Ketamine – that’s an anesthesia, isn’t it? Correct.
But did you know that in sub-anesthetic doses it is also a promising treatment option for pain and depression?
Let’s start at the beginning.
What is Ketamine and how does it work?
Ketamine is a medication primarily used for anesthesia. It is an antagonist of the NMDA receptors in the brain which are responsible for the anesthetic, analgesic and psychotomimetic effects. Although it’s not entirely clear how ketamine works in the treatment of depression, here’s what the scientists think. The binding of the NMDA receptors increase the neurotransmitter glutamate. This then activates the AMPA receptor. Together, the blockade of NMDA receptors and activation of AMPA receptors leads to the release of other molecules that allow neurons to communicate better. This process is called synaptogenesis and synaptic potentiation, and is the process that is thought to affect mood, thought patterns and cognition.
What is Ketamine being used for in psychiatry?
Ketamine is being used for the management of treatment-resistant depression, bipolar disorder, obsessive compulsive disorder, and post-traumatic stress disorder.
How is Ketamine administered?
At this time, Ketamine is available in multiple formulations, although the intranasal (esketamine) and intravenous routes have the most compelling evidence for the treatment of depression. Whether intranasal or intravenous, repeated dosing is necessary to maintain a therapeutic benefit.
If you’re wondering which is better, there are no current head-to-head studies comparing the two.
Can Ketamine be used alone?
Multiple studies have demonstrated compelling evidence of Ketamine’s effect in treatment-resistant depression. Intranasal esketamine is typically co-administered with an antidepressive medication. Intravenous Ketamine can be administered as monotherapy or adjunctively with a psychotropic regimen.
How is Ketamine tolerated?
Overall, Ketamine is well-tolerated. It has a rapid onset (within 1-2 days) and has been shown to have a rapid reduction in suicidal ideation and depressive symptoms.
The most common side-effect noted with Ketamine administration is dissociation. Individuals describe it as a perceptual disturbance or “abnormal sensation”, but studies have shown no deficits in cognitive function with Ketamine use. For the most part, any changes in perception or dissociation are most noticeable during the first infusion and improve quickly afterward.
Other side effects include high blood pressure, nausea and vomiting.
At this time, the long-term effects of Ketamine are unknown.
In Conclusion…
Ketamine and esketamine represent novel treatment avenues for treatment-resistant depression and other psychiatric disorders. Although the long-term effects are still unknown, multiple studies have demonstrated the efficacy of sub-anesthetic doses of Ketamine in the treatment of psychiatric disorders.
Still have questions? Visit the Ketamine section of our website for more information.
If you are battling treatment-resistant depression and want to know if Ketamine is a treatment option for you, call (913) 381-8555 and make an appointment.
References:
McIntyre RS, et al. Synthesizing the evidence of ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation. Am J Psychiatry 2021;178:383-399.
Moda-Sava RN, et al. Sustained rescue of prefrontal circuit dysfunction by antidepressant-induced spine formation. Science 2019;Vol 364, Issue 6436
Healthcare workers (HCW’s), including doctors, nurses, nursing assistants, and more, have been on the frontline of the COVID-19 pandemic since it’s onset. You can imagine that this has had a significant impact on their mental health, but to what extent?
Several studies have recently been published describing the increased levels of anxiety, depression, and post-traumatic stress of those directly facing the COVID-19 pandemic. In both China and Italy, around 1300 frontline workers in each country were surveyed. The results were similar in both groups. Increased anxiety was reported by 25-44%, 25-50% reported depression, 10-30% reported insomnia, and 50-70% reported post-traumatic stress symptoms and distress. Younger age and female sex were associated with higher levels of stress in both studies. This could be a confounding factor in both studies, as more nurses, and mostly female nurses, were surveyed, however, it could also be related to the fact that nurses spend more time in direct contact with their patients. Overall, it’s not surprising that the mental health of HCWs has been affected by working on the frontlines of the pandemic.
