are they thankful for?

We like to begin our dinner with a prayer usually spoken by our youngest. This is another way to celebrate the blessing we enjoy every day.

 

Smile

One of the best things to remember is that smiling makes you happy. This is true even if it is forced. It is also true that smiling at others makes them feel good as well. It is a win-win. You also feel good knowing you made someone else happy even if it were for only a short time.

I like to start each day by looking in the mirror, smiling and telling myself it is going to be a great day. It is quick, easy and it works.

Make it a practice to smile at everyone you walk by. Pay attention to how this makes you feel. I believe you will see a big difference.

 

Living each day with gratitude is not difficult. It doesn’t take much time. It won’t disrupt your schedule. What it will do is make you feel better about your life. It will increase happiness. The people you associate with will be able to detect a difference in your mood.

If you commit to trying the simple techniques outlined in this post, you will become a more likeable person. You will look forward to each day, have more energy and sleep better. Being grateful is one of the keys to happiness. Give it a try, you will be glad you did.

Thank you for reading my blog post. Please take some time and browse our website. If you have any questions, let us know. Sign up for our newsletter to get up to date information on our company. Meet our ambassadors. Receive discount codes and learn something new.

As always, I hope you and your family have a great week. Stay safe! I will see you all here next week.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

CBD Oil for Panic Attacks, Anxiety, Depression and Pain.

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Sunshine Nutraceuticals has recently added a few CBD products.  We are now stocking hemp oil liquid concentrate, hemp oil softgels and CBD gummies.  

I will be writing posts on the possible uses of cannabidiol (CBD). 

While reading these, please be aware that the research is currently thin, mostly due to the fact that marijuana and its chemical components have been classified by the Drug Enforcement Administration (DEA) as a schedule I substance until recently. 

It is also important to realize that these are just possible uses and we are not making any medical claims.  You should always consult a physician prior to ingesting CBD products for any specific condition.  There may be traditional medications necessary to effectively treat your medical condition.  CBD products are NOT meant to replace medical treatment from a licensed physician.

How we got here?

The FDA approved EpidiolexTM in 2018 for the treatment of seizures.  This drug contains CBD and was the first FDA-approved drug to contain purified extract from the marijuana plant. 

On December 20th, 2018, the 2018 Farm Bill was signed into law.  This bill removed hemp from the controlled substance act meaning cannabis plants and derivatives containing no more than 0.3% tetrahydrocannabinol (THC) on a dry weight basis were no longer controlled substances under federal law.

Cannabidiol  is a substance found in the marijuana plant.  CBD is not psychoactive so it will not produce a “high” like tetrahydrocannabinol (THC).  Cannabidiol has gained popularity for those searching for alternative natural treatments for many ailments.  This post will concentrate on the use of CBD for psychiatry disorders and pain relief.

Panic Attacks and Anxiety

I have had personal experience with panic attacks.  Panic attacks come on suddenly and consist of the following symptoms.

  • Increased heart rate
  • Chest pain
  • Trouble breathing
  • Sweating
  • Feeling of impending doom
  • Fear of losing control
  • Dizziness
  • Light headedness

These attacks often happen with no trigger and can lead to depression and self-isolation.  Although there are few studies specific to CBD and panic disorder, an article published in February of 2017 explored the anti-panic actions of cannabidiol.  The investigators concluded that CBD did exhibit anti-panic properties.  They also stated that CBD may prove to be a good alternative to benzodiazepines and antidepressant drugs in the treatment of panic disorder in the future.1

CBD was also reported to be safe and well-tolerated when taken orally in doses up to 1500 mg/day.2

Another study evaluated the use of CBD in reducing anxiety induced by simulated public speaking (SPST).  This was meant to simulate social anxiety disorder (SAD).    Treatment of SAD is often ineffective as only about 30% of patients achieve true recovery or remission.3

The researchers found that those pretreated with CBD experienced significantly less anxiety, cognitive impairment and discomfort in their speech performance.  They concluded that a single dose of CBD can reduce anxiety associated with SPST.  Cannabidiol was shown to inhibit the fear of public speaking which is one of the main symptoms of SAD.4

 

 

 

Depression

Many studies have demonstrated CBD’s ability to facilitate serotonin neurotransmission in some areas of the brain.5

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Low serotonin levels are associated with depression.  Since we know our traditional antidepressant agents work, in part, by increasing the availability of serotonin at receptor sites, CBD’s effect on this neurotransmitter could also lead to antidepressant effects.  The CBD likely does not increase the amount of serotonin, but increases the effect of the serotonin that is available in the body.

