Depression Treatment with Emotional Freedom Techniques (EFT)


Depression is exhausting and everything feels like a struggle … your sleep can be affected … as well as your performance at work … or in the bedroom. What to do if you don’t want to take medication?



According to the Report of the Surgeon General on Mental Health “many episodes of depression are associated with some sort of acute or chronic adversity”. Since the 1991 launch of Emotional Freedom Techniques (EFT), EFT founder Gary Craig and his many practitioners have worked with hundreds of people with depression. They too have noticed that depression tends to be a result of “acute or chronic adversity.” In EFT terms, however, this is referred to unresolved emotional issues such as such as trauma, guilt, shame, fear, anger and sadness.



Fortunately, EFT offers great potential for these unresolved emotional issues. You can use it to pull out the emotional roots of your depression … and enjoy your life again. The basics of EFT can be learned by anyone and can be self-applied (usually in minutes).



Described as “emotional acupuncture”, EFT draws from the principles of acupuncture (stimulating the meridian points balances the subtle energies in your body), but instead of using needles, you tap a series of acupuncture points with your fingertips. When your energy system is balanced, the negative emotional responses to past trauma, guilt and anger subside. Without the emotional fuel, depression can’t start its engine.





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How EFT can help you?





  • Remove Negative Emotions

  • Reduce Food Cravings

  • Reduce or Eliminate Pain

  • Implement Positive Goals



EFT is a form of psychological acupressure, based on the same energy meridians used in traditional acupuncture to treat physical and emotional ailments for over five thousand years, but without the invasiveness of needles. Instead, simple tapping with the fingertips is used to input kinetic energy onto specific meridians on the head and chest while you think about your specific problem - whether it is a traumatic event, an addiction, pain, etc. -- and voice positive affirmations.




This combination of tapping the energy meridians and voicing positive affirmation works to clear the "short-circuit" - the emotional block -- from your body's bioenergy system, thus restoring your mind and body's balance, which is essential for optimal health and the healing of physical disease.




Some people are initially wary of these principles that EFT is based on - the electromagnetic energy that flows through the body and regulates our health is only recently becoming recognized in the West. Others are initially taken aback by (and sometimes amused by) the EFT tapping and affirmation methodology.




Proper EFT Tapping





The basic EFT sequence is straightforward and generally takes only a few minutes to learn. With a little practice, you will be performing each round in under a minute.




NOTE: While it is important to tap the correct area, you need not worry about being absolutely precise, as tapping the general area is sufficient.




It's All in the Fingertips





The first thing to understand is that you will be tapping with your fingers. There are multiple acupuncture meridians on your fingertips, and when you tap with your fingertips you are also likely using not only the meridians you are tapping on, but also the ones on your fingers.




Traditional EFT has you tapping with the fingertips of your index finger and middle finger and with only one hand. Either hand works just as well. Most of the tapping points exist on either side of the body, so it doesn't matter which side you use, nor does it matter if you switch sides during the tapping. For example, you can tap under your right eye and, later in the tapping, under your left arm.




There is also a modified approach of having use both hands and all your fingers, so that they are gently relaxed and form a slightly curved natural line. The use of more fingers allows you to access more of the acupuncture points. When you use all your fingers you will cover a larger area than just tapping with one or two fingertips, and this will allow you to cover the tapping points more easily.




The following information provides an overview of the EFT technique to give you a sense of how this amazing "tool" works. But bear in mind that by far the best instruction for this powerful technique is visual/audio instruction.




Ideally, you will want to use your fingertips, not your finger pads as they have more meridian points. However, if you are a woman with long fingernails you should of course use your finger pads (otherwise you may end up stabbing yourself).




You should also remove your watch and bracelets, as that will interfere with your use of the wrist meridian tapping.




Tap Solidly - But Don't Hurt Yourself!





You should tap solidly, but never so hard as to hurt or bruise yourself.




If you decide to use both hands, t is recommended slightly alternating the tapping so that each hand is slightly out of phase with the other and you are not tapping with both hands simultaneously. This provides a kinesthetic variant of the alternating eye movement work that is done in EMDR and may have some slight additional benefit.




When you tap on the points outlined below, you will tap about 5-7 times. The actual number is not critical, but ideally should be about the length of time it takes for one full breath. There is probably a distinct benefit for tapping through one complete respiration cycle.




Please notice that these tapping points proceed down the body. That is, each tapping point is below the one before it. That should make it a snap to memorize. A few trips through it and it should be yours forever. However, unlike TFT, the sequence is not critical. You can tap the points in any order and sequence, just so long as all the points are covered. It just is easier to go from top to bottom to make sure you remember to do them all.




Remove your Glasses and Watch Prior to Tapping





Glasses and watches can mechanically and electromagnetically interfere with EF, so t is recommended to remove them prior to tapping.




