In my clinical practice, I've seen many clinically depressed individuals who present with poor concentration and memory difficulties. The cognitive impairment may be so severe that clinicians have named this phenomenon as "pseudodementia" or "false" dementia because the condition can mimic a full-blown and "real" dementia.
Do you wonder why it is so?
Apparently clinical depression can significantly affect the hippocampus, a memory center in the brain. Studies have shown that people with recurrent depression have reduced sizes of hippocampus.
In addition, the stress associated with depression can cause chronically low levels of brain-derived neurotrophic factors (BDNF), a protein necessary for hippocampus to regenerate. Without adequate supply of this protein, hippocampus cells will shrink or die.
Saturday, August 05, 2006
Thursday, July 27, 2006
Treating Difficult Cases of Depression
In my practice, I've encountered a number of refractory or difficult-to-treat depression. Some individuals have already been switched to at least five antidepressants to no avail. Still some have taken a combination of medications without much help.
What are some strategies that physicians can try when confronted with a resistant depression?
The most logical thing to do is to first reasses the diagnosis, look for and treat co-morbid conditons such as alcohol or thyroid problem, or address ongoing stresses.
If these have been tried (i.e. diagnosis is correct, no medical problems, etc.) with minimal or nil success, then consider trying any of these options:
One common strategy is augmentation. This means that another medication is added to the usual treatment regimen to "augment" the effect of the latter. Some common augmenters include: lithium, T3, or buspirone.
Another strategy is drug combination. In this technique, two antidepressants are combined or used together to optimize treatment. E.g. SSRI (e.g. citalopram) + SNRI (e.g. venlafaxine).
The next strategy is treatment optimization by increasing the medication's dose to the highest acceptable level.
What are some strategies that physicians can try when confronted with a resistant depression?
The most logical thing to do is to first reasses the diagnosis, look for and treat co-morbid conditons such as alcohol or thyroid problem, or address ongoing stresses.
If these have been tried (i.e. diagnosis is correct, no medical problems, etc.) with minimal or nil success, then consider trying any of these options:
One common strategy is augmentation. This means that another medication is added to the usual treatment regimen to "augment" the effect of the latter. Some common augmenters include: lithium, T3, or buspirone.
Another strategy is drug combination. In this technique, two antidepressants are combined or used together to optimize treatment. E.g. SSRI (e.g. citalopram) + SNRI (e.g. venlafaxine).
The next strategy is treatment optimization by increasing the medication's dose to the highest acceptable level.
For more quality mental health articles, visit Soar Dime.
Friday, July 14, 2006
How to Handle a Loss?
When you lose a loved one, how are you going to cope? What are some practical steps you can take to handle the difficulty and stay in control?
Some tips:
1. Acknowledge your emotions. It's more difficult to deny the pain than to simply accept what you feel.
2. Have a good cry. It's normal.
3. Establish support networks. Reconnect with long lost friends and loved ones. Learn to reach out. Socialize.
4. Focus on the good memories with the lost loved one. Review old photographs and video. Learn from the person's legacy.
5. Have faith. Pray for your lost loved one and for those who are left behind.
6. Be of service to others.
7. If necessary, ask for professional help.
Some tips:
1. Acknowledge your emotions. It's more difficult to deny the pain than to simply accept what you feel.
2. Have a good cry. It's normal.
3. Establish support networks. Reconnect with long lost friends and loved ones. Learn to reach out. Socialize.
4. Focus on the good memories with the lost loved one. Review old photographs and video. Learn from the person's legacy.
5. Have faith. Pray for your lost loved one and for those who are left behind.
6. Be of service to others.
7. If necessary, ask for professional help.
Learn the CARE Approach to mental health first aid.
Friday, May 12, 2006
Can Exercise Reduce the Risk of Dementia?
According to a recent study ( by Larson EB, et. al Ann Inten Med), moderate exercise can reduce the risk of dementia. Exercising more than three times per week has been found to be beneficial.
There's no actual explanation or mechanism on how it works. But it seems that this study supports the contention that an active (healthy) body leads to a healthy mind.
For more mental health articles, visit Soar Dime.
