Author Archives: Don Hall MD

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About Don Hall MD

Private practice psychiatrist

Anti-inflammatory Medicines May Have a Future in Depression Treatment

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New research out in October suggests that anti-inflammatory medications may prove helpful in treating depression (1).  Scientists are becoming more interested in this class of medication due to a growing body of research suggesting that depression and many other illnesses develop, in part, due to inflammatory processes in the brain.

Stress hormones and inflammatory products produced when the body is stressed make their way to the brain and damage neurons.  They also interfere with natural brain cell repair mechanisms.

Although prior studies of aspirin have failed to show improvements in treatment of depression, scientists in this month’s report looked a 18 studies (over 10,000 participants) of anti-inflammatory medicines and found that treatment with this class of medication was associated a significant reduction in depressive symptoms.

Studying the link between inflammatory processes and the onset of depression may lead to a completely new way of treating this illness.  While it is not time to rush out to the drug store and begin self-medicating ourselves with anti-inflammatory products to improve mood, this research does offer hope for a new class of antidepressant medications being developed in the future.

(1) Ole Kohler and others.  Effect of Anti-inflammatory Treatment on Depression, Depressive Symptoms, and Adverse Effects.  JAMA Psychiatry (Online First), October 15, 2014.

Five Tips to Reduce Anxiety and Depression

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0561. Develop a healthy habit. Growing a healthy habit may help to displace an unhealthy one.
2. Be open-minded about the benefits of medication to reduce worry or irritability, especially if your moods are creating conflicts in relationships or problems at work.
3. Consider counseling as way to unpack and examine your deeper feelings, ones that are not discussed in most day-to-day relationships.
4. Strengthen your social ties. Call an old friend or have breakfast with someone in the family.
5. Make a goal to grow spiritually over the next year. Then meditate on how your behavior may reflect that change.

Comfort in Grief – Spiritual Perspectives

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photo (57)In times of grief, a view of heaven may help.  Here are three images of God that illustrate the comfort that awaits the children of God.

The prophet Isaiah’s view of heaven included a vision of God as a kingly figure sitting on a throne, with flowing robes filling the temple and angels surrounding him with praises of his holiness (Isaiah 6:1-3).  How amazing it must be to dwell in his presence.

The apostle Mark described the presence of Jesus with children: ”And he took them in his arms and blessed them…” (Mark 10:16).  Jesus, as God among us, provided a glimpse of eternal heavenly compassion.

In my own mind, I like to imagine God as a loving father, sitting on his throne, with flowing robes billowing off of his shoulders and filing a heavenly temple.  I like to imagine all of his children sitting on his lap (it’s a big lap).  Our heavenly father looks down into the eyes of each one of us, in a way that fills our minds with amazement at his love and eternal provision for our souls.

Energy Balance in Depression and Anxiety

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photo (54)Two things I ask nearly every patient on every visit: “How are you sleeping” and, “Are you getting some exercise.”

If the answers are fine and yes, then I begin to relax in the belief that things are going pretty well for this person.  It’s a remarkably sensible formula: Rest + Exercise = Improved Health.

Our bodies were made to do things; and then, to rest in order to more things the next day.  People have been getting physical exercise since the time we lived in caves and hunted for dinner.  In modern times, we spend less time foraging through the woods for dinner and more time standing in front of the microwave oven.

Exercise researchers have shown that regular exercise is good for your mind and body.  It can even be a remedy for mild depression (see earlier blog).  The huffing and puffing of exercise blows off the emotional steam that comes with anxiety.  It is one of the few documented factors that help to reduce the risk of dementia and heart attacks.  Need I say more about the need to make some time for exercise?

Sleep researchers recommend 6-10 hour s of sleep.  Most people need about eight.  Some of us do better with nine.  Very few people function well with less than six.

In many ways, sleep seems like one of the easiest things to do with our time.  It is not.  A healthy sleep pattern takes discipline.  Reduce or eliminate caffeine if you sleep poorly.   Good sleep hygiene also requires that you spend the last hour or so of your day unwinding – not finishing a work or school project, not watching an adventure movie or reading a scary book. Let your mind and body relax.

Then make yourself go to bed.  Your mother does not control your bedtime anymore, so tell your own self “It’s time to go to bed so I can get up in the morning and exercise.”

Rick Warren’s Response to Son’s Suicide (Spiritual Perspectives)

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052One year after the loss of his son, Pastor Rick Warren said: “Obviously, I want my son back. But if you’re going to go through pain, you may as well use it for good (1).”

When something tragic like suicide happens, there are many different ways to respond. Two ways emerge from reading a recently published interview with Pastor Warren.

First, wait. Following Matthew’s death, Pastor Rick withdrew from the world for several weeks. He used the time to grieve the loss of a beloved son and draw closer to a loving God. Waiting quietly in prayer is often a good first step.

