New Patient Packet

The Mind, Body and Mood Connection

Your mental health is very important. You will not have a healthy body if you don't also take care of your mind. People depend on you. It's important for you to take care of yourself so that you can do the important things in life — whether it's working, learning, taking care of your family, volunteering, enjoying the outdoors, or whatever is important to you.

Good mental health helps you enjoy life and cope with problems. It offers a feeling of well-being and inner strength. Just as you take care of your body by eating right and exercising, you can do things to protect your mental health. In fact, eating right and exercising can help maintain good mental health. You don't automatically have good mental health just because you don't have mental health illness. You have to work to keep your mind healthy.

Nutrition

The food you eat can have a direct effect on your energy level, physical health, and mood. A "healthy diet" is one that has enough of each essential nutrient, contains many foods from all of the basic food groups, provides the right amount of calories to maintain a healthy weight, and does not have too much fat, sugar, salt, or alcohol.

By choosing foods that can give you steady energy, you can help your body stay healthy. This may also help your mind feel good. The same diet doesn't work for every person. In order to find the best foods that are right for you, talk to your health care professional.

Some vitamins and minerals may help with the symptoms of depression. Experts are looking into how a lack of some nutrients — including folate, vitamin B12, calcium, iron, selenium, zinc, and omega-3 — may contribute to depression in new mothers. Ask your doctor or another health care professional for more information.

Exercise

Regular physical activity is important to the physical and mental health of almost everyone, including older adults. Being physically active can help you continue to do the things you enjoy and stay independent as you age. Regular physical activity over long periods of time can produce long-term health benefits. That's why health experts say that everyone should be active every day to maintain their health.

If you are diagnosed with depression or anxiety, your doctor may tell you to exercise in addition to taking any medications or receiving counseling. This is because exercise has been shown to help with the symptoms of depression and anxiety. Your body makes certain chemicals, called endorphins, before and after you work out. They relieve stress and improve your mood. Exercise can also slow or stop weight gain, which is a common side effect of some medications used to treat mental health disorders.

Sleep

Your mind and body will feel better if you sleep well. Your body needs time every day to rest and heal. If you often have trouble sleeping — either falling asleep, or waking during the night and being unable to get back to sleep — one or several of the following ideas might be helpful to you:

  • Go to bed at the same time every night and get up at the same time every morning. Avoid "sleeping in" (sleeping much later than your usual time for getting up). It will make you feel worse.
  • Establish a bedtime "ritual" by doing the same things every night for an hour or two before bedtime so your body knows when it is time to go to sleep.
  • Avoid caffeine, nicotine, and alcohol.
  • Eat on a regular schedule and avoid a heavy meal prior to going to bed. Don't skip any meals.
  • Eat plenty of dairy foods and dark green leafy vegetables.
  • Exercise daily, but avoid strenuous or invigorating activity before going to bed.
  • Play soothing music on a tape or CD that shuts off automatically after you are in bed.
  • Try a turkey sandwich and a glass of milk before bedtime to make you feel drowsy.
  • Try having a small snack before you go to bed, something like a piece of fruit and a piece of cheese, so you don't wake up hungry in the middle of the night. Have a similar small snack if you awaken in the middle of the night.
  • Take a warm bath or shower before going to bed.
  • Place a drop of lavender oil on your pillow.
  • Drink a cup of herbal chamomile tea before going to bed.

Stress

Stress can happen for many reasons. Stress can be brought about by a traumatic accident, death, or emergency situation. Stress can also be a side effect of a serious illness or disease.

There is also stress associated with daily life, the workplace, and family responsibilities. It's hard to stay calm and relaxed in our hectic lives. As women, we have many roles: spouse, mother, caregiver, friend, and/or worker. With all we have going on in our lives, it seems almost impossible to find ways to de-stress. But it's important to find those ways. Your health depends on it.

