The closer you live to nature, the healthier you’re likely to be.

For instance, people who live within 1 kilometer of a park or wooded area experience less anxiety and depression, Dutch researchers report.

The findings put concrete numbers on a concept that many health experts had assumed to be true.

“It’s nice to see that it shows that, that the closer humans are to the natural environment, that seems to have a healthy influence,” said Dr. David Rakel, director of integrative medicine and assistant professor of family medicine at the University of Wisconsin School of Medicine and Public Health.

One previous study had noted fewer health inequalities between rich and poor people in areas with lots of green space, and other studies have echoed these health benefits. But much of this research had relied on people’s perceptions of their physical and mental health.

This new objective look at the matter involved scouring medical records of 345,143 people in Holland, assessing health status for 24 conditions, including cardiovascular, respiratory and neurological diseases. This information was then correlated with how much green space was located within 1 kilometer and 3 kilometers of a person’s postal code.

People living in more urban environments had a higher prevalence of 15 of the 24 conditions, with the relationship strongest for anxiety disorder and depression.

In areas with only 10 percent of green space, about 2.6 percent of people experienced anxiety disorders, compared to 1.8 percent of people in areas with 90 percent green space. The disparity was evident for depression as well – 3.2 percent of people living in more urbanized areas had depression versus 2.4 percent of those in more rural areas.

The health benefits were evident only when the green acres were within a kilometer, not at the 3 kilometer perimeter, except for anxiety disorders, gastrointestinal digestive disorders and so-called medically unexplained physical symptoms, the researchers said.

Children and poor people suffered disproportionately from lack of green acres, the researchers found.

The study findings were published online Thursday in the Journal of Epidemiology and Community Health.

Any number of factors could account for the benefits of green space, experts said.

More natural sunlight, for instance, has been linked with a lower incidence of Seasonal Affective Disorder (SAD) and other benefits.

“If patients in hospitals have direct exposure to sunlight through a window or natural sunlight, hospital stays are shorter and patients have less complications,” Rakel said. “That’s been well-established.

More light also means more vitamin D in the skin, which has been found to elevate mood and improve muscle strength, he added.

And fresh air, obviously, has a benefit as well, as do the exercise opportunities that come with more open space.

But much of the relief may come from the simple ability to de-stress.

“If we’re in a busy street with more technology and artificial things, we’re going to be multi-tasking more, which prevents us from focusing on one thing,” Rakel said. “In this day and age, we really need some sort of centering practice. We need to get our mind out of its own stories and focus on something that’s pure. Nature is a beautiful example of that – it’s the way things were meant to be.

Carlo Mueres is a talented depression therapist who have been working with depression for seven years. If you want more his help please check his depression and anxiety guide!

Part of the problem in finding drugs which may be effective for dementia is that our ideas about what constitutes dementia have been undergoing radical change in recent years. It had been traditional to distinguish between Alzheimer’s dementia, or senile dementia of the Alzheimer’s type (SDAT) and multi-infarct dementia (MID), which is theoretically caused by small strokes which insidiously pick off brain tissue to the point where an individual’s cognitive function is compromised.

It was originally thought that MID accounted for 60%+ of the dementias. Accordingly, early attempts to treat the dementias concentrated on the multi-infarct dementias. The initial hypothesis was that these multiple small strokes were being caused by a process of hardening of the arteries, sometimes called arteriosclerosis and sometimes atherosclerosis (although these terms refer to two quite different disorders) which impaired blood supply to the brain. The logical treatment, therefore, for this condition was to attempt to dilate blood vessels. This led to the use of a wide number of vasodilating drugs such as hydralazine.

It is quite rare now for such drugs to be used for this purpose. Arguably, if anything, such treatment may have made the condition somewhat worse in that a potential effect of vasodilators is the reduction of blood pressure and reducing blood pressure would mean that the brain would be less perfused with blood, as one of the functions of blood pressure in the first instance is to provide the propulsive force to send blood up against the force of gravity to perfuse the brain.