Using EFT in Public: Eliminating any Embarrassment





Many people are concerned about embarrassing themselves by using EFT in public, especially when implementing my revision of it, which really makes one stand out in a crowd.




After a while of using and perfecting the technique - in private quarters, if you prefer - you will be able to use only two fingers of one hand, and to say the affirmation softly under your breath or silently. This way you can do EFT in just about any social setting, and if people even notice what you are doing at all, it will appear to them that you are merely thinking.




The tapping points, and their abbreviations, are explained below, followed by a chart of the points. They are presented below in the exact order in which they should be tapped.




Tapping Points





1. Top of the Head (TH)

With fingers back-to-back down the center of the skull.





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2. Eyebrow (EB)

Just above and to one side of the nose, at the beginning of the eyebrow.





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3. Side of the Eye (SE)

On the bone bordering the outside corner of the eye.





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4. Under the Eye (UE)

On the bone under an eye about 1 inch below your pupil.





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5. Under the Nose (UN)

On the small area between the bottom of your nose and the top of your upper lip.





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6. Chin (Ch)

Midway between the point of your chin and the bottom of your lower lip. Even though it is not directly on the point of the chin, we call it the chin point because it is descriptive enough for people to understand easily.





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7. Collar Bone (CB)

The junction where the sternum (breastbone), collarbone and the first rib meet. This is a very important point and in acupuncture is referred to as K (kidney) 27. To locate it, first place your forefinger on the U-shaped notch at the top of the breastbone (about where a man would knot his tie). From the bottom of the U, move your forefinger down toward the navel 1 inch and then go to the left (or right) 1 inch. This point is referred to as Collar Bone even though it is not on the collarbone (or clavicle) per se.





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8. Under the Arm (UA)

On the side of the body, at a point even with the nipple (for men) or in the middle of the bra strap (for women). It is about 4 inches below the armpit.





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9. Wrists (WR)

The last point is the inside of both wrists.





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General overview and sequence:





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Tuning Into Your Problem






Now that you understand how to actually perform the mechanical tapping and where you need to tap, you will next need to know what to say while you are tapping.




The traditional EFT phrase uses the following setup:


"Even though I have this _____________,


I deeply and completely accept myself."


You can also substitute this as the second part of the phrase:


"I deeply and completely love and accept myself."





The blank above is filled in with a brief description of the addiction, food craving, negative emotion or other problem you want to address.




Examples Using the Traditional EFT Phrasing





While these examples represent a range of problems, keep in mind there really is no limit to the types of issues you can confront with EFT:


"Even though I have this fear of public speaking, I deeply and completely accept myself."


"Even though I have this headache, I deeply and completely accept myself."


"Even though I have this anger towards my father, I deeply and completely accept myself."


"Even though I have this war memory, I deeply and completely accept myself."


"Even though I have this stiffness in my neck, I deeply and completely accept myself."


"Even though I have these nightmares, I deeply and completely accept myself."


"Even though I have this craving for alcohol, I deeply and completely accept myself."


"Even though I have this fear of snakes, I deeply and completely accept myself."


"Even though I have this depression, I deeply and completely accept myself."





Other EFT Phrase Options





You can also try these other phrase variations. All of these affirmations are correct because they follow the same general format. That is...they acknowledge the problem and create self-acceptance despite the existence of the problem. That is what's necessary for the affirmation to be effective.




You can use any of them, but I suggest you use the recommended one above because it is easy to memorize and has a good track record at getting the job done.




"I accept myself even though I have this_________."


Or:


"Even though I have this ____________, I deeply and profoundly accept myself."


OR:


"I love and accept myself even though I have this_______________."





The following information provides an overview of the EFT technique to give you a sense of how this amazing "tool" works. But bear in mind that by far the best instruction for this powerful technique is visual/audio instruction.




Interesting Points About the Affirmation Statements





It doesn't matter whether you believe the affirmation or not...just say it.




It is better to say it with feeling and emphasis, but saying it routinely will usually do the job.




It is best to say it out loud, but if you are in a social situation where you prefer to mutter it under your breath...or do it silently...then go ahead. It will still likely be effective.




To add to the effectiveness of the affirmation, The Setup also includes the simultaneous tapping on one of the acupuncture meridian points.




Tuning in is seemingly a very simple process. You merely think about the problem while applying the tapping. That's it...at least in theory.




"The cause of all negative emotions is a disruption in the body's energy system."




Negative emotions come about because you are tuned in to certain thoughts or circumstances, which in turn, cause your energy system to disrupt.




Otherwise, you function normally. One's fear of heights is not present, for example, while one is reading the comic section of the Sunday newspaper and therefore not tuned in to the problem.



Tuning in to a problem can be done by simply thinking about it. In fact, tuning in means thinking about it.


Thinking about the problem will bring about the energy disruptions involved which then...and only then...can be balanced by applying The Basic Recipe.