Following the 2003 SARS outbreak, studies demonstrated an adverse psychological effect among healthcare workers as well. It is clear that pandemics like SARS and COVID-19 can create stress among all populations, but healthcare workers also are tasked with managing this stress while continuing to care for their patients, the increased risk of infecting themselves, and potentially their loved ones. If you or someone you know is experiencing increased anxiety, stress, and/or depression related to the pandemic, do not hesitate to reach out. The CDC has a specific page related to coping with mental health issues during this time, as well as numerous resources listed that you can access here.
References:
Lai J, Ma S, Wang Y. Factors associated with mental health outcomes among health care workers exposed to Coronavirus disease 2019. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229
Rossi R, Socci V, Pacitti F, et al. Mental health outcomes among frontline and second-line health care workers during the Coronavirus disease 2019 (COVID-19) pandemic in Italy. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766378
Pappa S, Vasiliki N, Katsaounou P, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206431/#__ffn_sectitle
Alcohol use disorder (AUD), or alcoholism, affects more than 14 million individuals over the age of 18 in the United States alone.1 AUD is described as a chronic brain disease that is characterized by compulsive drinking, loss of control over the consumption of alcohol, and experiencing negative emotions when not using alcohol.2
The treatment of AUD typically starts with detox. For individuals with a physiological dependence to alcohol, the abrupt cessation of drinking could result in serious complications, such as alcohol withdrawal seizures. A supervised medical detox, whether inpatient or outpatient, is always recommended.3
So I’ve completed detox, what’s next?
Treatment programs, like Awakenings KC, will employ various modalities to assist in continued abstinence from alcohol. These include, but are not limited to, behavioral therapy, family therapy, and/or the treatment of co-occurring disorders.
Ketamine is an anesthetic medication that acts on the central nervous system through antagonism of the N-Methyl-D-Aspartate (NMDA) receptor.4-6 Ketamine is different than other anesthetics in that it has a good safety profile and lacks the major drawback of respiratory depression.5
Over the past decade, it has been increasingly used in the treatment of depression and addiction. How does it work? Well, scientists are not 100% sure, but several mechanisms have been proposed and substantiated with research. Several animal and human models have demonstrated that ketamine can rewrite maladaptive reward memories, enhance neuroplasticity and neurogenesis, and enhance psychological therapy efficacy.4-6
Ketamine in the treatment of addiction.
Ketamine has shown promising results in the treatment of addiction.4-6 Studies have shown that ketamine infusion can promote abstinence from alcohol and reduce cravings. In recently detoxified alcoholics, abstinence rates increased from 24% to 66% in the ketamine group.7
Although ketamine itself has been utilized as a drug of abuse, in sub-anesthetic doses, it is not “rewarding”. In multiple studies, there were no patients that went on to abuse ketamine following their infusion treatments.6
In summary…
Ketamine has been shown to increase synaptogenesis and neuroplasticity.6 What does this mean? It helps restructure and reorganize the brain at a cellular level, helping to reverse the changes that are associated with depression and addiction.
Ketamine is safe, effective, and shows promising results in the treatment of depression and addiction.
If you’re interested in more information about ketamine infusions, check out the Awakenings KC website here or call for a consultation – (913) 381-8555.
Das RK, Grace G, Walsh K, et al. Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories. Nature communications. 2019;10:5187.
Ezquerra-Romano I, Lawn W, Krupitsky E, et al. Ketamine for the treatment of addiction: evidence and potential mechanisms. Neuropharmacology. 2018;142:72-82.
McAndrew A, Lawn W, Stevens T, et al. A proof-of-concept investigation into ketamine as a pharmacological treatment for alcohol dependence: study protocol for a randomized controlled trial. Trials. 2017;18:159.
Krupitsky EM, Burakov AM, Romanova TN, et al. Attenuation of ketamine effects by nimodipine pretreatment in recovering ethanol dependent men: psychopharmacologic implications of the interaction of NMDA and L-type calcium channel antagonists. Neuropsychopharmacology. 2001;6:936-47.
