Doctors suggest using nutritional treatments to elevate mood and relieve depression symptoms as alternative to antidepressant drugs.

Depression is one of the most frequent psychological problems encountered in medical practice. Some studies say 13 to 20 percent of American adults exhibit some depressive symptoms. The mortality rate among those who are depressed is four times greater than those without depression - major depression accounts for 60 percent of all suicides.

Yet, despite this professional recognition and the fact that depression is a treatable condition, only about a third of depressed patients receive appropriate intervention.

While the exact etiology of depression is unknown, numerous factors appear to contribute. These include genetics, life/event sensitization and biochemical changes.

Family, twin and adoption studies demonstrate that predisposition toward depression can be inherited. In addition, stressful life events can contribute to depression; most studies concur that the likelihood of a depressive episode is five to six times greater six months after events such as early parental loss, job loss or divorce. The link between depression and stressful life events has been conceptualized in the form of the sensitization model, which proposes that prior exposure to stressful life events sensitizes the brain's limbic system to the degree that subsequently less stress is needed to produce a mood disorder. Many of the current biochemical theories of depression focus on the biogenic amines, which are a group of chemical compounds important in neurotransmission--most importantly norepinephrine, serotonin and, to a lesser extent, dopamine, acetylcholine and epinephrine.

Antidepressant medications, which address the brain's biochemistry, include monoamine oxidase (MAO) inhibitors, tricyclic antidepressants and selective serotonin reuptake inhibitors. MAOs increase norepinephrine levels, while tricyclics essentially enhance norepinephrine transmission. Serotonin, in particular, has been the subject of intense research during the past 25 years, indicating its importance in the pathophysiology of depression. Basically, a functional deficiency in serotonin results in depression.

Amino Acid Supplements for Treating Depression

The nutritional treatment of depression includes dietary modifications, supportive treatment with vitamins and minerals, and supplementation with specific amino acids, which are precursors to neurotransmitters. Dietary modification and vitamin and mineral supplementation in some cases reduce the severity of depression or result in an improvement in general well-being. However, these interventions are usually considered adjunctive, since they are not typically effective by themselves as a treatment for clinical depression. On the other hand, supplementation with the amino acids L-tyrosine and D,L-phenylalanine can in many cases be used as an alternative to antidepressant drugs. Another particularly effective treatment is the amino acid L-tryptophan.

L-Tyrosine is the precursor to the biogenic amine norepinephrine and may therefore be valuable to the subset of people who fail to respond to all medications except amphetamines. Such people excrete much less than the usual amounts of 3-methoxy-4-hydroxyphenylglycol, the byproduct of norepinephrine breakdown, suggesting a deficiency of brain norepinephrine.

One clinical study detailed two patients with long-standing depression who failed to respond to MAO inhibitor and tricyclic drugs as well as electroconvulsive therapy. One patient required 20 mg/day of dextroamphetamine to remain depression-free, and the other required 15 mg/day of D,L-amphetamine. Within two weeks of starting L-tyrosine, 100 mg/kg once a day before breakfast, the first patient was able to eliminate all dextroamphetamine, and the second was able to reduce the intake of D,L-amphetamine to 5 mg/day. In another case report, a 30-year-old female with a two-year history of depression showed marked improvement after two weeks of treatment with L-tyrosine, 100 mg/kg/day in three divided doses. No side effects were seen.

L-Phenylalanine, the naturally occurring form of phenylalanine, is converted in the body to L-tyrosine. D-phenylalanine, which does not normally occur in the body or in food, is metabolized to phenylethylamine (PEA), an amphetaminelike compound that occurs normally in the human brain and has been shown to have mood-elevating effects. Decreased urinary levels of PEA (suggesting a deficiency) have been found in some depressed patients. Although PEA can be synthesized from L-phenylalanine, a large proportion of this amino acid is preferentially converted to L-tyrosine. D-phenylalanine is therefore the preferred substrate for increasing the synthesis of PEA--although L-phenylalanine would also have a mild antidepressant effect because of its conversion to L-tyrosine and its partial conversion to PEA. Because D-phenylalanine is not widely available, the mixture D,L-phenylalanine is often used when an antidepressant effect is desired.