Common symptoms include:

  • Headache
  • Sleep disorders
  • Difficulty concentrating
  • Short-temper
  • Upset stomach
  • Job dissatisfaction
  • Low morale
  • Depression
  • Anxiety

Remember to always make time for you. It's important to care for yourself. Think of this as an order from your doctor, so you don't feel guilty! No matter how busy you are, you can try to set aside at least 15 minutes each day in your schedule to do something for yourself, like taking a bubble bath, going for a walk, or calling a friend.


The Role of Laboratory Testing for Mood Disorders

In addition to the psychosocial contributors to mental and emotional pain, there can be multiple potential physiological causes. Our approach to uncovering these physical factors is a scientific one – gathering objective laboratory data that may include a close examination of a patient’s nutritional status, hormone levels, gastrointestinal function, energy metabolism, immune system, and genetic profile.

Our aim is to provide the physiological intervention that the patient’s body tells us it needs. While a thorough history and physical exam are vital, sometimes laboratory tests provide the most complete translation of what someone’s symptoms are trying to say.

Learn more about common lab tests ordered:

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Vitamins and Supplements to Help Manage Your Mood

Omega-3 Fatty Acids, DHA and EPA

These essential fatty acids reduce inflammation and play a critical role in brain function, especially memory and mood. Your body can’t make them, you need to either consume them in your diet or take a supplement. Not all Omega-3 supplements are created equal, a little research and comparison can help you choose a high quality supplement that is a good value without side effects or risks that come from less expensive but lower quality brand. Avoid products that include fish protein (fishy burp back) or are manufactured overseas (more likely to contain high levels of mercury).

Probiotics

I have to say that if I had to recommend one supplement to all patients to start today it would be a high quality probiotic. New and exciting research is emerging almost daily that shows the influence of our gut bacteria on our physical and mental health. The average American diet is not providing the diversity in gut flora that we need and even worse, processed foods, chemicals, preservatives and antibiotics kill off the most important and healthy organisms. It is crucial to keep your intestines in good shape because your brain is only as healthy as your gut. The nerve cells in our gut manufacture 80 to 90 percent of our body’s serotonin, the neurotransmitter we need to stay sane. That’s more than our brain makes. And the gut is in constant communication with the brain, sending it information that most definitely affects your mood, even as the messages never come to consciousness. In addition, the majority of our immune system cells are located in the gut. A functional and healthy gut microbiome will help modulate your immune system and can help you stay healthy and keep your autoimmune disorder in check.

Vitamin D

This deficiency has been linked to depression, dementia, and autism. Most of our levels drop off during the fall and winter months, since sunlight is the richest source. The majority of our patients are deficient in Vitamin D, confirmed by laboratory evaluation. There is a very strong link between Vitamin D deficiency and depression.

Magnesium

Chances are good that you are magnesium-deficient. Your lab values may look normal (this is because our bodies keep blood levels adequate at the expense of other systems in the body. Our lifestyles decrease our levels: excess alcohol, salt, coffee, sugar, phosphoric acid (in soda), chronic stress, antibiotics, and diuretics (water pills). Magnesium is sometimes referred to as the stress antidote, the most powerful relaxation mineral that exists and deficiency is seen in disorders such as headache, restless legs, muscle cramps and depression. It is found in seaweed, greens, and beans. We recommend taking magnesium at bedtime as it can help with sleep as well.

Vitamin B-12

B vitamins like vitamin B-6 and vitamin B-12 can provide some incredible health benefits, including reduced stroke risk. A vitamin B deficiency may affect your mental health, in fact, more than a quarter of severely depressed women are found to be deficient in B-12. The best sources of vitamin B-6 are poultry, seafood, bananas, and leafy green vegetables. Vitamin B-12 is found in animal foods (meat, fish, poultry, eggs, and milk) and shellfish, such as clams, mussels, and crab. Vitamin B-6,,= vitamin B-12, along with folate, are considered the “mighty methylators” for mental health, important for the process of building neurotransmitters such as serotonin, norepinepherine and dopamine. Because of the frequency of MTHFR variants in our patients we recommend taking methylated B vitamins and L-methylfolate unless you’ve had genetic testing and have no variant genes.

