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Diagnosis Bipolar Disorder: Bipolar disorder is a severe biologic illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal. (Lehne, 2004, p. 321)

The following is a short synopsis according to the DSM-IV-TR, Criteria for Bipolar Disorder includes a distinct period of abnormality and persistently elevated, expansive, or irritable mood for at least:
- 4 days for hypomania
- week for mania

During the period of mood disturbance, at least three or more of the following symptoms have persisted and have been present to a significant degree:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Excessive involvement in pleasurable activities that have a high potential for painful consequences. (American Psychiatric Association [APA], 2000).

Psychodynamics of the Disease the onset of the disease usually occurs during late adolescence or in the mid twenties. However, the disease has been known to occur up into the fifth decade of life. the mood swings that accompany this disorder are of several types. they are as follows: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,

Impairment in normal social functioning usually requiring hospitalization; Hypomanic Episode, evidenced by a milder form of the Pure Mania, without the loss of normal functioning that would require hospitalization; Major Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death; the last episode associated with Bipolar disorders is the Mixed Episode in which, patients experience symptoms of mania and depression simultaneously. the combination of high energy and depression puts them at significant risk of suicide. (Lehne, 2004, p. 321)

Case Presentation
A Caucasian woman in her mid twenties presented signs and symptoms of self mutilation with a straight edge razor inflicted gash across her lower abdomen approximately six inches below the umbilicus. the depth of the gash just stopped at the abdominal fascia. the patient was sent from the emergency room to the psychiatric floor. upon meeting the patient one day after her admission to E.R., she appeared dressed in pajama bottoms and a t-shirt, shuffling down the hall in her socks. she was holding her abdomen with one hand and appeared in some discomfort. her black hair was short and disheveled. When the patient arrived at her room she sat down on her bed. she acknowledged with blunted affect that she cannot stop self mutilation, and described how she cut herself through the muscles in her abdomen almost down to the fascia. her voice was tremulous and fast paced. this could be due to the fact that she had just been given her first dose of Clozaril. she stated that her mouth was dry and that she needed to drink some water. she then went on to say that she was getting very sleepy. the client felt comfortable with the interview.

She shared personal information in regards to being sexually abused by her bother beginning at the age of seven until the age of fifteen. her brother was two years older than her and died in an automobile accident at the age of eighteen. she went on to say that her mother never knew or acknowledged the sexual abuse and that she could not tell her because the mother idolized the son. the client was receptive to cognitive reframing; however she was very critical of herself and stated that she felt worthless and ashamed. she appeared very tired and stated that she wanted to sleep.

Table 1
Textbook characteristics of Bipolar disorder versus client characteristics observed

Textbook Characteristics:
Pure Manic Episode
Hypomanic Episode
Major Depressive Episode-
Affective Flattening
Alogia
Avolition-apathy
Anhedonia
Mixed Episode
Rapid-Cycling Bipolar Disorder- Patients experience four or Client

Characteristics Observed:
No current symptoms
Rapid breathing, rapid speech, however due to medication a client was concurrently exhibiting lethargy
Client acknowledged sadness/ worthlessness
Facial expression flat
Thoughts of dying, hard to focus
Hair/clothes unkempt
Expressed no interest in children or own

Client's Symptoms
1. Hypomania
2. Depression
a.) Affective Flattening
b.) Alogia
c.) Avolition & Apathy
d.) Anhedonia
3. Mixed Episode
4. Rapid Cycling
(Varcarolis, 2004, p. 485)

Nursing Interventions

1. Observe the client every 15 minutes while suicidal, remove all dangerous, sharp objects from room.

2. Reinforce that she is worth while,
a.) assist the client in evaluating the positive as well as the negative aspects of her life
b.) Encourage the appropriate expression of angry feelings.
c.) Schedule regular periods of time throughout the day for recreational/occupational therapy, encourage client to groom self, offer praise for completing grooming.
d.) Ensure client's participation in taking mood stabilizing medications. Watch client swallow medication.
3. Engage client in interpersonal therapies, cognitive-behavioral therapy,
4. Encourage client to attend group therapy, and journal episodes.

Table 2
Medical Interventions, Bipolar Disorder
Drug therapy using
Mood stabilizer
Antidepressants
Antipsychotics
Education and Psychotherapy
ECT
(Varcarolis, 2002, p. 483)

Clients Medical Interventions
Drug therapy includes
Lithium 300mg every h.s.
Not taking any Clozaril
Client is receiving psychotherapy, family counseling, group therapy while in hospital, and cognitive restructuring.
None

Nursing Interventions in the Diagnosis of Bipolar Disorder

If you are suffering from depression, you are not alone.