Studies of D,L-phenylalanine's efficacy show that it has promise as an antidepressant. Additional research is needed to determine the optimal dosage and which types of patients are most likely to respond to treatment.

Depression Treatment Using Vitamin and Mineral Therapy

Vitamin and mineral deficiencies can cause depression. Correcting deficiencies, when present, often relieves depression. However, even if a deficiency cannot be demonstrated, nutritional supplementation may improve symptoms in selected groups of depressed patients.

Vitamin B6, or pyridoxine, is the cofactor for enzymes that convert L-tryptophan to serotonin and L-tyrosine to norepinephrine. Consequently, vitamin B6 deficiency might result in depression. One person volunteered to eat a pyridoxine-free diet for 55 days. The resultant depression was alleviated soon after supplementation with pyridoxine was begun.

While severe vitamin B6 deficiency is rare, marginal vitamin B6 status may be relatively common. A study using a sensitive enzymatic assay suggested the presence of subtle vitamin B6 deficiency among a group of 21 healthy individuals. Vitamin B6 deficiency may also be common in depressed patients. In one study, 21 percent of 101 depressed outpatients had low plasma levels of the vitamin. In another study, four of seven depressed patients had subnormal plasma concentrations of pyridoxal phosphate, the biologically active form of vitamin B6. Although low vitamin B6 levels could be a result of dietary changes associated with depression, vitamin B6 deficiency could also be a contributing factor to the depression.

Depression is also a relatively common side effect of oral contraceptives. The symptoms of contraceptive-induced depression differ from those found in endogenous and reactive depression. Pessimism, dissatisfaction, crying and tension predominate, whereas sleep disturbance and appetite disorders are uncommon. Of 22 women with depression associated with oral contraceptive use, 11 showed biochemical evidence of vitamin B6 deficiency. In a double-blind, crossover trial, women with vitamin B6 deficiency improved after treatment with pyridoxine, 2 mg twice a day for two months. Women who were not deficient in the vitamin did not respond to supplementation.

These studies indicate vitamin B6 supplementation is valuable for a subset of depressed patients. Because of its role in monoamine metabolism, this vitamin should be investigated as possible adjunctive treatment for other patients with depression. A typical vitamin B6 dose is 50 mg/day.

Folic acid deficiency may result from dietary deficiency, physical or psychological stress, excessive alcohol consumption, malabsorption or chronic diarrhea. Deficiency may also occur during pregnancy or with the use of oral contraceptives, other estrogen preparations or anticonvulsants. Psychiatric symptoms of folate deficiency include depression, insomnia, anorexia, forgetfulness, hyperirritability, apathy, fatigue and anxiety.

Serum folate levels were measured in 48 hospitalized patients: 16 with depression, 13 psychiatric patients who were not depressed and 19 medical patients. Depressed patients had significantly lower serum folate concentrations than did patients in the other two groups. Depressed patients with low serum folate levels had higher depression ratings on the Hamilton Depression Scale than did depressed patients with normal folate levels.

These findings suggest that folic acid deficiency may be a contributing factor in some cases of depression. Serum folate levels should be determined in all depressed patients who are at risk for folic acid deficiency. The usual dose of folic acid is 0.4 to 1 mg/day. It should be noted that folic acid supplementation can mask the diagnosis of vitamin B12 deficiency when the complete blood count is used as the sole screening test. Patients in whom vitamin B12 deficiency is suspected and who are taking folic acid should have their serum vitamin B12 measured.

Vitamin B12 deficiency can also manifest as depression. In depressed patients with documented vitamin B12 deficiency, parenteral (intravenous) administration of the vitamin has resulted in dramatic improvement. Vitamin B12, 1 mg/day for two days (route of administration not specified), also produced rapid resolution of postpartum psychosis in eight women.

