J is for Juggling

If you are anything like me and you automatically associate juggling with clowns and the circus, then you must be giggling at thejuggler title of this post. No I have not thrown away a letter on the A to Z challenge and just picked any old word. I’m still doing my mental health theme. What does juggling have to do with mental health? Juggling therapy. Seriously? Yes, seriously. I giggled at first too, but the more I read about it, the more it actually made sense. Juggling therapy is advertized as a “fun” approach to improving mental, emotional and physical states. It “…works to balance both hemispheres of the brain (right brain & left brain) to improve motor-skill functions, reading, writing, creativity,  self-esteem, self-confidence, self-motivation, focus on tasks, multi-tasking. It can help combat and prevent the development of Anxiety, Alzheimer’s, depression and a host of other mental and emotional diseases.” Ok, so maybe the advertizing goes a bit overboard, but there is truth behind it.

Let’s start with physical well-being part. This part is obvious. Juggling is a cardiovascular activity, so of course it’s good for your body. It has the benefits of regular exercise in that it raises your heart rate and gets the blood flowing, but it’s easier on your joints compared to various other sports and exercises. Muscles have memory. As you learn to juggle, your muscles get to know the space and timing required to catch whatever you are juggling. It also improves hand-eye coordination which is a transferable skill meaning you can apply it to other activities; baseball, golf, applying make-up and yes, even video games.

What about outside of the physical part? I can understand how it can teach you multitasking and how to break down bigger problems into smaller pieces, but what effect does it have on your mind? Juggling activates several different brain regions for one thing; attention, motion, vision. Some studies have shown that it promotes the growth of gray matter in the mid-temporal lobe. This is the same area that is involved in processing emotional memory and believe it or not, generating panic attacks. A study in the Journal of Biopsychosocial Medicine did a study on female patients with anxiety disorders. They were divided into a juggling group and a non-juggling group. Both groups received appropriate medication and psychotherapy for six months. During the last three months of therapy, only the juggling group was trained on how to juggle. After treatment, both groups showed reduced anxiety, but the juggling group showed greater improvements in anxiety, anger and depression. Interesting results.

I can see how it would work. The repetitiveness of it is kind of a form of meditation. I’d try it. Why not, if it might help? There would have to be some ground breaking studies with the same results to get me to pay for it though.

What do you think? Would you try juggling to improve your mental health?

Sources:
Nakahara et al., 2007

NeuroMuscular Junction Wellness Center

I is for Insomnia

Insomnia is habitual sleeplessness or the inability to sleep. According to this definition, I don’t have insomnia. I am able to sleep. In fact I love sleep, I always want to sleep…except for those anxiety dreams, but that’s another post. If I don’t have insomnia, then why am I so tired all the time?

Upon further research, I learned there are three different patterns of insomnia. One is sleep onset insomnia, the inability to fall asleep. This I knew. It’s more common in people with anxiety. Your brain just doesn’t want to shut up and thoughts keep cycling in your head. Anxiety is similar to stress in that the hormone cortisol is at higher levels. One of the functions of cortisol is to keep you awake. I don’t have sleep onset insomnia. I have trouble staying awake!

Another pattern of insomnia is early morning awakening with an inability to go back to sleep. Usually you get around 6.5 hours of sleep. This pattern is typical of depression. I’ve been having this kind of trouble lately. I wake up at 3:30am and that’s it, I’m awake. It makes me pretty useless during the day.

The third pattern of insomnia is nocturnal awakenings. I didn’t know this counted as insomnia. I have this all the time. I wake up several times during the night for no apparent reason. Thankfully, I am usually able to get back to sleep, but it still leaves me waking up tired.

insomnia

How do you treat insomnia? By keeping good sleep hygiene for one thing. This includes going to bed and waking up at regular times, avoiding caffeine and alcohol close to bedtime, giving yourself time to wind down before bed, exercising during the day and keeping the bedroom a comfortable, dark place for sleeping, not TV! This stuff is pretty obvious. I try to follow these rules, but sometimes it just doesn’t work. Then what do you do? Well, I climb out from between hubby and Ewok and head to the couch where I watch the Phantom of the Opera until sleep finds me. Sometimes the movie has to play several times. My psychiatrist has prescribed me sleeping pills for when my insomnia is bad. I’m not comfortable taking them though. I’m sure there are lots of different options, but I am worried about becoming dependent or really wanting to sleep and taking too many. So I was pleased to discover an alternative to sleeping pills, cognitive behaviour therapy for insomnia (CBT-I)!

According the the Globe and Mail (a Canadian newspaper) it’s the first line of treatment for insomnia in Canada, USA and Britain……really? Then why was psych so quick to give me sleeping pills? CBT-I is supposed to teach you how to manage racing thoughts and limit the amount of time you stay in bed to your actual sleep time. This means only going to bed when sleepy, not napping, having a certain rise time and getting out of bed if you can’t sleep for some reason.

It’s hard to believe that this CBT-I stuff is recommended over sleeping pills for chronic insomnia and I’ve never heard of it. With 8 years of mental health treatment under my belt, I would have thought I’d come across it.