Folate

As mentioned above, folate is an important vitamin and an integral part of the process of methylation and neurotransmitter production in your body. Methylated folic acid is available in a supplement, by prescription or in foods such as dark leafy greens, beans and legumes, and citrus fruits and juices. Patients with variations in the MTHFR gene should avoid unmethylated folic acid as it can cause mental and physical health problems.

Amino Acids

Amino acids — the building blocks of protein — help your brain properly function. A deficiency in amino acids may cause you to feel sluggish, foggy, unfocused, and depressed. Good sources of amino acids include beef, eggs, fish, beans, seeds, and nuts. Amino acids are also building blocks for neurotransmitters such as Serotonin and Melatonin, among others.

Iron

Iron deficiency is pretty common in women. About 20 percent of women, and 50 percent of pregnant women, are deficient. The most common form of anemia — an insufficient number of red blood cells — is caused by iron deficiency. Its symptoms are similar to depression: fatigue, irritability, brain fog. Most adults should consume 8 to 18 mg of iron daily, depending on age, gender, and diet, according to the NIH. Good sources of iron include red meat, fish, and poultry. If you really want to get more red blood cells, eat liver.

Zinc

Zinc is used by more enzymes (and we have over 300) than any other mineral. It is crucial to many of our systems, including the thyroid. It activates our digestive enzymes so that we can break down our food, and works to prevent food allergies (which, in turn, averts depression in some people, since some of our mood disruptions are triggered by food allergies). It also helps our DNA to repair and produce proteins and even prevents the transformation of Testosterone to DHT (causing hair loss). Finally, zinc helps control inflammation and boosts our immune system. All patients, especially those with irritable bowel syndrome, PCOS and thyroid disorders, need a daily zinc supplement.

Iodine

Iodine deficiency can be a big problem because iodine is critical for the thyroid to work as it should, and the thyroid affects more than you think: your energy, metabolism, body temperature, growth, immune function, and brain performance (concentration, memory, and more). When it’s not functioning properly, you can feel very depressed, among other things. You can get iodine by using an iodine-enriched salt, or by eating dried seaweed, shrimp, or cod.

Selenium

Like iodine, selenium is important for good thyroid function. It assists the conversion of inactive thyroid hormone T4 to the active thyroid hormone, T3. It also helps one of our important antioxidants (glutathione peroxidase) keep polyunsaturated acids in our cell membranes from getting oxidized.

Calcium

Most women are aware of the need to consume adequate amounts of calcium to help prevent osteoporosis and bone loss. But calcium is also important for the prevention of mood disorders as well. Calcium doesn’t reduce depression itself but eliminating dairy from your diet can reduce depression, especially if you have food intolerances that cause inflammation in the brain. Calcium can also help prevent muscle cramps and fatigue that may be a symptom of low levels.

Vitamin C

Vitamin C is an important factor in our immune system. It is involved in the process of growth and repair of tissues in all parts of your body and is an important antioxidant.

Other Supplements

SAM-e (S-adenosylmethionine)

We actually make SAM-e when the amino acid methionine combines with adenosyl-triphosphate (ATP), which is involved in the synthesis of neurotransmitters. The supplement we take is a stabilized form of that substance. It has only been available in the U.S. since 1999. A 2002 review by the U.S. Agency for Healthcare Research and Quality found that SAM-e was more effective than a placebo and equally as effective as antidepressants. Other studies suggested that adding SAM-e to an antidepressant may improve results in women who haven’t responded to medication and in patients with obsessive compulsive disorder.

Turmeric (Curcuman)

It’s actually the seasoning used in curry dishes, and has been used for thousands of years in Chinese and Indian medicine to treat a variety of health conditions. It is currently being studied as an antioxidant with benefits in preventing memory decline, depression, anxiety and cardiovascular disease.

