A broken heart has become synonymous with the pain of romantic rejection and bad relationships. According to a new Michigan State University study, though, a bad marriage could quite literally break your heart—especially if you’re female.

Can Your Relationship Affect Your Heart Health?

Researchers decided to look at the effects of a bad marriage in older couples, since most marriage counseling and research into marital quality focuses on young people. They analyzed five years of data from the National Social Life, Health and Aging project, looking at about 1,200 married women and men ranging in age from 57 to 85. Participants answered questions about the quality of their marriages, in addition to undergoing lab tests and reporting their symptoms of and risks for cardiovascular disease.

The researchers found that people in bad marriages were more likely to have cardiovascular problems. They also learned that a bad marriage affects heart health more than a good marriage, and that women in bad marriages suffer more negative cardiovascular effects than men in bad marriages. They speculate that this may be because women are more likely to internalize negative feelings and to become depressed. The negative effects of a bad marriage on heart health increase with advancing age. [fat_widget_relationships_right]

Researchers also found that heart disease itself could harm marriages, but only for women, not for men. They point out that previous research has found that women are more likely to care for sick spouses than to receive care when they are sick. Consequently, married women with heart disease may get less support and be subject to more stress than married men with heart disease.

Heart disease is the leading cause of death for people in the United States, and it kills more women than all forms of cancer combined, according to the American Heart Association.

References:

1. About heart disease in women. (n.d.). Retrieved from https://www.goredforwomen.org/home/about-heart-disease-in-women/
2. Bad marriage, broken heart? (2014, November 19). Retrieved from http://www.sciencedaily.com/releases/2014/11/141119204855.htm

Have you ever busted out in good, hearty laughter for a couple of minutes and then felt a rush of blissful joy? You know the kind of laugh we’re talking about; the one where you have a tough time catching your breath, your stomach and cheeks hurt, and your eyes water like crazy. It is this kind of laugh that often leaves us feeling wonderful, and perhaps even a little exhausted afterward. But did you know that laughing like this is also great for your health? Want even more good news? So is smiling.

Smiles and laughter have been proven in multiple studies to benefit a person’s wellness, and these two simple actions can also dramatically change the way others perceive you. If it has been a while since you enjoyed a good chuckle or shared an ear-to-ear grin, it is time to turn that frown upside down and get busy doing things that make you smile and laugh.

Here are four reasons to get you started:

1. Laughter Is Medicine and Improves the Body’s Functioning Almost Like Exercise

[fat_widget_right]You may have heard from Reader’s Digest that laughter is the best medicine. Well, in many ways that old saying is true. Physiologically, we change as we laugh. When you bust out in laughter, your heart rate goes up and your breathing rate increases, which gets more oxygen flow to the cells and gives your muscles a big stretch.

Dr. William Fry, a leading researcher of the psychology of laughter at Stanford University, discovered that it took him 10 minutes of rowing to get his heart rate up to the level that hardcore laughter achieved in just one minute.

In other studies, people struggling with illness, depression, anxiety, and other conditions who incorporated more laughter into their lives reported drops in blood pressure rates, stronger immune systems, and less stress.

2. Laughter Releases Endorphins

Endorphins are the “feel good” chemicals that are released when you exercise, and research asserts that endorphins are also released during a good laugh. A 2006 study by Lee S. Berk of Loma Linda University demonstrated the mere anticipation of laughter was enough to release endorphins.

There is even a new type of yoga quickly gaining popularity called Laughter Yoga, in which participants are led through laughter exercises. Laughter Yoga emphasizes the benefits of increased endorphins and utilizes laughter to reduce stress, encourage a positive attitude, and improve a person’s health.

3. Smiling and Laughter Improve the Way Others See You

If you laugh and smile more, it improves your overall quality of life by changing the way people perceive you. A study that built on previous research about the effect smiling has on others (1994) found that smiling is a universal response that is understood among human beings. Smiling indicates happiness, which is one of six basic emotions universally presented and understood across cultures.

In this study, students were asked to evaluate slides of males and females smiling or displaying other facial expressions. The students were then asked to rate the slides on 12 adjectives: optimism, conciliation, calmness, reliability, leadership, happiness, intelligence, attractiveness, beauty, sympathy, sincerity, and kindness. The only trait that was not found to have a significant positive correlation to smiling was leadership, which seemed to be more affected by the manner in which the subject was smiling (head tilted, closed lip smile, etcetera).

4. Laughter and Smiling Can Help Relieve Pain

A study published in 2010 examined the therapeutic value of laughter in medicine. One of the pieces of research this study built on was that of Norman Cousins, who published an article titled “Anatomy of an Illness” in the New England Journal of Medicine in 1976. This article serves as the basis of most research concerning laughter and health care.

Cousins was diagnosed with a severe form of arthritis called ankylosing spondylitis. This condition primarily causes painful inflammation of the spinal joints, leading to chronic pain and discomfort. Cousins theorized that adding laughter to his health care routine would help and began introducing a heavy dose of “Candid Camera” and comedies into his regimen. He found that this daily serving of humor helped him sleep comfortably—more than he had been able to previously. He said, “It worked. I made the joyous discovery that 10 minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep.”

And as for the 2010 study that quoted Cousins’ finding? It concluded that there is “sufficient evidence to suggest that laughter has some positive, quantifiable effects on certain aspects of health … Add laughter to your working and daily life, remember to laugh regularly, share your laughs, and help others laugh too.”

When you feel down in the dumps, remember that you have an absolutely free, potent form of medicine available to help you relieve some of your symptoms. The acts of smiling and laughing can be healing, cathartic, and great for your health—even if you have to force it.

Smile and say hello to those you pass. Watch a comedy film or television show or attend a live stand-up comedy show. If you cannot shake the bad mood you are in, get around those that make you laugh. Laughter, after all, is contagious. As you become mindful of the positive effects of smiling and laughing, you may notice that your days feel lighter and a few laughs and smiles are aimed back at you.

References:

1. Griffin, R. (n.d.). Give your body a boost–with laughter. Retrieved October 7, 2014, from http://www.webmd.com/balance/features/give-your-body-boost-with-laughter
2. Mora-Ripoll, R. (2010). The therapeutic value of laughter in medicine. Alternative Therapies in Health and Medicine, 16(6), 56-64. Retrieved from http://search.proquest.com/docview/808403188?accountid=1229
3. Otta, E., Lira, B. B. P., Delevati, N. M., Cesar, O. P., & Pires, C. S. G. (1994). The effect of smiling and of head tilting on person perception. The Journal of Psychology, 128(3), 323-31. Retrieved from http://search.proquest.com/docview/213818302?accountid=1229
4. Psychophysiology: just the expectation of a mirthful laughter experience boosts endorphins. (n.d.). Retrieved October 1, 2014, from http://www.healinglaughter.org/blog/psychophysiology-just-the-expectation-of-a-mirthful-laughter-experience-boosts-endorphins

I really appreciate the authenticity with which you present your situation. The guilt you are feeling for writing in—and even for having the thoughts feelings you have—is palpable.