Pain

Approximately 62% of those who use CBD do so to treat a medical condition.  The top use is to treat chronic pain, arthritis and joint pain.12

Unfortunately, there are few studies using CBD alone to treat pain.  Researchers believe CBD works best when combined with THC in the treatment of pain.  The studies that do exist have come to conflicting conclusions. 

I must point out that pain is a subjective feeling.  Those who are utilizing CBD for pain must believe it is helping. 

Research has also shown that combining cannabinoids with opioids leads to greater pain relief.13

This is especially important given the current opiate crisis and risk of death by overdose.  The combination of CBD and opiates may lead to a decrease in opiate dosages in future treatment of chronic pain.

I remember watching an episode of 60 Minutes years ago where a couple was giving marijuana to their young child who had a rare seizure disorder.  They had been to many doctors and traditional medicine had failed to stop the seizures.  They were forced to break the law in order to treat their child’s condition.  Marijuana was the most effective treatment for the seizures.

We have come a long way with regards to the marijuana stigma.  It certainly can be abused, but I believe it will prove to be useful for several psychiatric disorders as well as pain relief.  Thanks to the approval of EpidiolexTM  and the Farm Bill of 2018, CBD can be purchased legally.  Only time and research will answer the questions about how effective this substance can be for various ailments.

I would love to hear any comments you have regarding this post.  Have you used CBD for any of the conditions above?  Did it work?  Send me an email and I will post the comments at the bottom of this post.  I was forced to remove the comment section due to never-ending spamming.

Have a great week and stay safe!

Somatic Mindfulness Exercises to Reduce Stress and Anxiety

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Can somatic mindfulness exercises help me?

Are they hard to learn?

What are the benefits?

 

Mindfulness has become a popular subject for therapists as well as those seeking self-help ideas to treat anxiety disorders and decrease stress and frustration of daily living.  The COVID-19 outbreak has increased interest even more. 

Mindfulness is the ability to be present in the moment without judgement.  Paying attention to the simple things that we often take for granted.  It is an amazingly simple idea that can really pay off. 

In this post, I am going to explain a few somatic mindfulness exercises you can do to help control anxiety and improve mental health.  These are simple to do and, as with most everything else, practice makes perfect.  If you work on these regularly, you will find them to be very useful.

A Scan of Your Body – C. A. L. M.

This is something I practice often and I find it to be very beneficial for those times when I feel irritated or overwhelmed.  This works best in a quiet place with minimal distractions.  C.A.L.M. helps you remember the large zones of the body to focus on.

Before beginning, get comfortable in any position that suits you at the time.  If possible, lay down.  I find this to be most relaxing but understand it isn’t always convenient.  Close your eyes and take a few slow deep breaths.

Chest:  The first region of the body to concentrate on is your chest.  Pay close attention to your breathing.  Notice how your chest rises as you breathe in and falls as you exhale. 

Are you breathing fast or slow? 

Attempt to regulate the speed of your breathing.  Keep it slow and steady.  As you regulate your breath, your mind and body are also under your control.  You begin to relax.  Imagine your stress and anxiety leaving your body with every exhaled breath.

After a few breaths, take a deep breath and tighten all muscles in your chest.  Hold this for three seconds concentrating on how it feels to be tense.  Finally, allow all your muscles to relax and notice the tension leaving your body with each breath.  Continue to breathe slowly and evenly as you allow your body to fully relax.

Arms:  Focus on your arms.  Using your mind, scan each arm from your shoulders all the way down to each fingertip. 

How do your arms feel? 

Are they tense, relaxed, warm, cold? 

Spend a little time concentrating on just your arms.  If you feel any tension, attempt to relax. 

After a couple of minutes, squeeze each fist and flex all the muscles in each arm tightly.  Finally, release the tension in your arms and relax each hand.  Take a few breaths and notice the feeling of calmness.  Let your body relax as you slowly breathe in and out.

Legs:  Next, focus your mind on your legs from your hips all the way down to your toes.

  How do they feel? 

Are they weak, shaky, warm or cold? 

Are your legs telling you anything about your level of stress or anxiety? 

Begin to squeeze your muscles starting at your feet and extending up to your hips.  Hold this tension for a few seconds and then release. 

Notice how you feel when the tension is released. As you breathe, imagine all the tension from each leg and foot leaving your body.

Mouth:  The last area to focus on is your mouth and jaw.  Many of us tense muscles around our mouth when we are anxious without realizing it. 

What expression is your mouth communicating? 

Is this a result of stress or anxiety? 