Without tuning in to the problem, thereby creating those energy disruptions, EFT does nothing.




Putting It All Together First Round of Tapping





Now you will need to tap on each of the points described above while you are stating the positive affirmation. This will only take a few moments to do.



You should:


  • Select an appropriate affirmation

  • Carefully "tune in" to your problem by actually trying to hold the problem in your thought:

  • State the affirmations in a loud voice with great passion, energy and enthusiasm



If you do this while tapping the points described earlier, it is highly likely you will notice a major decrease in the issue or problem that you were tapping on. If your problem or issue resolves completely, you are done with the tapping.




EFT Cautions and Advice





The following information provides an overview of the EFT technique to give you a sense of how this amazing "tool" works. But bear in mind that by far the best instruction for this powerful technique is visual/audio instruction.




Clinicians and clients should only do what feels right or good to them. You should not enter into emotional or physical waters that seem threatening. It is your responsibility to take care of yourselves in this setting. Remember professional help is easily available. Here are some cautions and advice with EFT.




Be Specific





It is essential for clinicians to be extremely specific with language when using EFT.




Tuning In





The clients need to be totally tuned in to the issue of concern when using EFT. Sometimes, when the material is emotionally painful, clients will want to disconnect from their feelings. Look for any signs that the client is becoming distracted or disengaged and make sure that they repeat the Reminder Phrase as they tap the treatment points.




Cognitive Shifts





As with energy movement, it is essential to pay attention to the cognitive shifts that can occur with even a single round of the tapping. A cognitive shift has occurred when you reframe the problem. Seeing the problem from a new angle, you will often express a sense of surprise and insight. These movements can offer valuable connections and associations and may open new pathways for healing. Following a cognitive shift, you often feel less guilt and self-blame, more hope, or a simple sense of relief in an area where there has never been relief before.




It is important to stop after tapping and see if you notice anything different or if something new came up after you tapped. This is frequently the underlying issue that is the real root of your problem.




Try It On Everything





EFT can be used to treat deep limiting beliefs, fears of the future, fear of success, fear of failure, and anxiety about expectations, poor body image and future relapse settings. One of the favorite sayings of Gary Craig, founder of EFT, is "Try it on everything."




Energy and Intention





Many clients report that they do not have the same success when using EFT by themselves and on themselves. This likely has to do, in part, with the advantage of combining the energy and intention of two people sharing a single purpose during a session. When clients are less than satisfied with their own results, it is best to find a therapist to help them resolve the issue at a deeper level.




Through Me, Not By Me





This is one of Gary Craig's other favorite sayings. EFT practitioners are NOT healing their clients. The healing is done through us if our clients are open to receive it.




Many people see themselves as special healers. This, in fact, interferes with the treatment process. The reality is that they are not healing anybody; the clients are actually healing themselves. Witnessing and facilitating this process is humbling as well as gratifying.




Keep Well Hydrated





Water conducts electricity, and EFT accesses the electrical energy that flows through our bodies and minds. It is very important for both you and your clients to be properly hydrated. That would be about one quart of pure water per day for every fifty pounds of body weight.







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Sources and Additional Information:










45 Lifestyle Recommendations on How to Get Through Depression



On a day-to-day basis, separate from, or concurrently with therapy or medication, people suffering from depression have their own methods for getting through the worst times as best they can. The following comments and ideas on what to do during depression were solicited from people in the alt.support.depression newsgroup. These recommendations might work for you, or might not. Just keep trying them, modifying them for your own lifestyle and personal preferences, until you find the set of techniques that work for you most efficiently.


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  1. Write. Keep a journal. Somehow, writing everything down helps organizing better your thoughts and feelings, keeping the misery from running around in circles.



  1. Listen to your favorite "help" songs (a bunch of songs that have strong positive meaning for you and relief for the depression nightmare).



  1. Read (anything and everything). Go to the library and check out fiction you've wanted to read for a long time. You also might find useful reading books about depression, spirituality, and morality; or on the people who suffered from depression but still managed to do fairly well with their lives, like Winston Churchill and Martin Luther, for example.



  1. Sleep for a while. Even when busy, do your best to get a good sleep. Notice if what you do before sleeping changes how you sleep in terms of length and rest quality. Follow the pattern, which helps you and verify how consistent the results are.



  1. If you might be a danger to yourself, don't be alone. Find people. If that is not practical, call them up on the phone. If there is no one you feel you can call, suicide hotlines can be helpful, even if you're not quite that badly off yet. You will get professionals and trained volunteers to talk to you and may be show a different angle to your troubles, to start with.



  1. Hug someone or have someone hug you. Personal touch is so important, and we almost lost it in our high-tech individualistic society.



  1. Remember to eat. Notice, how eating certain things (e.g. sugar or coffee) may influence on our mood and feelings. Keep “comfort food” always handy in the house to be able to get it as needed.



