Rolfing as Alternative Depression Treatment

Rolfing Overview

According to "Wikipedia Dictionary", Rolfing is a manipulation of the body and tissue to realign the structure of a body. The deep massage treatment was developed by Dr. Ida Pauline Rolf. Studies show the deep tissue rub is combined with pinpointing specific areas of the body in order to maintain or correct posture. Thus, Rolfing is referred to as Structural Integration, or Posture Realignment.

Depression can be a devastating alternative when combined with tragedies such as divorce, and lead to medications prescribed by physicians. However, physicians will also advise patients to seek massage therapy, when they feel Rolfing can benefit the patient. Actually, Rolfing is not a massage and it is not bone manipulation. It works from the fact that our muscles each have a wrapping which is a bit like being encased by a silk bag. These silk bags can start to stick to each other as a result of life's stresses, including depression. As they stick together, instead of working individually they start to work as a mass and this mass starts to pull the spine and bones in the wrong directions, thereby pulling you out of alignment. A physician may find a back out of alignment due to continuous slumping or bad posture. The therapist will work on the area of concern, and trigger in with a deep tissue massage, ultimately releasing the point of contention. It may require up to ten visits to completely release the pained area, or it could only take a few visits.

Rolfing works to free up your muscles so they can move freely and independently again. This is vital in returning your body to a state of balance and health. Once this happens, your spine can improve its alignment and posture. Once the muscles work properly the whole skeletal system can start doing what it's meant to do - support the muscles and protect the organs. It will improve you muscle and back pain, and it will also have a wonderful effect on your breathing and digestion, amongst other things.

Physical pain and Depression

In March 2008, a team of brain researchers at Harvard medical school published a paper investigating the relationship between pain and depression. The researchers observed that patients with pain often show signs of depression. They designed their experiment to investigate the mechanisms by which pain and depression might interact and confirmed that some chemical and a part of the brain are involved in the simultaneous presentation of depression and pain. They are strongly related at a very basic level.

Another team of researchers at the University of Toyama in Japan published research in the journal Neuropsychopharmacology on the relationship between anxiety and pain and stated:

“Clinically, it is well known that chronic pain induces depression, anxiety, and a reduced quality of life. There have been many reports on the relationship between pain and emotion. We previously reported that chronic pain induced anxiety with changes in opioidergic function in the central nervous system.”

So if pain is directly related to anxiety and depression, and Rolfing is doing great job in relieving pain, so it can provide a direct impact on patient’s levels of anxiety and depression.

How does Rolfing differ from Chiropractic and Massage?

Chiropractic care generally focuses on joint and bone alignment through quick and high velocity adjustments. Unless the connective tissue (muscle, tendon, ligamentous) tensions and strains are balanced and repositioned, the bones, which are embedded in this tissue will find their way back into patterns of misalignment. Rolfing works to achieve this balance of tensional strains and creating space by using slow applied pressure to reposition the soft tissue allowing bones to fall back into their natural relationships, optimizing joint motility and thus allowing more permanent changes in bone alignment. In certain cases Rolfing coupled with Chiropractic care can be highly effective.

The general goal for most types of massage is to bring relaxation and stress relief to individual muscles yet offering just temporary relief from symptoms. Rolfing addresses the underlying causes for pain and tension in the body truly holistically, resulting in often profound and significant lasting changes. Rolfers usually have more technical training in anatomy, physiology, kinesiology and therapeutic relationship than the average massage therapist. They understand the relationships that exist between regions of the body and know how to work methodically on a deeper more intrinsic level to bring about lasting change. Not just immediate pleasure, they are trying to encourage you to find a place of freedom and spaciousness that has been lost due to a lack of or limited patterns of movement. This is also achieved throughout each session by having the client actively perform specific movements, breathing into new areas of their body, calling attention to new sensations and even standing and walking during certain sessions.

What Does Rolfing Feel Like?

Rolfing generally feels like slow, applied pressure, similar to a deep tissue or myofascial massage. Today Rolfing is practiced with more effective results using gentle, techniques ranging from light to deeper pressure. Sensations typically range from pleasurable to a deeper feeling of release, depending on factors such as past injuries and chronic stress in the afflicted area that can be either physical or emotionally related.

Clients report a sense of lightness, awareness and better balance. Movement feels easier and more resourceful. Feelings of wellbeing reflect the body’s higher energy level. Chronic pain or discomfort often disappear rapidly throughout the sessions or soon after the series is complete.

The results of Rolfing are not only lasting, they are progressive. Clients report feeling and looking better long after their last session.

Other benefits of Rolfing

* Poor Posture

Almost everyone has a poor posture to certain degree. As the body collapses we get uneven tension in our body. This feels uncomfortable and puts a lot of stress and strain on joints, nerves and internal organs. Good posture feels great!

* Joint Pain

Back, neck, hip, knee, ankle, wrist, shoulder pain can all be alleviated with Rolfing. Balancing the joints takes away the pain.

* Headaches

Most headaches come from neck and/or shoulder imbalance, which interferes with blood flow and/or puts pressure on nerves in the neck and head. You don't have to put up with headache pain from these causes.

* Breathing Difficulties

Asthma, emphysema, and panic attacks involve breathing disorders. These conditions, although varied, all respond well to Rolfing. The balancing of the rib-cage (and body generally) and the releasing of pressure on the lungs and diaphragm helps with the overall health, wellbeing and functioning of the respiratory system.

* Anti-Aging

As posture becomes more stooped, internal organs have inhibitory pressure applied on them, preventing them from functioning to their optimum. As Rolfing prevents the breakdown and collapse of the structure of the body, we can stand straight, giving our whole body the opportunity to function properly. The lift and balance of Rolfing helps to organize and space the systems of the body, enabling them to function without stress.

* Arthritis

Helps to unclog and free the joints and move toxic build-up out of the body.

* Improving Performance

Many athletes, dancers, yoga students and sportspeople have noticed that the increased flexibility, mobility and fluidity that comes from Rolfing has enhanced and improved their individual performances.

* Post Partum

Most women will tell you that their body just isn't the same after their pregnancy. It is important to know that as your body expands for the baby, tissues are stretching and migrating into unfamiliar positions. For some women the pushing out of the abdomen also externally rotates the hips, which stay rotated after the birth. This means that the hip joints no longer fully support the spine and the ribcage collapses down, putting strain on shoulders and neck. For other women the diaphragm might be re-located, the spine compressed or the pelvis itself becoming unstable. Rolfing will put you back together, better than before your pregnancy.

Summary

Physicians and chiropractors believe Rolfing is a safe alternative to medicine, including prescribed drug treatment. Unfortunate side effects are linked to medications for depression that can cause dependability. And if you have heard talk of it being incredibly painful, the perception was once correct, but it is outdated now. In the old days Rolfing was known to hurt quite a lot. However things have changed, and the new breed of Rolfers are gentle and just as effective.