Depression affects many people at some time in their life, with some of us going through periods of depression that can lift after a very short time, while for others, it can be ingoing for many years.

Whichever category you fall into, here are some simple tips to help you manage your depression.

Depression - what is it?

Depression is best identified as feeling in a low mood. It may not stop you leading a normal life, but things may seem less worthwhile.

Most of us will admit to feeling depressed from time to time and this is perfectly normal.

Depression becomes a problem when it interferes with your day to day activities.

What Causes Depression?

Depression may be caused by an imbalance of chemicals in the brain or can be triggered by significant life events including:-

o A traumatic experience, such as rape or physical attack

o Frequent use of recreational drugs

How Do I know if I am Depressed?

Symptoms of depression may include:-

o Preoccupation with negative thoughts

o Difficulty in concentrating

o Feeling in a low mood most of the time

o Feelings of numbness, emptiness or despair

o Lack of sex drive

o Lack of confidence

o Pessimistic view of the future

This is no a definitive list and you may experience all or some of these symptoms.

You may also notice changes in your sleeping pattern, your eating habits, or there may be a rise in your alcohol or tobacco consumption.

Depression - Helping Yourself

Knowledge is power. the more you learn about depression, the better equipped you will be to deal with it.

Go to the library, do some research on the internet or join a self-help group where you can gather information about depression and the treatments available.

Being aware of the choices available to you will help you to make an informed choice about treatment if you need to seek help from your healthcare provider.

Whereas many of us may experience bouts of mild depression or low mood, clinical depression is a serious medical condition and if you have been experiencing symptoms described above for some time you should seek medical help as soon as possible.

Depression - Don't Suffer in Silence

While clinical depression is a serious illness, it can be treated and you do not need to feel ashamed, embarrassed or suffer in silence.

Some people allow depression to go untreated for years but clinical depression will not disappear by itself.
Professional help may include a course of antidepressants together with some counseling.

Depression - Help Yourself

Helplessness is a feeling often experienced by people with depression.

Together with professional help try and help yourself.

o Stay focused - depression can feed on itself and you can find yourself trapped in a vicious circle of negative thoughts that it seems impossible to get out of. Focus on positive thought and the positive things in your life. If you can't think of any, think of a positive goal you would like to achieve.

o Avoid your own company - depression feeds on loneliness. try and break the hold that depression has on you. Join a club or self-help group where you can talk to people who have successfully overcome depression.

o Do something worthwhile. Keeping yourself busy will give you less time to dwell on pessimistic thoughts. Take up a hobby or why not join a gym. Regular exercise will have a mental and physical impact on your wellbeing.

o Let go of the past. Many of us make the mistake of hanging on to past hurts and this too can cause depression. If there are things in your life that have caused you upset, past grudges, guilt or anger, perhaps it is time to let go.

Depression is not an easy thing to overcome but it can be done, all you have to do is make he decision to make a change.

Depression - Simple Tips to Beat the Blues

Treatments (for) Depression information are available from a wide variety of sources. Medication, Holistic, and Herbal Treatments will be the focus here. this information will hopefully lead to do more research and consult with your physician before starting any new health regimens.

Sources of Information

The Internet has a mind boggling amount of sources for Treatments, Depression info.
Magazines, medical journals, and books can be found about Depression and how it affects lives. Some celebrities have written personal testimonies of their experiences with battling Depression.

Sources other than print media may include video lessons on Depression. your local mental health organization will have a ton of information and if necessary refer you to a psychiatrist and/or a counselor (Psychotherapy). there are agencies that warehouse information and will send it to you sometimes for a fee.

Only you know how you are feeling and how Depression may be affecting your life. Armed with this information, you may be your own best educator. you can really be in control of your treatment given the right information and support.

Medications

Medications are used to change the levels of particular chemicals in the brain or to allow the brain to more efficiently make use of these chemicals, Serotonin and Norepinephrine.
These medications are very effective for many but there are serious side effects with these drugs. Some of the newer classes of drugs have fewer and less severe side effects. in children under the age of 21 who take antidepressant drugs, it is known that the drugs can cause them to have suicidal thoughts. while on antidepressants, children on these drugs should be closely monitored. only your doctor can tell which type of medication will best suit your needs.

