Psychosocial Intervention in Substance Misuse

Psychosocial interventions and support services describe a wide variety of services, supports and strategies that aim to change behaviour and support people who are affected by alcohol and drug use. These are services which are provided within community settings.


These types of services provide a range of psychosocial (non-medical) interventions for people with alcohol and drug issues including assessment, counselling, case management, coordination of care, group work, information, community education and professional consultation to other service providers.


The Alcohol and Drug Service also provides a range of specialist targeted services in the following areas:
Support for Youth
Outreach Services
Relapse Prevention
Management of Complex Needs
Brief and Early Intervention
Smoking Cessation


Support for Youth


The Alcohol and Drug Service employs specialist youth workers who work with young people affected by alcohol and drug use. These specialists also work closely with a range of youth services provided by community sector organisations.


Outreach Services


Outreach services are useful in providing services to clients who would otherwise be unable to access specialist alcohol, tobacco and other drug services in a timely and equitable manner.


Services are designed to provide: counselling; assistance with accessing other services; access to skilled and professional help; assistance with the development of strategies to reduce harm; and access to specialist advice and information. Services can be provided to individuals or in group settings.


Relapse Prevention


Relapse prevention is a collection of techniques that increase the client’s ability to control cravings and urges, and enhance coping skills for handling high-risk situations where lapse or relapse is a possibility. By combining the learning of specific skills with lifestyle changes, these interventions assist clients to manage lapses and prevent relapses.


Management of Complex Needs


A large proportion of clients who access alcohol, tobacco and other drug services are presenting with increasingly complex and multiple needs. In some cases, these clients also present with difficult (and at times high risk) behaviours. The needs of the client group can be complicated by the presence of coexisting mental health issues.


Brief and Early Intervention


Early intervention involves intervention at an early stage of a person’s alcohol and drug use to prevent the development of serious drug problems later on.


Early intervention focuses on service users who are engaged in patterns or contexts of drug use that have the potential to harm. Early intervention involves identifying drug use and assessing harm and intervening with service users who are consuming drugs in a potentially harmful way before problems become entrenched or dependence develops.


Smoking Cessation


Improving the health of Tasmanians by reducing the harm caused by tobacco in all its forms is the key policy objective of the Tasmanian Tobacco Action Plan 2006-2010.


Reducing smoking initiation and reducing the exposure to second-hand smoke, through tobacco control strategies, along with increasing the rate at which people quit smoking are key objectives of tobacco control activities. Interventions such as price increases, mass media campaigns and sale restrictions are effective in both preventing uptake and promoting quit attempts. Advice and support provided by health professionals is also an essential component of increasing the rate at which people quit smoking.

What causes olfactory hallucinations (phantosmia)?

Many people are sensitive to certain smells, but in an olfactory hallucination (phantosmia), you detect smells that aren't really present in your environment.

The odors detected in phantosmia vary from person to person and may be foul or pleasant. They can occur in one or both nostrils and usually can't be masked by food.

Phantosmia most often occurs as a result of a head injury or upper respiratory infection. It can also be caused by temporal lobe seizures, sinusitis, brain tumors, migraine, Parkinson's disease and stroke.

Because phantosmia can in rare cases be an indication of a serious underlying disorder, consult your doctor if you experience such symptoms.

Note that phantosmia is different from another disorder of sense of smell, known as parosmia, in which a smell is present in your environment but is distorted. Parosmia can occur with damage to the olfactory system, such as after a severe respiratory infection. In this situation, there's usually also a loss of sense of smell.

Complications

Left untreated, schizophrenia can result in severe emotional, behavioral and health problems, as well as legal and financial problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:

• Suicide
• Self-destructive behavior, such as self-injury
• Depression
• Abuse of alcohol, drugs or prescription medications
• Poverty
• Homelessness
• Family conflicts
• Inability to work or attend school
• Health problems from antipsychotic medications
• Being a victim or perpetrator of violent crime
• Heart disease, often related to heavy smoking

Coping and support

By Mayo Clinic staff

Coping with an illness as serious as schizophrenia can be challenging, both for the person with the condition and for friends and family. Here are some ways to cope with schizophrenia:

• Learn about schizophrenia. Education about the condition can help motivate the person with the disease to stick to the treatment plan. Education can help friends and family understand the condition and be more compassionate with the person who has it.
• Join a support group. Support groups for people with schizophrenia can help them reach out to others facing similar challenges. Support groups may also help family and friends cope.
• Stay focused on goals. Recovery from schizophrenia is an ongoing process. Keeping recovery goals in mind can help the person with schizophrenia stay motivated. Help your loved one remember to take responsibility for managing the illness and working toward goals.
• Learn relaxation and stress management. The person with the disease and loved ones may benefit from stress-reduction techniques such as meditation, yoga or tai chi.

Understanding Depression And Effective Treatments

How does depression differ from occasional sadness?

While everyone occasionally feels sad or "blue," these feelings tend to pass rather quickly.

By contrast, someone with depression experiences extreme sadness or despair that lasts for at least two weeks or longer. Depressed individuals tend to feel helpless and hopeless and to blame themselves for having these feelings. Depression interferes with activities of daily living — such as working or concentrating on tasks, or even eating and sleeping. Other possible symptoms of depression include chronic pain, headaches or stomach aches. Some people may feel angry or restless for long periods.

People who are depressed may become overwhelmed and exhausted and stop participating in certain everyday activities altogether. They may withdraw from family and friends. Some depressed individuals may have thoughts of death or suicide.

What causes depression?

A combination of genetic, chemical, biological, psychological, social and environmental factors likely contributes to the disorder. Depression is often a signal that certain mental, emotional and physical aspects of a person's life are out of balance. Chronic and serious illness such as heart disease or cancer may be accompanied by depression.