GABA

Most of the anti-anxiety medications today (Valium, Xanax, Ativan) act on the GABA (gamma-aminobutyric acid) pathways to calm and relax the nervous system. GABA is known as the “anti-anxiety” neurotransmitter. However, these types of drugs (benzodiazepines, and benzodiazepine-like drugs such as Ambien and Lunesta) have been found to have dangerous side effects including behavior changes, respiratory depression and memory loss.

Melatonin

Melatonin is a neuro hormone that is involved in the circadian rhythm or sleep-wake cycle. It can be helpful for treating patients with delayed sleep phase disorder. It should be taken at a dose of 1mg to 3mg one hour before bedtime. Exposure to blue light (phones, television or computers) after taking it make it will cause it to be ineffective. It should not be taken while pregnant or breastfeeding or at higher doses.


Common Side Effects of Antidepressants

Antidepressants can improve the symptoms of depression, but, like all medications, they can also have side effects. The vast majority of people who take antidepressants experience at least one side effect. Most of them are minor and usually subside on their own over time. Particularly bothersome side effects can be treated with medication or by dose reduction, changing the administration time, or switching to a different antidepressant. You can learn more about the common side effects of antidepressants here: INSERT PDF.


Resources for Affordable Prescription Medicine

Medicine can be a very expensive part of your health care treatment. If you doctor has prescribed medicine and you can’t afford to pay for it, you may be able to get the medicine for free or for a reduced cost. There are several kinds of assistance programs that may be able to help.

Private and Public Health Insurance

If you have health insurance, your plan may or may not pay for prescription medicine. It depends on what kind of insurance you have. For example, if you have private health insurance through your employer, some or all of the cost of your medicine may be covered. If you have the traditional Medicare plan (sometimes called fee-for-service), your medicine probably isn’t covered. If you have a Medicare managed care plan, some of the cost of your medicine is probably covered. In many cases, the Medicaid plan in your state covers the cost of prescription medicines.

State and Community Programs

Some state governments offer affordable medicine programs for seniors, people who are disabled and people who have low incomes. Community health centers, Area Agencies on Aging, free health clinics and other community programs may also offer help. To use these services, you may need to show that you don’t qualify for private health insurance or that you don’t make enough money to pay for your medicine.

Private Programs

Some social agencies, such as the Salvation Army, and some private hospitals offer financial help for people who can’t afford prescription medicines.

Patient Assistance Programs

Patient-assistance programs (also called PAPs) are sponsored by companies that make prescription medicines. Each company has its own rules about who qualifies for its PAP. In many cases, you will need to show that you don’t qualify for private or public health insurance (such as Medicare or Medicaid). You may also need to prove that your income is below a certain level. Each PAP has its own application process. In many cases, your doctor, nurse or social worker will need to apply for you. For others, the application must be mailed in. It’s important to keep in mind that applying doesn’t guarantee that you will get your medicines for free or for a lower price.

Prescription Assistance Resources

www.needymeds.com This website gives information about PAP’s. The site also lists drugs that are available through PAPs and gives contact information for the companies that make them. In many cases, you can download a copy of a drug company’s PAP application. The NeedyMeds site also links to state Medicaid Websites.

www.RxHope.com This site is supported by the Pharmaceutical Research and Manufacturers of America (also called PhRMA). Using the tools on the RxHope site, your doctor can apply for your to receive free or low-cost drugs from the companies that make them.

www.medicare.gov This is the official web site of the Medicare program. It offers a search tool called “Prescription Drug Assistance Programs” that can help you find a medicine assistance program in your area.

www.rxassist.org This Web site is sponsored by an organization called Volunteers in Health Care. By searching the database on this Web site, your doctor, nurse or social worker can find out which PAPs you might qualify for. The site also gives information about other resources, such as drug discount programs.