Cadabam's Blog

Tricyclic antidepressants such as amitriptyline, desipramine, and doxepin, may harm your heart, according to a new study conducted by researchers at University College London (UCL). This risk may extend beyond individuals who are being treated for depression, as these older antidepressants are also used to treat anxiety, sleep problems, headache, and back pain, among other conditions.
Although tricyclic antidepressants are one of the oldest classes of antidepressants, they are still used extensively, according to eMedExpert. Today, selective serotonin reuptake inhibitors (SSRIs) have replaced tricyclics as the treatment of choice for depressive disorders, primarily because patients tolerate them better and they are safer if taken in excess.
Researchers at University College London compared the use of tricyclic antidepressants with SSRIs or no antidepressant use in nearly 15,000 individuals in Scotland. Overall, the older antidepressants were linked with a 35 percent increased risk of cardiovascular disease, while use of SSRIs was not.
Based on these findings, Dr. Mark Hamer, senior research fellow in the Department of Epidemiology and Public Health at UCL remarked that they “suggest that there is an association between the use of tricyclic antidepressants and an increased risk of CVD that is not explained by existing mental illness.” The study results thus indicate that tricyclics have properties that are responsible for the greater risk.
Previous research has shown tricyclic use to be associated with a significantly higher rate of serious cardiovascular side effects, such as increased heart rate, as well as arrhythmias, blood pressure abnormalities, and congestive heart failure. They have also been linked with weight gain and diabetes, which are risk factors for cardiovascular disease.
The UCL study’s authors note that other factors may be involved in the possible link between tricyclic antidepressant use and cardiovascular disease. Hamer pointed out that individuals who take antidepressants are more likely to be overweight, smoke, and not get sufficient exercise, also risk factors for cardiovascular disease.
Before it can be determined with more certainty that tricyclic antidepressants can harm the heart, “there needs to be more research looking closely at the effects of these drugs on your heart,” notes Amy Thompson, senior cardiac nurse at the British Heart Foundation. Because antidepressants help a great many people, “it would be unwise for anyone taking them to stop based on the results of this study alone.”

Depressive disorders come in many different types, but each type has its own unique symptoms and treatments.
Major depression, the most common type of a depressive disorder, is characterized by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. Mental health professionals use this checklist of specific symptoms to determine whether major depression exists or not. Depression is also rated by your diagnosing physician or mental health professional in terms of its severity — mild, moderate, or severe. Severe depression is the most serious type.
A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Another type of depressive disorder is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of Depression
Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.
DEPRESSION
• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, or making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Symptoms of Mania (for Bipolar Disorder)
MANIA
• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social behavior

Depression is a very real and serious problem for both children and teens.
Research has shown that childhood depression often persists, recurs and continues into adulthood, especially if it goes untreated. The presence of childhood depression also tends to be a predictor of more severe illnesses in adulthood.
A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depressive disorders. By age 15, however, girls are twice as likely as boys to have experienced a major depressive episode.
Depression in adolescence comes at a time of great personal change–when boys and girls are forming an identity distinct from their parents, grappling with gender issues and emerging sexuality, and making decisions for the first time in their lives. Depression in adolescence frequently co–occurs with other disorders such as anxiety, disruptive behavior, eating disorders or substance abuse. It can also lead to increased risk for suicide.
One research study of 439 adolescents with major depression found that a combination of medication and psychotherapy was the most effective treatment option. Researchers are developing and testing ways to prevent suicide in children and adolescents, including early diagnosis and treatment, and a better understanding of suicidal thinking.

Clinical depression goes by many names — depression, “the blues,” biological depression, major depression. But it all refers to the same thing: feeling sad and depressed for weeks or months on end (not just a passing blue mood), accompanied by feelings of hopelessness, lack of energy, and taking little or no pleasure in things that gave you joy in the past.

A person who’s depressed just “can’t get moving” and feels completely unmotivated to do just about anything. Even simple things — like getting dressed in the morning or eating — become large obstacles.