Sources and Additional Information:

http://www.depression-solutions-supersite.com/rolfing.html

http://www.helium.com/items/528488-what-is-rolfing-and-what-does-it-do

http://www.rolfingnow.com/

http://uprighthealth.com/2008/09/09/how-can-rolfing-affect-you-emotionally/

http://www.rolfing.com.au/benefits.html

Psychotic Depression: Symptoms and Treatment

Overview

Psychotic depression (major depression with psychotic features) is one of the most severe forms of the general depressive disease, in which the person experiences occasional moments of delusional or paranoid being. Psychotic depression is characterized by not only depressive symptoms, but also by hallucinations (seeing or hearing things that aren't really there) or delusions. Psychotic depression is a chronic, cyclic condition. In general, the patient may have unremarkable general depressive episodes marked by moments of extreme psychoses. Suicide is most prevalent in patients affected by psychotic episodes. Psychotic depression is unlike schizophrenia because people who are experiencing this type of depression are usually aware that the psychotic episodes they experience are not real.

Diagnosing

Though major depression with psychotic features represents about 25% of consecutively admitted patients, it is frequently overlooked by professionals. Patients are often reluctant about revealing cognitive deficits and delusions and will sometimes deny thoughts of suicide, which makes this disorder difficult to diagnose. Similarities in the symptoms of psychotic depression, schizophrenia, and schizoaffective disorder also make diagnosis even more difficult.  Clinical data have shown that in multiple cases psychotic depression as much more in common with schizophrenia than with non-psychotic depression.

In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, psychotic depression is classified as a major depressive disorder, severe, with psychotic symptoms. This classification requires the usual criteria for a major depressive episode with the additional symptoms of hallucinations or delusions, which can be either mood-congruent or -incongruent. Some researchers have argued that psychotic depression should be classified as a separate clinical disorder due to a number of biological and behavioral symptoms that are specific for this depression type of disease.

While symptoms of psychotic depression can be intense, differentiation from other disorders and detection of undisclosed symptoms often require extensive examination of the patient. The delusions experienced by psychotically depressed patients are typically guilty, paranoid, and somatic; and their hallucinations are auditory, visual, or somatic. Studies conducted to test the neuro-vegetative symptoms of psychotic depression revealed multiple symptoms of severe depression and permanent depressive state of mind with both higher levels of retardation and higher levels of cognitive disturbance according to Hamilton Rating Scale for Depression (HAM-D) scores and compared with non-psychotic patients.

Patients with psychotic depression have shown a higher rate of errors of commission on verbal memory tests. Researchers found that these patients had a higher rate of cluster A personality disorder and a lower level of education compared with patients with non-psychotic depression.

Other features characteristic of psychotic depression compared with non-psychotic depression include a history of past delusions but fewer previous episodes, a positive family history of mental disorder, previous suicide attempts, greater suicidal ideation and intent. Psychotic depression is often considered a disorder of the elderly, but at least one study has reported that younger age was found to be a more common characteristic of psychotic rather than non-psychotic depression. In comparison with patients with schizophrenic disorders, patients with psychotic depression have shown greater emotional impact features and higher tendency to lose control.  If a patient’s psychotic depression is further complicated by agitation, determining whether the patient is suffering from agitated psychosis, severe anxiety, or a dysphoric manic state may be difficult. A number of questions can help in the differential diagnosis:

• Does the patient suffer from insomnia?


• If so, does the patient believe that he or she needs less sleep than usual?


• If delusions are present, are they guilt-ridden as in a depressive state or pleasure-seeking as in a hypomanic or manic state?


• Has the psychosis been present in the absence of affective symptoms?


• Is there a family history of psychotic or affective illness?

Treatment

An individual suffering from psychotic depression needs to be hospitalized as this disease only responds to intensive treatment. Hospitalization also ensures that the patient is under proper medical observation. The treatment for this form of depression can be divided into two parts; medication and electro-convulsive treatment.



As far as medication is concerned the treatment is mostly dependent on antidepressant and antipsychotic drugs. There are various antipsychotic or neuroleptic drugs available today but these have to be used under strict medical supervision as they have some side-effects.

Electro convulsive therapy (ECT) is recommended if the medications don't yield the desired result. In ECT, electric current is applied by putting electrodes on the scalp of the patient. It causes controlled convulsions and triggers massive neurochemical release in the brain. It mostly lasts for 30 to 90 seconds and this method is practiced for 6 to 10 times. It is carried out under the influence of anesthesia to ease the pain. Although that is one of the accepted fastest ways to relieve the patient, its most common side effect is temporary short term memory loss.

Researchers are also studying the effectiveness of RU-486 (the "abortion pill" and "emergency contraceptive"), which is said to dramatically relieve psychotic depression.

It is observed that, like all other forms of depression, even psychotic depression may eventually increase the risk of suicides. Hence a proper solution to this problem is a must, and combination treatment in the form of medications, counseling and talk therapies would definitely help the individual.

Prognosis

If you have symptoms of depression combined with hallucinations or delusions, don't hesitate to ask for help. It is particularly important to share the details of your symptoms with your doctor, because psychotic depression must be managed differently than other types of depression. The most serious risk of psychotic depression is suicide, so getting appropriate treatment as soon as possible is crucial.

Psychotic depression is an illness, not something to be ashamed of or a weakness. It is also a treatable condition, and most people recover within a year, however continual medical follow-up may be necessary.

Sources and Additional Information:

http://www.depression-information.org/depression-types/psychotic-depression.htm

http://www.psychiatrist.com/pcc/pccpdf/v05s01/v64s0104.pdf

http://www.buzzle.com/articles/psychotic-depression-symptoms-and-cures.html

http://www.everydayhealth.com/depression/psychotic-depression-losing-touch-with-reality.aspx

http://www.healthyplace.com/depression/main/psychotic-depression/menu-id-68/

Sleep Deprivation as Cure for Depression

History of Approach

Nearly 30 years have passed since Anna Wirz-Justice, MD, first prescribed a night without sleep for a severely depressed 80-year-old woman. "She used to just sit around all day, feeling suicidal," says the Swiss neurobiologist. "She hardly spoke or moved.''

The remedy worked.  By the next morning, the elderly woman "was talking and moving around as if she were actually another person," Wirz-Justice says. "She told me that at about two or three in the morning, she felt like a black cloud had been lifted from her shoulders."

Was Wirz-Justice on to something? She and other researchers thought so -- at first. There is no denying that sleep deprivation temporarily eases depression. Up to 60% of depressed people will show a 30% improvement after just one night awake, according to a review article published in the January 1990 issue of the American Journal of Psychiatry. People who feel the most depressed in the morning and improve later in the day seem to benefit the most from a night without sleep.