It is clear how much you love and care for your wife. You express concern about her physical and mental health and feel fearful that she will not survive long enough to grow old with you. This suggests that you want her to be around to grow old with and you know she needs to be healthier, both physically and emotionally, in order for that to happen. That said, you can’t control your wife’s choices and behaviors; you can only control your own choices and behaviors. In that vein, I think it could be helpful for you to consider engaging in your own therapy. You are dealing with fear, shame, guilt, and anxiety about the uncertainty of your marriage. This is a lot to carry around. Therapy can provide a safe place and a strong therapeutic relationship to support you as you sort through these issues.

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From your description, it does sound entirely possible that your wife could be depressed. She may also benefit from therapy. Again, you can’t control whether she goes to therapy, but you can encourage her to consider it and ask her to do it. If you do decide to enter therapy and you share the benefits of your therapeutic experience with her, she might feel the inspiration and motivation to get started herself. If she doesn’t feel ready for her own individual therapy, maybe she would be willing to go to couples therapy with you or even just come to some sessions with you and your therapist.

Of course, it’s possible your wife won’t change, or even attempt to. It’s understandable that, if this plays out, you may consider walking away from the marriage. It’s also understandable if you decide to stay, in spite of your concerns, because of how you feel about your wife. There’s not really a wrong answer here.

I guess the bottom line is this: You both seem to be hurting, and it seems to be damaging your marriage, but there also seems to be a lot of love here. If you can each make a commitment to working through this to get to a healthier place, you’ll be off to pretty strong start.

Sincerely,
Sarah

The day I had been waiting for had arrived. I’d finished cancer treatment and could move on with my life after nearly a year of difficult treatments. I remember the feeling of elation that followed me after that last day of radiation treatment. I finally felt free. My husband and I took a trip to Hawaii to celebrate, and I felt more alive than maybe ever in my life. It was like I’d been holding my breath for months and now I finally was able to exhale. I’d finally been released from the physical and emotional confinements of cancer treatment.

When I returned from my Hawaiian “cancer-cation,” I found that things were already changing from the way they had been during treatment. There were no more supportive cards arriving in the mail, email check-ins from friends started to dry up, and the fruit baskets stopped arriving. Then the calls offering support started to dry up. Medical appointments became less frequent. Support systems began to fade. And then came the feelings—big, dark, troubling feelings. I found myself thinking, “I could have died; I still could die!” and the recognition that I would be living in the shadow of cancer for the rest of my life began to emerge.

Soon it was time to return to work, and I began to feel the weight of expectations from friends, family, and coworkers. I was done with treatment, and everyone wanted me to return to life as normal. Everyone was expecting it. But I knew I was forever changed and there would be no going back to “the old me.” I began to feel the pull of depression and anxiety, as well as the need to make meaning of my cancer experience. I began to wonder if it was a good time to reach out for help.

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Does this experience resonate with you? It seems to be a common theme among cancer survivors I have worked with. In fact, it’s an experience so common and almost universal to people who have had cancer that many cancer hospitals and treatment facilities are now taking action toward creating survivorship programs that address the ongoing mental health needs of their patients. There is a reason they call the period after cancer “the new normal.” It’s an acknowledgment that the old, precancer life is gone and that we have to make our way to finding a new life for ourselves.

Why do so many of us who have experienced cancer face depression and anxiety post-treatment? Getting a cancer diagnosis is one of the most shocking and frightening experiences a person can face. It is, for many people, a traumatic experience. Even for those who don’t feel traumatized by it, it’s a moment that is seared into our minds forever and something we will never forget.

Immediately after diagnosis, we go through an overwhelming period where we struggle to manage our fears and grasp exactly what we will be facing in our treatment. We often have to make quick decisions about treatment options in a very short period of time. There is little time to process all the fear and trepidation we feel. Then treatment begins and we focus on getting through it. We stuff down our emotions and connect with the warrior part of ourselves. And then treatment ends and emotions that were buried as part of self-protection begin to resurface. The intensity of the feelings we experience can catch us totally off guard.

We may experience anxiety and depression. For many, the end of treatment only marks the beginning of a whole new set of challenges to be faced: how to manage the anxiety and fears of recurrence. How to find meaning in an old life that no longer fits. How to process the enormity of what you’ve been through. You may be feeling as I did—lost and rudderless in a your new, post-cancer identity.

You may be wondering how to get your life back on track after cancer. I wish I could provide you with some kind of a map to guide you, or a spreadsheet detailing exactly what to expect in your emotional and physical recovery. The reality is that just as each of us has a unique cancer diagnosis and treatment experience, each of us will have a different experience in how we process our experience with cancer.

Some will need extra time to recover physically and to reconnect with and forgive a body that betrayed them. Some will want to explore a newfound sense of meaning that they found in their cancer experience. Others may need help in implementing a plan to finally start to put their health and self-care into priority. Some may connect to all of this and more.

If any of this resonates with you, you’ll likely find that connecting with a supportive therapist who understands the issues unique to people with cancer will be helpful to you. The kind of emotional exploration done in therapy will arm you with tools for coping with the depth of emotion you feel and allow you to get back on the path to living in your new, post-cancer identity.

Although epilepsy is one of the most common causes of seizures, it’s not the only cause. Extreme emotional states can give rise to seizures. Psychogenic nonepileptic seizures (PNES) are seizures brought on by emotional states, occurring in between 2 and 33 per 100,000 people. According to one study, as many as 20% of people diagnosed with epilepsy might have PNES instead.

New research published in Epilepsy and Behavior aims to discern the differences between the two types of seizures, and researchers were able to correctly differentiate PNES from epilepsy in 83% of cases. They also found a clear connection between anxiety and seizures.

How Anxiety Triggers Seizures

Epilepsy is caused by rapid and chaotic discharge of electrical signals in the brain, but people experiencing psychogenic nonepileptic seizures don’t show this pattern. People with depression, anxiety, and similar mental health concerns can experience PNES, but doctors aren’t sure why. Strangely, a large percentage of people with PNES have epilepsy, making it even more challenging to distinguish psychologically induced seizures from those brought on by epilepsy. 