In moments of upheaval, simply wait as a stone waits for the artist to chisel away unneeded parts, gradually revealing the masterpiece that remains. In the words of a 17th Jesuit priest:

“All we need to think of is to keep still in his hands while he works on us…(2)”

Second, allow the experience to change you in a positive way. Rick Warren used his hardship “for good”, as he developed a desire to understand and support people with mental health challenges. Maybe your hardship will enliven growth in some aspect of your personal life.

When bad things happen, wait on God and be transformed. Let Him use the difficulties in your life to shape you into the woman or man He has in mind for you to become.

(1) Warren Smith. Pain and Gain. World Magazine. September 20, 2012

(2) Jean Baptiste Saint-Jure and Claude de la Colombiere. Trustful Surrender to Divine Providence, The secret of peace and happiness. St. Benedict Press, Charlotte, NC. 1980 (originally written in 17th Century).

Sunshine as Suicide Prevention

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photo (16)Sunny days may reduce the incidence of suicide. These are findings published this week by researchers who analyzed of 30 years suicide data in Austria, comparing the number of suicides on a given day to the corresponding history of cloudy days .

Two findings emerged. First, a single day of cloudiness may be the final straw for the person muddled in suicidal thinking. Second, a long period of cloudy days increases the risk of suicide.

Two take-away messages may be important for those who struggle with depression. First, you may not feel like going outside on sad days but these may be the most essential days to get into the sunlight. Second, when cloudy days follow cloudy days, it is vitally important to do things that stabilize or elevate your mood. Exercise, call a friend, or do that good thing that helps you feel better. And, reach out to a counselor or physician without delay if destructive thoughts begin to dominate your thinking.

Whether you experience periods of depressed mood or not, get outside in the sunshine this week. It may lighten your eyes as well as your spirit.

(1) Benjamin Vyssoki and others. Direct Effect of Sunshine on Suicide. JAMA Psychiatry. Published online September 10, 2014

Bad Things Happen to Good People

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photo (53)Spiritual beliefs may get distorted in times of depression; especially when bad things happen to good people. Viewing God as uncaring or unreal can be a part of the black mood experience. So how are we to think about a god who allows bad things to happen to good people?

In responding to this question, I will begin placing quotation marks around the words ‘good’ and ‘bad’ because sometimes what appears to be ‘bad’ is actually ‘good’. This, I believe, is frequently true in our view of life events.

Often, in the grand scheme of the universe as God knows it, what looks to be ‘bad’ is ultimately ‘good’. Look at Christ on the cross. Wow! Did a very ‘bad’ thing happen to a ‘good’ man? Or, did an ultimately very good thing happen to a very good man?

In smaller ways, God may be using ‘bad’ things to bring ‘good’ things into your life and the lives of those you love. Accepting this suggestion is not easy. Keeping faith when life hurts is hard.

We need a renewed perspective, like the writer of Trustful Surrender who said:

“If we could see all He sees
we would unhesitantly wish all He wishes.
We would beg Him on bended knees for those afflictions
we now ask Him to spare us.”(1)

Bad things do happen to good people. When they do, may God help us to submit to his will so that, in these hardships, we might be transformed into the man or woman he intends us to become.

(1) Jean Baptiste Saint-Jure and Claude de la Colombiere. Trustful Surrender to Divine Providence, The secret of peace and happiness. St. Benedict Press, Charlotte, NC. 1980 (originally written in 17th Century).

Combining Talk Therapy and Antidepressant Medication

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photo (11)An article in next month’s issue of JAMA Psychiatry will support combining talk therapy and antidepressant medication in treatment of depression. Merging talk therapy (cognitive therapy chosen in this study) and medication treatment worked better than medicine alone in relieving severe non-chronic depression (1). The antidepressant treatment group in this study saw a 62% improvement while the medicine plus cognitive therapy group saw a 73% improvement. Not outstanding differences between groups, but every little bit helps to someone stuck in a depression.

These results fit well with what most counselors see on a daily basis. In cases of severe depression, people do not have the clear thinking necessary to find solutions to every day hassles. Medications often help to clear these impediments to effective talk therapy.

Results also fit well with what most psychiatrists recommend. Medications are often not enough. In the book BTD (2), I discuss the importance of combining talk therapy, centered on adjusting expectations, with medication treatment.

If you have been doing talk therapy for several months and remain depressed, see a psychiatrist. If you have been trying medications for several months and are not getting better, see a professional counselor. In breaking the grip of depression, combining these two treatments can be better than either one alone.

(1) Pre-released online: Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder: A Randomized Clinical Trial. Steven D. Hollon and others. JAMA Psychiatry. Online August 20, 2014. doi:10.1001/jamapsychiatry.2014.1054

(2) Breaking Though Depression (see tab above)

Encouragement for Periods of Depression

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125There are dark clouds.
There are blue skies.
You have to know that there are blue skies beyond the dark skies.
Right now, clouds obstruct your view.
Right now, you have to know with intuition and faith, that good days are a reality and when the clouds pass you will experience again the joys of a beautiful day.

The key is to know that bad days will pass – better days will come.
It happens.
As you wait through cloudy days, hang onto a long-range vision and focus your mind on faith.
Strength will rise and clouds will part.