When was the last time you got 8 hours of sleep? Needed an extra cup of coffee this morning? Learn about the importance of sleep to our mental health and ways to improve your quality of sleep.
Living in the fast-paced 21st century, where busy schedules and endless to-do lists are typical, we tend to deprioritize sleep. We do not realize that we are making one of the biggest mistakes that potentially result in long-term health problems. Without sleep, our bodies cannot function in proper manners and contributes to mental health disorders and memory & learning impairment.
So, what is “sleep?”
Sleep allows you to physically be unconscious while your brain is mentally active. During sleep, our brains are working to process and restore the information that we retrieve from the time we were awake[1]. After a good night sleep, we are able to retain information and dramatically perform better on the next day. Sleep is taken for granted because many of us overestimate our abilities to fulfill daily duties. We are not aware that sleep is fundamental for a healthy mind, body, and soul.
[Photo courtesy University of Rochester Medical Center]
You may be wondering…what happens to our brain and body during sleep?
Neurotransmitters are chemical messengers which communicate between neurons throughout your brain and body. By acting on different groups of neurons in the brain, neurotransmitters regulate whether we are asleep or awake. They can “switch off” cells that signal the activation of arousal or relaxation.
The arousal signals are sent to the cerebral cortex when the alerting areas of the brain are most active, resulting in wakefulness.[2]
Areas of the brain that promotes wakefulness is inhibited when the sleep-promoting areas of the brain are most active, resulting in sleepiness.[2]
The Sleep Cycle
Sleep is not just one “snoozed off” action, but it occurs in stages and it is quite complicated. During sleep, the brain and body go through five stages; the non-rapid eye movement (non-REM) phrase includes the first four stages and the rapid eye movement (REM) phrase is the fifth stage.
Stages 1 – 2
Stages 1 – 2
As we shut our eyes to sleep, we enter stage 1 of the sleep cycle.
It is known as light sleep linking between being awake and falling asleep where eyes movements and muscle activity become weak and begin to move slow.
During this stage it is normal to experience hypnic myoclonia or hypnic jerks where the muscle contractions happen suddenly and gives a sensation of falling[3].
This stage typically lasts about 5 to 10 minutes.
When there are very minimal to no eyes movements, we’ve made it to stage 2.
This stage marks the actual onset of sleep when you become disengaged from the environment[3].
The body temperature continues to decrease, but heart rate and blood pressure are regular.
Stages 3 – 4
Stages 3 – 4
We then continue to stages 3 and 4 or as known as the deep non-REM.
These are the most difficult stages to wake someone up as the body begins the restorative process where blood pressure begins to drop, breathing becomes even slower and muscles are relaxed.
During these deep stages, blood supply to the muscles is increased, energy is restored, tissue growth and repair occur and important hormones are released for growth and development[3].
Stage 5
Stage 5
We enter REM sleep when breathing and heart rate become irregular, muscles are shut down becoming paralyzed, and eyes movements are rapid.
This is the stage where the brain is active and dreams come into play.
It is important to get enough REM sleep because it plays an important role in learning and memory function
It is the time for your brain to consolidate and process information from the day before in order to stored it in the long-term memory [3].
[Photo courtesy Luke Mastin]
Approximately, we experience three to four sleep cycles. The sleep cycle repeats itself every 60- 90 minute [6] in that appropriate 8 hours that we are supposed to get. During the first 2-3 cycles, we spend more time in the deep non-REM sleep, stages 3-4. REM sleep occurs more frequently in the last 2-3 cycles[4].
Now, what happens when you’re in sleep debt?
Sleep is not a luxury, but a crucial component of our daily lives. We spend one third of our lives asleep. Yet, many of us cannot get 8 hours of quality sleep for various reasons, putting ourselves in sleep debt.
When in sleep debt, parts of your brain become inactive which induces drowsiness. One to four percent of all highway accidents are caused by sleepiness; that’s about 100,000 crashes, 71,000 injuries and 1,550 deaths each year in the USA[1].