  1. Make yourself a fancy dinner, maybe invite someone over.



  1. Take a bath or a perfumed bubble bath. Go to spa, massage, or hot springs resort. You may find that spending just couple of hours there may change your mood and bring calmness to your life.



  1. Mess around on the computer. Talk to friends in social networks, blog, answer surveys, watch cartoons, and look if you can find relief in virtual life.



  1. Rent comedy videos. Try to concentrate on the fun of what you are watching.



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  1. Go for a long walk. Look around, notice people, nature, birds. Watch the sky and the moon at night.



  1. Dance. Dance alone at home, or go out with friends. Experiment with different music and its influence on your well-being. Try 5-rithms, Ecstatic, or Zen Dancing, as it is the best if you want to dance alone.



  1. Eat well. Try to alternate foods you like with the stuff you know you should be eating.



  1. Spend some time playing with a child. There is no other activity, more rewarding emotionally.  



  1. Buy yourself a gift. O yes, shopping therapy works excellent for some people. Do not have money – try windows shopping, or browse goodies on eBay or Amazon. Do not worry that you might not actually need the staff. If you just want it – buy it. That works pretty good as clothes for women, or electronic gadgets for men.



  1. Phone a friend. Hopefully, you do have a close friend who will be able to listen to your troubles, or an opposite, will talk you out of your problems.



  1. Read the newspaper comics page. Stupid jokes? So what? May be that what you need at the moment?  



  1. Do something unexpectedly nice for someone or for yourself. Break the boring routine, go out, and be creative.



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  1. Get involved in physical activities, get exercise at home, play active sport on WII. Get out to the fitness club and work to feel your body. Maybe, you get better, when depressive state will evaporate with your dew.



  1. If you have garden or backyard, get there, pull the weeds, or cut the grass. Therapeutic gardening is a scientifically proved approach to get better with depression.



  1. Sing. If you are worried about responses from critical neighbors, go for a drive and sing as loud as you want in the car. There's something about the physical act of singing old favorites that's very soothing. Maybe the rhythmic breathing that singing enforces does something for you too. Lullabies are especially good.



  1. If you cannot force yourself to any activities, try again. Pick a small and easy task, like sweeping the floor, and do it. This helps you feel better because you actually accomplish something, instead of getting caught up in abstract worries and huge ideas for change. For example say "hi" to someone new if you are trying to be more sociable.



  1. If you can meditate, it's really helpful. But when you're really down you may not be able to meditate. Your ability to meditate will return when the depression lifts. If you are unable to meditate, find some comforting reading and read it out loud.



  1. Bring in some flowers and look at them.



  1. If you're anxious about something you're avoiding, try to get some support to face it.



  1. Getting Up. Many depressions are characterized by guilt, and lots of it. Many of the things that depressed people want to do because of their depressions (staying in bed, not going out) wind up making the depression worse because they end up causing depressed people to feel like they are screwing things up more and more. So if you've had six or seven hours of sleep, try to make yourself get out of bed the moment you wake up...you may not always succeed, but when you do, it's nice to have gotten a head start on the day.



  1. Volunteer work. Doing volunteer work on a regular basis seems to keep the demons at bay, somewhat... it can help take the focus off of yourself and put it on people who may have larger problems (even though it doesn't always feel that way).



  1. In general, it is extremely important to try to understand if something you can't seem to accomplish is something you simply CAN'T do because you're depressed (write a computer program, be charming on a date), or whether its something you CAN do, but it's going to be hell (cleaning the house, going for a walk with a friend, getting out of bed). If it turns out to be something you can do, but don't want to, try to do it anyway. You will not always succeed, but try. And when you succeed, it will always amaze you to look back on it afterwards and say "I felt like such shit, but look how well I managed to...!" This last technique, by the way, usually works for body stuff only (cleaning, cooking, etc.). The brain stuff often winds up getting put off until after the depression lifts.



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  1. Do not set yourself difficult goals or take on a great deal of responsibility.



  1. Break large tasks into many smaller ones, set some priorities, and do what you can, as you can.



  1. Do not expect too much from yourself. Unrealistic expectations will only increase feelings of failure, as they are impossible to meet. Perfectionism leads to increased depression.



  1. Try to be with other people, it is usually better than being alone.



  1. Participate in activities that may make you feel better. You might try mild exercise, going to a movie, a ball game, or participating in religious or social activities. Don't overdo it or get upset if your mood does not greatly improve right away. Feeling better takes time.



  1. Do not make any major life decisions, such as quitting your job or getting married or separated while depressed. The negative thinking that accompanies depression may lead to horribly wrong decisions. If pressured to make such a decision, explain that you will make the decision as soon as possible after the depression lifts. Remember you are not seeing yourself, the world, or the future in an objective way when you are depressed.