Holistic Treatments

Holistic medicine attempts to treat the whole person-mind, body, and spirit. there are many Holistic treatments available. Acupuncture and Acupressure are holistic treatments.
Reflexology, Aroma Therapy, Meditation, and Relaxation Therapy are holistic as well. Adopting spirituality is encouraged. What happens in one affects the other two and Holistic treatments are meant to balance mind, body, and spirit, thus providing health and happiness.

Herbal Treatments

Herbal usage has been around for centuries. They can be used as spices, as part of a salad, or in healing a wide variety of health conditions. Herbal Depression treatments are most often found in supplement form. Specific herbs that are known to affect mood are blended with vitamins, minerals, and other nutritive substances to provide a more effective treatment.

Herbal supplements that have had the metabolic paths of their ingredients evaluated, that have had the interactions of the ingredients tested and that are made to pharmaceutical grade will be the most potent, safe, and effective treatments.

Herbal treatments have few to no side effects. Before beginning the use of any herbs, check with your physician first. Herbs may reduce the effectiveness of prescription medications you may be taking for other conditions.

Conclusion

There is a wide variety of treatments Depression info available. The Internet will be a major source for you. Other media such as books and videos are also plentiful. Some forms of Depression treatments include medication, Holistic treatments, and herbal treatments. your physician and your local mental health agency will have sources for you as well. you are or will be your own best educator. this information will hopefully allow you to make informed decisions and to work with your physician to determine the best treatment for you.

Treatments Depression Info - Facts About Treatments Depression Info

Iron and clinical depression

It is an established fact that iron is very essential for neurological functions and development. Iron deficiency is very prevalent all over the world. This deficiency can lead to depressed neurotransmitter response, leading to clinical depression. When iron is not transported from the blood plasma pool to the cerebrospinal fluid, depression can set in.

The Importance Iron Balance

The importance of iron for sustaining good health cannot be underestimated. Lack of iron can lead to exhaustion, clinical depression, vulnerability to viruses, cancer, and various degenerative conditions.

On the other end of the spectrum, excess iron or change in the iron-binding capability leads to a situation where the free unbound iron causes or aggravates all diseases, infections, cancers and toxicities.

Therefore, in our efforts to acquire the right proportion of iron or lose excess iron, we must not overlook the fact that iron must be bound and properly guided through the body from the time of ingestion to excretion.

If we do not pay attention to bind and properly guide iron during the detoxification process, the toxic effects of iron may nullify its various benefits.

It is very difficult to determine the exact iron content in the body, since no test or combination of tests, under any clinical condition, can give us the accurate estimate.

Before laboratory investigations lead us to any conclusion, it must be understood that the results of each laboratory test may be influenced by factors such as infection, inflammation, liver disease and malignancy. Sometimes laboratory tests are inadequate.

Most elements can either donate or accept electrons in order to attain a stable electronic configuration; but iron can both, donate as well as accept electrons.

Due to this ability of iron, it is highly reactive and can be highly toxic. Hydrogen Peroxide in our body readily dismutates in the presence of iron, giving rise to free radicals. Unbound iron speeds up this process of producing free radicals. Free radicals play havoc by damaging cell structures and ultimately killing the cell, resulting in various diseases.

The role of Proteins

Most living organisms bind iron atoms to protein molecules in order to prevent this damage done by unbound iron. This enables them to restrict the damaging action and take advantage of the various benefits offered by iron.

Proteins play an important role in metabolism by speeding up biochemical reactions by their enzymatic action. Enzymes produced due to chronic inflammation, action of free radicals and change in the related subclinical markers cause a breakdown of connective tissue, which holds the body together.

The words protein, peptide and polypeptide tend to be a little confusing. Although they have common characteristics, they are distinct.

Protein is a complete biological molecule with a three dimensional structure, whereas peptide is a finite chain of amino acids which lacks proper structural arrangement. A polypeptide is an infinite chain of amino acids which also lacks a proper structure.

Biochemical screening is a test done to detect the presence of any disease. Such tests have revealed that every degenerative disease results from six subclinical defects, namely, pH imbalance, anaerobic metabolism, free calcium excess, chronic inflammation, connective tissue breakdown and oxidative stress.