But there was a problem: Patients tended to relapse into depression as soon as they did get a good night's sleep. Moreover, habitual sleep deprivation may be linked to long-term health problems such as high blood pressure and diabetes. The challenge then became to find a way of relieving depression by tinkering with sleep-wake cycles.

Does it Work?

If a depressed mother stays up all night, or even the last half of the night, it is likely that by morning the depression will lift.  Although this sounds too good to be true, it has been well documented in over 1,700 patients in more than 75 published papers during the last 40 years. Sleep deprivation used as a treatment for depression is efficacious and robust: it works quickly, is relatively easy to administer, inexpensive, relatively safe and it also alleviates other types of clinical depression. Sleep deprivation can elevate your mood even if you are not depressed, and can induce euphoria. This throws a new light on insomnia.



This remarkable result is not well known outside a small circle of sleep researchers for three good reasons.  First, sleep deprivation is not as convenient as taking a pill.  Second, prolonged sleep deprivation is not exactly a desirable state; it leads to cognitive defects, such as reduced working memory and impaired decision making.  Finally, depression recurs after the patient, inevitably, succumbs to sleep, even for a short nap.  Nonetheless this is an incredibly important observation; it shows that depression can be rapidly reversed and suggests that something is happening in the sleeping brain to bring on episodes of depression.  All this offers hope that studying sleep deprivation may lead to new, unique and rapid treatments for depression.

How does it Work?

Neuroscientists have been trying to solve this puzzle.  The first hint of what may be happening during sleep came from J. Christian Gillin, at the University of California at San Diego. Using imaging, he found that a small area of the cerebral cortex in the front of the brain  — the anterior cingulate cortex — which was consistently overactive in depressed patients, quieted to normal levels of activity after the patients were deprived of sleep. And when the patients were allowed to sleep, the activity in this area returned to the elevated levels.

Helen Mayberg at Emory University has shown that electrical stimulation of the anterior cingulate cortex, which disrupts normal activity, also reduces depression.  Some patients reported feeling immediate relief and calm after the procedure.

This tells us where in the cortex to look, but we also need to understand the changes that occur in the cortex during sleep. As you fall asleep, neurons in the brain stem that project throughout the cortex and keep it activated stop firing. The reduced stimulation from the brain stem disconnects the cortex from sensory input and there is a major shift in the pattern of electrical activity in the cortex. During the early part of the night the cortex is in a state of slow-wave sleep punctuated by brief periods of rapid-eye movement sleep (REM), which become more frequent and longer lasting toward early morning.

One major class of antidepressants, tricyclics, blocks REM sleep, which suggests that sleep deprivation may work against depression the same way. This is consistent with the tendency for depressed individuals to sleep longer than they do when they feel normal. Additional support for this hypothesis comes from genetic studies of families with short REM latency — the tendency to enter REM early in the sleep cycle. This condition disrupts slow wave sleep and extends REM sleep. The risk of depression is much greater if you come from a family with this genetic background. While this is a rare genetic defect that can only account for a small fraction of all depressed patients, these special cases give us valuable clues to conditions that predispose some people to clinical depression.

Power of Hormones

Today, researchers are experimenting with ways to make use of the body's biological clock -- its circadian, or 24-hour, rhythms -- without asking patients to abandon rest altogether. The solution may lie in timing sleep to benefit from certain hormones that ebb and flow throughout the day.

For instance, thyroid stimulating hormone (TSH) helps control our metabolism and, indirectly, our levels of energy. An estimated 25% to 35% of depressed patients have low TSH levels. In recent years, researchers at the National Institute of Mental Health have found that sleep inhibits the release of TSH, while staying awake through the night and the early morning hours boosts it.

Some researchers are trying to manipulate the body's hormonal tides by having patients stay awake through the early morning hours for about a week. Doctors at the University Hospital of Freiburg in Germany tried this experiment on a group of depressed patients who felt better after one night without sleep: They told the patients to go to sleep at 5 p.m. that evening and rest until midnight the next night -- a total of 31 hours. Then the patients gradually eased back to a normal sleep cycle over the course of the week. One night they slept from 6 p.m. until 2 a.m., the following night from 7 p.m. until 3 a.m., until finally they returned to an 11 p.m. to 6 a.m. sleep cycle. Remarkably, the majority -- 75% -- didn't relapse into depression, according to results published last fall in the European Archives of Psychiatry and Clinical Neuroscience.

Methods

There are two methods of using sleep deprivation as a treatment for depression: total or partial deprivation.

Partial deprivation - sleeping the first half of the night only, and waking up halfway through - proved more effective than going to sleep later, or sleeping only the second half of the night. It is thought that partial sleep deprivation, sleeping up to 4 hours a night, will have the same antidepressant benefits as total sleep deprivation. Whereas with total sleep deprivation, the benefits are felt the following day, but are not long-lasting, sleeping four hours can be done continuously, over several days or even weeks, so naturally the benefits here are superior.

Even in patients with bipolar disorder can benefit. Research shows patients with bipolar disorder after sleep deprivation, are pulled from their depressed state to manic state. Manic states can cause sleep deprivation, lasting weeks and even months, so the cycle continues. The patient feels great, lighter in mood, and feel no need for sleep. Of course one should limit this, because of other health risks in prolonged sleep deprivation. Partial deprivation, up to 4 hours sleep is definitely the way to go for long-term treatment.

The ideal way to try for yourself, seems to be to stay awake a full night the first night, then limit yourself to 4 hours a night after that. Try this for a week or two, and see how you feel. I think in most cases, you will have positive results.

If you know someone suffering with severe depression, who barely has energy to talk to you, and no matter how you try to animate them, you have no success, try visiting them in the evening and keeping them awake all night. You will find the next morning their mood will be elevated, they will be more lucid and talkative, and more likely to want to move around and do things. Try then to convince them to use an alarm clock and wake themselves up after only four hours, they'll see for themselves how much better they feel.

The optimum time for sleep appears in some studies, to be from 10pm-2am, 11pm-3am, or12-4 am, underlining the fact that sleeping only the first half of the night provides the best results. In other reports, however, 2-6am 3-7am was optimal. It would depend presumably on your normal bedtime.

Sleep deprivation treatment was popular in the 1970s, but with the discovery of new and effective antidepressant medications, it was soon deemed old-fashioned and unhelpful. Nowadays doctors are reconsidering and endorsing this treatment, finding it helpful even alongside these medications, as the body seemed to accept medication more easily. Many psychiatrists were convinced by remarkable transformations of severely depressed, psychotic and even suicidal patients, back to relative normality after only a few hours. Antidepressant medication alongside sleep deprivation, has proven to help prevent relapse into the depressed state, although these studies are still ongoing.