We’ve compiled a library of depression resources for you to explore. We encourage you to take your time with these resources, print out things you’d like to read more carefully, and bring anything you have additional questions about to your family doctor or a mental health professional.

Depression is readily treated nowdays with modern antidepressant medications and short-term, goal-oriented psychotherapy. Don’t be put off by the amount of things written about depression — because it’s so common, a lot has been written about it! Read what you need, and leave the rest for another day.

There are many drug rehabilitation programs available and it will therefore pay to learn about the differences in each one of them. If you or somebody close to you has a drug related problem you would do well to choose a drug rehabilitation program that will help to get you or the patient to break their bad habits. Perhaps the first option open to you is to try using medications such as clonidine, benzodiazepines as well as suboxone and a few more, each of which will help in getting the drug addict to gradually withdraw from using opiates, alcohol and even methadone.

There are also many medical centers that have doctors especially trained in handling drug abusers and these rehabilitation centers are worth checking out because the center is the right place where patients can get proper rehabilitation treatment as well be given appropriate medications.

Besides choosing medications, there are also non-medicinal drug rehabilitation programs that can help patients with equal effectiveness, and perhaps with even more effectiveness than medicinal based drug rehabilitation programs. In the non-medicinal programs use is made of giving patients plenty of nutrients – perhaps through IV. There are also many medicinal as well as non-medicinal drug rehabilitation programs that can be chosen though these require use and administration by highly specialized personnel and which also requires getting tests done as well as giving the patients IE nutrients.
One common problem that drug abusers face is that fatty tissue in their bodies start to contain residues of the drugs that they have consumed. This could in turn lead to damage to brain, liver, kidney and muscles and it also leads to craving for more drugs. One drug rehabilitation program that can help such people is bio-physical detoxification in which the patient needs to be treated for months or even weeks – during which time the patient needs to take numerous sauna baths, and also takes nutritional and vitamin supplements as well as must perform exercises intensively.

However, there is also a traditional drug rehabilitation program that has been tried out for many years and almost every rehab center in the world has been using them to good effect. Of course, the success of the traditional & twelve step rehab solutions vary and depend on how well the rehabilitation treatment is given and also depends on the professionalism of the people giving such rehabilitation treatments.

In this present day and age when more and more people are taking to the abuse of prescription medicines as well as taking illegal substances, finding the best drug rehab program assumes even greater importance. Even social educational models are being used in drug rehabilitation and if the patient can be made to exercise self restraint and use their own will power, enlightenment and cognitive realization will follow and a better future will await the lost and drug abused soul.

Many people may leave the TV on at night or some sort of dim light thinking it is harmless. A new study
on hamsters is saying that it is possible that this kind of exposure to a dim light at night could create changes in the brain that lead to mental health concerns such as depression.
“People might want to try to avoid falling asleep with their TVs on all night,” said Tracy Bedrosian, a doctoral student in neuroscience at Ohio State University. “They might want to try to minimize light exposure during the night,”
Bedrosian and colleagues placed hamsters in two different settings that involved light. In one setting hamsters were exposed to 16 hours of daylight and eight hours of complete darkness each day. In the other, the animals experienced 16 hours of daylight, but at nighttime, a dim light was kept on, about the intensity of a TV screen lighting up a dark room.
What the researchers discovered was that after eight weeks the researchers would evaluated behaviors that would suggest they were depressed. For example, they looked to see whether the hamsters still engaged in activities they normally enjoy, such as drinking sugar water.
Hamsters in both groups were given a choice between drinking tap water or sugar water. The hamsters exposed to light at night drank similar amounts of tap and sugar water — they’d lost their preference for the sweet treat.
“That suggests to us that they are not getting the same pleasurable and rewarding feeling from drinking their sugar water, and that it may be interpreted as a depression-like response,” Bedrosian said.
The hamsters exposed to night light had a reduced number of so-called dendritic spines on the surface of cells in this region. Dendritic spines are hair-like protrusions that brain cells use to communicate with one another.
The findings agree with studies on humans that have found the hippocampus to be involved in depression. A patient with major depression has a smaller hippocampus, Bedrosian said.
The brain changes in the hamsters might arise from fluctuations in the production of the hormone melatonin, Bedrosian said. Melatonin signals to the body that it’s nighttime, but a light at night dampens its production. The hormone has been shown to have some antidepressant effects, and so a decrease in melatonin might spur depression symptoms, Bedrosian said.
This study adds to previous findings connecting exposure to light during sleep and depressive behavior. One study found that mice exposed to bright lights at night tend to become depressed and to gain weight.