Vitamin C, as the cofactor for tryptophan-5-hydroxylase, catalyzes the hydroxylation of tryptophan to serotonin. Vitamin C may therefore be valuable for patients with depression associated with low levels of serotonin. In one study, 40 chronic psychiatric inpatients received 1 g/day of ascorbic acid or placebo for three weeks, in double-blind fashion. In the vitamin C group, significant improvements were seen in depressive, manic and paranoid symptom complexes, as well as in overall functioning.

Magnesium deficiency can cause numerous psychological changes, including depression. The symptoms of magnesium deficiency are nonspecific and include poor attention, memory loss, fear, restlessness, insomnia, tics, cramps and dizziness. Plasma magnesium levels have been found to be significantly lower in depressed patients than in controls. These levels increased significantly after recovery. In a study of more than 200 patients with depression and/or chronic pain, 75 percent had white blood cell magnesium levels below normal. In many of these patients, intravenous magnesium administration led to rapid resolution of symptoms. Muscle pain responded most frequently, but depression also improved.

Magnesium has also been used to treat premenstrual mood changes. In a double-blind trial, 32 women with premenstrual syndrome were randomly assigned to receive 360 mg/day of magnesium or placebo for two months. The treatments were given daily from day 15 of the menstrual cycle until the onset of menstruation. Magnesium was significantly more effective than placebo in relieving premenstrual symptoms related to mood changes.

These studies suggest that magnesium deficiency may be a factor in some cases of depression. Dietary surveys have shown that many Americans fail to achieve the Recommended Dietary Allowance for magnesium. As a result, subtle magnesium deficiency may be common in the United States. A nutritional supplement that contains 200-400 mg/day of magnesium may therefore improve mood in some patients with depression.

Phytomedicine Considerations

* St. John's wort (Hypericum perforatum) as a standardized extract is licensed in Germany and other European countries as a treatment for mild to moderate depression, anxiety and sleep disorders.

St. John's wort has a complex and diverse chemical makeup. Hypericin and pseudohypericin have received most of the attention based on their contributions to both the antidepressive and antiviral properties of St. John's wort. This explains why most modern St. John's wort extracts are standardized to contain measured amounts of hypericin. Recent research, however, indicates that the medicinal actions of St. John's wort can be ascribed to other mechanisms of action and also to the complex interplay of many constituents.

While St. John's wort's ability to act as an antidepressant is not fully understood, previous literature points to its ability to inhibit MAOs. MAOs act by inhibiting MAO-A or -B isozymes, thereby increasing synaptic levels of the biogenic amines, especially norepinephrine. This earlier research showed that St. John's wort extracts not only inhibit MAO-A and MAO-B but also reduce the availability of serotonin receptors, resulting in the impaired uptake of serotonin by brain neurons.

More than 20 clinical studies have been completed using several different St. John's wort extracts. Most have shown antidepressant action either greater than placebo or equal in action to standard prescription antidepressant drugs. A recent review analyzed 12 controlled clinical trials - nine were placebo-controlled and three compared St. John's wort extract to antidepressant drugs maprotiline or imipramine. All trials showed greater antidepressant effect with St. John's wort compared with placebo and comparable results with St. John's wort as with the standard antidepressant medications. The first U.S. government-sanctioned clinical trial of St. John's wort, a three-year study sponsored by the Center for Complementary and Alternative Medicine, based in Washington, D.C., found that St. John's wort was not effective in treating major depression, but agreed more clinical trials were needed to test the herb's effectiveness in mild to moderate depression.

Dosage is typically based on hypericin concentration in the extract. The minimum daily hypericin dosage recommended is approximately 1 mg. For example, an extract standardized to contain 0.2 percent hypericin would require a daily dosage of 500 mg, usually given in two divided dosages. Clinical studies have used a St. John's wort extract standardized to 0.3 percent hypericin at a dose of 300 mg three times daily.

The German Commission E Monograph for St. John's wort lists no contraindications to its use during pregnancy and lactation. However, more safety studies are needed before St. John's wort is recommended for this population.