Significant transitions and major life stressors such as the death of a loved one or the loss of a job can help bring about depression. Other more subtle factors that lead to a loss of self-identity or self-esteem may also contribute. The causes of depression are not always immediately apparent, so the disorder requires careful evaluation and diagnosis by a trained mental health care professional.

Sometimes the circumstances involved in depression are ones over which an individual has little or no control. At other times, however, depression occurs when people are unable to see that they actually have choices and can bring about change in their lives.

Can depression be treated successfully?

Absolutely. Depression is highly treatable when an individual receives competent care. Licensed psychologists are highly trained mental health professionals with years of experience studying depression and helping patients recover from it. There is still some stigma or reluctance associated with seeking help for emotional and mental health problems, including depression. Unfortunately, feelings of depression often are viewed as a sign of weakness rather than as a signal that something is out of balance. The fact is that people with depression cannot simply "snap out of it" and feel better spontaneously.

Persons with depression who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen a depression.

Getting quality treatment is crucial. If depression goes untreated, it can last for a long time and worsen other illnesses. Even people with severe depression benefit from treatment.

What evidence supports the use of psychotherapy for treatment?

Many research studies have demonstrated that psychotherapy, or talk therapy, is effective for treating depression and relieving symptoms experienced by individuals who suffer from depression. Psychological treatments may prevent a person with milder depression from becoming more severely depressed. And although a past history of depression increases the risk of future episodes, there is evidence that ongoing psychotherapy may lessen the chance of recurrence.

How does psychotherapy help people recover?

There are several approaches to psychotherapy — including cognitive-behavioral, interpersonal and other kinds of talk therapy — that help individuals recover from depression. Psychotherapy helps people identify the factors that contribute to their depression and deal effectively with the psychological, behavioral, interpersonal and situational contributors.

Skilled health and mental health professionals such as licensed psychologists can work with individuals who are depressed to:

• Pinpoint the life problems that contribute to their depression, and help them understand which aspects of those problems they may be able to solve or improve. A licensed psychologist can help depressed patients identify options for the future and set realistic goals that enable them to enhance their mental and emotional well-being. Psychotherapy also can assist individuals who have been depressed in the past with identifying how they have successfully dealt with similar feelings.
• Identify negative or distorted thought patterns that contribute to feelings of hopelessness and helplessness that accompany depression.
• Develop skills to relieve suffering and prevent later bouts of depression. Skills may include developing or strengthening social networks, creating new ways to cope with challenges and crafting a personal self-care plan that includes positive lifestyle changes.

In what other ways do psychologists help individuals suffering from depression, and also help their loved ones?

Living with a depressed person can be very difficult and stressful on family members and friends. The pain of watching a loved one suffer from depression can bring about feelings of helplessness and loss.

Family or couples therapy may be beneficial in bringing together all the individuals affected by depression and helping them learn effective ways to cope together. This type of psychotherapy can also provide a good opportunity for individuals who have never experienced depression themselves to learn more about it and to identify constructive ways to support a loved one who is suffering from depression.

The support and involvement of family and friends can play a crucial role in aiding someone who is depressed. Individuals in the "support system" can encourage a depressed loved one to stick with treatment and practice the coping techniques and problem-solving skills he or she is learning through psychotherapy.

Are medications useful for treating depression?

Medications are helpful for reducing symptoms of depression in some people, particularly when their depression is severe. Some health care professionals treating depression may favor using a combination of psychotherapy and medications. Given the side effects, any use of medication requires close monitoring. Psychotherapy is often recommended as a first line of treatment for children and adolescents, especially those with mild to moderate depression. Further, some adults with depression may prefer psychotherapy to the use of medications if their depression is not severe. By conducting a thorough assessment, a licensed and trained mental health professional can help make recommendations about an effective course of treatment for an individual's depression.

Depression can seriously impair a person's ability to function in everyday situations. But the prospects for recovery are good for individuals with depression who receive appropriate professional care. 

The American Psychological Association gratefully acknowledges the assistance of Daniel J. Abrahamson, PhD, Lynne M. Hornyak, PhD, and Lynn P. Rehm, PhD, in developing the original version of this fact sheet on depression.

Updated July 2010

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Children and TV: Limiting your child's screen time

Children and TV often go hand in hand. Understand the effects of too much screen time — and how to enforce reasonable limits.

By Mayo Clinic staff

Are you concerned about how much time your child spends watching TV or movies, playing with a smartphone or computer, or enjoying video games?

Although some screen time can be educational, it's easy to go overboard. Consider this guide to children and TV, including what you can do to keep your child's screen time in check.

The effects of too much screen time

The American Academy of Pediatrics discourages media use by children younger than age 2 and recommends limiting older children's screen time to no more than one or two hours a day. Too much screen time has been linked to:

• Obesity. The more TV your child watches, the greater his or her risk is of becoming overweight. Having a TV in a child's bedroom also increases this risk. Children can also develop an appetite for junk food promoted in TV ads, as well as overeat while watching TV.
• Irregular sleep. The more TV children watch, the more likely they are to have trouble falling asleep or to have an irregular sleep schedule. Sleep loss, in turn, can lead to fatigue and increased snacking.
• Behavioral problems. Elementary students who spend more than two hours a day watching TV or using a computer are more likely to have emotional, social and attention problems. Exposure to video games is also linked with an increased risk of attention problems in children. Watching excessive amounts of TV at age 4 is linked with bullying at ages 6 through 11.
• Impaired academic performance. Elementary students who have TVs in their bedrooms tend to perform worse on tests than do those who don't have TVs in their bedrooms.
• Violence. Too much exposure to violence through media — especially on TV — can desensitize children to violence. As a result, children might learn to accept violent behavior as a normal way to solve problems.
• Less time for play. Excessive screen time leaves less time for active, creative play.