Our body metabolism and exposure to pollution gives rise to extremely reactive ions called free radicals. Free radicals are produced due to iron imbalance which indicates that iron is not bound to protein and therefore, is free to cause damage to cells.

Iron deficiency or Copper deficiency?

Acute inflammation is actually a positive sign since it triggers the immune system to fight diseases and withhold iron. This is kept in mind by health professionals while formulating medications for treating cancer, iron deficiency, excessive tiredness, memory loss and depression.

Sometimes tests show that a person has low iron content in blood serum. Prescribing iron supplements may pose a risk because low iron may actually indicate low copper content.

When clinical tests show low serum iron, elevated Total Iron Binding Capacity (TIBC) and low Transferrin Saturation, it could not only mean that there is free iron but also a copper deficiency.

How do we know? Let's get a little technical. Ceruloplasmin is a copper protein complex found in blood plasma. Ferritin is a protein complex that is found in cells, and it stores iron in soluble and non-toxic form. Transferrin is a blood plasma protein that binds iron tightly and therefore, reduces free iron. now, Ceruloplasmin takes iron from Ferritin and attaches it to Transferrin. Two molecules of iron can be attached to a single molecule of Transferrin. Therefore, there is a vacancy for two iron molecules on every Transferrin molecule. in a normal person, only 30% of these vacancies get filled. When fewer iron molecules are attached to Transferrin, the TIBC rises. This is an indication of low copper. since copper is low, it cannot produce Ceruloplasmin and the above-mentioned process of attaching iron to Transferrin cannot take place.

In short, clinical tests that show low iron content in blood serum may actually indicate low copper content. Therefore, prescribing iron supplements may aggravate the condition.

What else does free iron indicate?

Also, when there is free iron, it can mean that there are not enough amino acids. Amino acids are the most abundant neurotransmitters available in the brain. Research has shown that a lack of specific neurotransmitters may induce clinical depression. Antidepressants regulate the action of these neurotransmitters thereby providing relief to the person.

Moving towards the Right Solution

If the above-mentioned factors are studied well, a proper diagnosis and treatment for clinical depression can be arrived at.

The risk of infection, disease and high toxic levels can be reduced once we identify iron imbalance. thereafter appropriate measures must be taken to restore the iron balance. Therefore we must consider a few factors:

1. since intestinal mucosa contains Transferrin, it must be well maintained.

2. Protein levels should be optimally maintained.

3. the right balance of aerobic-anaerobic metabolism must be attained. too much of anaerobic metabolism results of production of toxins and resulting in fatigue, which is a symptom of clinical depression.

4. Overpowering acid stress by maintaining alkalinity

5. Getting rid of toxins and organic solvents that may hinder the iron binding action done by proteins.

6. Individuals who are diagnosed to have free iron should take to a diet rich in whole eggs and cultured dairy products.

7. A proper phlebotomy and testing program must be conducted to monitor iron overload.

Since iron deficiency or excess plays a key role at every step in the diagnosis and treatment of clinical depression, we should be careful to monitor its status in order to avoid the chain of events that are triggered by its imbalance.

Last but not least, a clinical depressed person who snores, needs to address to apply snoring remedies in order to stop the snoring and support their biochemistry.

Iron Imbalance Can Lead to Clinical Depression

Knowing how to cure bipolar disorder is essential for all the people involved. But first, discerning the signs of the illness and recognizing the presence of the abnormality is significant.

Bipolar disorder is difficult to diagnose as its behavioral manifestations are often misunderstood and not immediately recognized by mental health professionals. These individuals may already be experiencing difficulty with the illness but because of underdiagnosis or misdiagnosis, they may suffer unnecessarily for years. Bipolar disorder is a serious medical condition. however, with the right treatment, many individuals with bipolar disorder can lead fulfilling lives.

Although there is yet no known method on how to cure bipolar disorder, psychiatrists and psychologists believe that it is a manageable condition. although affected individuals may not be aware of ways on how to cure bipolar disorder, effective management of the illness may help prevent the recurrence of manic and depressive or mixed episodes.

Medications that treat acute manic, depressive or mixed episodes are the basis of how to cure bipolar disorder. These prevent the recurrence of bipolar disorder episodes. The emphasis of this treatment is on the efficient management of the duration of the disorder, which usually requires nascent symptoms to be treated. Pharmacological and psychotherapeutic techniques are two of the means on how to cure bipolar disorder. Some medications that would help an individual suffering from bipolar disorder include atypical antipsychotics and antidepressants.