Differences between Psychogenic Nonepileptic Seizures (PNES) and Epilepsy

Differentiating between PNES and epilepsy can help people experiencing seizures get faster, more effective treatment. To evaluate differences between the two types of seizures, researchers administered questionnaires to evaluate whether and how frequently participants avoided circumstances that made them feel anxious. The group of participants included 30 people with PNES, 25 with epilepsy, and 31 with no history of seizures. Researchers found that PNES was more common among people who regularly experienced anxiety and who took steps to avoid sources of anxiety.

[fat_widget_left]Researchers also found that people who reported more somatic symptoms were more likely to experience seizures. Somatic symptoms are physical symptoms, such as headaches or vomiting, that don’t have an underlying medical cause. The study’s authors note that their research highlights the need for effective interventions among people struggling with anxiety. Because people who experience PNES tend to avoid anxiety, researchers point to the need for treatments that can help people with PNES reduce avoidance behaviors while more effectively managing anxiety.

References: 

1. Mellers, J. D. (2005). The approach to patients with “non-epileptic seizures”. Postgraduate Medical Journal, 81(958), 498-504.
2. New research links anxiety to seizures. (2014, August 1). Retrieved from http://www.lincoln.ac.uk/news/2014/08/932.asp
3. The Truth about Psychogenic Nonepileptic Seizures. (n.d.). Retrieved from http://www.epilepsy.com/article/2014/3/truth-about-psychogenic-nonepileptic-seizures

Traumatic brain injury (TBI) is defined as an “alteration in the function of the brain or other evidence of brain pathology caused by an external force,” according to the Brain Association of America in 2011. Defining brain injury has not been consistent in the medical research because of the complexity of the brain physiology. Improvements in technology has helped improve understanding of the brain but there still remain significant unknowns. Science journalist Carl Zimmer describes the brain as:

• an intricate network of billions of neurons
• a collaboration of neurons in constant communication
• a chemical labyrinth that senses the world inside and outside
• an organ that produces love and sorrow,
• keeps our hearts beating,
• keeps our lungs breathing,
• composes our thoughts,
• and constructs our consciousness.

Nobel Laureate Eric Kandel described the human brain as “the most complex organ in the universe.” Damage to this vital organ can cause significant limitations to a person’s ability to process the activities of daily living and function both mentally and physically. Traumatic brain injury (TBI) happens suddenly but can leave a lifetime of permanent disabilities.

Medical research has not successfully discovered curative interventions to repair the brain to pre-injured status. The lack of proven effective treatments for restoring impairments means focus for interventions is on treating the symptoms associated with the multiply traumatic changes associated with brain injuries. This void in medical treatments indicates the need for psychosocial support for the TBI survivor, the spouse/partner, and family members. The main focus of therapy is 1) to help facilitate adaptation to a changed life, 2) to facilitate a quality of living with limited abilities, and 3) to create a collaborative new reality of well-being.

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Impact on Family Dynamics

Traumatic brain injury does not happen in a vacuum. It is a chronic health issue that affects the entire family. Murray Bowen’s family systems theory explains how traumatic changes to one member of the family cascades throughout the family system. In nature, this is like throwing a pebble into a pond and observing how the water ripples throw out the pond. When one family member suffers traumatic changes, the stress is felt throughout the family system. The established patterns and roles are altered, changing the entire family dynamics. The heighten changes are a major stressor and cause a negative shift in the family’s well-being.

Family members are often described as the “neglected victims” of TBI. Many marriages end in divorce after brain injuries. The loss of an intact family causes further losses for the survivor. The difficulty learning to understand and cope with the monumental changes post injury are some of the reasons there is a need to conduct therapy from a family perspective. The therapeutic process needs to address loss, grief, and adaptation to creating a new life. Maintaining and developing socializations skills as well as a strong support system of family, friends, and a spiritual leader are helpful to the healing process.

‘An Invisible Disease’

There are many challenges to traumatic brain injury that sets it apart from other chronic illnesses. First, it has been described as an “invisible disease” and a “silent epidemic.” It is estimated that 1.7 million people are diagnosed each year. However, these numbers are considered an underestimate because of the lack of visible damages and the subtleties of impairments. The extent of cognitive deficits may not be apparent until much later. The insidious nature of the impairments means family members and professionals may overestimate the abilities of the survivor.

However, trauma to the brain frequently causes pervasive cognitive dysfunction and variety of personality changes, such as impulsivity, anger, fatigue, irritability, unpredictability, and depression. Lack of critical thinking, impaired social perceptiveness, and lack of empathy are also considered hindrances for the lack of awareness the survivor has about his or her own impairments and the decrease in motivation to adapt to a new reality. These problematic issues have a negative impact on martial/couple relationship, family dynamics, and relationships in general. Yet, the research indicates that a meaningful and supportive relationship can contribute to the TBI survivor’s healing from the psychological trauma.

Including Partners and Family Members

The recommended plan of care for the injured person includes psychosocial support for the caregiver, spouse, and family members. The North American Brain Injury Society (NABIS) reports a need for more effective incorporation of family support based on the last decades of research. Marriage and family research has shown that maintaining strong and supportive relationships are integral to helping the survivor cope with challenging changes, as well as for the spouse and family members to adapt to living with a new person.

References:

1. Bowen, M. (1985). Family therapy in clinical practice. Northvale, NJ: Jason Aronson.
2. Brain Injury Association of America. (nd).http://www.biausa.org/index.htm
3. Brey, R. (2006). The silent epidemic: Traumatic brain injury’s massive impact on suffers and society. Neurology Now, 5.
4. National Institute of Mental Health (NIMH). (nd). http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
5. National Institutes of Health. (2008). Traumatic brain injury: A family finds its way. National Institutes of Health: Medline Plus, 3(4), 2-7. Retrieved from NIH Medline Plus: http://www.nlm.nih.gov/medlineplus/magazine/issues/fall08/toc.html
6. Nichols, P., & Schwartz, R. (2004). Bowen family systems therapy. In Family therapy concepts and methods (pp. 119-146). Allyn & Bacon.
7. North America Brain Injury Society, NABIS. (2008). Barriers and recommendations: Addressing the challenge of brain injury in America. Washington, D.C.
8. Wood, R., Liossi, C., & Wood, L. (2005). The impact of neurobehavioural sequelae on personal relationships: Preliminary findings. Brain Injury, 19(10), 845-851.
9. Zimmerman, C. (2004). Soul made flesh: The discovery of the brain and how it changed the world. New York: Free Press.