Lack of sleep causes the body to respond as if you were under stress. When under stress, Dr. Malcolm von Schantz explains that the body automatically activate inflammatory genes preparing for injury to occur[8]. In the case of sleep-deprivation, there is no actual injury. Genes in the body’s cells function improperly when one is sleep-deprived which produce negative health problems including:
high blood pressure
diabetes
heart diseases
depression
lower sex drive
According to Dr. Kushida, director of the Standford University Center for Human Sleep Research,
loss of sleep ultimately leads to memory and learning impairment due to the disturbances in brain function when adequate sleep is not met[9]. Furthermore, sleep-deprived physically makes you look bad by giving you the premature wrinkling and dark circles under your eyes. Without sleep, stress hormone cortisol is produced, and it can eventually break down collagen and causes skin problems [8]. They called it “beauty sleep” for a reason.
Tips & Tricks for Better Sleep
Keep Track of Your Sleep
Exercise Daily
Naps are a big NO NO!
Avoid Drinking Coffee, Smoking, and Heavy Meals Before Bed
Eliminate Electronic Devices
Evaluate Your Bedroom
When in Doubt, Meditate!
Seek Professional Help
Keep Track of Your Sleep
Try sticking to the same bedtime and wake-up time throughout the week (even on weekend!).
Keeping track of your sleep schedule in a notebook could be helpful.
Dr. Matthew Ebben, a psychologist and specialist in sleep medicine, suggests that sleep diary is a wealth of information that includes not just when you sleep and wake up, but intake of caffeine, medications, alcohol, nap, exercise, and mood.
It is a useful tool to help many realize what they are doing that encourage them to deprioritize sleep[10].
Exercise Daily
Find time in your busy schedule to fit in a minimum of 15-30 mins of exercise.
Even if it’s just light exercise, it is still better than nothing.
Exercise reduces stress by producing endorphins or as known as natural painkillers which in turn improve the ability to sleep[11].
Get moving!
Naps are a big NO NO!
Napping is great for quick energy, but if you are having trouble falling asleep at night, you should definitely avoid any nap times during the day.
Long naps interfere with your body clock and nighttime sleep.
Avoid Drinking Coffee, Smoking, and Heavy Meals Before Bed
These behaviors can disrupt sleep because of the caffeine, nicotine and the discomfort feeling.
It is wisely suggested that you should have your last meal two to three hours before your bedtime[12].
Limiting caffeine intake throughout the day can dramatically improve your sleep.
Caffeine is a stimulant that we take to feel and remain alert during the day but it delays the timing of your body clock that will make it hard to fall asleep when the time comes.
Eliminate Electronic Devices
Not only do electronic devices distract you from your sleep, but the light exposure can interfere with melatonin.
You can still use your phone or tablet to read or do anything, but dim the light down to minimum and hold them at least 14 inches away from you[13]
Evaluate Your Bedroom
Many find that having a comfortable setting can help them fall asleep easier and getting more quality sleep.
Bedroom should not be too hot or too cold, it should be around 60-67 degrees[14].
Make sure the room is kept dark and noise-free for a comfortable nighttime.
Using comfortable mattress and pillows play a great part in your sleep, too.
Replace the mattress when they are 7 years or older because it will not be supportive anymore and replace pillows once a year to properly support your neck and spine.
Lastly, keep your bedroom nice and neat and only use it for sleep.
When in Doubt, Meditate!
Mindfulness meditation is a mind-calming practice that focuses on breathing and awareness of the present moment.
According to Dr. Herbert Benson, the director emeritus of the Harvard affiliated Benson-Henry Institute for Mind Body Medicine, mindfulness meditation is a method that evoke relaxation response in the body that help ease many stress-related ailments such as depression, pain, and high blood pressure[15].
Ideally, practicing mindfulness meditation 20 minutes during the day is enough.