• How to limit screen time

  Your child's total screen time might be greater than you realized. Start monitoring it and talk to your child about the importance of sitting less and moving more. Also, explain screen time rules — and the consequences of breaking them. In the meantime, take simple steps to reduce screen time. For example:
  • Eliminate background TV. If the TV is turned on — even if it's just in the background — it's likely to draw your child's attention. If you're not actively watching a show, turn off the TV.
  • Keep TVs and computers out of the bedroom. Children who have TVs in their bedrooms watch more TV than children who don't have TVs in their bedrooms. Monitor your child's screen time and the websites he or she is visiting by keeping TVs and computers in a common area in your house.
  • Don't eat in front of the TV. Allowing your child to eat or snack in front of the TV increases his or her screen time. The habit also encourages mindless munching, which can lead to weight gain.
  • Set school day rules. Most children have limited free time during the school week. Don't let your child spend all of it in front of a screen. Also, avoid using screen time as a reward or punishment. This can make screen time seem even more important to children.
  • Talk to your child's caregivers. Encourage other adults in your child's life to limit your child's screen time, too.
  • Suggest other activities. Rather than relying on screen time for entertainment, help your child find other things to do, such as reading, playing a sport, helping with cooking or trying a board game.
  • Set a good example. Be a good role model by limiting your own screen time.
  • Unplug it. If screen time is becoming a source of tension in your family, unplug the TV, turn off the computer or put away the smart phones or video games for a while. You might designate one day a week or month as a screen-free day for the whole family. To prevent unauthorized TV viewing, put a lock on your TV's electrical plug.

  Become an active participant

  When your child has screen time, make it as engaging as possible:
  • Plan what your child views. Instead of flipping through channels, seek quality videos or programming. Consider using parental control settings on your TV and computers. Preview video games and smartphone applications before allowing your child to play with them.
  • Watch with your child. Whenever possible, watch programs together — and talk about what you see, such as family values, violence or drug abuse. If you see a junk food ad, explain that just because it's on TV doesn't mean it's good for you.
  • Record programs and watch them later. This will allow you to fast-forward through commercials selling toys, junk food and other products. When watching live programs, use the mute button during commercials.
  • Encourage active screen time. Have your child stretch or do yoga while watching a show. Challenge your family to see who can do the most jumping jacks during a commercial break. Choose video games that encourage physical activity.
  It can be difficult to start limiting your child's screen time. It's worth the effort, however. By creating new household rules and steadily making small changes in your child's routine, you can curb screen time and its effects.

Mental illness in children: Know the signs

By Mayo Clinic staff

Mental illness in children can be hard for parents to identify. As a result, many children who could benefit from treatment don't get the help they need. Understand the warning signs of mental illness in children and how you can help your child cope.

Why is it hard for parents to identify mental illness in children?

It's typically up to the adults in a child's life to identify whether the child has a mental health concern. Unfortunately, many parents don't know the signs and symptoms of mental illness in children. Even if you know the red flags, it can be difficult to distinguish signs of a problem from normal childhood behavior. You might reason that every child displays some of these signs at some point. Concerns about the stigma associated with mental illness, the use of certain medications and the cost of treatment might also prevent parents from seeking care for a child who has a suspected mental illness.

What mental health conditions affect children?

Children can experience a range of mental health conditions, including:

• Anxiety disorders. Children who have anxiety disorders — such as obsessive compulsive disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder — experience anxiety as a persistent problem that interferes with their daily activities.
• Attention-deficit/hyperactivity disorder (ADHD). This condition typically includes a combination of issues, such as difficulty sustaining attention, hyperactivity and impulsive behavior.
• Autism. Autism is one of a group of serious developmental problems called autism spectrum disorders that appear in early childhood — usually before age 3. Though symptoms and severity vary, all autism disorders affect a child's ability to communicate and interact with others.
• Eating disorders. Eating disorders — such as anorexia nervosa, bulimia nervosa and binge-eating disorder — are serious conditions. Children can become so preoccupied with food and weight that they focus on little else.
• Mood disorders. Mood disorders — such as depression and bipolar disorder — can cause a child to feel persistent feelings of sadness or extreme mood swings.
• Schizophrenia. This chronic mental illness causes a child to lose touch with reality (psychosis).

What are the warning signs of mental illness in children?

Warning signs that your child might have a mental health condition include:

• Mood changes. Look for feelings of sadness or withdrawal that last at least two weeks or severe mood swings that cause problems in relationships at home or school.
• Intense feelings. Be aware of feelings of overwhelming fear for no reason — sometimes with a racing heart or fast breathing — or worries or fears intense enough to interfere with daily activities.
• Behavior changes. This includes drastic changes in behavior or personality, as well as dangerous or out-of-control behavior. Fighting frequently, using weapons or expressing a desire to badly hurt others also are warning signs.
• Difficulty concentrating. Look for signs of trouble focusing or sitting still, both of which might lead to poor performance in school.
• Unexplained weight loss. A sudden loss of appetite, frequent vomiting or use of laxatives might indicate an eating disorder.
• Physical harm. Sometimes a mental health condition leads to suicidal thoughts or actual attempts at self-harm or suicide.
• Substance abuse. Some kids use drugs or alcohol to try to cope with their feelings.

Teen Depression

Teen depression is a serious medical problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teen thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although mood disorders, such as depression, can occur at any time in life, symptoms may be different between teens and adults.

Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for teens. But for some teens, the lows are more than just temporary feelings — they're a symptom of depression.

Teen depression isn't a weakness or something that can be overcome with willpower — it can have serious consequences and requires long-term treatment. For most teens, depression symptoms ease with treatment such as medication and psychological counseling.

Teen depression signs and symptoms include changes in your teen's emotions and behavior, such as the examples below.

Emotional changesBe alert for emotional changes, such as:

• Feelings of sadness, which can include crying spells for no apparent reason
• Irritability, frustration or feelings of anger, even over small matters
• Loss of interest or pleasure in normal activities
• Loss of interest in, or conflict with, family and friends
• Feelings of worthlessness, guilt, fixation on past failures or exaggerated self-blame or self-criticism
• Extreme sensitivity to rejection or failure, and the need for excessive reassurance
• Trouble thinking, concentrating, making decisions and remembering things
• Ongoing sense that life and the future are grim and bleak
• Frequent thoughts of death, dying or suicide

Behavioral changesWatch for changes in behavior, such as:

• Tiredness and loss of energy
• Insomnia or sleeping too much
• Changes in appetite, such as decreased appetite and weight loss, or increased cravings for food and weight gain
• Use of alcohol or drugs
• Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
• Slowed thinking, speaking or body movements
• Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse
• Poor school performance or frequent absences from school
• Neglected appearance — such as mismatched clothes and unkempt hair
• Disruptive or risky behavior
• Self-harm, such as cutting, burning, or excessive piercing or tattooing

What's normal and what's notIt can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

If depression symptoms continue or begin to interfere in your teen's life, talk to a doctor or a mental health professional trained to work with adolescents. Your teen's family doctor or pediatrician is a good place to start. Or your teen's school may recommend someone.

When to see a doctorIf you suspect your teenager is depressed, make a doctor's appointment as soon as you can. Depression symptoms likely won't get better on their own — and they may get worse or lead to other problems if untreated. Depressed teenagers may be at risk of suicide, even if signs and symptoms don't appear to be severe.

If you're a teen and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care professional such as your doctor or school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone else you trust.

Suicidal thoughtsIf your teen is having suicidal thoughts, get help right away. Take all talk of suicide seriously. Here are some steps you can take:

• Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor or encourage your teen to do so.
• Seek help from your doctor, a mental health provider or other health care professional.
• Reach out to family members, friends or spiritual leaders for support as you seek treatment for your teen.

When to get emergency helpIf you think your teen is in immediate danger of self-harm or attempting suicide, make sure someone stays with him or her. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your teen to the nearest hospital emergency department.

What's the connection between diabetes and depression? How can I cope if I have both?

Diabetes and depression: Coping with the two conditions

What's the connection between diabetes and depression? How can I cope if I have both?

Answer

If you have diabetes, you have an increased risk of developing depression. And if you have depression, you have a greater chance of developing type 2 diabetes. The good news is that diabetes and depression can be treated together. And effectively managing one can have a positive outcome on the other.

How they're related
Though the relationship between diabetes and depression isn't fully understood:

• The rigors of managing diabetes can be stressful and lead to symptoms of depression.
• Diabetes can cause complications and health problems that may worsen symptoms of depression.
• Depression can lead to poor lifestyle decisions, such as unhealthy eating, less exercise, smoking and weight gain — all of which are risk factors for diabetes.
• Depression affects your ability to perform tasks, communicate and think clearly. This can interfere with your ability to successfully manage diabetes.

Managing the two conditions together

• Diabetes self-management programs. Diabetes programs that focus on behavior have been successful in helping people improve their metabolic control, increase fitness levels, and manage weight loss and other cardiovascular disease risk factors. They can also help improve your sense of well-being and quality of life.
• Psychotherapy. Similarly, participants in psychotherapy, particularly cognitive behavioral therapy, have reported improvements in depression, which has resulted in better diabetes management.
• Medications and lifestyle changes. Medications — for both diabetes and depression — and lifestyle changes, including different types of therapy coupled with regular exercise, can improve both conditions.

If you have diabetes, watch for signs and symptoms of depression, such as loss of interest in normal activities, feelings of sadness or hopelessness, and unexplained physical problems like back pain or headaches.

If you think you might be depressed, seek help right away. Your doctor or diabetes educator can refer you to a mental health professional.

I'm curious about marijuana and depression. Can marijuana cause depression?

Marijuana and depression: What's the link?

I'm curious about marijuana and depression. Can marijuana cause depression?

Answer  

Some research suggests that marijuana smokers are diagnosed with depression more often than nonsmokers are — particularly regular or heavy marijuana users. However, it doesn't appear that marijuana directly causes depression.

It's likely that the genetic, environmental or other factors that trigger depression also lead to marijuana use. For example, some people may use marijuana as a way to cope with depression symptoms. Heavy users may also appear depressed as a result of the dulling effects of the drug on feelings and emotions.

There are also links between marijuana and other mental health conditions. Marijuana use may trigger schizophrenia or detachment from reality (psychosis) in people who are at higher risk of psychosis. The symptoms of diagnosed psychotic illness and its course may be aggravated if marijuana use continues. There is also some evidence that teenagers who attempt suicide may be more likely to have used marijuana than those who have not made an attempt. As with marijuana use and depression, more research is needed to better understand these associations.

The bottom line: Marijuana use and depression accompany each other more often than you might expect by chance, but there's no clear evidence that marijuana directly causes depression.

Is there a link between pain and depression? Can depression cause physical pain?

Pain and depression: Is there a link?

Is there a link between pain and depression? Can depression cause physical pain?