If you’ve ever had surgery that required anesthesia, you know the process of waking up can be a jarring one. Anesthesia induces a deep state of unconsciousness in a matter of seconds, but it can take several hours to return to normal after waking. Many people experience confusion, sleepiness, and even delirium-induced hallucinations as they awaken from surgery, but research on this waking process is limited. New research points to a complicated, meandering process through which the brain wakes up from anesthesia.

How Anesthesia Works

The state induced by anesthesia looks a lot like a deep sleep, but it’s actually quite different. Doctors rely on a variety of chemicals to induce unconsciousness, and each works slightly differently in the brain. What all general anesthesia recipes have in common is that they induce unconsciousness while preserving the body’s automatic functions, such as breathing and digestion. Anesthesia also reduces sensitivity to pain, which is why people don’t typically have dreams of being in surgery or experiencing pain when they’re under the knife.

Because a wiggly patient can quickly be injured, anesthesia also limits or eliminates your ability to move. For the one to two people out of 1,000 who briefly awaken during surgery, this paralysis can be terrifying. Fortunately, people who awake during surgery don’t typically experience pain.

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Waking from Anesthesia

Doctors have traditionally theorized that, as anesthesia is eliminated from the body, the brain’s electrical activity steadily increases until the brain returns to normal. But new research at Rockefeller University has found that the process of waking up is much more complex.

Researchers knocked rats out using a popular anesthesia called Isoflurane. As the rats awakened from the anesthesia, researchers examined electrical activity in areas of the brain believed to be associated with wakefulness. In fully awake brains, the electrical activity in neurons oscillates, but in an anesthetized or sleeping brain, electrical activity is slower.

Instead of finding a gradual increase in oscillating neurons, researchers found that oscillations occurred suddenly. While every rat’s brain eventually had oscillations in the same “hubs,” the process through which neurons became more active in each hub varied from rat to rat. Researchers believe this indicates that there’s not a single path through which the brain awakens from anesthesia. Because every rat’s brain ultimately used the same hubs, though, the research suggests that certain brain activity is a necessary prerequisite to consciousness.

While research on rats isn’t always applicable to humans, rats and humans respond in similar ways to anesthesia. While anesthesia is extremely safe, a small number of people who undergo surgery don’t wake up. Among people over the age of 65, the risk is higher. By gaining a better understanding of how the brain wakes up from anesthesia, researchers may eventually find a way to reduce the risks of undergoing surgery.

References:

1. General anesthesia. (2013, January 19). Retrieved from http://www.mayoclinic.org/tests-procedures/anesthesia/basics/risks/prc-20014786
2. To recover consciousness, brain activity passes through newly detected states. (2014, June 9). Retrieved from http://newswire.rockefeller.edu/2014/06/09/to-recover-consciousness-brain-activity-passes-through-newly-detected-states/
3. WorldCrunch.com. (2011, August 4). Under the knife: Study shows rising death rates from general anesthesia. Retrieved from http://healthland.time.com/2011/08/04/under-the-knife-study-shows-rising-death-rates-from-general-anesthesia/

Multiple sclerosis (MS) is a progressive autoimmune disease that results in neurological impairment due to lesions on the myelin sheaths that cover nerve fibers and axons. About 400,000 people in the United States and 2.3 million worldwide have MS.

At this time, we do not know what causes MS. There are many theories, but no concrete explanation to date.

Here are some things you may not know about MS. All data presented are from the National MS Society.

1. MS has four types.

Most people (85%) with MS have relapsing-remitting MS (RRMS) type. With RRMS, people may have one or more symptoms during an exacerbation/relapse, then be symptom free for weeks, months, years, or even decades. When the next exacerbation of the disease occurs, the same person may have a different symptom or set of symptoms from previous exacerbations. Exacerbations are caused by inflammation, known as active lesions.

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Secondary progressive MS (SPMS) occurs in some people with RRMS. For those people, SPMS is considered the second stage of the disease. With SPMS, the remission between flare-ups is no longer present, and people with this type of MS generally have some symptoms at all times. The number of people who will progress to this stage is hard to determine because of the unpredictability of the disease.

Primary progressive MS (PPMS) is the most debilitating type of MS. About 10% of people with MS are diagnosed with PPMS initially. With PPMS, the disease progresses steadily, with no remission. The chronic nature of symptoms in those with PPMS is believed to be related to permanent nerve damage.

Progressive relapsing MS (PRMS) is diagnosed in only 5% of people with MS. With this type of MS, the disease progresses steadily, with some brief remission in the early stage.

2. MS has no cure or treatment, but the progression can be slowed for some with disease-modifying drugs.

Although there is no cure or treatment for MS, those with the relapsing-remitting, secondary progressive and progressive relapsing types often find that intervention with disease-modifying drugs prevents new lesions from forming, thus slowing disease progression and altering the course of the disease. Some drugs on the market can be used to help treat symptoms during a relapse/exacerbation.

There are now 10 disease- modifying drugs for MS, many that have been approved within the past few years. These drugs are very expensive, but patient assistance programs through the pharmaceutical companies can help those who qualify access the medication.

3. MS affects mostly Caucasian women of northern European descent.

For reasons we do not clearly understand, MS is diagnosed in women 2.5 to four times more than in men. It is also found primarily in people far from the equator. People of northern European ancestry, particularly from Scotland, have the greatest risk.

In general, one person out of 750 in the United States has a chance of being diagnosed. Among those with first-degree relatives who have the disease, the risks increase to one in 40. Those who have an identical twin with MS have a one-in-four chance of diagnosis. Some combination of genetics, geography, ethnicity, and possibly an infectious trigger are believed to be responsible for MS, according to current data from the National MS Society.

4. Only about one-third of people with MS use wheelchairs 20 years after diagnosis.

When we think of MS, most of us imagine a person who is unable to walk. MS does affect gait, mobility, muscle strength, and flexibility, but not for everyone. Research shows that only one in three people with MS use wheelchairs two decades following diagnosis. Some use canes or other devices for walking assistance.

An active lifestyle is important for people with MS to maintain their strength and mobility. Adaptive recreation, yoga, hydrotherapy, hippotherapy (horses), and other activities can make a real difference. Many years ago, people with MS were told not to exercise. However,

Jimmie Heuga, an Olympic medalist who was later diagnosed with MS, changed the mind-set in the field of MS treatment about exercise.