Seek Professional Help
If you have tried everything and still having difficulties falling asleep, you should seek professional help. Your problems may be the surface to more serious problems like insomnia, narcolepsy, obstructive sleep apnea, depression and etc.
References 1
References 2
References 3
[1] Why Sleep is Important. (n.d.). Retrieved from https://www.apa.org/topics/sleep/why.aspx
[2] Brain Basics: Understanding Sleep. (2017, May 22). Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
[3] Thompson, Jill. (2017, Sep 26). Hypnic (Hypnagogic) jerking explained. The Sleep Advisor. Retrieved from https://www.sleepadvisor.org/hypnic-jerking/
[4] Understanding sleep cycles. National Sleep Foundation. (n.d.). Retrieved from https://sleep.org/articles/what-happens-during-sleep/
[5] Gordon, A. M., Ph.D. (2013, Jul 26). Your sleep cycle revealed. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/between-you-and-me/201307/your-sleep-cycle-revealed
[6] Field, A. (n.d.). Why is sleep so important. Harvard Business Review. Retrieved from https://hbr.org/2009/01/why-sleep-is-so-important.html
[7] How much sleep do we really need? National Sleep Foundation. (n.d.) Retrieved from https://sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need/page/0/1
[8] Ghosh, P. (2015, May 15). Why do we sleep? BBC News Science and Environment. Retrieved from http://www.bbc.com/news/science-environment-32606341
[9] Kushida, C. A., Ph.D. (n.d.). College students: getting enough sleep is vital to academic success. American Academy of Sleep Medicine. Retrieved from https://aasm.org/college-students-getting-enough-sleep-is-vital-to-academic-success/
[10] DiGiulio, S. (2018, Mar 15). How to use a sleep diary to figure out what’s keeping you up at night. NBC News. Retrieved from https://www.nbcnews.com/better/health/how-keep-sleep-diary-actually-improve-your-sleep-ncna805281
[11] How Exercise Affects Sleep. National Sleep Foundation. (n.d.). Retrieved from https://sleep.org/articles/exercise-affects-sleep/
[12] Caffeine and Sleep. National Sleep Foundation. (n.d.). Retrieved from https://sleepfoundation.org/sleep-topics/caffeine-and-sleep
[13] Mayo Clinic. (2013, June 3). Are smartphones disrupting your sleep? ScienceDaily. Retrieved from www.sciencedaily.com/releases/2013/06/130603163610.htm
[14] Gregoire, C. (2015, May 25). 7 big things we’ve learned about sleep in the past decade. Huffington Post. Retrieved from https://www.huffingtonpost.com/2015/05/25/sleep-research-health_n_7215662.html
[15] Corliss, J. (2015, Feb 18). Mindfulness meditation helps fight insomnia, improves sleep. Harvard Health Publishing Harvard Medical School. Retriever from https://www.health.harvard.edu/blog/mindfulness-meditation-helps-fight-insomnia-improves-sleep-201502187726
Have you ever felt tension in your chest when you feel stressed? Or those short-lived moments of intense panic and fear? Maybe breathing or concentrating seems impossible? Many of us can likely relate to these questions and we call this experience anxiety. Some might think that only a select few of us have to deal with anxiety when in fact it is something all of us experience, to some degree, at some point in our lives.
Anxiety is an emotion characterized by feelings of tension and worried thoughts. It is accompanied by physical symptoms such as sweating, trembling, or increased heart rate [1]. Popular convention suggests that anxiety is just a mental disorder when it is actually part of the body’s natural response to anticipation of future threats. In fact, some arousal (anxiety) is actually helpful for increasing productivity levels.
The Yerkes-Dodson Law suggests that there is an empirical relationship between stress and performance. Moderate levels of stress can help you concentrate and focus on a given task. However, extreme levels of anxiety can interrupt your concentration and interfere with your performance. Anxiety culminates into anxiety disorder when feelings of tension and worry become too excessive and hard to control, causes significant distress or impairment, and occurs more often than not for at least six months [2]. The chart below shows that performance level is strong when stress is moderate and hindered when stress is too low or too high.