Ginkgo (Ginkgo biloba) extract, while clearly not a primary treatment of choice for most patients with major depression, should be considered an alternative for elderly patients with depression resistant to standard drug therapy. This is because depression is often an early sign of cognitive decline and cerebrovascular insufficiency in elderly patients. Frequently described as resistant depression, this form of depression is often unresponsive to standard antidepressant drugs or phytomedicines like St. John's wort. One study showed a global reduction in regional cerebral blood flow in depressed patients older than 50 when compared with age-matched, healthy controls.

In that study, 40 patients, ages 51 to 78, with a diagnosis of resistant depression (insufficient response to treatment with tricyclic antidepressants for at least three months), were randomized to receive either Ginkgo biloba extract or placebo for eight weeks. Patients in the ginkgo group received 80 mg of the extract three times daily. During the study, patients remained on their antidepressant drugs. In patients treated with ginkgo, there was a decline in the median Hamilton Depression Scale scores from 14 to 7 after four weeks. This score was further reduced by 4.5 at eight weeks. There was a one-point reduction in the placebo group after eight weeks. In addition to the significant improvement in symptoms of depression for the ginkgo group, there was also a noted improvement in overall cognitive function. No side effects were reported.

Many nutrition-oriented practitioners have found that the answer to depression is as simple as one's diet. A diet low in sugar and refined carbohydrates (with small, frequent meals) can produce symptomatic relief in some depressed patients. Individuals most likely to respond to this dietary approach are those who develop symptoms in the late morning or late afternoon or after missing a meal. In these patients, ingestion of sugar provides transient relief, followed by an exacerbation of symptoms several hours later.

Donald Brown, N.D., teaches herbal medicine and therapeutic nutrition at Bastyr University, Bothell, Wash. Alan R. Gaby, M.D., is past president of the American Holistic Medical Association. Ronald Reichert, N.D., is an expert in European phytotherapy and has an active medical practice in Vancouver, B.C.

Source: Excerpted with permission from Depression (Natural Product Research Consultants, 1997).

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Serendipity Topics Available in E-book Format

Toma recently compiled his recovery topics into book format. He is offering his first electronic book: Serendipity: A Journal of Recovery exclusively to readers who visit the Serendipity website.

The book is published in Portable Document Format (PDF) and is approximately 82 pages in length. It includes a table of contents, plus a bonus index of the key recovery concepts and principles emphasized in the Serendipity website topics.

To read the book, you will need Acrobat Reader software, available FREE from the Adobe website at: http://www.adobe.com.

Click on the link to download your FREE personal copy of Serendipity: A Journal of Recovery.

next: Co-dependency Recommended Books

Side Effects of Depression Medications After Childbirth

Two side effects of medications for postnatal depression are especially problematic for new mothers: weight gain and loss of libido.

Note: You should always discuss medication side effects with your doctor. Stopping or changing your medication on your own could be disastrous! This information is intended as an informational resource to help you communicate effectively with your physician.

Weight Gain

Dissatisfaction with physical appearance is a common concern for new mothers, many of whom haven't made it back into their pre-pregnancy clothes yet. If medication might slow down weight loss, or worse yet, cause weight gain, it may seem that the cure is worse than the disease. The older class of antidepressants, called tricyclics or heterocyclics, are the biggest culprits for increasing appetite and weight. They include amitriptyline (Elavil), doxepin (Sinequon), imipramine (Tofranil), Nortriptyline (Pamelor) and clomipramine (Anafranil). Unfortunately, these medications are felt by some doctors to be a better choice for breast-feeding mothers than the newer medications which don't usually lead to weight gain.

Of course, weight gain may be beneficial for a woman who has lost weight DUE to postpartum depression--for example, a woman who is wearing a smaller size than before pregnancy.