  1. While people may tell you to "snap out" of your depression, that is not possible. The recovery from depression usually requires antidepressant therapy and/or psychotherapy. You cannot simple make yourself "snap out" of the depression. Asking you to "snap out" of a depression makes as much sense as asking someone to "snap out" of diabetes or an under-active thyroid gland.



  1. Remember: Depression makes you have negative thoughts about yourself, about the world, the people in your life, and about the future. Remember that your negative thoughts are not a rational way to think of things. It is as if you are seeing yourself, the world, and the future through a fog of negativity. Do not accept your negative thinking as being true. It is part of the depression and will disappear as your depression responds to treatment. If your negative (hopeless) view of the future leads you to seriously consider suicide, be sure to tell your doctor about this and ask for help. Suicide would be an irreversible act based on your unrealistically hopeless thoughts.



  1. Remember that the feeling that nothing can make depression better is part of the illness of depression. Things are probably not nearly as hopeless as you think they are.



  1. If you are on medication:

     a. Take the medication as directed. Keep taking it as directed for as long as directed.
     b. Discuss with the doctor ahead of time what happens in case of unacceptable side-effects.
     c. Don't stop taking medication or change dosage without discussing it with your doctor, unless you discussed it ahead of time.
     d. Remember to check about mixing other things with medication. Ask the prescribing doctor, and/or the pharmacist and/or look it up in the Physician's Desk Reference. Redundancy is good.
     e. Except in emergencies, it is a good idea to check what your insurance covers before receiving treatment.


  1. Do not rely on your doctor or therapist to know everything. Do some homework; find the information on your depression type and everything associated. Note that not everything you are reading is true, or absolutely true, or should be true for you. Apply your critical thinking to all the information acquired.



  1. Feel free to seek out a second opinion from a different qualified medical professional if you feel that you cannot get what you need from the one you have, or you want be absolutely confident that your diagnosis is correct.



  1. Skipping appointments, because you are "too sick to go to the doctor" is generally a bad idea…



  1. Do not try to keep everything in your head, write them down, or record audio reminders on your mobile phone. Try concentrating and working out one task at a time. Trying to do too many things can be too much. Have a short list of things to do "now" and a longer list of things you have decided not to worry about just yet. When you finish writing the long list, put it aside for a while. Also, keep a list of what you have already accomplished too, and congratulate yourself each time you get something done. Don't take completed tasks off your to-do list. If you do, you will only have a list of uncompleted tasks. It's useful to have the crossed-off items visible so you can see what you have accomplished.



  1. Get a pet. Pet therapy works excellent for some people. The most popular doctors are definitely cats and dogs.



  1. Make your own list of recommendations and share with other people. Every depression is unique and individual, as all people are different. But you will be surprised of how much common you can find with other human beings. 



Depression and Suicide - Preventing Suicidal Attempts

Types of Suicidal Behavior



The concept of suicide is relatively straightforward, as it is defined by a legal judgment where there is clear evidence that the person intended to take his or her own life. Cases where clear evidence is lacking but the suspicion is of suicide are usually recorded as undetermined deaths and are often included in the suicide statistics. Non-fatal suicidal behavior is more complicated because of the range of behaviors encompassed and the variety of terms used.


The terms usually imply something about the level of intent to die; for example, ‘attempted suicide’ implies a strong intention to die, whereas ‘deliberate self-harm’ does not. It is tempting to make judgments about the level of intent, but this is difficult to do in practice.


People are often unaware of the medical lethality of the overdose they have taken (by far the most common type of self-harm), thus rendering this a poor criterion. Moreover, when asked, most commonly, people simply say they wanted to escape; they may not be clear about whether they wanted to die or not. Finally, individuals with more than one episode of self-harm are quite likely to have a mixture of levels of intent across different episodes. One solution suggested by Kreitman (1977) was to use the term ‘parasuicide’ as a descriptive term to cover all deliberate but non-fatal acts of self-harm, thus, remaining neutral about level of intent to die.


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Signs of Possible Suicidal Intentions



Although suicide is very hard to predict, there are some reliable indicators of risk.
  • Those who are seriously depressed are quite likely to have thoughts of suicide. (NOTE: 'thoughts' does not necessarily imply an attempt or even a desire to act on the thoughts.)

  • Other emotional illnesses such as severe anxiety or confusion can lead to the idea that "life is not worth living."

  • The person is always talking or thinking about death. It might be even perceived as obsession.

  • Anyone who has previously attempted suicide is at increased risk.

  • Recent losses, particularly deaths of close relatives or friends, heighten vulnerability.

  • Alcohol and drugs can dissolve inhibitions against suicide.

  • Having a "death wish," tempting fate by taking risks that could lead to death such as driving fast or running red lights.

  • Preparations for death, such as giving away possessions or acquiring a gun, are cause for great concern. It might show up as putting affairs in order, tying up loose ends, changing a will, or visiting or calling people to say goodbye.