Hebbian version of the Yerkes–Dodson law
It’s important to understand anxiety affects each person differently and symptoms can vary. Anxiety disorders are the most common mental disorder and affects approximately 30% of adults at some point in their lives [3]. The type of anxiety disorder can vary and range from generalized anxiety disorder to more specific phobias and panic disorder. Potential causes and symptoms of anxiety disorders include:
Possible Causes
Genetics
Stress from work, social settings, financials, trauma, etc.
Existential panic
Illict Abuse
Excess Caffeine Use
Lack of Sleep
Poor Diet
Lack of Exercise
High heart rate
Panic Attacks
Muscle tension
Irritability
Racing thoughts
High heart rate
Insomnia
Detachment from reality
Difficulty/inability to concentrate
Nausea
Fatigue
Shortness of breath
Symptoms
Coping strategies for Anxiety
A key component of anxiety is your body’s physical response; your heart rate and breathing speeds up and you perspire and feel tense. A state of relaxation is an important step in comprehensive treatment as it will help slow down or manage physical effects. It’s harder to feel anxious if you are already in a calm, relaxed state and it’s easier to calm yourself by practicing regular relaxation techniques. The elements that characterize a state of relaxation include:
Elements of Relaxation
Slow and even heart rate
Deep and even breathing
Loose and relaxed muscles
Hands and feet feel warm, heavy, or both
Mind feels at peace
The body has energy for several hours
Feeling refreshed
The following 6 coping strategies can help slow down your heart rate and breathing pattern to manage your anxiety.
AWARE Method
Mediation
Visualization
Progressive Muscle Relaxation
Autogenic Relaxation
Diaphragmatic Breathing
AWARE Method
AWARE Method
One way you can reach a state of relaxation is by learning how to personally manage your symptoms and cope with the anxiety. Paradoxically, learning to accept your anxiety is an easy way to help you overcome it. Dr. Aaron Beck and colleagues developed a cognitive therapy tool for managing anxiety known as the AWARE method.
A W A R E
Accept the anxiety – Accept the anxious thoughts and feelings as natural. Focus on feeling anxiety without becoming annoyed or frustrated with yourself. Greet it by saying “hello” out loud or to yourself when the anxiety appears. Challenge yourself to be with the experience, not fight it. If you resist the anxiety you’re essentially prolonging the unpleasantness of it. Instead, you should just flow with it.
Watch your anxiety – Look at it objectively, without judgement, and rate it on a zero to ten scale. Record the scores and see how your anxiety goes up and down. The more you can separate yourself from the experience, the more you can just watch it. Dissociate your basic self from the anxiety; be in the anxiety state, but not of it.
Act with your anxiety – Normalize the situation and function with it. Slow things down if you have to, but keep going and breathe slowly and normally.
Repeat as much as possible – Continue to work on accepting your anxiety, watch it, and act with it until it goes down to a comfortable level
Expect the best – Anticipate that your worried thoughts and fears won’t happen, because they rarely ever do. Expect that you will accomplish your goal, and if you experience anxiety along the way remember to accept, watch, and act with it. Don’t be surprised the next time you have anxiety but rather surprise yourself with how you handle it. Being aware of future anxiety will help place you in a better position to accept it when it comes again.
Mediation
Meditation
Meditation exercises produce deep physiological relaxation and feelings of peace and tranquility [5]. It involves an active process of focusing your attention on your breathing to the point where you abandon the constant loop of stress provoking thoughts.
For example, think of a time when you were totally absorbed in a sensory experience such as listening to a beautiful piece of music or receiving a massage. You weren’t trying to analyze or manipulate the experience, you were just living it. This is similar to how your psychological posture should be during meditation.