Antidepressants which do not generally cause weight gain include Effexor (venlafaxine), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine), Zoloft (sertraline), and Wellbutrin (bupropion). Medications for anxiety (such as temazepam, alprazolam, clonazepam and buspirone) also do not usually cause weight gain. Medications for postpartum psychosis including "antipsychotic" or "neuroleptic" medications as well as mood stabilizers including lithium, carbamazepine and valproic acid may all cause weight gain and increase appetite.

What can be done about weight gain? Ask your doctor whether a blood test might help determine whether a lower dose of a tricyclic might be as effective, since increased appetite is less problematic at lower doses. Let your doctor know about your concerns, and be sure to find out whether he/she can prescribe an equally effective alternative. Commit yourself to an exercise program, which may have mental health benefits, too. Finally, revise your own timetable about when and what you "should" weigh--isn't feeling well right now the single most important thing?

Fortunately, weight gain caused by medication is typically reversible once the medication is stopped. Try to accept how you look right now, perhaps by reminding yourself what a gift feeling good is to yourself and your baby.

Sexuality and Antidepressants

Unfortunately, the very medications that don't cause weight gain may lead to sexual side effects in as many as half of women recovering from postnatal depression. This isn't too surprising, since the drugs work on two separate neurotransmitters, each of which affect distinct parts of the brain and body.

The medications most likely to interfere with sexual desire or inhibit orgasm are those that affect serotonin. They include Anafranil, Effexor, Luvox, Paxil, Prozac, and Zoloft. Unfortunately, since these antidepressants are not generally sedating, many doctors prefer them for new mothers who have to be able to rouse themselves at night to look after the baby. One serotonin enhancing antidepressant ("SSRI's") that doesn't interfere with sexual pleasure is called Serzone(nefazodone)-- its drawback is that it's also more sedating that the SSRI's that do cause sexual side effects. Wellbutrin also does not alter sex drive or pleasure.

What can be done about it? First, this side effect may spontaneously resolve after a month or two. Second, talk with your doctor about whether a lower dose might be equally effective without the side effect. Ask your psychiatrist to tell you about other strategies which might help, including co-medication with something that reverses this side effect.

Most importantly: communicate with your partner. Be sure your sexual partner realizes that this is a reversible side effect, and not caused by problems in the relationship. New mothers--with or without postpartum depression--don't have a lot of sexual energy. As the baby begins to sleep through the night, and your body gets back to normal, you may find that your sex drive is better too. If you haven't communicated well about sexual matters up until now, view this as an opportunity to improve the marital relationship by expressing to your partner what feels good.

Valerie Davis Raskin, M.D., Associate Clinical Professor of Psychiatry at the University of Chicago, author of When Words Are Not Enough: The Women's Prescription for Depression and Anxiety and co-author of This Isn't What I Expected: Overcoming Postpartum Depression has contributed the following on side effects of medications for postpartum women. Article last updated on July 28, 1997.

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For a small group of children and adults with ADHD, ADHD medications can have serious side-effects.

Just how safe are ADHD drugs?

In early 2006, two FDA advisory committees met to discuss health risks associated with ADHD (attention deficit hyperactivity disorder) medications.

One FDA review of data concerning serious cardiovascular adverse events in patients taking usual doses of ADHD medications revealed reports of sudden death in patients with underlying serious heart problems or defects, and reports of stroke and heart attack in adults with certain risk factors.

Another FDA review of ADHD medicines revealed a slight increased risk (about 1 per 1,000) for drug-related psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems.

In the end, the pediatric panel cited evidence from clinical trial studies that the incidence of psychiatric events was very small. The panelists also explained that most reports of cardiovascular events were associated with other risk factors, such as underlying heart disease or heart defects.

The FDA recommended that children, adolescents, or adults who are being considered for treatment with ADHD drugs work with their physician or other health care professional to develop a treatment plan that includes a careful health history and evaluation of current status, particularly for cardiovascular and psychiatric problems (including assessment for a family history of such problems).

Are ADHD medications safe for your child?

Dr. William Barbaresi, chairman of the Division of Developmental and Behavioral Pediatrics and a co-director of the Mayo Clinic Dana Child Development and Learning Disorders Program says that ADHD drugs are safe.