  • A sudden lift in spirits in a depressed person can mean a decision has been reached that will "end the misery."

Factors associated with increased suicide risk after acts of deliberate self-harm



The individual, who has performed an actual self-harm attempt, can be considered as stepping closer in the group of risk, whose mere thoughts have been already translated to the practical actions. Watch for the following behavioral factors that are associated with higher risk of the suicide. 
  • Act of deliberate self-harm planned long in advance.

  • Suicide note written.

  • Acts taken in anticipation of death (e.g. writing a will).

  • Being alone at the time of deliberate self-harm.

  • Patient making attempts to avoid discovery.

  • Not seeking help after deliberate self-harm.

  • Stating a wish to die.

  • Believing the act of deliberate self-harm would prove fatal.

  • Being sorry the act of deliberate self-harm failed.

  • Continuing suicidal intent.

Two particular groups of patients are at significantly increased risk of suicide: those with a history of suicide attempts; and those recently discharged from psychiatric inpatient care. About 1% of all deliberate self-harm patients commit suicide within 12 months of a suicide attempt, and up to 10% may eventually die by suicide. In addition 10–15% of patients in contact with health services following a suicide attempt will eventually die by suicide, this risk being greatest during the first year after an attempt. Up to 41% of suicide victims have received psychiatric inpatient care in the year prior to death, and up to 9% of suicide victims kill themselves within 1 day of discharge.


Depression and Suicidal Attempts



Those with depression have a greater risk of deliberate self-harm and suicide. A recent meta-analysis estimated the standardized mortality ratio for completed suicide of those who had previously attempted suicide to be over 4000, higher than the risk attached to any particular psychiatric disorder, including major depression or alcoholism. Other risk factors for suicide include:
  • older age

  • male gender

  • single status

  • personality disorder

  • history of aggression

  • suicidal thoughts

  • social isolation

  • physical illness

  • alcohol abuse

  • recent suicide attempt

Suicide and Bereavement (loss of something or someone that one loves)



There is an increased risk of suicidal gestures, completed suicide and death from accidents following the death of a spouse or a parent. The suicide risk for those widowed was first observed over a century ago by Durkheim who found that suicide was higher amongst those widowed compared to those married.


When compared to the general population Mergenhagen and colleagues found the mortality ratio for suicide in young widowers (45–64 years of age) was about four and a half times the rate for married men of similar age. Most studies have found a gender bias with younger men being at the greatest risk of suicide, although Heikkinen and coworkers found evidence of an association between widowhood and women aged 60–69 years.
Several longitudinal studies have found that the risk of suicide is greatest for the period immediately following the loss. The risk of suicide among the widowed population was generally higher in the first 4 years after the death of the spouse, the risk of suicide in the first year was 2.5 times higher, and in the first, second and third years about 1.5 times higher.


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Relation between depression and suicide



There is a strong link between depression and suicidal behavior, but there is also high divergence, as shown especially by the fact that the vast majority of depressed people do not commit or attempt suicide. The presence or absence of other factors might help explain this divergence. Factors such as other psychiatric diagnoses, especially personality disorder; protective factors; and other psychological factors, such as personality and affective traits, and problem-solving skills, have all been shown to distinguish suicidal from non-suicidal depressed individuals.


The relationship between depression and suicide is mainly dependent on one particular facet of depression—hopelessness about the future. Hopelessness appears to consist mainly of a lack of positive thoughts about the future rather than preoccupation with a negative future. Risk assessment and intervention in suicidal behavior are difficult because of the relatively low base rate of suicidal behavior and the heterogeneity of those who engage in it. Predictive models, whether using depressive hopelessness or a range of factors, are able to identify those at risk only through incorrectly classifying unacceptably high numbers of people as at risk. Because of predictive inaccuracy, the emphasis has shifted to assessment of relative risk rather than absolute risk.


Treatments of depression are themselves never likely to be effective treatments for suicidal behavior per se. The majority of studies testing specific interventions for suicidal behavior have shown no benefit over treatment as usual, though a number of studies have shown positive results. There is no obvious pattern to the successful interventions in terms of their content, though they do seem either to target a specific subgroup of parasuicides or to involve a brief, flexible treatment delivered at home. Both these strategies potentially limit the problem of heterogeneity. A modular approach provides a framework for incorporating a range of treatment strategies derived from the interface between basic and applied research. Developing strategies to tackle depressive hopelessness, particularly lack of positivity about the future, is one of the most needed and promising lines for future research.






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Low testosterone levels in men can cause depression

Men with low levels of testosterone are more likely to be depressed, Australian researchers have found, and they recommend that those with abnormally low levels be treated with injections of the sex hormone. A study of men over the age of 70 revealed that those with the lowest testosterone levels are three times more likely to suffer depression than those with the highest levels.