One issue to be considered with regard to exercise for those with MS is heat sensitivity. Becoming overheated often triggers a pseudo-exacerbation in which the person experiences symptoms for several hours or days. For this reason, people may need to use cooling equipment when exercising or outside on hot or humid days. MS fatigue is also an issue to be considered, as most people with MS experience this symptom most of the time. Physical therapy can be helpful for people with MS who have muscle spasms, stiffness, mobility, balance, gait, or other problems.

5. People with MS often experience mental health or cognitive impairment.

About 50% of people with MS will experience cognitive impairment. This is most often a problem with executive functioning, such as planning, spatial relations, following directions, working memory, prioritizing, and making decisions. People may one day simply forget how to drive home from work, or get lost going to a grocery store where they have shopped for years. It may take people longer to think of words that they normally use, or respond to questions. These changes can be very frightening.

Depression can be a symptom of MS or secondary to the disease due to lifestyle changes and losses. Depression is not related to the degree of disability. Anxiety is also reported frequently by people with MS due to the unpredictability of the disease. Suicide rates are higher among people with MS than in the general population and among people with other chronic illnesses.

If you know or work with someone with MS, be aware that every person experiences MS differently.

Many people have heard that anxiety medications can have some serious side effects, such as addiction, memory problems, impaired driving, and sleepiness. But a provocative new study claims that taking anti-anxiety medications leads to greater long-term mortality.

Anxiety is the most common mental health challenge; an estimated 40 million Americans every year experience anxiety. Although contemplating such a serious side effect can be frightening, is one study reason to give up on anti-anxiety medications altogether?

The Study

The study tracked 35,000 people prescribed anxiety medications and compared them to 70,000 people who did not take such drugs. Study participants were tracked for about seven years, on average. Even when the researchers controlled for variables such as socioeconomic class, medical conditions, and age, the group taking the anti-anxiety medications was more likely to die early.

The study’s authors argue that anti-anxiety medications cause four excess deaths per year for every hundred patients. Although the numbers may seem alarming, they’re relatively low. The numbers also reveal nothing about an individual patient’s personal risk of death.

Are Anti-Anxiety Drugs Dangerous?

[fat_widget_right]Every drug poses some risks, and anti-anxiety drugs are no exception. However, it’s important to note that the study tracked long-term use of anxiety medications. Doctors have known for a while that long-term use of certain anti-anxiety drugs carries risks such as cognitive impairments. Many people take anti-anxiety drugs for brief periods of time, and the effects could be different for short-term users.

Although the study’s authors controlled for several factors that could increase long-term mortality, they couldn’t control for everything. It could be that doctors are more likely to prescribe anti-anxiety medications to people with more severe anxiety or that people with severe anxiety are more likely to continue taking medication for years.

Anxiety itself is correlated with a host of health problems that may increase the likelihood of death. The study could simply be tracking the effects of severe, chronic anxiety.

If you take anti-anxiety medication and are worried about the drug’s effects, talk to your doctor. A variety of lifestyle and health factors can alter your relative risks. Your doctor can recommend specific steps to take to reduce your specific risk factors. Because anxiety itself can be damaging to your health, you may find that the risks of anti-anxiety medications don’t outweigh the benefits.

Options for Coping with Anxiety

Although medication can help you fight anxiety, drugs aren’t the only antidote. If you’re concerned about taking medication, consider therapy. Treatments such as cognitive behavioral therapy can aid you in detecting and reversing anxious, negative thoughts.

If you have specific fears, your therapist might use exposure therapy. Your therapist may also recommend other strategies to amplify the effects of therapy, such as meditation, exercise, a healthier diet, or a regular sleep schedule.

The study did not find that antidepressants increase the risk of death, and these drugs can be effective at treating anxiety. Selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft are popular options, but your doctor might also recommend a nontraditional antidepressant such as Bupropion.

No matter what treatment option you choose, be honest with your treatment provider about your concerns, as well as any specific medical risk factors you have. Only then can you and your doctor properly evaluate the right course of action.

References:

1. Facts & statistics. (n.d.). Retrieved from http://www.adaa.org/about-adaa/press-room/facts-statistics

2. Raison, C. (2010, March 23). What are the long-term brain effects of Xanax? Retrieved from http://www.cnn.com/2010/HEALTH/expert.q.a/03/23/xanax.long.term.use.raison/index.html?hpt=Mid

3. Salzman, C. (2000). Cognitive improvement after benzodiazepine discontinuation. Journal of Clinical Psychopharmacology, 20(1), 99. doi: 10.1097/00004714-200002000-00017

4. Weich, S., Pearce, H. L., Croft, P., Singh, S., Crome, I., Bashford, J., & Frisher, M. (2014). Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: Retrospective cohort study. BMJ, 348. doi: 10.1136/bmj.g1996

This evening my local newspaper contained this sad headline: “Maryland couple found dead at home.” A husband and wife, both aged 72, died in an apparent murder-suicide. The wife reportedly had a stroke a few years ago, and the husband’s health had recently deteriorated as well, according to the story. The article quoted friends of the family who said that while the husband was devoted to his wife, he had become overwhelmed by the demands of caregiving combined with his own health problems.

No matter the circumstances, this is a tragic story. While reading it, I couldn’t help but think about the difficulty faced by so many caregivers with whom I have worked. Each one expressed absolute determination to care for his or her spouse without assistance, believing that no one else could do it as well. The loyalty, patience, and nurturing care demonstrated by these individuals are admirable, perhaps even saintly. But nobody, even the most patient person on earth, is immune from the effects of putting someone else’s needs above one’s own day after day, week after week, month after month.

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According to WebMD, caregiver burnout is defined as “a state of physical and emotional exhaustion” resulting from the one-sided nature of caring for someone who is chronically ill. The person who is sick does not intend to burden his or her caregiver, but the nature of being unable to care for oneself creates that one-sided dynamic. The spouse who is caring for the ill person may be happy to take on the responsibility of feeding, bathing, and taking his or her loved one to appointments, knowing that were the situation reversed, the other person would gladly oblige. Even so, constant caregiving for a chronically ill spouse can disrupt one’s life in multiple ways. Many caregivers are reluctant to reach out for help, which puts them at risk of burnout.

Help is out there! Caregivers do not have to feel alone.

According to HelpGuide.org, here are some of the signs and symptoms of caregiver stress leading to burnout:

• Anxiety, depression, irritability
• Feeling tired
• Trouble sleeping
• Increased health problems of your own
• Difficulty concentrating
• Increased feelings of resentment about caring for your ill loved one

If you feel that you may have some of these symptoms, please don’t wait to ask for help!