"ADHD medications have been prescribed longer than most every other class of medications currently available," says Barbaresi. "There's more research literature available on ADHD medications than on a large percentage of medications currently prescribed within the United States. As long as physicians follow appropriate guidelines and monitor patients for side effects, ADHD medications should be considered safe."

As for effectiveness, Barbaresi says "stimulants — which are the medications most frequently prescribed for ADHD — not only help children with ADHD in the short term but also are effective in the long run. For example, treatment with stimulants is associated with decreased risk of development of substance abuse disorders and decreased emergency room utilization."

The ADHD medicines that were the focus of the revised labeling and new Patient Medication Guides ordered by the FDA include the following 15 ADHD drugs:

• Adderall (mixed salts of a single entity amphetamine product) Tablets
• Adderall XR (mixed salts of a single entity Amphetamine product) Extended-Release Capsules
• Concerta (methylphenidate hydrochloride) Extended-Release Tablets
• Daytrana (methylphenidate) Transdermal System
• Desoxyn (methamphetamine HCl) Tablets
• Dexedrine (dextroamphetamine sulfate) Spansule Capsules and Tablets
• Focalin (dexmethylphenidate hydrochloride) Tablets
• Focalin XR (dexmethylphenidate hydrochloride) Extended-Release Capsules
• Metadate CD (methylphenidate hydrochloride) Extended-Release Capsules
• Methylin (methylphenidate hydrochloride) Oral Solution
• Methylin (methylphenidate hydrochloride) Chewable Tablets
• Ritalin (Methylphenidate hydrochloride) Tablets
• Ritalin SR (methylphenidate hydrochloride) Sustained-Release Tablets
• Ritalin LA (Methylphenidate hydrochloride) Extended-Release Capsules
• Strattera (atomoxetine HCl) Capsules

Sources:

• FDA
• William Barbaresi, M.D., developmental and behavioral pediatrician at Mayo Clinic

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Why is it that so many women feel bad about the way they look? Why do most American females, regardless of their age, think they are too fat? Why do 9 over 75 percent of fourth-grade girls report that they are "on a diet?"

The term "body image" has been coined to describe a person's inner sense of satisfaction or dissatisfaction with the physical appearance of her/his body. For most of us, our body image reflects reality: whether we gain or lose a few pounds, achieve muscular definition through exercise or develop "love handles," we generally know it. Our body image is a relatively accurate reflection of our morphology.

But some have body images that are totally out of whack, with perceptions of form and appearance that are extraordinarily distorted. These people are usually women; and although we tend to associate such misperception of one's appearance with anorexia (self-starvation) or bulimia (repeated binging and purging), research now shows that "normal" women suffer from these same body-image problems. In other words, women who have no clinical eating disorder or weight problem-who appear objectively fine-look in the mirror and see ugliness and fat. Why does this happen?

Images of female success and fashion portray the ideal woman as smart, popular, successful, beautiful and always portrayed as very thin (the average fashion model weights 25 percent less than the average woman). Pressure to measure up is great, and is constantly reinforced by family and friends, as well as advertising and popular media. Women still are taught that their looks will determine their success, and that thin equals beautiful. Whenever there is a gap between the cultural image of this ideal woman and an individual's self-perception, consequences may be temporary or only negligibly significant. For others, anxiety, depression, reclusiveness, chronically low self-esteem, compulsive dieting or eating disorders may develop. The results can be tragic: 25 percent -30 percent of women with eating disorders remain chronically ill, and 15 percent will die prematurely.

Information about the symptoms of and treatment for eating disorders is readily available from a variety of sources. Perhaps a rudimentary focus, therefore, would be to ask the question, what can women do to avoid the trap of negative body image and eating disorders? The following are some beginning steps:

1. Realistically view your genetic shape. Study photos of your mother, grandmothers, aunts and sisters to get a sense of their family genes for body shape.
2. Participate in non-competitive physical exercise (dance, yoga, bicycling).
3. Analyze your body image. What situations make you feel fat? What do you do when you feel fat? Identify negative thoughts and challenge them with positive affirmations.
4. Adopt a healthy eating plan for life-give up "going on diets."
5. Look at your self esteem holistically: What is truly, ultimately important to you? What are your skills and talents? What kind of person do you want to be?