Pain and depression are closely related. Depression can cause pain — and pain can cause depression. Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain.

In many people, depression causes unexplained physical symptoms such as back pain or headaches. This kind of pain may be the first or the only sign of depression.

Pain and the problems it causes can wear you down over time, and may begin to affect your mood. Chronic pain causes a number of problems that can lead to depression, such as trouble sleeping and stress. Disabling pain can cause low self-esteem due to work, legal or financial issues. Depression doesn't just occur with pain resulting from an injury. It's also common in people who have pain linked to a health condition such as diabetes or migraines.

To get symptoms of pain and depression under control, you may need separate treatment for each condition. However, some treatments may help with both:

• Antidepressant medications may relieve both pain and depression because of shared chemical messengers in the brain.
• Talk therapy, also called psychological counseling (psychotherapy), can be effective in treating both conditions.
• Stress-reduction techniques, physical activity, exercise, meditation, journaling and other strategies also may help.
• Pain rehabilitation programs, such as the Pain Rehabilitation Center at Mayo Clinic, typically provide a team approach to treatment, including medical and psychiatric aspects.

Treatment for co-occurring pain and depression may be most effective when it involves a combination of treatments.

If you have pain and depression, get help before your symptoms worsen. You don't have to be miserable. Getting the right treatment can help you start enjoying life again. 

Can a junk food diet increase your risk of depression?

Junk food blues: Are depression and diet related?

Can a junk food diet increase your risk of depression?

Answer 

from Katherine Zeratsky, R.D., L.D.

Depression and diet may be related. Some preliminary research suggests that having a poor diet can make you more vulnerable to depression. Researchers in Britain looked at depression and diet in more than 3,000 middle-aged office workers over the course of five years. They found that people who ate a junk food diet — one that was high in processed meat, chocolates, sweet desserts, fried food, refined cereals and high-fat dairy products — were more likely to report symptoms of depression.

The good news is that the people who ate a diet rich in fruits, vegetables and fish were less likely to report being depressed. These results are in line with other research findings that healthy diets help protect against disease. For example, studies suggest that people who follow the Mediterranean diet — which emphasizes fruits, vegetables and fish, and limits meat and dairy products — have lower rates of Parkinson's and Alzheimer's diseases.

More research is needed on the connection between depression and diet. In the meantime, you might want to eat your veggies and cut back on the junk food.

How to Safely Take Antidepressants

Depression | How to Safely Take Antidepressants

How will my doctor choose an antidepressant for me?

Your doctor will probably think about the following 10 points when choosing an antidepressant medicine for you:

1. If you were depressed before and a certain antidepressant worked well, that antidepressant might be the right choice of medicine for you again.
2. If any of your brothers or sisters, parents, uncles or aunts had depression and a certain antidepressant worked well for them, that medicine might work for you too.
3. The choice of an antidepressant depends on your health. If a certain antidepressant would have a bad effect on a health problem you have, that medicine wouldn't be the right choice for you.
4. Antidepressants can have side effects. The right medicine for you may be the one that gives you the fewest side effects.
5. The choice of an antidepressant depends on how often you have to take it. The less often you have to take the medicine, the easier it is for you to take all the doses you need to treat your depression.
6. Some antidepressants cost more than others. Your doctor will choose an antidepressant that works for you and that you can afford.
7. Your doctor will want to choose a medicine he or she has experience prescribing.
8. Your doctor will choose an antidepressant that will help you with symptoms like sleeplessness, anxiety and lack of energy.
9. If you're taking other medicines, your doctor will consider how an antidepressant will work with these other medicines.
10. Some antidepressants don't work well with certain foods. If your doctor gives you one of these antidepressants, he or she will let you know which foods you should stop eating.

Are antidepressants tranquilizers or "uppers"? Can I get addicted to them?

No. These drugs aren't tranquilizers. They don't give you a "high." They aren't addictive.

Do antidepressants cause side effects?

Yes. All antidepressants have some side effects. However, not all people taking antidepressants get these side effects. Most of the side effects happen in the early weeks of therapy and lessen over time.

What are some of the common side effects of antidepressants?

Different antidepressants can cause different side effects. Possible side effects may include the following:

• Anxiety
• Bladder problems
• Blurred vision
• Constipation
• Diarrhea
• Dizziness when standing up
• Dry mouth
• Excessive tiredness
• Feeling of weakness
• Hand tremors
• Increased heart rate
• Increased sleepiness
• Insomnia
• Muscle twitching
• Nausea
• Sexual dysfunction (inability to ejaculate or to have an orgasm)
• Tremor
• Vomiting
• Weight gain

What if the side effects don't go away?

Talk to your doctor. He or she may change your dosage, or you might try another medicine to get rid of the side effects.

How will I know if my antidepressant is working?

You will be able to sleep better. You'll be better able to meet your day-to-day obligations and take care of yourself. You will have more energy. Your weight problems will get better, and your appetite will be closer to normal. You will have an increased desire to engage in life. You and your family and friends will notice these changes. Be patient, though. It may take some time to get back to the way you felt before the depression.

How long will I take the antidepressant?

Antidepressants are usually taken every day. It can take up to a month to see the full results of taking an antidepressant. You may need to try different kinds or amounts (dosages) to find the antidepressant that works best for you. Your doctor will let you know how long to take your antidepressant. If this is the first time you have been treated for depression, you will probably continue to take this medicine for about 6 months after you begin to feel better. If this is the second time you've been depressed, you might keep taking the medicine for at least a year. Depression that comes back a third time may require you to continue taking an antidepressant for a long time.
You can get unwanted side effects if you stop taking your antidepressant suddenly. If you want to stop taking your medicine, talk to your doctor first. Your doctor can help you avoid any side effects from stopping the medicine too quickly.