Fortunately, if a caregiver begins to experience some of these symptoms, it is not too late to make changes. The following self-care tips, from CareGiver.org, can reduce caregiver stress and lessen the risk for burnout:

• Practice stress-reduction strategies. Examples include taking a yoga class, learning deep-breathing techniques, meditating, praying, or chanting.
• Get plenty of rest.
• Maintain a routine including nutritious meals and a regular bedtime.
• Exercise! Walk, run, swim, stretch, or take a group exercise class at a local gym. Try to get a minimum of 10 minutes of exercise daily.
• Schedule time off from caregiving. Whether you ask for help from a family member, a friend, a neighbor, someone from your religious community, or hire someone from an agency, it is healthy to take a break.
• Ask for help. People who care about you and your loved one are likely to be glad to offer support.
• Reach out for support to help you with your feelings. Talk to your pastor, a trusted friend, or a counselor. Many communities have support groups for caregivers.
• Remember, you must care for yourself in order to care of someone else. There is nothing selfish about caring for your own health.

Your local department of aging/disabilities can guide you to the resources available in your community. It’s important for your chronically ill loved one that you are taking care of yourself while taking care of him or her. You can also find help here. The National Center on Caregiving has numerous outstanding resources to help you.

To find a therapist for help with caregiver issues/stress, click here.

Last week was officially Brain Awareness Week. Yes, the brain—the organ that basically governs all of our body processes—is officially honored for one week in March every year by The Dana Foundation, a New York City-based organization dedicated to advancing brain research and public education.

This only adds to the timeliness of GoodTherapy.org’s recent chat with one of our upcoming continuing education presenters, Dr. John B. Arden. Arden is the director of Kaiser Permanente’s mental health training programs in Northern California and author of a number of books on neuroscience, psychotherapy, mindfulness, and how they work together in our everyday lives. His latest title, The Brain Bible: How to Stay Vital, Productive, and Happy for a Lifetime, offers a scientifically backed examination of simple steps we can all take to nurture optimum cognitive functioning and maintain overall brain health.

Dr. Arden will be presenting on “Neuropsychology: A Brain-Based Therapy” in a GoodTherapy.org web conference in May 2014.

GoodTherapy.org (GT): Can you explain to me what you mean by “brain-based therapy” and where the idea for it originated?

[fat_widget_right]Dr. John B. Arden: Everybody thinks they have the best type of therapy. So my job has been to sift through a lot of theory and try to get to the science, so that my training programs can operate at the cutting edge of what’s going on… and integrate all these seemingly disconnected theories and scientific domains into one robust vision of providing humanized services for people who want to see us [therapists].

The words “brain-based” need not be thought of at all as another one of these clubs; … but rather, okay, … since we all have a brain, every one of these psychotherapies and theories ought to relate in some way to the brain .… In the long run, brain-based therapy is the common denominator vision of the future, and it’s not just my idea.

GT: Your most recent book, The Brain Bible, discusses “how to stay vital, productive, and happy for a lifetime.” What is the brain’s role in nurturing vitality, productivity, and happiness?

Dr. Arden: We know now that if you want to be healthier—not pick up the latest virus that’s floating around, not suffer from dementia later in life, not suffer from anxiety and depression—and in general, be happier, there are a number of characteristics that have been identified by many scientists over the past 30 or 40 years.

What I try to do in The Brain Bible is take the most important five that have consistently come up as a focus of inquiry and have a robust body of scientific literature backing them as the healthy behaviors for living with greater pleasure, less depression, less anxiety, and less chance of getting dementia later in life. …

And these five factors are incorporated in the mnemonic SEEDS; if you’re planting SEEDS now, and you cultivate them throughout your lifetime, chances are you’re going to feel a whole lot better about yourself and about everybody around you; people are going to want to be around you, you’re going to be ill less often, and you’re going to get dementia symptoms much later than other people.

GT: So, what are these SEEDS factors?

Dr. Arden:

• S—social connectivity: We have these social brain networks that need to be fostered and kindled and cultivated through a lifetime, and those people who don’t [do this] tend to be more depressed, more anxious, get ill more often, and get dementia symptoms much earlier than others. [For example], we know that the telomeres, which are the caps on the ends of our chromosomes, actually shrink with loneliness. So social connectivity—as in, good quality social relationships—has multiple benefits to our immune system and to our mental health, even down to the chromosomal level.
• E—exercise: From an evolutionary vantage point, we as a species were hunter gatherers until roughly 11,000 years ago. That meant we moved about 10 miles a day, and we have the same biology today as we had then … The bottom line is our bodies evolved to move a lot, and very, very few of us move 10 miles a day. And if we don’t get regular exercise, … we don’t have these body-enhancing, brain-enhancing biochemical processes occurring, so our brains get bogged down. On the other hand, when we do get that aerobic boost on a regular basis—let’s say for 30 minutes a day—all sorts of wonderful brain-enhancing biochemical processes occur, including the birth of new neurons in the brain. It is the best antidepressant and the best anti-anxiety agent that we have; it’s better than any antidepressant medication, better than psychotherapy, and better than psychotherapy and medication combined. It is a must—an evolutionary imperative.
• E—education: If we’re not learning something new on a regular basis, we’re not building an infrastructure of brain connectivity. The more connectivity you have, the richer your thoughts—and we call that cognitive reserve later in life. … Learning a lot throughout your life does a lot to build your brain and without doing that, you’re looking in the rearview mirror worrying about the past or the future. So learning something new every day is a way to keep your life vital and exciting.
• D—diet: We are what we eat, and the cornucopia of chemicals that we operate our brain with don’t come out of nowhere; they’re not immaculately conceived. Our body makes these brain chemicals based on the foods that we eat or do not eat. Every one of these neurotransmitters has a precursor amino acid, and if you want to starve your brain of these chemicals, you can have a bad diet, or skip breakfast, or eat simple carbohydrates, or fried foods, or whatever—but you’re going to end up rendering your brain incapable of learning and incapable of having positive thought. So diet is absolutely fundamental.
• S—sleep: Many people think of sleep as just one thing, and as long as they can stay not conscious and not awake, everything’s fine, but there is a sleep architecture that has be adhered to. And there are many things we can do to screw up that sleep architecture, like take various substances, including some pharmacological agents that doctors prescribe for sleep. So getting good hygiene and having good sleep practices is critical for mental health and for not developing dementia later on, but most importantly for not having too much anxiety the next day, or too much depression.