Drug rehabilitation is a supportive approach to treatment and recovery from chemical dependency and drug addiction. “Drug Rehabilitation” is the umbrella term given to the process of medical and psychological rehabilitation for drug addicts and alcoholics. No matter what the substance abused, treatment is the key to recovery for individuals and families suffering from drug abuse and alcoholism. For drug rehabilitation programs to be effective addicts must enter the rehabilitation process with honesty, open-mindedness, and willingness; treatment only works when its roots are in an honest assessment of the reality of addiction. Drug rehabilitation centers are not a “one size fits all” proposition. The key to effective drug rehab programs is their ability to help an addict find an understanding of what’s driving the addiction in the first place – namely the behaviors and thought processes of the addict. Drug rehabilitation is available in a many forms, from basic outpatient detoxification programs through intensive long-term residential rehab centers in beautiful settings. The ultimate goal of any drug rehab program is to enable the individual in recovery to live a life free from the effects of drugs and alcohol, therefore not returning to their use and abuse. Rehabilitation is not easy, but professionals at high quality programs will give you every opportunity to get clean and stay sober through kindness, education and support. Drug rehabilitation is a process with many phases that will help guide the addict to an existence free from the devastating effects of chemical dependency and substance abuse.
What is drug rehabilitation, and how does it work? A drug rehabilitation is a center or program that an individual enters in order to treat a drug addiction or alcohol abuse problem. Drug rehabilitation is a process in which those addicted to drugs and alcohol (technically just another type of drug) learn that their conditions are treatable and learn the tools necessary to live a drug-free existence. Drug rehab is an essential first step in the recovery process because drug addiction is a disease, and like any other disease requires treatment to arrest it’s progress. Drug addiction is in fact a clinical disorder that demands clinical treatment administered in a professional rehabilitation environment. Many drug rehabilitation programs will teach addicts that the process which takes place in a rehabilitation center must continue long after the completion of formal treatment for the best chance of success, and requires eternal vigilance and continuing practice for the remainder of the recovering addict’s life. Realizing you are in need of drug rehabilitation is the first step on the path to recovery, and is without a doubt the most important step. Choosing to enter drug rehabilitation is not an easy decision, and the only drug rehab patients who find success are those who commit themselves honestly and wholeheartedly to the struggle for sobriety and freedom from the chains of addiction.

‘Drug rehab center’, ‘drug treatment center’, ‘alcohol rehabilitation center’, ‘drug rehabilitation program’, and ‘substance abuse rehabilitation center’ are all terms used to describe basically the same thing – a safe and supportive environment for recovery from drug addiction and/or alcoholism. They usually take the form of a residential addiction rehabilitation center, but can also be intensive outpatient rehabilitation or day treatment programs, or day/night rehabilitation programs – a type of treatment center that takes on the same form and provides many of the same services as a residential drug treatment center or alcohol rehabilitation center, but utilizes more that one location for treatment – often a center for counseling and group therapy by day, and a separate residential setting at night. Alcohol and drug rehabilitation centers, whether they are residential treatment centers or day/night rehabilitation programs, all provide a nurturing, safe, and supportive setting to recover from drug addiction and alcoholism. Outpatient drug rehabilitation programs and intensive outpatient drug rehabilitation programs are more aptly suited to individuals who have already completed a higher level of care like primary residential drug treatment, or individuals whose addiction to drugs – whatever the drug – alcohol, heroin, cocaine, methamphetamines, other opiates (Vicodin, Oxycontin, morphine, methadone), barbiturates, or benzodiazepines (Valium, Xanax, Ativan, Klonipin to name a few) is less severe. Outpatient rehabilitation programs are also appropriate for cases where the drugs are already out of the individual’s system through a process of detoxification, whether it’s rapid opiate detox for heroin addiction, substitution therapy and detoxification for opiate addiction (using more cutting edge treatments such as Subutex, Suboxone, Buprenex or Buprenorphine), or more traditional detox from drugs and alcohol using benzodiazepines or barbiturates to treat the withdrawal symptoms. Individuals who hope to find success in an outpatient rehabilitation program must already have some level of distance from drug addiction, alcohol abuse or alcoholism, and must be stable and have the ability to function in an uncontrolled environment when not at the drug treatment center for rehabilitation services.