But Is It Practical?

Doctors admit that sleep deprivation regimen is tough to follow. Patients should probably try such sleep manipulation only under supervision and perhaps in a group to make the experience more enjoyable, says Edward DeMet, PhD, who studies sleep deprivation at the Veterans Affairs Medical Center in Long Beach. "Obviously, if you need to be driving the next day, you shouldn't do this," he says.

There are other ways to manipulate sleep to improve depressive symptoms. For instance, patients who go one night without sleep and who are exposed to bright light in the morning appear to prolong the emotional benefits of that sleepless night. People who try sleep deprivation while taking antidepressant medicine are also less likely to relapse, according to a study by Wirz-Justice and colleagues published in the August 1999 issue of the journal Biological Psychiatry.

Because antidepressants such as Prozac or lithium often take weeks to work, sleep deprivation may be most useful as a temporary tool that gives people a lift before the drugs take effect.

"It's much easier to pop a pill in the morning than stay up all night," says Wirz-Justice, a professor at the Psychiatric University Clinic's Chronobiology and Sleep Laboratory in Basel, Switzerland. "But sleep deprivation is very cheap and it's very fast. For patients who are severely depressed, the experience for that one day lets them know it's possible to get better. They finally have hope."

Sources and Additional Information:

http://www.medicinenet.com/script/main/art.asp?articlekey=50800

http://opinionator.blogs.nytimes.com/2010/04/07/in-sleepless-nights-a-hope-for-treating-depression/

http://hubpages.com/hub/depressionandsleep

http://www.psychforums.com/depression/topic23253.html

Difficulties for Depression Recognition in Primary Care

To fight the health disorder, it should be properly recognized first. The patient comes to the primary care with his problems, which might be seemingly unrelated to the clear case of the clinical depression, and unfortunately, the recognition of depression success rate in primary care is statistically less than we would like it to be. For example, 50% of people with major depression, identified by independent screening in Great Britain, were not recognized as depressed by the primary physician. The recognition of depression is particularly difficult in certain patient groups such as the physically ill, or in certain cultures, when depression is not socially accepted diagnosis. Yes, in some cultures it is just "normal" to be sad, but clinical depression is much more than cultural specifics, or normal mood swings.

                                                                                                                                                      

Depression is Often Unrecognized and Undertreated

Numerous studies indicate that 30-70% of cases of major depression are undiagnosed or undertreated in primary care. While some observers note that physicians are more likely to identify severe depression and to miss only milder forms of the illness, recent studies clearly demonstrated that nearly half of the undetected patients with depression in primary care developed suicidal ideation and 53% continued to meet criteria for major depression one year after the index evaluation.

                               

Physician, patient, and system variables probably account for these disturbing findings. Several theories have been offered, including health services issues, sociocultural barriers, poor consumer education, and insufficient physician knowledge level. Patient denial, cognitive impairment, lacking awareness of depressive symptoms, and inability to articulate symptoms compound the difficulties of detecting depression in primary care. Patient nonadherence, resistance to diagnosis, cultural factors, social forces, subtherapeutic dosages of antidepressants, and low insurance reimbursement rates lead to the inadequate treatment of depression. Many employment, health, disability, and life insurance practices discriminate against individuals with mental illness, thereby reinforcing stigma and adversely affecting their socioeconomic status.

Problems for Depression Recognition

There may be a number of possible reasons for a lack of recognition of depression within primary care, both related to the physicians and the patients. Generally these can be summarized as follows:

Patient factors

• Patients ignore depression in themselves;


• When depressed, older adults may complain less of depressed mood and present somatic symptoms which may not be identified by the clinician;


•  Physical co-morbidity may also make the interpretation of depressive symptoms difficult. Depressed patients may appear demented, and patients with early dementia may present with depression;


• Fear of the stigma of mental illness;


• Worry about side effects of medication;


• Blaming depression on circumstances, regarding it as ‘understandable’;


•  Older adults may misattribute symptoms of major depression for ‘old age’, ill health or grief;


• Although depression is more frequent in women, differential reporting of symptoms may lead to depression being under diagnosed in men;


• In some cultures, depression is not considered as socially acceptable disorder, causing patients to cover up the symptoms for the proper diagnostics.

Practitioner factors

• Primary care practitioners may lack the necessary skills or confidence to correctly diagnose late-life depression;


• Primary care physicians have been shown to view depression as a normal response to difficult circumstances, illnesses or life events and depression may be under diagnosed because of dissatisfaction with the types of treatment that can be offered, especially a lack of availability of psychological interventions;

•  Physicians typically have little time per patient.

Recommendations for Patients

Unfortunately those patients who go unrecognized and untreated after the primary care visit lose the advantage of starting the instant treatment and getting on track to the recovery.

Please, remember that it is your health and your well-being is on stack, and you should do everything possible to help your primary physician in its diagnosis.  Get ready for the conversation, perform several self-checks for depression, if you just suspect that you may have it. Remember, that it is a disorder as any others, and you may significantly improve the quality of your life by accepting it and starting the professional treatment.

Sources and Additional Information:

http://www.euphix.org/object_document/o5838n27170.html

The Atlas of Depression by David S. Baldwin

http://www.york.ac.uk/inst/crd/EHC/ehc75.pdf

http://www.nchph.org/caremodel/decisionsupport/5.7%20Assessment%20and%20Management%20of%20Depression%20in%20Primary%20Care%20Practice.doc

http://fampra.oxfordjournals.org/content/23/3/369.long

Agitated Depressive Disorder

Agitated Depression a state of clinical depression in which the person exhibits irritability and restlessness. This term is applied to depressive disorders in which agitation is prominent. Agitation occurs in many severe depressive disorders but in agitated depression, it is particularly severe. Agitated depression is seen more commonly among the middle aged and elderly than among younger patients. However, there is no reason to suppose that agitated depression differs in other impotent ways from the other depressive disorders.

Definition of Agitated Depression

A major depression with agitation that may be driven by hypomania.

Although many people experience symptoms such as feeling slowed down and lethargic when they are depressed, others may experience just the opposite. They may feel anger, agitation and irritability. This is what "agitated depression" refers to.

Agitated depression was once called melancholia agitata. It is now also known as mixed mania.

Agitation occurs in many severe depressive disorders, but in agitated depression it is particularly severe. There is no reason to suppose that agitated depression differs in other important respects from other depressive disorders.

Diagnostic Criteria for Agitated Depression

• Major Depressive Episode


• At least two of the following symptoms:


• Motor agitation


• Psychic agitation or intense inner tension


• Racing or crowded thoughts

Agitated depression meets the criteria for major depressive episode but not those of a mixed bipolar disorder according to the DSM-III-R.