Start by making yourself as comfortable as possible
Close your eyes
Relax your breathing and allow it to naturally find its rhythm
Next, focus your attention on the movements of your chest and stomach as you’re breathing
Once you are aware of your attention wandering, bring it back to your breathing
Continue to let your mind wander as you breathe by using a mantra to keep your breathing natural
credit: https://redd.it/1xsu1a
Visualization
Visualization
Visualization practice combines a 4-4-8 breathing pattern with meditation practice. To do so:
start by inhaling for 4 seconds
holding for 4 seconds
and exhaling for 8 seconds
Repeat
Use your mind’s eye create a picture of a pleasant scene (your happy place). For example, imagine you are walking on the beach. A cool fresh breeze blowing across your face and through your hair. As you are listening to the sounds of waves, you hear the birds singing across the beach.
Just imagine some experience that you personally find relaxing. Focus on the details of the experience (sights, sounds, smells, feelings, etc.) and continue to breathe evenly and deeply. Open your eyes once you’ve reach a calm and relaxed state.
Progressive Muscle Relaxation
Progressive Muscle Relaxation
Another technique you can try is the Progressive Muscle Relaxation (PMR) relaxation method that involves tensing muscle groups and releasing them. Contrasting muscle tension with release can be very effective in managing the symptoms of stress, anxiety, and moments of panic/intense anxiety [4]. Begin in sequence and work progressively throughout all major muscle groups, tensing and relaxing them one at a time. It is helpful to practice this technique several times (when not anxious) so you can more easily cue yourself to the relaxed state.
TO BEGIN: Sit with your back fairly straight or lie down on a comfortable surface. Try keeping your eyes closed and take a deep breathing in through your nose. Feel free to listen to relaxing music, if desired.
As you breathe deeply, focus your attention on your feet.
Toes – Curl your toes as tightly as you can and hold for five seconds. Relax.
Calves – Flex feet to tighten calves and hold for five seconds. Relax.
Thighs – Tighten your thigh muscles by pressing your knees together as tightly as you can for five seconds.
Hips and buttocks – Flex your hip and buttock muscles for five seconds. Relax.
Stomach – Focus on your belly button, take a deep breath in, release that breath, and tighten stomach muscles.
Shoulders – Move your shoulders forward, squeeze chest muscles and hold for five seconds. Relax.
Hands – Extend your arms in front of you. Clench your fists tightly for five seconds. Relax. Feel the warmth and calmness in your hands as you release.
Upper arms – Bend your elbows. Tense your biceps for five seconds. Relax. Feel the tension leave your arms.
Back – Squeeze shoulder blades together and hold for five seconds. Relax. Feel the anxiety and tension leave your body as you relax.
Forehead – Wrinkle your forehead; try to make your eyebrows touch your hairline for five seconds. Relax.
Eyes and nose – Close your eyes as tightly as you can for five seconds. Relax.
Lips, cheeks, and jaw – Tighten your lips, cheeks, and jaw and hold for five seconds. Relax. Feel the warmth and calmness in your face.
Focus on any muscles that may still feel tense. Breathe in for three seconds, hold for three seconds, and release for five seconds – releasing any remaining tension.
Once you begin to feel relaxed, focus your attention on feeling warm or as if you were on a sunny beach. Let the light and warmth travel throughout your relaxed body. Feel the waves come in and out with your breathing. Stay in this moment.
TO END: Slowly become aware and active. Become aware of your feet pressing on the floor, feel your body on the chair. Take five deep breaths with each breath becoming more alert. Wiggle your fingers and your toes [4].