The answers to those questions should start you on a path to a healthy body image and help you avoid the dangers of negative body image.

next: Eating Disorders: Body Image and Advertising
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For Parents, Health Professionals, and Educators

The following are facts that will help you to prevent, address, or treat eating disorders or dysfunctions in your child, student, patient, or loved one.

Myths about healthy eating

• Food is fattening.
• Fat is unhealthy for the body.
• Dieting and restricting food is the best way to lose weight.
• It's okay to skip meals.
• Nobody eats breakfast.
• Food substitutes such as Power Bars and Slim Fast are okay to take the place of meals.
• Meals are to be served, not eaten, by parents.
• Exercise can keep a person slim and fit. You can never overdo a good thing.
• Being fat is about being unhealthy, unhappy and unattractive. It must be avoided at all costs.
• Fat-free eating is healthy for eating disorders.
• A meal is anything you put in your mouth around mealtime.

Myths about eating disorders

• Once anorexic, always anorexic. Like alcoholism, eating disorders are not curable.
• People with anorexia are easy to identify. They are noticeably skinny and don't eat.
• Once an anorexic has achieved a normal weight, she is recovered.
• An eating disorder is about eating too little or too much.
• Parents are the cause of their child's eating disorder.
• Eating disorders affect only adolescent girls.
• People lose weight using laxatives and diuretics.
• Physicians can be counted on to discover and diagnose an eating disorder.

Things you need to know about children at risk for eating disorders

• Of the currently more than 10 million Americans afflicted with eating disorders, 87 percent are children and adolescents under the age of twenty.
• The average age of eating disorders onset has dropped from ages 13-17 to ages 9-12.
• In a recent study, young girls were quoted as saying that they would prefer to have cancer, lose both their parents, or live through a nuclear holocaust than to be fat. 81% of 10 year olds are afraid of being fat.
• The US Dept of Health and Human Services task force reports that 80% of girls in grades 3 to 6 displayed body image concerns and dissatisfaction with their appearance. By the time girls reached the 8th grade, 50% of them had been on diets, putting them at risk for eating disorders and obesity. By age 13, 1o% had reported the use of self-induced vomiting.
• 25% of first graders admit to having been a diet.
• Statistics show that children who diet have a greater tendency to become overweight adults.
• Childhood obesity is at an all time high, afflicting five million children in America today, and with another six million on the cusp.
• Early puberty and the bodily changes that go along with it have become a primary risk factor for the onset of eating disorders. It is normal, and in fact, necessary, for girls to gain 20 percent of their weight in fat during puberty.
• The number of males with eating disorders has doubled during the past decade.
• By the age of five, children of parents who suffer with eating dysfunctions demonstrate a greater incidence of eating disturbances, whining and depression.
• Adolescents with eating disorders are at a substantially elevated risk for anxiety disorders, cardiovascular symptoms, chronic fatigue, chronic pain, depressive disorders, infectious diseases, insomnia, neurological symptoms, and suicide attempts during early adulthood.
• A study of 692 adolescent girls showed that radical weight-loss efforts lead to greater future weight gain and a higher risk of obesity.
• Eating disturbances in your very young child may be the result of anxiety, compulsivity, or the child's imitation of significant adult role models. Issues of control, identity, self-esteem, coping and problem solving are what drive adolescent and adult eating disorders
• 50% of American families do not sit down together to eat dinner.