Agitated Major Depressive Disorder Symptoms

It is not tough to identify the symptoms of agitated depression. People that suffer from this type of depression are not able to sit still and keep on restlessly moving here and there all the time. It is due to the outburst of emotional energy caused because of agitated depression. Those that suffer from this type of depression tend to complain a lot and develop the feelings of being misunderstood by others. At least 2 of the following manifestations of psychomotor retardation (not more subjective anxiety) are required for several days during the current episode:

• Tearing of cloths

• Motor agitation

• Intense inner tension

• Racing thoughts

• Never ending baseless thoughts

• Continuous talking

• Hand wringing


• Pacing


• Pulling or rubbing on hair, skin, or clothing


• Outbursts of complaining or shouting


• Difficulty in explaining problem

Agitated depression in bipolar I disorder

The occurrence of agitated depression in bipolar I disorder is not rare and has significant prognostic and therapeutic implications. Whether the co-occurrence of a major depressive syndrome with one or two of these symptomatic clusters makes up a "mixed state" remains unclear.

Clinical Forms of Agitated Depression

1. Psychotic agitated depression
   
   Proposed name: Melancholia


2. Non-psychotic agitated depression
   
   Meets the RDC criteria


3. Excites anxious depression
   
   Provisional name: Psychic agitation and racing or crowded thoughts.

Complications for Agitated depression

The complications that have been mentioned in various sources for Agitated depression includes getting involved in risky activities, dysfunction in family and work, and even suicide or homicide.

Treatment

Agitated depression can be difficult to treat because the behavior patterns associated with this form of depression lend to the inability to consistently take medication. It is important to get properly diagnosed by a mental health care professional who can supervise your treatment closely. Psychotherapy is also useful in treating agitated depression. It is usually necessary to have long term treatment as a combination drug and psychotherapy. The drug therapy has to be fine tuned to your specific needs. This can take up to a month to see results and a cessation of side effects in most people but it is highly effective.

The common treatment approaches are:

1. Medicines - Antidepressants and anticonvulsant like divalproex, aripiprazole, clozapine or olanzapine is largely used in treatment of agitated depression.


2. Psychotherapy - In most of the cases psychotherapy is preferred to treat agitated depression.


3. Combination of medicines and psychotherapy - When drug therapy and psychotherapy is used in combination then effect is much better for curing agitated depression.


4. Electroconvulsive therapy - Electricity is passed to the brain through electrodes to overcome from agitated depression.

Sources and Additional Information:

http://www.depression-guide.com/agitated-depression.htm

http://www.happymoods.info/what-is-agitated-depression

http://www.survivingdepression.net/types/agitated.html

http://www.total-health-care.com/depression/agitated-depression.htm

http://www.wrongdiagnosis.com/a/agitated_depression/complic.htm

Reichian Therapy against Depression

Reichian Theory

When we are open, we experience pleasure, liveliness, and vitality. Many of us, however, find that our lives and relationships feel painfully constricted. We develop coping strategies early in life to ward off difficult, uncomfortable feelings. These defenses become habitual and can inhibit us from experiencing joyful, expansive feelings as well as pain. We become frozen and trapped in our defenses, and can become physically ill. These symptoms are cries for help from our wounded past, a past that may keep us from being fully available to the present. Our contracted self reveals itself in our character structure and body armor. To find our free, authentic self we must become conscious of our armoring - our self-distortions that turn us into unnatural adults that attack, cling, avoid, deny or pretend. Reichian therapy is an intensive, confrontational, personally demanding process for those who wish to profoundly change themselves and their life.

As we shed unnecessary layers of armor and facade we begin to discover our true, naturally sexual and spiritual natures.

What is Reichian / Orgonomic Therapy?

Reichian Therapy, developed by Wilhelm Reich, is a method for character transformation that recognizes the essential identity of the mind and body. Also known as Orgone Therapy, Orgonomic Therapy, and Bio-psychotherapy, Reichian Therapy recognizes how "armoring" against the free flow of life energy blocks full emotional expression. The Orgonomic therapist works with the principles of psychodynamic psychotherapy to reveal to the patient\client their character attitudes and their character armoring.

With a functionally deep understanding of the mind/body relationship, the Orgonomic Therapist simultaneously analyzes the patient's character ("Character Analysis") as it presents itself through the ways in which they walk, talk, hold themselves, etc., and the chronic muscular tensions that anchor and support this behavior. This is done through relationship-building verbal dialog, description, analysis, and the release of muscular tension through deep massage. Developed out of Wilhelm Reich's character-analytic technique, which views the mind and body as one functional unit, Reichian Therapy is the classical foundation of Somatic Psychology.

Therapy works on many levels: past, present and future; conscious and unconscious; physical, emotional, spiritual. Nonetheless, the primary goal at the physical level is to restore full natural respiration and the capacity to experience pleasurable sensations and the joy of life. Psychologically, the goal is to be able to love fully.

The ability to work at all these levels, and especially to go deeper, makes Reichian work unique and is a result of Wilhelm Reich’s comprehensive understanding of the human psyche and body.

Orgonomic therapeutic process facilitates:

• Self-awareness and deep insight


• Emotional and physical release, followed by an increased energy flow


• Changes in habitual, unhealthy defensive patterns


• Effective, lasting change

Bio-Psychotherapy includes:

• Skilled, therapeutic dialog


• Authentic, supportive, actively engaged relationship with the therapist


• Character analysis: examine and change unproductive defense mechanisms


• Body work: massage and deep tissue muscular intervention


• Facilitation of deep feeling expression


• Breathing enhancement


• Dream analysis

Benefits of Orgnomic Therapy:

• Alleviate symptoms of depression


• Ease anxiety and panic


• Decrease stress-related symptoms


• Assistance with eating, sleep, and other disorders


• Reduce physical symptoms (headaches, nervous disorders, digestive problems, sexual dysfunction, autoimmune issues, etc.)

Reichian Therapy

The Reichian Therapist locates painful constrictions and facilitates expansion. What makes Reichian Therapy uniquely powerful is that it includes body work to address the physical, somatic component - the physical expression of the mind's defenses. Dreams deepen the exploration because they provide direct access to the unconscious.