Mental rehabilitation is an important component in the management of the mentally ill. This article presents a selective review of the publications in this journal. Questions addressed in this review range from assessment of rehabilitation needs to different rehabilitation approaches. Although the number of publications providing the answers is meager, there are innovative initiatives. There is a need for mental health professionals to publish the models they follow across the country.
Mental rehabilitation is a therapeutic approach that encourages a mentally ill person to develop his or her fullest capacities through learning and environmental support.

Mental rehabilitation and psychiatric treatment are separate, yet equally important complementary components of mental healthcare. Even as psychiatric treatment (Pharmacological and psychological) aims at controlling psychiatric symptoms, psychiatric rehabilitation focuses on functioning and role outcomes. The new focus of rehabilitation is on wellness and optimum quality of life.

The rehabilitation program should start right from the first time the patient has come into contact with a mental health professional. A clinician waiting to start rehabilitation after the patient becomes asymptomatic, may not benefit the patient or the family in the long run.

This article reviews publications in the IJP from its inception to date, in the area of rehabilitation. We have tried to summarize these articles and suggest future directions. This includes editorials, commentaries, review articles, book reviews, and case reports.

Literature review

Schmidt in his article, ‘A measurement of rehabilitation of psychiatric patients,’ comments that in psychiatry, as in general medicine, a full restitution ad integrum cannot be expected even after the most efficient treatment, although, functioning can fortunately be restored after the disease. He has reported from a community-based mental health review in Sarawak, a state in the federation of Malaysia. They focused on patients in terms of rehabilitation of their previous working capacity. The rehabilitation status was measured by taking into consideration whether they were, ‘working’ ‘probably working,’ ‘Does some work,’ ‘Probably not working,’ and ‘Not working’. They assessed 584 consecutive patients visiting the clinic for follow-up and found that 82% of them were within the first three categories (‘Working’, ‘probably working’, ‘does some work’) and were functioning well, while 18% (‘Probably not working’ and ‘not working’) were not functioning, and therefore, could not claim to have been rehabilitated.

Nagaswamy carried out a very important assessment of the rehabilitation needs of schizophrenic patients. They interviewed 59 schizophrenic outpatients and their families to assess the subjective rehabilitation needs. They found that 64.4% wanted a job, 54.4% wanted some help for the family. Almost 90% of them desired rehabilitation in one form or another and most exhibited multiple needs, which emphasized the role of multifaceted, comprehensive, aftercare package programs. Even as the need for job as a priority was similar to findings in the west, this population differed by having low priority for social skills training and psycho-social structuring, in contrast to the west.

Verma and Shiv reported on the effect of rehabilitation in leprosy patients with psychiatric morbidity. They assessed 100 patients with leprosy, among whom 46 were rehabilitated and were staying in an ashram. Others were staying in a slum. They were assessed using the Goldberg General Health Questionnaire (GHQ) and Indian Psychiatric Interview Schedule (IPIS). They found statistically significant differences on psychiatric morbidity between the non-rehabilitated (85%) and rehabilitated groups (68%).