The results held regardless of overall physical health; the link between poor health and depression is well established. "There is good rationale for considering using testosterone replacement to improve mood" for patients with low levels of testosterone, said the author of the study, published in Archives of General Psychiatry. "This is the most compelling case for the link yet."


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Lead author Dr. Osvaldo P. Almeida, MD, PhD, director of research at the Western Australian Centre for Health and Ageing, and professor and chair of Geriatric Psychiatry, School of Psychiatry and Clinical Neurosciences, at the University of Western Australia, in Perth, notes that. "Older men with depression should be assessed for hypogonadism, and older hypogonadal men who fail to respond to standard antidepressant therapy may benefit from testosterone replacement."


The study looked at 3,987 men aged 71 to 89 years who live in Perth, Australia. The men were screened for cognitive impairment and depression, and 203 (5.1%) had a score within the depression range (scores of 7 or more). Compared with men in the highest 20%, the odds of having depression in men in the lowest 20% for total testosterone were almost doubled. This change could be accounted for by other health problems, but when they looked at the more reliable "free testosterone" blood test , the researchers found that even after eliminating the effects of other health issues, the low testosterone itself was associated with a 270% higher risk of depression.


According to Dr. Almeida, "The findings of this study are compelling in suggesting a causal relationship between low free testosterone and depression in older men… The association is biologically plausible; there is evidence from lab work that testosterone may increase the bioavailability of serotonin and noradrenaline in the brain and this could explain its antidepressogenic effect."


It is free testosterone, or testosterone that is not bound to the proteins albumin and sex-hormone-binding globulin, that is biologically active (also called "bioavailable" testosterone). "In other words, if we wish to clarify what testosterone does, we need to look at free testosterone," said Dr. Almeida.


He noted, too, that while depression is more prevalent among women, the gap between the sexes "all but disappears" later in life. "Our findings may partly explain why that is so," he said.


"There's definitely a connection," claims Dr. William McDonnell, director of the Fuqua Center for Late-Life Depression at Emory University. "For years, we've known that depression can be related to low thyroid levels and to B-12 deficiency. But the effect of low testosterone levels has been little known. It's really an undiscovered field."


Although it's often hard to pinpoint the cause of depression, or even to say exactly what it is, there's little denying that testosterone levels drop with age and that many older men experience depression.


The numbers, in fact, are dramatic. As if youth doesn't confer enough blessings, only 1 percent of men ages 20 to 40 have low testosterone. But rates rise to 7 percent between ages 40 and 60, and to 20 percent between 60 and 80, according to a study on WebMD.com. Roughly 35 percent of men older than 80 show low levels.


As many as 5 million American men have low testosterone levels, known medically as hypogonadism.


"Somewhere between age 60 and 80, at least half of all men will experience a significant decline in testosterone levels," said Dr. Martha Louise Elks, associate dean of the Morehouse School of Medicine.


Symptoms of low testosterone


As men get older, the ability to produce testosterone declines.  This decrease in testosterone production is sometimes referred to as andropause or “male menopause.”  If testosterone levels fall below the normal range some typical symptoms may include:
·         Low sex drive
·         Erectile dysfunction (ED)
·         Fatigue
·         Reduced muscle mass and strength
·         Inability to concentrate
·         Decreased bone density; osteoporosis


In addition to age-related low testosterone, there are certain medical conditions that can cause low testosterone.  These medical conditions can begin in youth or in adulthood, and can affect testosterone levels throughout a man’s life.  Some of these conditions are associated with the testicles, primary gland and hypothalamus (a part of the brain that controls many of the body’s glands).  Occasionally, the problem can be genetic.
In younger men, low testosterone production may reduce the development of body and facial hair.  Muscle mass and genitals may not develop normally, and younger men’s voices may fail to deepen.


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Check levels


"Either doctors don't think to check or patients are embarrassed to ask about it," Elks said. "I don't know if a blood test needs to be routinely given for it, but physicians at least need to routinely ask about changes in libido as a man ages."


Elks is a hormone specialist. The relationship between depression and low testosterone "has been common knowledge in the medical literature for years, but it just hasn't been taught much in medical school," she said. "Sexual dysfunction obviously is a topic that male teachers have a hard time talking about."


Another reason it escapes detection is the steady -- rather than dramatic -- nature of testosterone decline.


Emory is embarking on a study of testosterone levels in patients with depression. One study group is composed of patients with Parkinson's disease, half of whom also experience depression.


"Some Parkinson's patients who don't respond very well to antidepressants like Prozac or Paxil have very low testosterone levels," said McDonald, a geriatric psychiatrist.


Also to be studied are prostate cancer patients, as well as depressed men without Parkinson's who fail to respond to medication. Testosterone worsens prostate cancer, and patients are treated with drugs and even castrated in severe cases. Researchers will assess depression rates in this group as well.