Has anyone else heard of this? Has anyone tried it? I’d love to hear from you about CBT-I or about what methods you use to get to sleep.

Sources:

Globe and Mail

Canadian Sleep Society

Optimism, It’s all in Your Genes

You know those people who always look on the bright side, they make friends easily, they are always bright and shiny? They make life look easy, fun even. We love to hate them, don’t we? Well, we shouldn’t. It’s not their fault, they have a genetic advantage. That’s right! Proceedings from the National Academy of Science have found a possible genetic basis for optimism, self-esteem and mastery. Mastery is the belief that you have control over your own life and place in the world.

It all has to do with oxytocin, the love/cuddle hormone. Genetic variation of the oxytocin receptor (OXTR) may influence personality traits. DNA is made of four different base pairs; adenine, guanine, cytosine and thymine. Subtle changes in these base pairs can change how genes function. In the case of OXTR, one variant has more adenine. Carriers of this variant are prone to lower self-esteem and mastery and are more prone to depression. Individuals expressing the OXTR variant with more guanine (as opposed to adenine) are more prone to optimism. Scientists aren’t sure yet exactly how oxytocin release is affected by this change, but they are working on it.

Now don’t go getting all bent out of shape, these happy, shiny people have it easy, I’m doomed to be depressed forever. This variant can influence how you see the world and your place in it, but it is not the be all and end all. Your genes and your environment work together. Having the adenine variant just means you have a vulnerability towards depression, it doesn’t mean you are fated to be so. Your experiences and your attitude are major factors in your outlook on life.

Sources:
National Institute of Health

Combating Cognitive Symptoms in Depression

Yesterday I told you about some of the reading I’ve been doing on the cognitive symptoms of major depressive disorder (MDD). It might have been too research-oriented for some of you, sorry about that. This stuff is what makes my heart go pitter-patter, sometimes I get carried away. Today I’ll be more practical and talk about what I’ve read about treating these cognitive symptoms.

Medication Helps

Contrary to popular belief, antidepressant therapy is not the cause of you feeling like you’ve got a head full of cotton. Some medications can induce similar symptoms, but it is not a common side effect. Most people improve with antidepressant therapy. Only about 20% still have trouble with concentration and decision making after remission. Serotonin and norepinephrine re-uptake inhibitors (SNRIs) are pretty good at relieving cognitive symptoms. In a study comparing the cognitive status between depressives on selective serotonin re-uptake inhibitors (SSRIs) and those on SNRIs it was found that there was more improvement in the SNRI group. Those on the SSRIs were still having difficulty with episodic memory. They still had deficits in both verbal and visual memory. Episodic memory refers to memory linked to emotion and past experience as opposed to semantic memory which is memory of knowledge. So it looks like antidepressants that target more than one neurotransmitter are more helpful in the cognitive department. Remember, serotonin is involved in motivation and norepinephrine in concentration.

Bupropion, an atypical antidepressant has also been shown to improve cognitive symptoms. The primary focus of this one is increasing dopamine circulation in the brain. It also has an effect, although weaker, on norepinephrine and acetylcholine receptors. Again, remember, dopamine is for enjoyment and norepinephrine is for concentration. What about acetylcholine you say? That’s a big one. It acts on neurons throughout the whole body. I’m not going to get into it, that’s a whole biology lecture, but know that this is why bupropion is sometimes prescribed to help quit smoking.

Psychotherapy Strategies

Remediation techniques aim to improve someone’s situation by targeting a specific cognitive skill. This technique is highly individualized. Programs are based on you personal interests and strengths. It involves various pen and paper tasks and some psychophysical computer tasks. The problem with remediation is that it is time-intensive. Your therapist needs to get to know your strengths and problem areas, then design the training program. Since it it’s based on training, you have to do it often, sometimes several times a week.

Another strategy is compensation which relies on trade-offs. You find alternate ways of performing a task you have difficulty with. For this to work, your therapist has to be familiar with your learning style. You are basically taught to alter the course of your behaviour to suit your cognitive dysfunction. It has been found that doing this does not come naturally to people with MDD. From what I’ve read, it sort of sounds like cognitive behaviour therapy.

Finally there’s the adaptive approach. Here you change the environment rather than the individual. This may mean changing jobs and/or depending on other people. This is used as a last resort when remediation and compensation are not working.

The Answer

There is no real answer, not yet. The cognitive side of MDD is only beginning to be studied. There is a long way to go. I have tried venlafaxin (SNRI) and it did give me better clarity. I couldn’t handle the side effects and the withdrawal when I missed a dose, so I eventually came off it. Also, not a pretty experience. I am currently on bupropion in combination with some others. I did notice a difference when I added bupropion. Most days are alright, but the fog still comes and goes.

I recommend fighting through it. Don’t throw in the towel on those foggy days. The brain is a wondrous thing. If those who lose their vision from traumatic brain injury can regain some of it, who knows what kind of adaptations we could build by just exercising our brains.

Sources:
cogstate.com 
Office of Mental Health 
Trivedi and Greer, 2014

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