The Price of Constriction

The growing relationship with the therapist illuminates the protective stance we have in relation to others and ourselves. As we grow and survive adversity, we develop repetitive coping strategies to fend off difficult feelings. These strategies can alienate others, keep us from our true feelings, needs, and desires, and inhibit our ability to actualize who we really are. Our creativity and success in the world becomes minimized. Constricted respiration can be an additional sign of dysfunctional coping. Very few patients, indeed few people, breathe to full energetic capacity. One of the best ways to suppress painful emotions is to hold your breath. Infants and children spontaneously hold their breath in frightening situations. This happens to them many times each day in a dangerous environment. By adulthood, the chest is frozen in chronic breathlessness. Problems of depression, anxiety, phobias, insomnia, emptiness, loneliness, eating disorders, and addiction are defined and understood as reaction patterns to both present and past issues. These patterns have their roots in chronic character styles developed throughout a lifetime. As these behavior patterns are confronted, the character defenses are dislodged giving way to deeper issues and feelings.

Pleasure and Pulsing

Whether the global problem is one of love, of work, or of both, the common factor is lack of fulfillment and enjoyment in life. The rock song of the 70s wailed it well: "I can't get no satisfaction," (and the performers' lives seemed to make this a self-fulfilling prophecy). Reich saw the global problem as a disorder of pleasure.

What is pleasure? It's not so-called "cheap thrills," for they're not pleasurable after the fact. It's not just what "feels good," for such can ruin one's health and body (hepatitis, AIDS, cirrhosis, lung cancer, VD) as well as one's home and family (the casual affair, credit card binges, gambling).

For our purposes, pleasure can be defined as the natural, unfettered build-up and release of energy; full pleasure is pleasure experienced when making deep ("soul-to-soul") contact with another person; and mature pleasure is full pleasure governed by genitality and autonomy. Energy is not defined as a force alien to our natural selves or foreign to science, but is instead posited as an intervening variable to explain and communicate the sensations and feelings, sometimes very intense and "streaming," that occur in our bodies. It is in no sense connected to the mystical or the occult.

The build-up and release of energy seems to be the basis of the spontaneous, naturally-occurring movement that occurs in, and perhaps is a necessary condition of, all life. It is pulsation. Pulsation consists of an energy cycle in which mechanical tension leads to a bioelectric charge, a bioelectric discharge, and then mechanical relaxation, after which the cycle repeats.

This tension-charge-discharge-relaxation [TCDR] cycle can be demonstrated in unicellular organisms, as in the movements of amoebas, and in more complex organisms at all levels: the exchange of materials at the cellular level, the firings of nerve cells, the pulses in arteries, the peristaltic movements in the digestive system, the inspiration-expiration of breathing, the process of orgasm, daily (circadian) cycles, monthly cycles (menstruation), reproductive cycles (conception to birth), and perhaps even the cycle of life, itself.

Of course, no one fits any of these patterns exactly, and people have wide varieties and combinations of these and other patterns for differing times, circumstances, and stressors. Physiological conditions add their overlay to these patterns, as well. Being physically sick, having blood-sugar fluctuations, or experiencing pre-menstrual pressures (or lesser-known vague hormonal cycles in men) all distort the TCDR cycles.

The Concept of Armor

After years of living, we have diminished our capacity to feel to such an extent that we experience anxiety whenever the intensity of our feelings (our energy) starts to rise to a biologically normal level. In defending against this anxiety, we adjust our lives to feel only as much as we can tolerate, which often is just a mere fraction of the potential.

We defend against this anxiety by setting up resistances to the energy flow, and we do this by automatically tightening our muscles in specific patterns. This blocks or reduces the strong feelings to manageable proportions, and is known as muscular armor.

The prototype of this is the startle reaction, where we suck in our breath, hunch our shoulders, and become hyperalert as a reflex against a sudden noise or movement. A more recognizable block would be the "lump in the throat" one feels during a sad movie. Here, the throat muscles (pharyngeal constrictors) go into spasm as if to "choke down" the sadness that wants to come out. When the person cries fully, the tightness disappears.

Reich elaborated seven areas of armoring: the eyes, including the back of the neck; the jaw; the neck and throat; the chest; the diaphragm; the abdomen; and the pelvis. No two people have muscular armor in the exact same places for the same reasons, but there are patterns of armoring that seem to appear with certain traumas and conditions.

For example, people with ocular armoring ("eye blocks") often have headaches behind their eyes or in the back of their necks, and habitually block off visual contact with others. People with chronic jaw tension may grind their teeth (bruxism), and they have sweet smiles masking jaw muscles over-developed from "biting back" anger. The housewife at the beginning of this article had a strong throat block, as did also a man with a history of childhood oral-genital sexual abuse. A muscleman afraid of crying might develop a puffed-up chest, et cetera.

Character armor is an attitude or set of attitudes toward life that usually arises out of the muscular armor. The muscleman described just above might well have a puffed-up, inflated attitude about himself and thus relate to people through this defense, afraid to let his softness and vulnerability show. Contrariwise, a person with neck and chest armor in chronic contracted position may approach the world in a beaten-down, milquetoast way, protecting himself from experiencing his own rage.

Obvious cases like these, of course, are easy to identify. Usually, however, the muscular and character armoring patterns are subtle, and they can, and do, shift around during the course of therapy.

When we originally armor ourselves, we do so in idiosyncratic patterns that relate to our past histories. But the common factor is that everyone's TCDR cycle is distorted, and the result is usually a feeling of intense internal pressure, and perhaps even pain, accompanied by many of the standard psychological symptoms. Some people don't experience specific symptoms, but instead have a global feeling of being dissatisfied, or of having angst. And others have tightened up so much they cannot even feel; they have deadened themselves to their own distress.

The Process of Expansion

The Reichian Therapist usually starts body work by focusing on the eyes and respiration. The eyes (as an extension of the brain) help us to sustain contact with the world and ourselves. Almost everyone has some blocking in the eyes, and it is important that the eyes be reasonably unarmored for therapy to proceed. It is also important to dissolve blocks in respiration as breathing is essential in building and sustaining an energy level that will "push" emotions to the surface.

Reichian Therapy or Orgone Therapy, works from the head down toward the pelvis, leaving the latter for last. At the same time character analytic work is proceeding, peeling back layers of character attitudes that hide emotion, the layers of body armor are dissolved as well. The combined work results in spontaneous emotional release and provides the therapist with a deeper understanding of the character of the patient, yielding insight on "where to go" to deepen the therapy.

Reichian Therapy supports individuals, couples, and groups to experiment with their character and body structure in bold and profound ways that insist on change. Couples struggle as their character stances collide. Productive communication can become paralyzed. Reichian Therapy alters this stasis and teaches effective communication strategies so that the couple can maintain harmony and support the autonomy of the individuals. Group therapy is a process where participants can reveal their habitual, dysfunctional relationship patterns and learn different ways of being/behaving through the confrontation and support of other group members. Group is a very effective, fast, catalytic tool for change.