Can I drink alcohol when I'm taking an antidepressant?

You should be careful about drinking alcohol until you know how the medicine affects you. The affects of alcohol can combine with the affects of the antidepressant and cause problems. Regular heavy drinking can make it harder to treat the depression and certain kinds of medicine can lead to seizures for heavy drinkers. Talk to your doctor about drinking while taking an antidepressant.

Will antidepressants affect my other medicines?

Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John's wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant.

What is antidepressant discontinuation syndrome?

Antidepressant discontinuation syndrome can occur if you suddenly stop taking your antidepressant medicine. Antidepressant discontinuation syndrome is not dangerous or life threatening and usually goes away within 1 week.
The symptoms include:

• Anxiety
• Feelings of sadness
• Irritability
• Fatigue
• Headaches
• Nausea and vomiting
• Dizziness

Which antidepressants can cause this problem?

You are more likely to have a problem if you stop taking certain antidepressants, such as paroxetine and sertraline, but you can get symptoms from stopping any antidepressant medicine.

What can I do if I have antidepressant discontinuation syndrome?

If you accidentally missed a dose of your antidepressant medicine, start taking it again as soon as possible. If you are out of medicine, call your doctor so he or she can refill your prescription.
If you decided to stop taking your antidepressant medicine on your own, talk to your doctor about why you stopped. For example, was the medicine causing an unpleasant side effect? Your doctor can help by altering your dosage or suggesting another type of antidepressant.
If your doctor recommended that you take a lower dosage of your medicine and you are experiencing symptoms of antidepressant discontinuation syndrome, talk with your doctor. You may need to take a higher dosage for a period of time before weaning your body from the medicine completely.

How do I keep this from happening again?

Take your medicine exactly as your doctor tells you. If you want to stop taking your medicine, talk to your doctor first. Just because you are unable to stop taking your medicine all at once does not mean that you are addicted. Your body often needs time to adjust to lower levels of the medicine. This is why your doctor may recommend tapering off of antidepressant medicine rather than abruptly stopping it.

Are antidepressants safe for children and teens?

In some cases, the use of antidepressants has been linked to an increase in suicidal thoughts and suicidal behavior in children, teens and young adults. The Food and Drug Administration (FDA) now requires antidepressants to carry a warning about the risk of suicide in children, teens, and young adults 24 years of age or younger. However, this doesn't mean that people in this age group should not take antidepressants. It does mean that they should be carefully monitored by their doctors and loved ones while they are on an antidepressant.
Many doctors will want to see a child or teen sometime in the first few weeks after starting an antidepressant to assess any risk for suicide. If you are worried that your child may be suicidal, call your doctor right away or take your child to the nearest emergency room.

Are antidepressants safe for any woman who has depression?

If you're planning to get pregnant, talk to your doctor about your medicines before you try to get pregnant. If you accidentally get pregnant while you're taking an antidepressant, tell your doctor right away. Your doctor will know if your particular antidepressant is safe to take.
All medicine you take passes into your breast milk. If you are planning to breastfeed or you currently breastfeed, talk to your doctor about your medicine.
In most cases, it's okay to take birth control pills or hormone replacement therapy (also called HRT) at the same time as depression medicines. Taking hormones may even help some depressed women feel better. However, if your birth control pills seem to be causing symptoms of depression, discuss this with your doctor. He or she may suggest you use another method to prevent pregnancy for several months in order to find out if your birth control pills are causing depression.

This content has been supported by Forest Laboratories Inc.

Written by familydoctor.org editorial staff

Reviewed/Updated: 09/12
Created: 06/96

Xeplion (paliperidone)

Main use	Active ingredient	Manufacturer
Schizophrenia	Paliperidone palmitate	Janssen-Cilag

How does it work?

Xeplion injections contain the active ingredient paliperidone, which is a type of medicine called an atypical antipsychotic.

Paliperidone works in the brain, where it affects various neurotransmitters, in particular dopamine and serotonin (5HT). Neurotransmitters are chemicals that are stored in nerve cells and are involved in transmitting messages between the nerve cells.

Dopamine and serotonin are neurotransmitters known to be involved in regulating mood and behaviour, amongst other things. Psychotic illness is considered to be caused by disturbances in the activity of neurotransmitters (mainly dopamine) in the brain. Schizophrenia is known to be associated with an overactivity of dopamine in the brain, and this may be associated with the delusions and hallucinations that are a feature of this disease.

Paliperidone works by blocking the receptors in the brain that dopamine acts on. This prevents the excessive activity of dopamine and helps to control schizophrenia.

People with schizophrenia may experience 'positive symptoms' (such as hallucinations, disturbances of thought, hostility) and/or 'negative symptoms' (such as lack of emotion and social withdrawal). Paliperidone is effective in relieving both positive and negative symptoms of schizophrenia, whereas older antipsychotics are usually less effective against the negative symptoms.

Paliperidone also relieves 'affective symptoms' that are associated with schizophrenia, such as depression, guilt feelings or anxiety.

Xeplion injection is a type of injection called a depot injection. It is administered into the muscle of the upper arm or buttock, where it forms a reservoir of medicine that is slowly released into the bloodstream. The injection is given once every four weeks.

What is it used for?

• Schizophrenia (in people who have previously responded to paliperidone or risperidone treatment taken by mouth).

How is this treatment given?