GT: What are some of the brain degrading habits we should all be avoiding?

Dr. Arden: All the SEEDS factors, if not adhered to, are brain degrading. But what else? Substances … Alcohol on a regular basis—and I’m not talking about alcoholism, just regular drinking—is not brain healthy. And another real common one is medical marijuana, which is really out there right now [being touted] as this panacea, but it is not brain healthy. … Do I think it’s the worst thing in the world if you smoke a joint? No. But if you do that on a regular basis, just like if you drink alcohol on a regular basis, not so good for your brain.

Reference:

BrainFacts.org. What is neuroscience? Retrieved from http://www.brainfacts.org/about-neuroscience/what-is-neuroscience/

There is a range of both situational and organic causes of depression. Genetics can also play a role in depression; new studies in something called epigenetics have proven that it only takes one generation of mice to pass down a fear of something that parental mice had a bad experience with.

The theory which drives much of present-day pharmaceutical intervention, espousing that low serotonin is a cause of many depressive states, has not been proven. What we do know is that making serotonin more available in the brain can shift the depressive symptoms. However, it is now becoming clear that people who take antidepressants (most common are serotonin reuptake inhibitors) are more susceptible to recurrences of depression through their lives than people who do not use these medications.

I am concerned that this approach may be prescribing a life sentence of an ongoing struggle between depression and medication for people who take antidepressants rather than allowing a natural state to facilitate change and growth. Also of grave concern to me is the way that we have forever shifted culture by trying to rid ourselves of uncomfortable symptoms while perpetuating a belief system that only positive feelings are acceptable. This is not in sync with the cycles of nature in any way.

We forget we are of the natural world. This approach does not understand that symptoms are only a small part of what really needs our attention. Our culture’s classic symptom-oriented response leads to exactly what the word depression describes: a condition of “pressed-down energy”—-stuck energy that may be very important to look at, exploring the meaning of the situation and allowing it to influence our life choices, leading eventually to change that will re-establish and support the life flow.

The Role of Serotonin

Regarding current chemical trends in treatment, let’s look briefly at what we do know about serotonin: it (along with melatonin and other chemicals) is a neurotransmitter and neural protector that is incorporated into every neural network on the planet, as well as within the human body. Serotonin acts as an information carrier (neurotransmitter), a hormone transmitter, and a modulator of various tissues. It regulates neural networks that refine the communication between the brain and the heart, allowing them to work as a cohesive system.

Serotonin plays a huge role in neuroplasticity (growth of new neural networks in the brain), which is necessary for any living adaptive system. It helps to unify the entire brain into a cohesive biological system by modulating the brain and central nervous system, and continually altering the chemistry of target neurons. It influences form, influences sensory and motor neurons in order to track the source of stimuli from outside the system, and regulates the information that comes to us through our senses.

Serotonin neurons are in our heart, brain, digestive system, and immune system, and are activated by stimuli outside of the body. Serotonin exists (in the body) in any place we touch the outside world and the outside world touches us; it is the interface. As information touches the neural network the serotonin neurons coordinate our physiological response.

The serotonin chemical is highly reactive to any kind of change in the environment. It modulates the information received through our senses, the sensory gating channels. As sensory inflows occur it narrows or opens the gates to what becomes our awareness. In depression it would appear that these gating channels are narrowed and do not allow the sufferer to have a complete picture of his here and now situation.

The Body Connection

Over 70% of the serotonin in our body is manufactured in the gut, so I would assume this would be a good place to begin the exploration of dealing with depression—looking at the condition of the gut flora, the diet, and the overall physical health of the person with depression. Some depressions are simply caused by poor physical health which needs to be remedied.

For others, depression may be situational. In this case, I think it is important not to seek to suppress the experience, but to facilitate the cycle that one is in, so that the meaning of the mood issues can be perceived and lead to a new way of being rather than be pushed back to status quo. Herbs that can support this process as well as other etiology will be listed later in this paper.

These days, it is rare to find a person whose depression hasn’t been perceived from the perspective that to be “down” is an illness, rather than a part of the rhythm of life. And while I understand the extremely high severity and difficulty in some cases, I repeat that I think we have exacerbated depression through suppression of a natural cycle.

Situational depression happens for more reasons that we can count, and many that we don’t understand. Some causes are that a person might be recovering from loss or trauma, or dealing with unmet needs from another stage of life. Especially potent are the unmet needs of childhood that leave some aspect of the person stuck in an earlier stage of development, despite the progression of the body through time. This is seen as soul loss in some cultures.

Depression is often related to the feeling of helplessness that leads to a state of despair and of giving up. It is extremely important for the person to explore and acknowledge the meaning of the depression and take the difficult steps to remedy their situation—whether something is not working in their present day reality, or there are unprocessed stimuli from a past experience, as seen in posttraumatic stress (PTSD) or soul loss.

Often it may be a combination of the two, the present-day situation triggering the old issue and making it difficult to perceive the present accurately. When we look at the role of serotonin and how it modulates information from outside it is easy to see how, if we ignore either the difficult life situation or the old material, we can upset the inherent regulatory balance of the chemicals involved.

Depression: Physical, Psychic, or Both?

My main orientation to mental health and depression grows from a Reichian perspective—anything that is suppressed will come out in other ways, because energy needs to move. Energy is just information, something that comes to do the work of informing us of something. This is similar to the way electric currents run through a wire or water through a hose. Its nature is to move.

In my work at Body-Psychotherapy of Seattle, I look to open the compromised system and restore the flow of life on the five levels of existence: the body, emotions, thinking mind (thoughts), actions (will/ behavior) and the “big mind” (spiritual/etheric influence of a person). The point is to create an integration of a person’s life experience between these five realms so they work in coherence with one another rather than, for example, overusing the thoughts to justify one’s actions or to deny one’s difficult emotions.

Working physically with the body is important to me because whatever physiological and muscular reaction we have to the external environment become involuntary reaction patterns wired into the nervous and muscular systems. These responses are set into motion when the body senses something that remotely resembles a past compromising situation, even if that is not happening in the present. Over time, chemical reactions and the associated muscle memory create strong, overused muscles that become an actual physical armoring that keeps us stuck reliving our early life experiences over and over again.

One of the major challenges of depression in our culture is the necessity to be high functioning all of the time. I would approach depression very differently if we had a society that had built-in flexibility to allow people to adjust to these natural cycles when they beckon. Chronic stress and feeling a lack of meaning in life contribute to, if not cause, depression. This creates a real dilemma in finding healthy responses.