About Wilhelm Reich

Wilhelm Reich was born at the end of the 19th century in what was then the Austro-Hungarian Empire. His early life on a farm was filled with sexual openness and experimentation that would influence much of his later work. Reich fought in World War I, and then went to school in Vienna, studying Freud, and becoming a part of the Vienna Psychoanalytic Association by the time he was 23. At 25 he set up his own private practice, and by his mid-30s he had developed a great deal of theories which would later underpin Reichian therapy.

Sources and Additional Information:

http://www.orgonomictherapy.com/reichian-therapy.htm

http://reichiantherapy.bc.ca/whatis.php

http://www.drjoe.com/WR-1.htm

http://www.dschiffphd.com/Reichian-Orgone-therapy.html

http://www.wisegeek.com/what-is-reichian-therapy.htm

Link between ADHD Drug Ritalin and Depression

What ADHD is?

Attention Deficit Hyperactivity Disorder (ADHD) has become America’s number one childhood psychiatric disorder. It has been estimated that more than 5 million children are presently affected by this disorder in the U.S., which represents as many as 7 to 12 percent of preadolescent children. These percentages mean that almost every classroom can have children with ADHD. This disorder usually begins in infancy and continues into adulthood.  Usually there is a gender skew with this disorder, where boys are usually affected more often than girls, at a ratio of 4 to 1 for boys and 9 to 1 for girls.

It seems that the problem with ADHD has increased in later years, however, rather than having now a greater number of children affected by it, the reason for the increased number may well be that more children are diagnosed today than they were in the past.  Children are usually diagnosed with the disorder when they start school, thus many are only diagnosed during the first three grades and not before.

What Ritalin is?

Methylphenidate (or MPH) is an amphetamine-like central nervous system (CNS) stimulant commonly used in treating Attention Deficit Hyperactivity Disorder (ADHD) in children and adults. It is also one of the primary drugs used to treat symptoms chronic fatigue syndrome (CFS), symptoms of traumatic brain injury, and drowsiness brought on my narcolepsy. Common brand names of drugs containing methylphenidate include Ritalin, Concerta and Methylin, among others. Ritalin is manufactured by Novartis AG. It was granted FDA approval in 1980, ushering in the so-called generation of “Ritalin kids” as the drug became hugely popular in the 1980s for children diagnosed with ADD or ADHD.

Ritalin Controversy

From the date of its approval, Ritalin has been the focus of much controversy. This controversy includes harmful Ritalin effects, Ritalin abuse (including snorting Ritalin), Ritalin addiction and other Ritalin side effects. Since 1980, prescriptions for Ritalin have skyrocketed, and now there are more than 5 million young patients who take this medicine on a daily basis.

While it is true that children can show improvement in ADHD symptoms while on Ritalin, the Ritalin effects last only several hours. Ritalin effects ADHD symptoms but the Ritalin effects wear off when the drug wears off.

In most cases the Ritalin side effects are mild but some, though rare, are life-threatening. Nervousness and insomnia are the most common adverse Ritalin side effects. Parents need to be clear about the benefits as well as the potential Ritalin effects – including the potential for Ritalin abuse and addiction - before administering Ritalin to their children.

Kiddie Cocaine

Ritalin is often referred to as "Kiddie Cocaine" for good reason. Long-term Ritalin effects have been linked to brain development abnormalities similar to those found with cocaine use. The Journal of the American Medical Association, one of American's leading medical journals, published an article in August entitled "Ritalin Acts Much like Cocaine." An Archives of General Psychiatry report states; "Cocaine has pharmacological actions that are very similar to those of methylphenidate (Ritalin), which is now the most commonly prescribed psychotropic medicine for children in the U.S."

DEA data on methylphenidate and amphetamine for the treatment of ADD symptoms shows:

• That methylphenidate (Ritalin, Concerta) and amphetamine (Adderall, Dexedrine) produce effects similar to cocaine in laboratory animals and in humans.


• In clinical studies, methylphenidate and amphetamine produce behavioral and psychological effects similar to cocaine.


• In simple terms, this data means that the human body cannot tell the difference between cocaine, amphetamine, or Ritalin.

Ritalin effects children the same way related stimulants like cocaine effect adults. Just as predictably, children are subject to Ritalin side effects, as adults are subject to the side effects of cocaine and other stimulant drugs.

Aside from the Ritalin side effects and potential for Ritalin abuse and addiction, another disturbing aspect of Ritalin is the long-term Ritalin side effects.

Until recently physicians believed that Ritalin side effects remained as short-term. Scientists at the University at Buffalo found otherwise. Research with gene expression in animals suggests that Ritalin has the potential for causing long-lasting changes in brain cell structure and function. Methylphenidate (Ritalin) appears to initiate changes in brain function that remain long after the therapeutic Ritalin effects dissipate.

In particular, the study results, made on preteen rats, from a research team led by William A. Carlezon Jr., PhD, director of the behavioral genetics laboratory at McLean Hospital and associate professor at Harvard Medical School, strongly suggest that Ritalin use in childhood may present a serious risk factor for depression development in adult years. "Rats exposed to Ritalin as juveniles showed large increases in learned-helplessness behavior during adulthood, suggesting a tendency toward depression," Carlezon says in a news release. "These rats also showed abnormally high levels of activity in familiar environments. [This] might reflect basic alterations in the way rats pay attention to their surroundings."

While research now indicates adverse long-term Ritalin side effects physically, other studies show that Ritalin use does not make an impact on behavior in the long run. A comprehensive follow-up study at Montreal Children's Hospital revealed that the behavior of hyperactive children did not differ significantly from the behavior of non-hyperactive children after taking ADHD medication for five years.

"Although it appeared that hyperactive kids treated with Ritalin were initially more manageable, the degree of improvement and emotional adjustment was essentially identical at the end of five years to that seen in a group of kids who had received no medication at all," the report stated.

Given the lack of long-term benefits, the potential for long-term Ritalin side effects and Ritalin abuse and addiction, many parents uncomfortable with Ritalin side effects choose alternative treatments for Attention Deficit Disorder.

Other Side Effects

While the purpose of this post establishing link between Ritalin and Depression, we cannot skip other side effects, caused by this drug:

• Appetite Disturbance


• Stomach Aches


• Headaches


• Stunted Growth


• Rebound


• Difficulty Sleeping


• Irritability


• Anxiety


• Jittery Feelings


• Blood Glucose Changes


• Blood Pressure Changes


• Paranoia/Psychosis


• Seizures


• Death

Though rare, Ritalin has been known to cause sudden death in a few individuals. While many times there are additional factors that lead to this fatal ending, it is a dangerous effect to be aware of.