Stage 2

More recent attempts to treat the dementias have proceeded on the basis that Alzheimer’s dementia is the commonest form of dementia. For many years, the term Alzheimer’s dementia was reserved for dementias that came on before the age of 65 (for this reason it was also called persenile dementia), which were not obviously caused by strokes. It was conceded that there was another dementia that was like Alzheimer’s dementia, which appeared to come on after the age of 65 but this was thought to be less common. Distinctions on the basis of age have now collapsed and both dementias of the Alzheimer type are now called senile dementia of the Alzheimer type. The amalgamation of these two groups led to an awareness that Alzheimer’s-type dementia is the commonest form. The primary therapeutic focus in the field, therefore, has been on an attempt to reverse the deficits which are supposed to be present in SDAT.

In particular, it has been held that in Alzheimer’s, there is a dysfunction of cholinergic pathways in the brain, for which there are both historical and clinical reason. Historically, when early work in psychopharmacology began, there were only four known neurotransmitters – noradrenaline, 5-HT, dopamine and acetylcholine (ACh). Noradrenaline quickly became the neurotransmitter involved in depression and mood disorders. Dopamine was known to be involved in Parkinson’s disease, and, when it became clear that neuroleptics acted on it, schizophrenia, after which the psychoses in general came to be seen as disorders of dopamine neurotransmission. For the most part, 5-HT was associated with either depression or anxiety. This left ACh without a function. It seemed convenient to parcel it out to the dementias.

There was, in addition, some clinical evidence in favour of an association between the cholinergic system and dementia. Part of the reason for this claim can be seen in a number of the chapters of this blog, in which drugs with anticholinergic effects have been noted as potentially causing amnesia or confusion (see The Management of Side Effects & Side Effects of Antidepressants articles).

Stage 3

In the last 5 years, a number of other dementias have been described. A distinction has been drawn between cortical and subcortical dementias. The cortex of the brain is the area responsible for higher cognitive functions, such as speaking, reading, planning and executing actions, etc In the cortical dementias, memory is usually the function most noticeably affected but those who are affected also have problems with planning even simple functions such as dressing and they typically cannot read, draw or execute any complex tasks. Alzheimer’s and MID are cortical dementias. There are also subcortical parts to the brain which are common to humans and other mammals. They involve a number of what are termed midbrain and brainstem structures.

Read more at dementia managing

This past week we saw the news media captivated by the idea that a 6-year-old boy, Falcon Heene had been carried off by a weather balloon. That is until the boy was later found in his own garage attic and shortly thereafter it was revealed on a television news show that the entire incident was likely a hoax. In replying to a reporter’s question, the young Falcon turned to his dad on camera and said, “You guys said that, umm, we did this for the show.” Oops.

The parents – Richard Heene and Mayumi Heene – have all along claimed it was not a hoax or a publicity stunt. Now, according to The New York Times, the parents will voluntarily surrender to police as soon as charges are filed, which is expected to happen on Wednesday.

While the truth continues to unfold, the police in the investigation have concluded it was likely indeed a publicity stunt: “We have evidence to indicate it was a publicity stunt done with the hope of marketing themselves to a reality-television show sometime in the future,” said Larimer County sheriff Jim Alderden on Sunday afternoon at a news conference in Fort Collins, Colorado.

So that leaves us with the inevitable question – what could possibly psychologically motivate parents to use their child’s very life in order to further themselves?

We see clues to the answer in some other information that’s trickling out about the parents. ABC News noted that former business partner Barbara Slusser – who chased hurricanes and other storms with the Heenes – that they parted ways when Slusser felt that the Heenes often put their kids in harm’s way. Slusser told ABC News, “The last straw for us was when Hurricane Gustav and Hurricane Ike were heading toward the Texas coastline and Heene wanted to go back there and take the kids.”