As before, clench the muscles around your mouth and jaw for a few seconds and pay close attention to the feeling.  Relax your muscles and with your eyes still closed, smile. 

Enjoy the feeling of relaxation as your breathing helps to remove stress from your body.

  Continue to breathe is this relaxed state thinking about the areas where you noticed evidence of stress and anxiety or tension.  As you breathe, imagine the tension leaving your body with each breath. 

This exercise can be a life-changing skill once developed.  With practice, you will be able to close your eyes and imagine the stress and tension leaving your body just by breathing.

  You can train yourself to identify tension in different areas of your body and remove it using your mind. 

Grounding Exercises

Heel drops:  In this exercise you will start by standing.  Slowly lift up your heels so you are standing on your toes.  Return to your standing position.  Do this repeatedly in a slow, rhythmic pattern.  Pay attention to how your hips and lower back feel while doing this exercise.  Each time you return to a standing position, imagine stress and tension leaving your body. 

Bamboo Swaying:  In this exercise you will stand and allow your body to slowly sway back and forth like a bamboo in the wind.  The rocking motion helps to relieve tension.  If you feel little tremors through your body while doing this exercise, do not be alarmed.  This is one of the ways your body releases tension.

It is important to take a moment to scan your body after these grounding exercises to see how you feel. 

Do you feel more grounded?

  More connected to the earth below? 

Do you feel less tension or stress? 

Other Ways to Practice Mindfulness

In today’s society, most of us are used to doing more than one thing at a time.  This can lead to frustration, anxiety, burnout and even depression.  Trying to take care of our families, get our work done, prepare meals and keep the house clean can feel overwhelming.  One of your goals should be to try to do one thing at a time.  This can be learned by taking small steps. 

Make a list of what needs to be done starting with the most important tasks.  Begin with the first task on the list and try to let go of distractions that come your way.  I suggest silencing your cell phone and computer email during this time. 

If you find yourself worrying about different things or thinking about something else, take a few deep breaths and imagine those thoughts leaving your mind with your breathing.  If you find yourself doing more than one thing at a time, stop, and choose the thing on the top of the list and return to it.  This can be difficult at first but will become easier with practice.

Tell your intrusive thoughts to leave your mind.  Keep doing this until you get results.  There are several exercises that can be done to help you succeed.  Start to notice times where you are thinking about one thing only. 

How does this feel? 

Here are a few things that can be done to practice focusing on one thing only.  Try to do these exercises several times each day, especially when you are feeling stressed or overwhelmed.

  • Watch a fire. This can be in your fireplace or a campfire.  Don’t think about anything, just watch.
  • Watch the raindrops running down a window.
  • Listen to the ticking of a clock.
  • Listen to the ocean waves.
  • Breathe mindfully as explained above.
  • Watch trees blowing in the wind.

I also like to take a walk outside and observe nature when I get stressed.  Concentrating on something as simple as the beauty of a leaf or the bark on a tree can change your mindset. 

Michael Brown pictured with Final Thought written

With practice, somatic mindfulness can become an important tool to fight stress, anxiety, depression and burnout.  We started with breathing which I believe to be a very important first step to calm the body. A few months ago I wrote a post on anxiety.  This would be a great time to review that article.  It has more information on breathing techniques and other ideas to help relieve stress and anxiety.  When these exercises aren’t enough, don’t forget about our Anxiety Formula.  This is the best-selling product in our store and our customers love it.  Take a look at this video recorded by a friend of mine who uses the product.

We can all live a more productive, enjoyable life if we take some simple steps to take care of our mind and body.  You are reading this because you are committed to be a happier and healthier person.  Remember what I have been telling you all:

  • Get plenty of sleep.
  • Drink eight, 8 ounce glasses of water daily. More if you are sweating (exercise or hot weather).
  • Eat whole foods – stay far away from fast food, junk food and empty calories.
  • Exercise – Stay active. Find an exercise you like and do that activity for at least 30 minutes, 5 days per week.
  • Avoid alcohol and drugs. If you need a reminder why you shouldn’t drink alcohol, read my article on ethanolism.
  • Think positively and surround yourself with positive people.
  • Spend as much time with your happiness elements as possible!

That is all for this week.  I hope you are all staying safe during this COVID-19 outbreak.  PLEASE STAY HOME if you are not an essential worker.  This virus has turned out to be worse than we initially thought. 

Wash your hands often,

maintain a six-foot distance from others, and

stay isolated until this virus runs its course. 

We will get through this.

If you have any questions or comments, please feel free to contact me.  I welcome any interaction from my readers.  This blog is for you!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.