Summary

As a parent, you should be really careful to admit your kid is positively diagnosed with ADHD clinical diagnosis. Note that ADHD symptoms may confuse you, as parents are often given ADHD checklists or questionnaires, which list symptoms such as:

• fails to give close attention to details


• makes careless mistakes


• doesn't listen


• doesn't follow instructions


• loses things


• talks too much


• moves around too much or is always on the go


• can't wait his turn


• interrupts others

Can these be ADHD symptoms? Sure, but they can also be symptoms of a normal preschooler or an immature five year old, so it is important to consider the symptoms in the context of the child you are thinking about, especially his age and developmental level.

Most importantly, remember that for a child to have ADHD, the symptoms should be causing impairment for your child. That means that the ADHD symptoms should be causing him to have some trouble learning, making and keeping friends, participating in after-school activities (including sports) or even functioning at home.

Sometimes, teachers and associated medical professionals are eager to stamp overly normal, but active, child with AD/HD diagnosis, as that makes their life easier. Do not accept this verdict as granted, seek for second opinion, and admit the disorder only when evidence is overwhelming. If and when diagnosis is confirmed, and Ritalin is admitted, closely monitor your child for the side effects appearance, and ring a bell, when they go out of control immediately.

Sources and Additional Information:

http://www.anxiety-and-depression-solutions.com/articles/conventional/pharmaceutical/ritalin.php

http://www.add-adhd-help-center.com/ritalin_side_effects.htm

http://www.webmd.com/add-adhd/news/20031208/preteen-ritalin-may-increase-depression

http://www.ritalinadvisor.com/side-effects

http://pediatrics.about.com/od/adhd/a/adhd_symptoms.htm

Childhood Abuse and Clinical Depression in Adults

Overview

Childhood abuse and neglect is an insidious problem with far-reaching consequences. According to the U.S. Department of Health and Human Services Administration for Children and Families, in 2007 close to 800,000 children were determined to be victims of neglect or abuse. These statistics likely underestimate the actual incidence of abuse because an unknown but significant amount of abuse is never reported or investigated. Abuse has devastating, enduring effects on children. Adults who were abused as children continue to suffer from their childhood trauma. One of the many effects of childhood abuse is treatment-resistant depression.

Types of Abuse

The forms of childhood abuse include neglect, emotional abuse, physical abuse and sexual abuse. The lion's share of abuse and neglect takes place within the home. Younger children and infants are particularly vulnerable as they lack the physical, emotional, verbal and social resources to defend themselves or to obtain help. Emotional abuse and neglect are harder to substantiate legally but have insidious effects on individuals and on society. All forms of childhood abuse cause immediate harm and have lasting effects. In many cases, victims of childhood abuse become perpetrators of abuse, continuing the cycle of abuse and victimization of children.

Effects of Abuse

Children who are abused experience symptoms of trauma, including anxiety, depression, difficulties at school or work, anger, aggression, cognitive and learning deficits, medical illness, social withdrawal, impulsivity, sexual activity at an early age and difficulty maintaining close relationships. Victims of childhood abuse are at higher risk for substance abuse, arrest, incarceration and legal problems.

Physiological effects include impairment of regions of the brain that regulate emotions and memory and sensitization of physiological stress response mechanisms. For example, according to a report in the December 2002 "American Journal of Psychiatry," women with histories of chronic childhood abuse and trauma have a smaller left hippocampus volume--a region of the brain involved in spatial memory--than non-depressed and non-childhood traumatized women. Similarly, women with childhood histories of abuse excrete greater amounts of the stress hormone cortisol in response to stress than do women who do not have childhood trauma. These varied effects of abuse often persist into adulthood.

Researchers at McLean Hospital, the largest psychiatric affiliate of Harvard Medical School, have confirmed that child abuse and neglect can "rewire" the developing brain. When brain circuitry is altered during the formative years it may eventually cause such disorders as anxiety and depression to more readily surface in adulthood.



According to Martin Teicher, MD, PhD, director of the Developmental Biopsychiatry Research Program, "science shows that childhood maltreatment may produce changes in both brain function and structure. These changes are permanent. This is not something people can just get over and get on with their lives."

During the course of their studies, the researchers found that four abnormalities are more likely to be present in victims of child abuse and neglect:



* Changes to the Limbic System, the area of the brain that, together with the hypothalamus, controls hunger, thirst, emotional reactions and biological rhythms. In addition, it coordinates complex activities requiring a sequence of performance steps. Changes to the limbic system can result in epileptic seizures and abnormal electroencephalograms (EEG), usually affecting the left hemisphere of the brain, which is associated with more self-destructive behavior and more aggression.

* Deficient Development of the Left Side of the Brain, which can contribute to depression and impaired memory.

* Impaired Corpus Callosum, the pathway integrating the two hemispheres of the brain, which can result in dramatic shifts in mood and personality.

* Increased Blood Flow in the Cerebellar Vermis, the part of the brain involved in emotion, attention, and regulation of the limbic system, which can disrupt emotional balance.

Sexual abuse is even more harmful than physical abuse.  Adolescents and young adults who were abused or neglected during childhood are more than three times as likely to become depressed or suicidal, according to a study in the Journal of Child Psychiatry (1999). This research study also found that children who are sexually abused are more likely to become depressed or suicidal. Victims of sexual abuse were about six times more likely to attempt suicide; additionally, the risk of repeated suicide attempts was eight times higher than in children who were not sexually abused.  Further, 36 percent of those subjected to sexual abuse were diagnosed with a depressive disorder, compared to a 25 percent rate in victims of all types of child abuse or neglect.

Sexual abuse carries the greatest risk of depression and suicide and this has always been noted in the research.  More than a third, 36 percent of sexually abused youths attempted suicide, compared to 16 percent of physically abused youths.   Six percent of children without a history of abuse reported attempting suicide.

Researchers from this study also found that the incidence of suicide attempts was higher during adolescence. ``Adolescence is the most vulnerable time for sexually abused youths, who are more prone to make repeated suicide attempts,'' the researchers said. Contextual factors such as family conflict, parental substance abuse and illegal activities should be addressed and dealt with in the treatment of depressed and suicidal adolescents who have been neglected in childhood.  Familial, parental and environmental factors are often possible contributors to depression. Familial factors include a poor marriage; parental factors include a low parental involvement; and environmental factors include welfare dependence and other socioeconomic issues.

Sources and Additional Information:

http://www.livestrong.com/article/75492-childhood-abuse-treatmentresistant-depression/

http://www.bellaonline.com/articles/art4046.asp

http://www.drlowenstein.com/_data/user_docs/child-abuse-and-adult-depression.pdf

http://www.healthyplace.com/abuse/abuse-and-depression/child-abuse-adult-depression/menu-id-102/

http://www.4therapy.com/consumer/conditions/article/7023/490/Child+Abuse+Can+Cause+Permanent+Damage+to+the+Brain,+Body,+and+Emotional+Well-Being