Category Archives: Boise, ID Mental Health

Bend Mental Health

Use these for better sleep

Sleep is so important for your mental health, but 45 percent of Americans say lack of quality sleep regularly affects their daily activities.

A possible culprit these days, according to a recent study, is the blue light coming from the screens we all love. Blue light keeps us alert and regulates our internal clock. We get it naturally from the sun, but the light coming from our TVs, computers, and smart phones is stimulating our brains long past sunset.

The good news is there’s a simple solution. Either cut out screen time at night or start wearing special glasses for a few hours before bedtime.

In the study, participants wore blue light-blocking glasses for three hours before bedtime while continuing to use screens as usual. At the end of two weeks, their melatonin levels were up 58 percent — a huge increase. The participants fell asleep faster and slept better and longer than they had before using the glasses.

Just search “blue light blocking glasses” online and you’ll find plenty of retailers selling the product at various price points. Your newer devices may have a blue light-blocking setting that you could use for a similar effect.

If your mental health is not where you’d like it to be, come see me. We’ll talk about sleep and other lifestyle changes you can make to start feeling better.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.


Lithium for depression: An oldie but a goodie

There are drugs far more fashionable than Lithium these days: Pharmaceutical companies pay their representatives big money to promote their latest offerings, both with mental health care providers and in advertising.

The thing is, I’m not convinced any new and fancy drug can beat tried and true Lithium in effectiveness.

John Cade, the psychiatrist who discovered Lithium’s effectiveness in treating mental health disorders.

Doctors started prescribing Lithium in the 1800s to treat gout, epilepsy, and cancer. In 1948, an Australian psychiatrist named John Cade stumbled upon its usefulness in treating mania. After testing it out on guinea pigs, who became quiet and relaxed with its injection, he took his experiment to the next level by taking Lithium himself for several weeks.

Once he determined it was safe, Cade administered the drug in liquid form to a psychotic man who had been living in a mental asylum for three decades. In three weeks, the patient began to show signs of improvement: He looked after himself, his speech slowed, and erratic behaviors decreased. At the end of two months, the man was released from the asylum and resumed normal life.

It was a game changer for psychiatry. It was one of the first success stories in using drugs to treat mental illness.

Almost 70 years later, those success stories continue — and not just with bipolar depression, its most famous application. It’s been shown to work extremely well with unipolar depression, too.

A recent Finnish study found taking Lithium significantly decreased hospital readmission for those who had previously been hospitalized for unipolar depression. Antidepressants and antipsychotic drugs lacked the same effect. Lithium alone was more effective than lithium in combination with another drug.

The study’s authors are recommending more research into Lithium as well as its wider use as treatment for depression.

Lithium does have a narrow window of effectiveness, so the dose must be carefully watched. Go here to read more about Lithium and its possible side effects.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

Mindfulness changes brains for PTSD sufferers

A practice tied closely to Buddhism, Taoism, and yoga is proving itself to be a valuable tool for a surprising group of people: Veterans suffering from PTSD.

A new study found mindfulness training changed the brains of veterans suffering from PTSD. (The left image highlights changes in the brains of a control group, and the right image highlights changes in the brains of a group that received mindfulness training.)

I’m talking about mindfulness, or the art of paying attention to the present. A new study found mindfulness training actually changed the brains of Iraq and Afghanistan war veterans afflicted with Post Traumatic Stress Disorder.

People with PTSD tend to replay traumatic memories in an endless loop. When you look at their brains at rest, you’ll see heightened activity in the parts of the brain that respond to danger. You’ll also see low levels of activity in the network involved in wandering thoughts.

But after going through a mindfulness course, the veterans’ brains were different. The wandering thought network had strengthened and developed better connections to the network involved in shifting and directing attention.

Here’s what that means, according to the study’s lead researcher:

“The brain findings suggest that mindfulness training may have helped the veterans develop more capacity to shift their attention and get themselves out of being ‘stuck’ in painful cycles of thoughts. We’re hopeful that this brain signature shows the potential of mindfulness to … provide emotional regulation skills to help bring [PTSD sufferers] to a place where they feel better able to process their traumas.”