There's no actual explanation or mechanism on how it works. But it seems that this study supports the contention that an active (healthy) body leads to a healthy mind.
For more mental health articles, visit Soar Dime.
Saturday, March 11, 2006
Ways to Prevent Dementia
Dementia is an illness that involves memory loss associated with other forms of cognitive impairment such as language disturbance (aphasia), and eventually emotional and behavioral changes. Recent studies however have shown some practical ways to prevent cognitive decline.
The key is to reduce some of the risk factors. Maintaining a normal blood pressure and cholesterol level should help. See your family physician for regular check-up.
Avoid too much salt and saturated and hydrogenated fats in your diet. But intake of polyunsaturated and monounsaturated fats, antioxidants such as Vit. E and C, and fruits and vegetables may reduce the risk of cognitive decline.
Regular physical activities are crucial in preventing cognitive impairment by lowering the risk of high blood pressure, diabetes, and stroke. Likewise, stimulating mental activities such as playing cards, performing crossword puzzles, and learning new things may lower the risk of cognitive problem.
Although more investigations are necessary to clarify the roles of each factor, a healthy lifestyle should help in maintaining a healthy brain.
The key is to reduce some of the risk factors. Maintaining a normal blood pressure and cholesterol level should help. See your family physician for regular check-up.
Avoid too much salt and saturated and hydrogenated fats in your diet. But intake of polyunsaturated and monounsaturated fats, antioxidants such as Vit. E and C, and fruits and vegetables may reduce the risk of cognitive decline.
Regular physical activities are crucial in preventing cognitive impairment by lowering the risk of high blood pressure, diabetes, and stroke. Likewise, stimulating mental activities such as playing cards, performing crossword puzzles, and learning new things may lower the risk of cognitive problem.
Although more investigations are necessary to clarify the roles of each factor, a healthy lifestyle should help in maintaining a healthy brain.
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Friday, September 16, 2005
Dealing With Disaster-Related Stresses
How do we deal with the stresses related to disasters?
Hurrican Katrina has taught us how people behave under difficult circumstances. Some are in denial -- downplays the severity and the consequences of the disaster. Some behave differently and blame the "system" for its failure to address the situation. Some deal with the loss and destruction through prayers and social networks.
When disaster strikes, here are my suggestions to help you deal with stress:
1. Accept your emotions
2. Talk about it.
3. Establish support networks and strengthen existing relationships.
4. Learn to cope.
5. Ask for help.
6. Address some pressing issues right away
7. Encourage and inspire yourself.
8. Make use of your strengths.
9. Be willing to help others by being available and supportive.
Hurrican Katrina has taught us how people behave under difficult circumstances. Some are in denial -- downplays the severity and the consequences of the disaster. Some behave differently and blame the "system" for its failure to address the situation. Some deal with the loss and destruction through prayers and social networks.
When disaster strikes, here are my suggestions to help you deal with stress:
1. Accept your emotions
2. Talk about it.
3. Establish support networks and strengthen existing relationships.
4. Learn to cope.
5. Ask for help.
6. Address some pressing issues right away
7. Encourage and inspire yourself.
8. Make use of your strengths.
9. Be willing to help others by being available and supportive.
Learn the CARE Approach to mental health first aid
Sunday, June 26, 2005
Escitalopram Versus Venlafaxine
A study conducted by Bielski, et. al. compared escitalopram to venlafaxine in the treatment of major depressive disorder. While escitalopram is a SSRI, the latter is a SNRI.
The results of the study showed that in terms of efficacy, there were no statistical differences between the two drugs. However, escitalopram was better tolerated than venlafaxine. A significant number of patients who took venlafaxine developed nausea and did withdraw from the study.
Source: Bielski, et. al. A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder. J Clin Psychiatry 2004; 65(9): 1190-6.
The results of the study showed that in terms of efficacy, there were no statistical differences between the two drugs. However, escitalopram was better tolerated than venlafaxine. A significant number of patients who took venlafaxine developed nausea and did withdraw from the study.
Source: Bielski, et. al. A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder. J Clin Psychiatry 2004; 65(9): 1190-6.
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