Almost all people with this disorder can get significant stabilization of their mood swings. Lithium is recognized as very effective in curbing mania and preventing manic and depressive periods.

In psychological treatment, the emphasis is often on issues that arise in the affected person's life brought about by the manic episodes. The focal point in the treatment of this disorder is helping the patient distinguish the beginning signs of a manic episode and taking restorative action. Psychotherapy is an essential tool in improving the illness in people with bipolar disorder. those who suffer from this abnormality frequently have strained relationships in the event of manic and depressive periods. Psychotherapy helps in restoring these broken relationships. this method of treatment can also educate the people involved in helping to detect the onset of symptoms, dealing with the episodes, managing the stress associated with them and, in general, how to cure bipolar disorder.

Other factors that would help the patients in understanding how to cure bipolar disorder include being mindful of little changes in an individual's energy levels, mood and sleeping and eating habits. a patient and his doctor must also have a program on ways on dealing with changes indicative of the onset of mood swings. Hospital commitment, wherein a person is placed in the hospital against his will, is sometimes a necessity for someone suffering from bipolar disorder because of the effects of manic episodes.

Since bipolar disorder is a lifelong ailment, ongoing treatment is required to keep the patient's mood stable even when he shows signs of feeling better. it is also critical that the people affected with the illness and their families seek the best treatment plan. Patients and their families may also find mutual support self-help groups beneficial.

Knowing How to Cure Bipolar Disorder

Doctor, I have been to four psychiatrist over the past 10 years and have tried everything. they tell me I'm depressed or bipolar. The meds always just make me worse. I was in therapy for six years and figured out that my parents were awful parents, but I still feel the same way. can you help me?

John met with me for the first time due to problems he was having on the job. his financial firm had sent me similar people in the past-you know, those bright and brilliant people who seem like they should be excelling, but never seem to get their act together. A third of the patients they referred ended up having Adult ADHD and had never been diagnosed. two of them got better on medications and one couldn't tolerate medications but found some relief from specialized goal-focused CBT for ADHD as well as coaching.

John is a 46 year-old single man in a relationship with a woman and has been previously married twice. he has 3 children. he says he doesn't know what to do and his girlfriend of 7 months is going to leave him if he doesn't get some help.

ADHD is over-diagnosed, right?

Well, yes, in some places everyone is diagnosed with ADHD. However, more often than not, ADHD is missed and the person is labeled with depression or bipolar disorder.

When someone tells me they are depressed but every type of treatment in the book, including medications and several trials of different therapies haven't worked, I start wondering if something else is going on. many times, symptoms of ADHD can masquerade as other diagnoses. People with ADHD often have mood swings and difficulty with mood regulation. this isn't in the DSM IV criteria, but if you have worked with hundreds of patients with ADHD, you know that ADHD causes mood swings. when someone with ADHD is sad or in a funk, they have a hard time shaking it. and when they are excited, they are really excited. this is one of the gifts and wonderful things about people with ADHD. they are passionate people, passionate about life and passionate about letting other people know about it. If someone isn't careful and doesn't spend the time getting to know the person, then one might think the person has bipolar disorder. Yes, bipolar disorder and ADHD do have a higher rate of occurring together; however, more often that not, people with ADHD who say they have mood swings really mean ADHD swings not manic swings.

Many clinicians were taught that if someone presents with depression and ADHD, first treat the depression and THEN treat the ADHD. well, this is just backward thinking. very often, the patient feels depressed, frustrated, has lost interest in doing very much, but this is because he has experienced one failure after another or has gone from one job to the next. In my experience treating people, when you treat the ADHD, the person begins to acquire the ability to achieve their goals, improve relationships, meet deadlines, remember to pick up the children, avoid accidents on the road, remember their tickets before driving to the airport and feel a lot more competent, confident and happy.

Unfortunately, when patients are treated for depression with antidepressants, or worse, treated with atypical antipsychotics for bipolar disorder and kept on these medications for months or years, their symptoms often do not improve and might worsen. I have never seen this data in the literature, but during my training at Massachusetts General Hospital, I was taught a VERY IMPORTANT PEARL. Never Never Never take away someone's dopamine. Dopamine gives us zest for life, motivation, and enables us to pay attention. it is the piece of the puzzle people with ADHD may be missing that inhibits and blocks them from reaching their potential. Guess what antidepressants and antipsychotics do? Through a feedback loop, these medications can decrease the function of dopamine in the frontal lobes and limbic system. Not good for someone with ADHD.