Mindfulness can help people remember that traumatic memories are in the past, helping them to feel safer and more in control. It’s an amazing tool, and I’m excited to see such good results for people with PTSD.

To read more about mindfulness, go here or here.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

Mindfulness: It’s good for your heart

Over the years, I’ve seen mindfulness meditation make a big difference for clients dealing with depression and anxiety. But today I learned that mindfulness is good for the heart not just metaphorically, but physically as well. 

A new study shows that people who are more mindful — in other words, they are better at focusing on “the now” instead of rehashing the past or worrying about the future — have healthier glucose levels. Two things that might help explain this connection, researchers found, are: 1. Mindful people are less likely to be obese, and 2. Mindful people have a stronger sense of control over their lives — they believe they can make important changes.

This is good news for everyone, not just the mindful among us, because mindfulness is a trait that can be learned and developed. Working with a therapist is helpful, but practicing mindful meditation on your own can be, too. You can even find apps for your smartphone that will walk you through various meditations, helping bring your mind back to what is going on inside and around you.

Eventually, we hope, doing these mindfulness exercises will help you cultivate the everyday mindfulness that will change how you behave and how you respond to stressful situations.

So let’s work to be more aware of the world around us! It’s good for our hearts!

Wondering where you fall on the mindfulness spectrum? Here are some questions to consider:

  • Do you find yourself running on autopilot frequently?
  • Do you forget names soon after you hear them?
  • Do you snack without being aware of what you’re eating?
  • Do you break or spill things out of carelessness?

Go here for the full questionnaire researchers use to measure mindfulness. 

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

Fighting depression with sunshine and exercise

Fighting depression with sunshine and exercise 

It’s June, and here in Boise we’ve shaken off any lingering symptoms of winter. That’s good news for people suffering from depression and other mental health conditions.

Exercise and sunshine are both simple but effective tools in treating depression, so why not take advantage of both at the same time?

A 2005 study introduced a group of women to a three-part strategy for fighting their mild to moderate depressive symptoms. For eight weeks, these women walked briskly outdoors five days a week, increased their light exposure, and took a special vitamin regimen. In the end, moods significantly improved as did overall well being, self esteem, happiness, and depression. A control group who simply took a placebo vitamin showed improvement, too, but the effect was much greater in the group participating in the three-part intervention.

Another study, this one from 2002, divided 98 participants into three groups. The first group exercised in bright light, the second group exercised in normal light, and the third group stretched or relaxed in bright light.

Each group reported some relief from depression, but those who were out in the bright light (either exercising or relaxing) also showed improvement in less common symptoms like carbohydrate craving, weight gain, social avoidance, and fatigue — symptoms that exercise alone didn’t temper.

Of course, when you’re considering the benefits of sunshine, remember to also weigh its risks, including skin cancer. Vitamin D (the “sunshine vitamin”) supplements may be another effective tool to consider.

For more details on these studies and on the relationship between Vitamin D and depression, check out this report from the National Institutes of Health.

Is there a relationship between trauma and obsessive compulsive disorder?

Very interesting study came out this month in the European Journal of Psychotraumatology. It studied patients who were diagnosed both with obsessive-compulsive disorder (OCD) and posttraumatic stress disorder. (PTSD) For these people, repetitive behavior patterns, rituals and compulsions may ward off anxiety and may serve as a coping mechanism to control reminders of traumatic events. So, if a person was raped at a young age, that person may have obsessions related to being dirty or unclean and may cope with those obsessions by washing his hands several times a day. Some patients suffer so severely that she may wash her hands raw enough to make them bleed. These patients are truly in a lot of distress.
This study was a case report of a 49 years old Dutch man who was raped as a child by an unknown man. The patient was treated with Paxil (an antidepressant) as well as with 9 sessions of psychotherapy, particularly eye movement desensitization and reprocenssing (EMDR), and an exposure type of therapy. It was observed that the PTSD symptoms went away before the OCD symptoms did.
This studies conclusion found that there is a connection between PTSD and OCD and by treating the PTSD first, one may be able to subsequently cure the OCD as well.
It is my belief that for many people, EMDR can be a faster route to get relief in those who have experienced trauma and also suffer from OCD symptoms.