Autogenic Relaxation
Autogenic Relaxation
Once you’ve learned to relax your muscle groups using the progressive muscle technique you can begin autogenic relaxation. This method teaches your body to respond to verbal commands so that you can achieve relaxation and reduce anxiety. Once you assume a comfortable position, close your eyes and slowly recite these instructions:
My hands and arms are heavy and warm (5 times)
My feet and legs are heavy and warm (5 times)
My abdomen is warm and comfortable (omit if you have ulcers) (5 times)
My breathing is deep and even (5 times)
My breathing is calm and regular (10 times)
My forehead is cool (5 times)
When I open my eyes I will remain relaxed and refreshed (3 times)
Perform the following sequence of body movements:
Move hands and arms about
Move feet and legs about
Rotate head
Open eyes and sit up
Diaphragmatic Breathing
Diaphragmatic Breathing
You can also manage your anxiety with this intentional breathing technique. Most people aren’t aware that deep breathing actually makes use of the body’s built-in natural relaxation response, which occurs when we exhale. You can use a deep diaphragmatic breathingtechnique to reduce your anxiety with deep breathes. This method uses a 3-3-5breathing pattern:
Inhale for 3 seconds
Hold for 3 seconds
Exhale for 5 seconds
Make sure to breathe slowly and evenly with your mouth closed. Take notice of what you’re feeling throughout your body while exhaling; your muscles might feel warm and begin to feel light or heavy. Try and let yourself enjoy whatever sensations you’re experiencing. Repeat the diaphragmatic breathing exercise until you feel relaxed.
Professional Treatment for Anxiety Disorder
While these techniques are useful for managing symptoms of anxiety, there are proven treatment options that help fight against anxiety disorders such as
Psychotherapy attempts to help a patient identify triggers of his/her anxiety and learn cognitive behaviors to help deal with the issues.
Pharmacotherapy and diet/exercise management can improve serotonin levels in the brain and stabilize mood – an effective option for treating anxiety symptoms [6].
TMSis a non-invasive, outpatient treatment option that uses a pulsed magnetic field to stimulate function in specific regions of the brain and help treat anxiety. Researchers investigated how effective TMSis as a treatment option for generalized anxiety disorder and the results suggest 84.6% of patients’ anxiety symptoms were in remission [7].
IOPs are useful for providing cognitive behavioral therapy (CBT), Dialectical Behavioral Therapy(DBT), crisis stabilization, and motivational and supportive therapy. IOPs show to be effective through continual support from the group and clinical team as they provide a steady increase in motivation, self-esteem, safety and security, and decrease unwanted behaviors associated with anxiety such as anxiousness and irritability [8].
All of us experience anxiety, and while oftentimes you can manage it, you shouldn’t wait until your symptoms reach a critical stage before seeking professional help. If you think you might be suffering from anxiety and personal strategies aren’t working to manage it, consider consulting a mental health professional. Effective treatment options vary from person to person, so start by talking to a psychiatrist or therapist and learn what works best for you.
[6] Young, S. N. (2007). How to increase serotonin in the human brain without drugs. Journal of Psychiatry & Neuroscience : JPN, 32(6), 394–399.
[7] White, D., & Tavakoli, S. (2015). Repetitive transcranial magnetic stimulation for treatment of major depressive disorder with comorbid generalized anxiety disorder. Annals of Clinical Psychiatry: Official Journal of American Academy of Clinical Psychiatrists, 27(3), 192-206. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26247218
Transcranial Magnetic Stimulation (TMS) is a treatment for Major Depressive Disorder (commonly known as depression) that is gaining recognition for its success rate. We provide free consultations to see if TMS is right for you. In our office, we have had over 200 patients go through the TMS treatment since 2013. Of those who did it, 66% achieved full remission from depression and 90% had a positive response to the TMS treatment. Here are 6 facts on how TMS can treat your depression.
Works Cited
Ranna Parekh, M. M. (2017, January). What is Depression? Retrieved from psychiatry.org: https://www.psychiatry.org/patients-families/depression/what-is-depression
Ph.D., E. S. (2014, August 7). Are Antidepressants Effective? Retrieved from psychologytoday.com: https://www.psychologytoday.com/blog/how-everyone-became-depressed/201408/are-antidepressants-effective
What causes depression? (2017, April 11). Retrieved from Health.harvard.edu: http://www.health.harvard.edu/mind-and-mood/what-causes-depression
Staff, M. C. (2015, December 03). mayoclinic.com. Retrieved from Transcranial Magnetic Stimulation: http://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/details/risks/cmc-20163840