Treatment for low testosterone takes various forms -- shots, patches and a gel called AndroGel produced by Unimed Pharmaceuticals Inc., a subsidiary of Solvay Pharmaceuticals Inc., whose U.S. headquarters is in Marietta.


"If you like the mood shifts of adolescence, you'll love the mood shifts of testosterone shots," Elks said.


Supplements can have a quick effect, boosting stamina and dramatically increasing a man's sense of well-being.


"Someone with low testosterone is generally sluggish, has problems sleeping, doesn't concentrate well and is losing weight," McDonald said. "It's a general malaise. Give him testosterone and he'll start putting on weight, sleep better and get his energy back."


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Side Effects


Taking testosterone supplements is not without danger. Besides spurring the growth of prostate cancer, supplements can "affect the liver and raise overall cholesterol," wrote Dr. Ken Goldberg for WebMD. Men receiving them should have "an annual PSA blood test, digital rectal exams every six months and annual liver and blood counts."


AndroGel has been on the market since mid-2000. It is applied to the shoulder, upper arm or abdomen once a day, and quickly restores testosterone levels.


AndroGel has been a popular product, with sales topping $100 million last year, said Unimed CEO Jean-Louis Anspach. A market that had been growing at a rate of 9 percent to 12 percent in the three years before the gel's launch has grown by more than 60 percent since.





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Bipolar Disorder

Overview



Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.



Statistics



About 5.7 million Americans, or 2.6% of the American population over the age of 18, have bipolar disorder.



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Symptoms



The manic phase may last from days to months and can include the following symptoms:
  • Agitation or irritation

  • Elevated mood


    • Hyperactivity

    • Increased energy

    • Lack of self-control

    • Racing thoughts


  • Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)

  • Little need for sleep

  • Over-involvement in activities

  • Poor temper control

  • Reckless behavior


    • Binge eating, drinking, and/or drug use

    • Impaired judgment

    • Sexual promiscuity

    • Spending sprees


  • Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.



The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:
  • Difficulty concentrating, remembering, or making decisions

  • Eating disturbances


    • Loss of appetite and weight loss

    • Overeating and weight gain


  • Fatigue or listlessness

  • Feelings of worthlessness, hopelessness and/or guilt

  • Loss of self-esteem

  • Persistent sadness

  • Persistent thoughts of death

  • Sleep disturbances


    • Excessive sleepiness

    • Inability to sleep


  • Suicidal thoughts

  • Withdrawal from activities that were once enjoyed

  • Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.



Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.



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How does bipolar disorder affect someone over time?



Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.



Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:
  1. Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.

  2. Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.

  3. Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.

  4. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.  Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder.  Rapid cycling affects more women than men.



Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.  Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.



Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.


Treatment



For the manic phase of bipolar disorder, antipsychotic medications, lithium, and mood stabilizers are typically used. For the depressive phase, antidepressants are sometimes used, with or without the manic phase treatment.



There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. However, in studies that followed patients for 2 years, lithium and some antipsychotics were found to be moderately successful.



Antipsychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.



Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.



Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.



Risk factors for bipolar disorder



Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.




Genetics



Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person's chance of developing the illness. Genes are the "building blocks" of heredity. They help control how the body and brain work and grow. Genes are contained inside a person's cells that are passed down from parents to children.



Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.



Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had:
  • Missed work because of their illness

  • Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders

  • Been treated or hospitalized for bipolar disorder.

The researchers also identified certain traits that appeared to run in families, including:
  • History of psychiatric hospitalization

  • Co-occurring obsessive-compulsive disorder (OCD)

  • Age at first manic episode

  • Number and frequency of manic episodes.

Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.



But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person's environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.



Brain structure and functioning



Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.  Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain's structure and activity.



Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with "multi-dimensional impairment," a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia.  This suggests that the common pattern of brain development may be linked to general risk for unstable moods.



Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.



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Tests & diagnosis



A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:
  • Ask about your family medical history, particularly whether anyone has or had bipolar disorder

  • Ask about your recent mood swings and for how long you've experienced them

  • Observe your behavior and mood

  • Perform a thorough examination to identify or rule out physical causes for the symptoms

  • Request laboratory tests to check for thyroid problems or drug levels

  • Speak with your family members to discuss their observations about your behavior

  • Take a medical history, including any medical problems you have and any medications you take

Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.



Prognosis



Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.



Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early manic states may feel good, discontinuing medication may have very negative consequences.



Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.



Complications



Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:
  • Alcohol and/or drug abuse as a strategy to "self-medicate"

  • Personal relationships, work, and finances suffer

  • Suicidal thoughts and behaviors

This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.



When to contact a doctor



Call your health provider or an emergency number right way if:
  • You are having thoughts of death or suicide

  • You are experiencing severe symptoms of depression or mania

  • You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms

If you have suicidal thoughts



Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
  • Contact a family member or friend.

  • Seek help from your doctor, a mental health provider or other health care professional.

  • Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.

  • Contact a minister, spiritual leader or someone in your faith community.



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