Family involvement and the treatment of Depression

There was an interesting study that came out this month in Psychiatr Serv. 2013 Feb 1. It was a study of Veterans who were being treated for Depression. It confirms what I have believed all along, that is to get the families involved in the treatment of those suffering with Depression.

In this study after questioning patients, it was found that 64% of Veterans did not have family involvement and the rest did. Among those that did it was found that the patients had better social support and medication adherence. This group had much better outcomes than the those that did not have family involvement.

In my practice I have always believed that a patient needs involvement of his family. Not only can family provide support and make sure that a patient takes their medications, a family can provide valuable feedback to the mental health practitioner about how the patient is doing. The family may notice side effects like irritability or anger or lack of social activity of which the patient may not be cognizant. It is common in mental illness for a patient to not have good insight regarding her illness. I often tell my patient with poor insight to ask his/her family how they think he is doing

Another reason I like to involve the family is that I like to educate them about the nature of mental illness and how to best help. Family may have wrong information about mental illness. Sometimes family may believe the patient has a character flaw that would be cured if “he would only try harder”. Proper psychoeducation can help the family be of the best help to the patient.
Depression is one of the top causes of disability benefits in this country. It a serious problem for all of us. I would like to see mental health practitioners include in the care of their patients the participation of families.

EMDR reduces the subjective vividness and objective memory accessibility.

We’ve heard a lot about EMDR or Eye Movement Desensitization and Reprocessing. There have been much research supporting its efficacy, many books written, even U-tube videos made demonstrating its usefulness. What does it do exactly? The mechanism isn’t completely clear.
In eye movement desensitization and reprocessing (EMDR), a treatment for post-traumatic stress disorder (PTSD), patients make eye movements (EM) during trauma recall. A recent study in Cogn Emot. 2012 Jul 6 showed that EMDR apparently reduces the subjective vividness of the memories, making the memories easier to deal with and handle. Thereby making the memory fade faster in susequent visits.

Differentiating between Bipolar Disorder I and Bipolar Disorder II

Many people have heard about the diagnosis Bipolar Disorder. Formerly this diagnosis was named Manic Depression. Today we differentiate between Bipolar Disorder I and Bipolar Disorder II. Bipolar Disorder I is characterized by periods of depression alternating with periods of manic behavior. What is manic behavior? It is discreet periods of high energy which can be either positive or negative in nature. The positive kind would manifest itself by an unusual burst of energy, not needing much sleep, high amounts of goal directed behavior, happy even euphoric behavior, increased amounts of impulsivity, creativity and sometimes grandiosity. Sometimes people in this state talk rapidly and cut others off. Usually, people experiencing this kind of mania like to be there. They enjoy being happy, productive, highly energetic and creative. The problem is that sometimes this mania is highly unpractical and distructive to theirs and their loved ones life. This is particularly true with Bipolar Disorder I which has higher levels of mania. A manic person may suddenly leave a long happy marriage for a random person they met in a bar. They may leave a good job to go explore the world. At the moment the person in a manic state may not understand or consider the implications of his behavior. They may not realize it is a problem. Its usually later when they are out of the manic state and more settled down when they may come to realize the problem. Frequently, family members are the first to mention the problem. Some patients never recognize the problem in themselves and only get help after family insist on it. While positive manic states are sometimes not recognized as being a problem, alternatively, the negative manic states almost always are. If not by the patient himself, certainly by family members, work colleagues or friends.
Negative manic states are high energy states also. There may be problem sleeping. Instead of happy or euphoric mood, in its place is an angry or highly irritable mood. You see these people driving down the road and in response to someone cutting them off they react in a highly explosive way. They may track down the perceived perpetrator and pull a gun on them or start a fist fight. However, this is more common in men. Negative mania is erratic and often scary to the patient and/or those around him. With women, they may report being highly annoyed and easily provoked emotionally. Family members may report they feel like they are “walking on eggshells.”
Bipolar Disorder II is similar to Bipolar Disorder I in that it has periods of depression but it alternates with lower levels of mania. The mania is not as distructive. A person may appear to be a person who is involved in a lot of things and has a lot of projects going at the same time. They seem to exude more energy and creativity than the average person during these times. We sometimes call this type of mania “hypomania” People who have hypomania may not have problems in this state. For them, the problems come when they are in their depressed phase.
Another thing I would like to mention is that sometimes manic states look like anxiety. Be sure to get your anxiety checked out by a specialist if the standard treatments of anxiety, ie. therapy or antidepressants aren’t doing the job. Manic episodes are often missed by the general primary care provider.
How is Bipolar Disorder treated?
If a person has been treated previously with an antidepressant, a mood stabilizer may be added. Some people with Bipolar Disorder( I or II) cannot tolerate antidepressants at all. They may make them too manic. In that case they may need a mood stabilizer or antipsychotic. The other part of treatment is psychotherapy. In my view, they should both be in the treatment plan for best results. Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, Marriage and Family therapy and psychodynamic types of therapy can be useful. Recent research shows that CBT can be done effectively in short periods of time from 8-16 weeks in duration for some. CBT focuses on the present and doesn’t spend large amounts of time with what happened in the past. It is goal focused and skill building in nature. Other treatment modalities that I have found to be helpful is spirituality exploration and developing healthy health habits such as good sleep hygiene and an exercise routine. I have found herbal remedies are not as effective in Bipolar spectrum disorders. Although some people prove to be the exception to the