John says he has never before felt depressed. he has lots of friends and was very popular in high school, college, and at his previous four jobs. he is extremely affable, generous and creative, which is the rule, not the exception, with ADHD people. of course he was popular. he says he was always the life of the party and his teachers and coaches said he was an exuberant and spunky man, yet they were always puzzled that he never quite lived up to his capacity in the classroom or on the soccer field. he seemed to not git the big picture or perform consistently.

More often than one might imagine, adults with ADHD find themselves without a job and without a plan. Losing a job can have many causes, especially in this downward spiraling economy. But being without a plan is easily associated with ADHD. People with ADHD are characterized by difficulty in visualizing the future along with the inability to put the pieces together to get there.

According to Dr. Lew Mills, ADHD people come to a full stop. aside from having difficulty with deciding what to do next, at a full stop they lose all forward momentum. it seems as if they will never find a job. The full stop blocks forward motion.
Paradoxically, an ADHD person may also feel barraged with a torrent of thoughts about where to turn, but each leads to a few weeks of submitting applications, sending a few resumes and then they conclude that something else is more interesting or promising. after a some time at the full stop, it is nearly impossible to move forward again. Paralysis sets in and depression follows.

For a non-ADHD person, with a raft of. successes in their work life, it might make sense to take this opportunity for some serious re-evaluation of one's life priorities.. However, for an ADHD adult, on the brink of depression and perhaps financial ruin, this broader perspective is difficult to achieve and anxiety will soon swamp any view of the big picture.

Once you lose your momentum, you cannot select a career direction. You can easily be overwhelmed by the possibilities or depressed by the lack of possibilities. People with ADHD may find it difficult to make the first move once they reach the full stop.

As for John, he was a great student until the 6th grade, when school became less structured and therefore more challenging. During his early years, his parents helped him structure and plan his studying and schedule. they even quizzed him at night to help him focus and concentrate. he attended a magnet school where the teachers were highly involved and reviewed his homework, calendar, provided a lot of extra help and enjoyed his enthusiasm. his coaches in tennis and soccer also enjoyed helping him and, for a while, didn't mind encouraging him to Focus. Maintain your attention. make sure to stay alive. However, they observed that he often seemed to be out in left field. he couldn't stay focused during the practices or games. he also had difficulty remembering the strategies that were discussed pre-game.

When his classes became more difficult and he was expected to be more adult and autonomous; keeping up became increasingly difficult. he was no longer able to compensate for his lack of organization, foresight and focus, inattention, or inability to plan. his grades began to suffer; he no longer was an A student, and started getting Bs and Cs for the first time in his life. he didn't get what was happening, and his teachers and parents were just as confused. he became frustrated and demoralized, but remained persistent and continued to put all of his energy into doing well.

Since his parents were always involved, he was tutored three times each week. his grades improved a little, but never returned to straight A's.

The You just aren't trying Syndrome:

Hundreds of people I have seen in treatment are smart and very bright. they may have done very well at certain points in their lives and no one would imagine that they have ADHD. Oftentimes, very organized and structured parents or schools can serve as the person's frontal lobes or breaks in the early years. People with ADHD are great with structure. However, once the structure is gone, they have difficulty providing it for themselves. that is why when they get to college or graduate school and have achieved academically their entire lives, psychiatrists and others never entertain the possibility of ADHD. ADHD doesn't start as an adult. it starts during childhood. However, people with ADHD are often poor reporters and historians and may believe they had no trouble with attention or focus when, in reality, they did and their environment helped them compensate.

John did well in school for a while - in the early grades when there was a lot of structure. his high intelligence helped him compensate. as structure diminished and the difficulty of his coursework and material increased, he had more trouble keeping up.

As I dug a little deeper into his history, I began to suspect ADD, inattentive type. I asked him if he daydreamed a lot, even in the years when he was doing well. he said yes. he admitted that he would have been late to school every day had it not been for his super competent and organized mother who ran a tight ship. he said that he often forgot his homework or lunch but his mother would come to the rescue and bring it to him.

His mother not only ran a tight ship for John but also for her husband. she often complained that her husband didn't listen to her. on the weekends, he would leave projects incomplete. At one point, there were four half-finished projects in the garage. John's father sympathized with John because he behaved similarly all of his life. Luckily, he was in a career that allowed him to jump from task to task and he did not need to focus for extended periods of time. he was a trader on Wall Street and thrived on the excitement and the ups and downs. he never finished college, even after 6 years, and went to work at an entry-level position, working his way up to quite a successful position.