So we seem to have a set of parents who already don’t quite understand the idea of how to raise children in a safe, responsible and thoughtful manner, thinking nothing of storm-chasing hurricanes and tornadoes with their young children in tow. Storm-chasing, of course, can be a very dangerous and unpredictable endeavor. One of the reasons adults do it is for the thrill of the unpredictability of the storm – putting oneself in harm’s way to experience a ferocious component of nature. But your children? They aren’t old enough to make such decisions for themselves – they trust their parents’ good judgment and experience.

But an account on Gawker by someone who worked with Richard Heene sheds even more light on the Heenes’ motivation – money and additional fame. This was a family that had been on the television program, Wife Swap, and they had already tasted celebrity. They wanted more of it.

Carlo Mueres is a talented depression therapist who have been working with depression for seven years. If you want more his help please check his depression and anxiety guide!

A nervous breakdown refers to a mainstream and often-used term to generically describe someone who experiences a bout of mental illness that is so severe, it directly impacts their ability to function in everyday life. The specific mental illness can be anything – depression, anxiety, bipolar disorder, schizophrenia, or something else. But the reference to a “nervous breakdown” usually refers to the fact that the person has basically stopped their daily routines – going to work, interacting with loved ones or friends, even just getting out of bed to eat or shower.

A nervous breakdown can be seen as a sign that one’s ability to cope with life or a mental illness has been overwhelmed by stress, life events, work or relationship issues. By disconnecting from their regular responsibilities and routines, an individual’s nervous breakdown may allow them to try and regroup their coping skills and temporarily relieve the stress in their life.

Someone with a nervous breakdown may be seen as having “checked out” from society temporarily. They no longer maintain their social relationships with others, and find it difficult or impossible to go to work and may call in sick multiple days in a row. People with a nervous breakdown often don’t even have the coping resources available to take care of themselves, or do much more than rudimentary self-care and maintaining. They may over-eat (if it provides them comfort) or simply fail to eat altogether, not feeling the need or energy to do so.

Since a nervous breakdown is not a clinical or scientific term, it’s meaning can also vary in terms of its length and severity, as well as outcomes. Many people who suffer from a nervous breakdown usually seek out treatment (or have treatment sought out on their behalf by a loved one), and treatment is usually on the serious end of the spectrum of all the interventions available. Inpatient hospitalization for a serious nervous breakdown would not be unusual, to help a person become stabilized and find an effective treatment strategy for the mental disorder they’re affected by.

People who suffer from a nervous breakdown and seek out treatment for it will usually recover from the most extreme depths of the “breakdown” within a few weeks’ time (which may be quickened with inpatient psychiatric treatment). Longer-term recovery usually takes months of ongoing outpatient treatment with mental health specialists, such as a psychiatrist or psychologist.

A nervous breakdown is not a condition to be afraid of, as it is simply an indication of overhwelming stress and mental illness in a person’s life. Loved ones and friends of someone who is suffering from a nervous breakdown should be supportive of the individual’s efforts in seeking help for it.

Carlo Mueres is a excellent depression therapist who have been working with depression for seven years. If you want more his help please check his depression and anxiety guide!

All antidepressants may not be created equal when it comes to worsening of suicidal ideation during treatment, researchers found.

Men taking nortriptyline (Aventyl, Pamelor) were 2.4 times more likely to have an increase in suicidal thoughts than were those taking escitalopram (Lexapro), Nader Perroud, MD, of King’s College London, and colleagues reported online in BMC Medicine.

Nortriptyline, a tricyclic antidepressant, was also associated with a 9.8-fold higher risk of new onset of suicidal ideation compared with the selective serotonin reuptake inhibitor (SSRI) in the prospective open-label trial.

The reason behind the difference may be that nortriptyline acts predominantly on the noradrenergic system, which, when overactive, is associated with anxiety and agitation.

Because “suicidal ideation is more common in agitated and irritable types of depression,” the researchers said, “it is possible that nortriptyline may induce or worsen suicidal thoughts in some male subjects possibly through an induction of this more agitated type of depression.”

Another possibility is that nortriptyline is less effective against mood symptoms, they noted.