• This medicine is for injection into a muscle only. It must not be administered under the skin or into a vein. You will be given the injection by a medical professional who has been appropriately trained in the technique.
• Xeplion injection is administered into the muscle of either the buttock or the upper arm, where it forms a reservoir of medicine that is slowly released into the bloodstream.
• The first two doses of the injection are given into the upper arm, one week apart, to allow for the concentration of the medicine to build up rapidly in the body. After that, Xeplion is given once a month into either the upper arm or buttock. The injection site should be alternated between the left and right sides of the body. It is a good idea to make a note of the date when your injection is administrated and when your next injection is due. (Your monthly injection can be given a week early or a week late if necessary.)
• Unless your doctor tells you otherwise, you should not suddenly stop treatment with this medicine, even if you feel better and think you don't need it any more. This is because the medicine controls the symptoms of the illness but doesn't actually cure it. This means that if you suddenly stop having the injections your symptoms could come back. When treatment with this medicine is stopped, it should be done gradually, following the instructions given by your doctor.

Warning!

• This medicine may cause drowsiness or dizziness. If affected do not drive or operate machinery. You should avoid drinking alcohol because it is likely to make any drowsiness or dizziness worse.
• This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start treatment with the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.
• This medicine can cause some people to put on weight and your doctor will want to weigh you regularly. Talk to your doctor about this before you start treatment so that you can discuss strategies, such as diet and exercise, for minimising any weight gain.
• Antipsychotic medicines can sometimes affect the ability of the body to control its core body temperature. This is more likely to be a problem in elderly people and can result in heat stroke in hot temperatures and hypothermia in cold temperatures. It is important to avoid situations that can result in you overheating or getting dehydrated. Ask your doctor or pharmacist for more advice.
• This medicine may rarely cause a decrease in the normal amounts of blood cells in the blood. For this reason you should consult your doctor immediately if you experience any of the following symptoms: unexplained bruising or bleeding, purple spots, sore throat, mouth ulcers, high temperature (fever), feeling tired or general illness. Your doctor may want to take a blood test to check your blood cells.
• Antipsychotic medicines are associated with an increased risk of getting a blood clot in a vein (deep vein thrombosis) or in the lungs (pulmonary embolism). For this reason, you should consult a doctor immediately if you get any of the following symptoms, which could suggest you have a blood clot: stabbing pains and/or unusual redness or swelling in one leg, pain on breathing or coughing, coughing up blood or sudden breathlessness.
• Consult your doctor immediately if you experience any abnormal movements, particularly of the face, lips, jaw and tongue, while you are on this medicine. These symptoms may be indicative of a rare side effect known as tardive dyskinesia, and your doctor may ask you to stop treatment with this medicine, or decrease your dose.
• Consult your doctor immediately if you experience the following symptoms while having Xeplion injections: high fever, sweating, muscle stiffness, faster breathing and drowsiness or sleepiness. These symptoms may be due to a rare side effect known as the neuroleptic malignant syndrome, and your treatment may need to be stopped.

Use with caution in

• Elderly people.
• Severely decreased liver function.
• Decreased kidney function.
• Diabetes (if you have diabetes your blood sugar levels should be monitored closely while you are having treatment with this medicine, because it may increase your blood sugar).
• People with disease involving the heart and blood vessels (cardiovascular disease) for example heart failure, angina, previous heart attack or an irregular heartbeat (arrhythmia).
• People with a personal or family history of an abnormal heart rhythm seen as a 'prolonged QT interval' on a heart monitoring trace or ECG.
• People with low blood pressure (hypotension).
• People who are dehydrated.
• People with a history or risk of stroke or small temporary strokes (transient ischaemic attacks).
• Elderly people with dementia and a risk of stroke (other similar antipsychotic medicines are associated with an increased risk of stroke and death in this group of people).
• People with a personal or family history of blood clots (venous thromboembolism), for example in a vein of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism).
• People with other risk factors for getting a blood clot, for example smoking, being overweight, taking the contraceptive pill, being over 40, recent major surgery or being immobile for prolonged periods.
• People with a history of seizures, eg epilepsy.
• People with conditions that increase the risk of epilepsy or convulsions, eg brain damage or withdrawal from alcohol.
• Parkinson's disease.
• People with a history of a drop in the numbers of white blood cells in the blood, particularly if this was caused by a medicine.
• People with a tumour of the pituitary gland in the brain that produces the hormone prolactin (prolactinoma).
• People with tumours whose growth may be stimulated by the hormone prolactin, eg breast cancer.

Not to be used in

• People who are allergic to risperidone.
• Breastfeeding.
• This medicine is not recommended for people with moderate to severely decreased kidney function.
• This medicine is not recommended for children less than 18 years of age, as its safety and efficacy have not been established in this age group.
• Xeplion injection does not work quickly enough to manage people who are acutely agitated or in a severely psychotic state and who need a treatment that immediately controls their symptoms.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• The safety of this medicine for use during pregnancy has not been established. It should not be used during pregnancy unless considered essential by your doctor, and only if the potential benefits to the mother outweigh any possible risks to the unborn child. Antipsychotics used during the third trimester could cause side effects or withdrawal symptoms in the baby after birth and the baby may need extra monitoring because of this. Seek further medical advice from your doctor.
• If you do get pregnant while having treatment with this medicine it is important to consult your doctor straight away for advice. You should not suddenly stop treatment with this medicine unless your doctor tells you to, as this could cause your symptoms to come back.
• This medicine passes into breast milk and could be harmful to a nursing infant. It should not be used during breastfeeding. Mothers who need treatment with this medicine should not breastfeed. Seek further medical advice from your doctor.

Label warnings

• This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Very common (affect more than 1 in 10 people)

• Difficulty sleeping (insomnia).
• Headache.