Gopinath and Rao in their invited review article, have reviewed important world literature regarding psychiatric rehabilitation. They describe the principle, components, and efficacy of various rehabilitation activities. They have discussed the scenario in India and suggested steps to be taken to improve rehabilitation efforts in India.

Kastrup have studied the psychological consequences of torture and they have described the principles of treatment. They have described a model for rehabilitation of such victims, being followed at their center at Copenhagen.

Mathai in an unique, but small case control study, tried cognitive re-training of four detoxified male alcoholics and compared it with four controls. At the end of six weeks they found a significant improvement in information processing, memory, and reduction of neuro-psychological deficits. They concluded that neuropsychological rehabilitation was effective in improving cognitive defects of abstinent alcoholics.

Agarwal in his review of the book, ‘Innovation in psychiatric rehabilitation,’ published by the Richmond Fellowship Society (India) comments, ‘Large rehabilitation facilities may be the only viable option’. He opines that there were many rehabilitation initiatives, but unfortunately most of them have not tried to evaluate their efforts scientifically as well as in economic terms.

Ponnuchamy examined the role of family support groups in mental rehabilitation. They observed that members attending support group meetings, expected to get more information about the illness, to develop skills to cope with problems at home, and to learn skills to deal with the ill person. They concluded that participation in a support group meeting positively affected key variables in the participant’s adaptation to mental illness in a relative.

Thara in a commentary has stressed the need for cost-effectiveness studies for rehabilitation. She reports the experience of Schizophrenia Research Foundation (SCARF) in rural areas, where it was found that the most suitable elements of a rehabilitation program were empowering the families and offering simple, culture-specific interventions, such as distribution of livestock and fishing nets.

Kumar have assessed the prevalence and pattern of mental disability among the rural population in Karnataka. It was a community-based, cross-sectional, house-to-house survey. They used Indian disability evaluation and assessment scale (IDEAS), developed by Rehabilitation committee of Indian psychiatric society (IPS). They studied one thousand subjects randomly. The prevalence of mental disability was found to be 2.3%. The prevalence was higher among females (3.1%) than among males (1.5%). The prevalence was the highest among the elderly and illiterates.

Suresh Kumar observed that there is a definite limitation to the domains of social functioning, cognitive functioning, and psychopathology in chronic schizophrenia patients who have had no rehabilitation. Vocational rehabilitation significantly improves these limitations, which in turn helps these patients to integrate into the society so as to function efficiently in their roles.

Drug alcohol rehab helps the addict to understand the complexity of addiction; it is much more than just using drugs too much. They learn that addiction is beyond their control and they have little choice in the matter of continuing to use. Cadabam’s drug and alcohol rehab program makes sure that each and every client learns the cognitive and behavioral skills necessary to gain control back from the addiction. The skills learned help make life outside of treatment easier to cope with, without the use of drugs or alcohol. Cadabam’s rehab center makes sure that the addict knows the necessary skills to not use addictive substances.
It is important for the addict to understand that drugs affect the brain’s reward system. Drug and alcohol make the brain produce an excess of dopamine, which is a pleasure chemical in the brain that tells humans to seek whatever it was that caused the release of dopamine, or more pleasure. It is usually released because of food, exercise and sex—all things humans need to survive and keep the human race going. Drugs cause the brain to become flooded with dopamine, which produces the “high” feeling that makes people want to use the substance more. The human body will begin to require more and more dopamine just to feel normal, which creates an urge to use the substance again and again. This urge quickly turns into a need and thus the addiction is active and willpower alone cannot stop the cravings.
Drug and alcohol addiction is an illness. It is a disease. Rehabilitation is the only way to recover from the depths of addiction. It is not a punishment. A drug and alcohol rehab center is a positive experience that will help the addict change his or her life and learn how to live without drugs and alcohol.
The Cadabam’s drug and alcohol treatment center offers world class services for all of the reasons stated above. Cadabam’s rehabilitation center educates its clients about addiction and why staying sober is so difficult. And it is not institutionalized. The main campus holds many of its activities outdoors and the choice in therapies is second to none.