ADHD runs in families. Fortunately, John's mother was spared and therefore was able to maintain an organized and structured household. However, John's father had ADHD symptoms but was never diagnosed. The condition didn't seem to impair his ability to achieve success in his career. Fortunately, he chose a career that was a good match for someone with ADHD. At 87, the heritability rate of ADHD in families is one of the highest of any syndromes in psychiatry. Despite this, many people in our culture and in the mental health field continue to feel it is not a real syndrome and shouldn't be addressed as such.

I told John that I highly suspected a diagnosis of ADHD, which is what had been haunting him for most of his life. I was of the opinion that he did not have depression, bipolar or borderline personality disorder and that his symptoms could get a lot better. I also reassured him that he didn't have a learning disability or dementia. People with ADHD can have learning disabilities, but more often than not, they are very talented, gifted, and intelligent. when ADHD is recognized and appropriately treated, people with ADHD are free to express their talents and gifts to the world.

John was very relieved, and looked as though he had been given a new lease on life. we discussed the potential treatments including coaching, cognitive behavioral therapy, and medications.

Treatment for ADHD must be individualized, as each person is unique. But there are some general guidelines that are helpful to remember. People are complex and their lives are complex. Treatment isn't about writing a prescription and seeing the patient once a year. Treatment is about a relationship and helping the person develop a comprehensive game plan to move on with their lives to achieve their full potential.

First and foremost, the relationship between you and the patient is the foundation for helping him improve, whether you are prescribing medications once every three months, doing therapy or coaching.

Second, people with ADHD often have difficulty maintaining and focusing on relationships. many experts believe that connection is one of the primary pillars of helping someone improve. this MUST be a part of the treatment.

Third, I believe that all too often the treatment focus is on deficits or problems. this is how we are all trained-what is the problem? what is wrong and how are we, the treatment provider, going to fix the person?. People come to us with so many gifts, talents and strengths. it is essential to help the person realize their strengths and show them what extraordinary challenges they have overcome. The best gift we can give our patients is showing them their own power, potential and the possibilities of what CAN be.

John returned after two weeks, having started the Adderall. for the first time in his life, he felt like he was out of the fog. he wasn't giddy or anxious; he just felt ok, in the present. he was engaged in our session, where we discussed and wrote down goals for each area of his life for the next three months, year, and five years. we addressed areas of work, community, spirituality, relationships and personal growth. I recommended weekly cognitive therapy with me to work on these goals, as well as meeting with an ADHD coach.

One year later, we touched base on his achievements. he had left his job for a promotion at a competing company and was engaged to his girlfriend. his mood was much better; he was exercising, and we both smiled at the strides he had made. it was not only exciting for him, but it was one of the reasons that I love my work, creating a relationship with people and helping them achieve their potential and share it with the world. There is no greater gift.

Scott Shapiro, MD
Edward Hallowell, MD

Adult Attention Deficit Disorder - Overdiagnosed?

Depression is increasingly common, and a growing number of people in the Western world are taking anti-depressant medication. Many herbs and supplements offer natural help for depression, but how do you know which ones are effective and safe?

There are also many therapies that can be used as self help for depression even if you are taking medication.

Depression is a more serious condition than just feeling a bit down. At its worst it can be a debilitating illness. Depression is usually divided into mild, moderate and severe. Although severe depression usually needs medical treatment and often also psychotherapy, there is a growing interest in natural help for depression.

Probably the most common herb used to treat depression is St. John's Wort (Hypericum perforatum). It is widely used in Europe especially for mild or moderate depression, although in the US this herb is classified as a dietary supplement.

Some studies have reported that St. John's Wort is more efficient than a placebo and as effective as tricyclic antidepressants when used in the short term to treat mild to moderate depression. St. John's Wort is also often suggested for SAD, seasonal affective disorder. this wintertime condition affects mainly people who live in areas that get little winter sunlight.

However, in some studies the herb has not been found effective for major depression. because it can interfere with some prescription medications, you should consult your doctor before starting to take this herb. the quality of the supplement is also important, as there are many over-the-counter herbal products that have fairly low levels of hypericin (the active ingredient) and are not as effective as the higher quality supplements.