Common (affect between 1 in 10 and 1 in 100 people)

• Dizziness.
• Sleepiness (somnolence).
• Depression.
• Anxiety, restlessness and agitation (akathisia).
• Abnormal movements of the hands, legs, face, neck and tongue, eg tremor, twitching, rigidity (extrapyramidal effects).
• Faster or slower than normal heartbeat.
• Cough.
• Blocked nose.
• Disturbances of the gut such as nausea, vomiting, abdominal pain or discomfort, indigestion, diarrhoea or constipation.
• Fatigue, weakness or loss of strength (asthenia).
• Reaction at site of injection.
• Infection of the upper respiratory tract.
• High blood pressure.
• Back pain.
• Increased blood glucose levels. Tell your doctor if you notice you feel unusually hungry or thirsty, or need to pass urine more often than usual. People with diabetes should monitor their blood sugar closely.
• Increased weight. Your doctor will want to weigh you regularly to make sure you are not gaining too much weight.
• Elevated levels of fats called triglycerides in the blood.
• Rash.
• High blood prolactin (milk producing hormone) level (hyperprolactinaemia). This may uncommonly lead to symptoms such as breast enlargement, production of milk and menstrual disturbances.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

• Sexual problems such as reduced sex drive and erectile dysfunction.
• Changes in appetite.
• Increased level of cholesterol in the blood.
• Confusion.
• Nightmares.
• Drop in blood pressure causing dizziness that occurs when moving from a lying down or sitting position to sitting or standing - see warning section above.
• Sensation of spinning.
• Sensation of ringing, or other noise in the ears (tinnitus).
• Dry mouth.
• Blurred vision, dry eyes, conjunctivitis.
• Muscle spasms.
• Stiff or aching joints.
• Skin reactions such as nettle rash (hives), eczema, dry skin, acne and itching.
• Abnormal heart rhythm seen as a 'prolonged QT interval' on a heart monitoring trace or ECG.
• Irregular heart beat called atrial fibrillation.
• Awareness of heartbeat (palpitations).
• Shortness of breath.
• Tardive dyskinesia (see warning section above).
• Tingling, pins and needles or numb sensations.
• Convulsions.
• Problems with speech.
• Decreased numbers of blood cells in the blood (see warning section above).
• Infections.
• Abnormally frequent urination, painful urination or urinary incontinence.

Rare (affect between 1 in 1000 and 1 in 10,000 people)

• Neuroleptic malignant syndrome (see warning section above).
• Problem with eye movement such as rolling of the eyes into the back of the head.
• Watery or red eyes.
• Bruising, inflammation, cysts or abscess at site of injection.
• Blood clot in the leg or the lungs (thromboembolism) – see warning section above.
• Prolonged erection in men. (If you get an erection that lasts longer than four hours (priapism) having these injections, you should consult a doctor immediately. Treatment of this condition should not be delayed more than six hours, as this can cause damage to the erectile tissue in the penis and irreversible erectile dysfunction.)
• Problems with body temperature control – see warning section above.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while having treatment with this one, to make sure that the combination is safe.

There may be an increased risk of drowsiness and sedation if paliperidone is used with any of the following (which can also cause drowsiness):

• alcohol
• tricyclic antidepressants, eg amitriptyline
• strong opioid painkillers, eg morphine, codeine, dihydrocodeine
• benzodiazepines, eg diazepam, temazepam
• sedating antihistamines, eg chlorphenamine, hydroxyzine
• sleeping tablets, eg zopiclone.

Paliperidone may enhance the blood pressure-lowering effects of medicines that lower blood pressure, including medicines used to treat high blood pressure (antihypertensives) and medicines that lower blood pressure as a side effect, eg benzodiazepines. If you are taking medicines that lower blood pressure you should tell your doctor if you feel dizzy or faint after starting treatment with this medicine, as your doses may need adjusting.

There may be an increased risk of an abnormal heart rhythm, seen as a ‘prolonged QT interval’ on an ECG, if other medicines that can have this effect are used by people treated with paliperidone. These medicines include the following:

• antiarrhythmics (medicines to treat abnormal heartbeats), eg amiodarone, procainamide, disopyramide, sotalol
• the antihistamines astemizole, mizolastine or terfenadine
• arsenic trioxide
• atomoxetine
• certain antidepressants, eg amitriptyline, imipramine, maprotiline
• certain antimalarials, eg halofantrine, chloroquine, quinine, mefloquine, Riamet
• certain other antipsychotics, eg thioridazine, haloperidol, sertindole, pimozide
• cisapride
• dronedarone
• droperidol
• intravenous erythromycin or pentamidine
• methadone
• moxifloxacin
• saquinavir.

There may also be an increased risk of a prolonged QT interval if medicines that can alter the levels of salts such as potassium or magnesium in the blood, eg diuretics such as furosemide, are taken in combination with paliperidone.

Paliperidone may oppose the effect of medicines for Parkinson's disease that work by stimulating dopamine receptors in the brain, for example levodopa, ropinirole, pergolide, bromocriptine.

Paliperidone may oppose the effect of anticonvulsant medicines used to treat epilepsy.

Paliperidone may increase blood sugar levels and disturb the control of diabetes. People with diabetes may need an adjustment in the dose of their antidiabetic medication.

Paliperidone may oppose the effect of histamine (used to treat leukaemia) and is not recommended for people having this treatment.

The following medicines may speed up the breakdown of paliperidone in the body and so could make it less effective. If you take any of these medicines your doctor may need to increase your dose of paliperidone:

• carbamazepine
• rifampicin
• the herbal remedy St John's wort (Hypericum perforatum).

Read more: http://www.netdoctor.co.uk/brain-and-nervous-system/medicines/xeplion.html#ixzz2msnl1imA 
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