Putting Phytotherapy into Practice

Herbs can play a major role in supporting a person’s entire system to meet the demands placed on it while undergoing a difficult change process. It is important that an herbalist refrain from trying to be the sole health care provider for someone with serious depression. It is important to have a guide (or several) working together to negotiate all levels (body, emotions, thinking, behavior, etc.) into synchronicity.

I am less and less comfortable giving out lists of herbs for certain conditions. I think that an herbalist must have his or her own allies to call upon in order to promote health in another. It is our relationship and our experience with the plants that that charge the treatment. But I can suggest some approaches to choosing herbs.

First, be sure to think about the person’s constitution and match herbs to the unique disposition. In Ayurvedic medicine, there are three dosha, which are elements that make up a person’s composition. Everyone has a different combination of these elements, which may become unbalanced to unhealthy levels. Different substances can affect the traits of the dosha in different ways, so it’s important to tailor the remedy to the person.

For example, do not give a drying herb to someone with an aggravated dry (Vata) state; this is a person who might have dry mucous membranes and an airy personality, and be easily distracted. Nor should you give sweet herbs to a Kapha, a person who is overly earthy, lacking expression, and slow moving. They would do better with spicy or bitter remedies, those that might confuse and exacerbate the symptoms of a Vata person.

As you can see, the symptoms of depression will manifest differently in different constitutions; basically each constitution will be exaggerated in its imbalanced state. A Pitta person may be agonizingly irritable and restless, a Vata will demonstrate confusion and lack of concentration, and a Kapha will cover all of the windows and stay in bed for months.

All of these are common symptoms and may co-occur in one person, but look closely to see the subtleties and with practice you will be guided in choosing appropriate herbs. Overall, herbal remedies for depression need to be stimulating (to get things moving) as well as nourishing to the body and soothing to the nervous system.

More Tips for Internal Stability During Depression

People in any depression should avoid as many environmental toxins as possible; eat organic foods; and avoid caffeine, sugar, and processed foods. They should surround themselves with a natural, nonstimulating environment.

Promote healthy gut flora through the use of probiotics and regular elimination practices. If one’s feces smell strongly, be sure to take this as a warning sign from the gut.

For a period of time, promote good elimination through the use of herbs like Aloe, Rhubarb, Licorice, and Pasqueflower, or use bitters such as Dandelion or Gentian Root. This is going to be especially important in working with people with the cold, damp constitution, as they will tend toward a slower metabolism. But the Pitta and Vata may also have absorption problems for different reasons.

After creating a well-functioning environment in the gut, use alteratives (a category of herbs with tonic effects) to support the liver in removing toxins from the body. Dandelion and Pasqueflower, as mentioned above, are also categorized as alteratives. Many good blends are available. One I make for myself includes Ashwaganda, Burdock, Red Clover (for the blood), and Yellow Dock.

Extremely important is the use of nervines—beneficial plants—throughout the treatment course to soothe the nervous system and calm anxiety. Some of my favorites: Lemon Balm, Scullcap (especially helpful for racing or obsessive thought patterns typical of a Vata or Pitta person), Rosemary, Passion Flower, and Milky Oats (which would be good for a Pitta person, as it is so cooling and damp). And, of course, the use of St. John’s Wort should also be considered in depressive states—although studies suggest it works best in moderate cases. The sun herbs, like St. John’s Wort, Hawthorne, Rosemary, and Frankincense (as aromatherapy), are especially good in seasonal depressive states.

All depression treatments must include getting out into natural light on a regular basis; even if it is dark and cloudy, this will have a positive effect. Moving the body through walking or exercise is also crucial, but especially hard to facilitate in the person with a Kapha constitution.

After supporting the liver and the nervous system, look to adaptogens—stabilizing herbs—to put some zing back in the kidney and adrenal systems, as these are heavily taxed in depression. There are many wonderful adaptogens; I vary my blends regularly to get a sense how the different herbs work and work together.

Always use herbs you are familiar with, so you can sense how they are affecting you or, if you are a therapist, your client. I love Schisandra, Ashwagandha, Polygonum, Gotu Kola, Astragalus, Rhodiola, Dong Quai, Ginseng, and Motherwort.

Wisdom in Worldly Healing

For me, the most important treatment guidance is taken from the practices of other cultures. In South America and Africa, shamans travel between the worlds to resolve soul loss, some of which is described above. Much of the work I do involves treating soul loss of several types, but, different from the indigenous practices, I like to make sure that I have fully prepared all aspects of a person’s system so that they can retain the results long after the treatment ends. I do the scouting and the guiding, but my style also puts the onus of the work on the client: with my help they bring awareness to their old patterns and interrupt them via interventions (for example by thought-stopping, a cognitive behavioral therapy intervention).

I teach them how meet the old underlying need, building relationship and nurturing the young parts of themselves from within. Over time and with vigilance, the information that once ran through neural network systems in predictable, outdated, and problematic patterns can begin to pool as if in a dam, and finally overflow to form new neural networks that better fit the current reality.

Another model that I always have in mind with depression is from ancient mythology involving the underworld. Persephone is a Goddess who was abducted to the underworld by Hades. She faced many challenges there. But up above her mother Demeter searched and held ground for her until she was returned. Innana of the Sumerians traveled the same journey, having to face the fierce Goddess Ereshkigal in the underworld until her time came to be released. This is this same journey that one takes through the belly of depression. An herbalist working on these levels might consider using Spagyric Essences, alchemically prepared herbal remedies which can positively affect depressive states. They are prepared by first distilling the essential oil, the Soul, out of the plant; then leaving the hydrosol and plant matter to ferment and distilling the alcohol from that. This is the Spirit level of the plant. The remaining plant matter is purified through fire until it is reduced to white ash from which the mineral salts, the Body of the plant, is extracted. All three are put back together to form a remedy that works on the etheric levels to create change beyond the body. That change trickles down to the body and facilitates health. Organic Unity carries a line of Spagyric Essences that are made from wildcrafted plants, prepared according to corresponding astrological influences and infused with healing prayers and love. In my experience, this care makes a huge difference in the potency of the remedy and its impact on the client. I highly recommend them.

Finally, I think that the most important thing to keep in mind when working with a severely depressed person is that they must not be left on their own. Like Demeter, someone must hold space for them and watch for them from above, creating an anchor to the larger world. This space must be held by someone who is not afraid of the dark. Someone who is patient and kind, wise and strong. A practitioner with knowledge of the territory, a big loving heart, and good boundaries!