What causes psychosis?

There has been a lot in the news lately about people suffering from psychotic episodes. Recently, a man, whom many thought was under the influence of bath salts, took off his clothes and chewed off the face of a homeless man. Toxicology reports denied him being under the influence of bath salts but confirmed marijuana being in his system. Another news event broadcasted the sad episode of a Jet Blue pilot who started behaving in an erratic way,  talking in religion themes and Iraq and the end of the world. He had to be restrained by flight attendants and passengers on the airplane before the plane making an emergency landing.
What causes psychosis? Is this a biochemical or genetic condition? Are there environmental factors or health habits that contribute to it? What can be done to treat or prevent the condition from happening?

The definition of psychosis found in Wikepedia is: refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur.
The two major categories of mental illnesses we often associate with psychosis are the mood disorders such as Depression and Bipolar Disorder as its substypes as well as Schizophrenia. In Bipolar Disorder these psychotic episodes occur during the manic phases of the illness. There are other condtions that can cause psychosis. People under the influence of psychostimulants such as Ritalin or Cocaine or Methamphetamine may become psychotic, particularly if predisposed genetically to psychosis. Lately, in the news we have heard about people acting strangely under the influence of Bath Salts. And very recently, marijuana may have been a factor in the face eating incident.
In later years there is another cause that is being more and more recognized. Children who experience trauma may exhibit psychotic symptoms, particularly hearing voices. These children often don’t meet criteria for drug usage, mood disorders like Bipolar illness or Schizophrenia.
I personally have concerns about Marijuana. Many people would like to think that Marijuana is harmless. It is used for some chronic health issues like pain control and lack of appetite. Unfortunately, it is also being used inappropriately. I have had patients who come see me for an Anxiety problem who have complained to me that pot makes them anxious or even “crazy”. Pot will do this in people that are genetically predisposed toward psychosis. I once saw a promising young 18 year old man deterioriate and contract Schizophrenia, and Marijuana was believed to be the major culprit.

What is the treatment? It depends on the cause. If it is Bipolar Disorder, mood stabilizers and psychotherapy are the treatment of choice. Schizophrenia will probably require antipsychotic medication. If psychostimulants brought it on, they probably will need to be discontinued. For children with the history of trauma, medications may not be as effective as psychotherapy. Although many may find some benefit from both. Finally, the cause of the psychosis of the Jet Blue pilot was found to be the lack of sleep. I can’t emphasize enough the role of sleep in good mental health. I teach all my patients sleep hygiene who come to see me. A brain cannot heal or function optimally without a good nights sleep. What is the optimal amount? About 7-8 hours for most people.