All antidepressants now carry black box warnings of suicidality risk, particularly in children and young adults, and especially early in treatment, but whether this risk differs between agents or by gender has been debated.

Prior studies have looked only at emergence of suicidal thoughts in patients who reported none initially, which “highlights the relatively rare cases with de novo treatment-emergent suicidal ideation,” Perroud’s group said, but could be “‘throwing the baby out with the bath water’ through removing a large proportion of patients at risk.”

So they analyzed findings from the Genome-Based Therapeutic Drugs for Depression (GENDEP) trial, “the largest comparative study of an SSRI and tricyclic antidepressant,” to look at both issues.

The multicenter study included 811 adults with moderate to severe unipolar depression allocated to open-label, flexible dose escitalopram or nortriptyline for 12 weeks. Among them, 473 reported suicidal ideation at baseline.

Overall, suicidal ideation dropped significantly over time in both treatment groups (P less than 0.0001).

And although nortriptyline was associated with higher mean suicidal scores than escitalopram throughout treatment (P less than 0.0001), the difference disappeared after adjusting for baseline scores (P=0.449).

Increases in suicidal ideation – defined as 0.5 standard deviation or greater score increase – were seen at some point in 31.9% of patients.

Treatment group did not appear to have an impact on suicidal ideation changes during therapy in the overall cohort, but it did make a difference in men.

Among men, the overall rate of increase in suicidal thoughts was 35.29% with nortriptyline compared with 23.7% with escitalopram. Even after adjustment for depression severity at baseline and during the study, the effect remained significant.

Carlo Mueres is a excellent depression therapist who have been working with depression for seven years. If you want more his help please check his depression and anxiety guide!

Nortriptyline has been found to cause a ten-fold increase in suicidal thoughts in men when compared to its competitor escitalopram. These findings are published in the open access journal BMC Medicine.

The research was carried out by Dr. Nader Perroud from the Institute of Psychiatry, Kings College London, who headed up GENDEP, an international team. Dr Perroud said “Suicidal thoughts and behaviours during antidepressant treatment have prompted warnings by regulatory bodies”. He continued “the aim of our study was to investigate the emergence and worsening of suicidal thoughts during treatment with two different types of antidepressant.”

Both escitalopram and nortriptyline have their effect through the mood modulating neurotransmitter systems. The former is a selective serotonin reuptake inhibitor (SSRI), preventing serotonin from re-entering the cell and thereby prolonging its effect on nerve synapses. The latter is a tricyclic antidepressant that inhibits the reuptake of noradrenaline, and to a lesser extent, that of serotonin.

The study was carried out on 811 individuals with moderate to severe unipolar depression. Whilst an overall trend in reduction of suicidal thoughts was observed, men who took nortriptyline were found to have a 9.8-fold increase in emerging suicidal thoughts and a 2.4-fold increase in worsening suicidal thoughts compared to those who took escitalopram.

Perroud concludes, “Our findings that treatment-emerging and worsening suicidal thoughts may also be associated with psychomotor activation triggered by antidepressants needs to be investigated in future studies.

The study also refutes the idea that newer antidepressants such as the SSRIs are worse than older medications in terms of increasing suicidal thoughts.”

Notes: Suicidal ideation during treatment of depression with escitalopram and nortriptyline in Genome-Based Therapeutic Drugs for Depression (GENDEP): a clinical trial Nader Perroud, Rudolf Uher, Andrej Marusic, Marcella Rietschel, Ole Mors, Neven Henigsberg, Joanna Hauser, Wolfgang Maier, Daniel Souery, Anna Placentino, Aleksandra Szczepankiewicz, Lisbeth Jorgensen, Jana Strohmaier, Astrid Zobel, Caterina Giovannini, Amanda Elkin, Cerisse Gunasinghe, Joanna Gray, Desmond Campbell, Bhanu Gupta, Anne E Farmer, Peter McGuffin and Katherine J Aitchison

Carlo Mueres is a excellent depression therapist who have been working with depression for seven years. If you want more his help please check his depression and anxiety guide!