Good nutrition is important when you are suffering from any illness and there are some nutrients that are especially important for depressed people. Omega-3 fatty acids are so-called healthy fats that the body uses for many functions, including maintaining the nervous system.

Many studies also connect them with mood and emotional health. Omega-3 can be found in oily fish, some seeds and nuts, flaxseeds and flaxseed oil. It is also available in supplement form.

Many therapies can be used as self help for depression and they can often complement medical care. Many of them are safe to use even if you are taking prescription anti-depressants. These complementary therapies are not intended to replace medical care, but are safe to use to relieve symptoms in depressed people.

Some common therapies to use as self help for depression include yoga, meditation, relaxation techniques, acupuncture, massage and aromatherapy.

Herbs and supplements can provide natural help for depression without the side-effects of many anti-depressant medicines.

However, alternative or complementary treatments and supplements are not monitored and tested with the same strict methods as medical drugs. some herbs can sometimes interfere with certain medicines. It is important that you talk to your doctor before taking alternative remedies to make sure it is safe to take them, especially if you are on anti-depressant medications already.

Natural Help for Depression: Herbs, Supplements and Therapies

So what are the signs and symptoms of Post Natal Depression?

After many years of trying for a baby what a blow it was to find that after the birth of my beautiful daughter I felt utterly useless, had no energy and I was constantly questioning the purpose of life.

I had imagined that this would be the most ecstatic time of my life when everything I had yearned for such a long time (the arrival of my first child) had finally come to pass.

How wrong can you be? Instead I felt desperation and totally unable to cope on my own. My family kept rotas to keep me company and, as they though, sane

The doctor kept telling me I had post natal depression but I was in denial and insisted something far more serious was wrong with me. For the sake of my family, and my beautiful baby, I eventually entered into a counselling program and started a course of antidepressants. I honestly thought I would never be normal again but I'm pleased to say that a full recovery ensued and I also went on to have another gorgeous daughter.

If you are reading this article and can relate to my experience please don't delay like I did. go to your GP who can tell you if you have post natal depression and seek the treatment that is best for you.

If you think you could be suffering from post natal depression your symptoms could be some or all of the following:

Crying - This can be for no reason at all, over silly little things and can even be most of the time.

Low Mood - you find it difficult to show an interest in anything and you take little or no pleasure in your loved ones or surroundings.

Feelings of Guilt - you feel you are a burden on others and feel particularly guilty that you are a bad mother.

Eating - This can be either over-eating or an inability to eat.

Aches and Pains This can be problems with your eye sight, pain in your abdomen, even headaches and in particular worrying that something very serious is wrong with you.

No interest in sex.

These are only a few of many possible symptoms but do remember this can happen to anybody. even the bubbly and chirpy Stacey Solomon who won our hearts on the X Factor and became queen of the jungle became a victim to this very cruel form of depression.

The Signs and Symptoms of Post Natal Depression

The study results conclude that mood disorder and depression are two Faces of the same coin. we can call depression as a symptom of mood disorder. Feeling of hopelessness, apathy and low energy are indications of depression. Mood disorder is also characterized by failures and rejections in ones life. it is both a psychotic and a neurotic condition.

Depression is mainly because of the consequences of life such as the death of kin etc. Most of these kinds of depression (bipolar) fade away with the time and as one takes the new situation in his/her stride. it is not for nothing that they say time is the best healer. the chronic mood disorders (unipolar), in some cases genetic, require medical attention as they can be life threatening (suicides). the unipolar mood disorders are major types and clinical attention is necessary. no amount of love from kin, positive thinking or counseling can help. Medical assistance is imperative to cure the depression spread over sessions. Lack of treatment can result in permanent behavioral disorder.

Off late is believed that depression is connected to deficiency of norepinephrine and serotonin. Drug therapy uses various antidepressants. Caution needs to be exercised in administration of drug supplements in bipolar patients. Mood disorders or depressions of unipolar type has benefited from electroconvulsive therapy.

Psychologists have argued in recent years that the depression or the mood disorder is a result of learned helplessness when a person understands his actions have been useless and looses hope. it is also found that such people are emotionally dependent on others for morale boosting.

The most determinants of mood disorder are tackled even without medication. but non-negligence and timely diagnosis (initial diagnosis need not be even at the psychiatrist's site) can result preventing physical and physiological disorders and alcoholism etc.

Mood Disorders - Depression