Things you need to know about eating disorders and their effects

• The number of people with eating disorders and subclinical eating disorders is triple the number of people with AIDS.
• Eating disorders are the most lethal of all the mental health disorders, killing and maiming between six and 13 percent of their victims.
• Increasing numbers of married and professional women in their twenties, thirties, forties and fifties are seeking help for eating disorders that they have harbored secretly for twenty or thirty years. Eating disorders are not restricted to the young.
• Disordered eating is rampant in our society. On American college campuses today, 40 to 50 percent of young women are disordered eaters.
• Osteopenia is common in adolescent girls with anorexia nervosa. It was found that despite recovery for over one year, poor bone mineral accrual persists in adolescent girls with AN in contrast to rapid bone accrual in healthy girls.
• In a recent study, it was determined that estrogen-progestin did not significantly increase BMD compared with standard treatment. These results question the common practice of prescribing hormone replacement therapy to increase bone mass in anorexia nervosa.

Parenting Issues

• Many parents fear that through honest intervention with their child about food and eating, they could make matters worse or lose their child's love. They worry that they may interfere with their child's privacy and developing autonomy by stepping in to rectify an eating problem in the making. Parents need to recognize that a problem cannot be resolved unless and until it is identified and confronted.
• Some health professionals believe that parents do not belong in their child's treatment for eating disorders. Professionals' concerns about the issues of separation/individuation and protecting the child's privacy too frequently blind them to the need to educate and guide parents, through the family therapy process, to become mentors to their child, supportive of recovery efforts. The most successful separation takes place through healthy bonding.
• "Anorexia Strategy: Family as Doctor" - "When a teenage girl develops anorexia, a team of experts usually takes charge of bringing her back to a normal weight, while her parents stand on the sidelines... The goal of the therapy is to mobilize the family as a whole in a fight against the eating disorder." Dr. James Lock, assistant professor of psychiatry at Stanford School of Medicine. The New York Times; June 11,2002.
• Too many or too few parental limits imposed during the growing up years deprive children of the opportunity to internalize the controls they need to ultimately learn to regulate themselves. These children may eventually turn to an eating disorder to compensate; nature abhors a vacuum.

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Culture has been identified as one of the etiological factors leading to the development of eating disorders. Rates of these disorders appear to vary among different cultures and to change across time as cultures evolve. Additionally, eating disorders appear to be more widespread among contemporary cultural groups than was previously believed. Anorexia nervosa has been recognized as a medical disorder since the late 19th century, and there is evidence that rates of this disorder have increased significantly over the last few decades. Bulimia nervosa was only first identified in 1979, and there has been some speculation that it may represent a new disorder rather than one that was previously overlooked (Russell, 1997).

However, historical accounts suggest that eating disorders may have existed for centuries, with wide variations in rates. Long before the 19th century, for example, various forms of self-starvation have been described (Bemporad, 1996). The exact forms of these disorders and apparent motivations behind the abnormal eating behaviors have varied.

The fact that disordered eating behaviors have been documented throughout most of history calls into question the assertion that eating disorders are a product of current social pressures. Scrutiny of historical patterns has led to the suggestion that these behaviors have flourished during affluent periods in more egalitarian societies (Bemporad, 1997).It seems likely that the sociocultural factors that have occurred across time and across different contemporary societies play a role in the development of these disorders.

Sociocultural Comparisons Within America

Several studies have identified sociocultural factors within American society that are associated with the development of eating disorders. Traditionally, eating disorders have been associated with Caucasian upper-socioeconomic groups, with a "conspicuous absence of Negro patients" (Bruch, 1966). However, a study by Rowland (1970) found more lower- and middle-class patients with eating disorders within a sample that consisted primarily of Italians (with a high percentage of Catholics) and Jews. Rowland suggested that Jewish, Catholic and Italian cultural origins may lead to a higher risk of developing an eating disorder due to cultural attitudes about the importance of food.

More recent evidence suggests that the pre-valence of anorexia nervosa among African-Americans is higher than previously thought and is rising. A survey of readers of a popular African-American fashion magazine (Table) found levels of abnormal eating attitudes and body dissatisfaction that were at least as high as a similar survey of Caucasian women, with a significant negative correlation between body dissatisfaction and a strong black identity (Pumariega et al., 1994). It has been hypothesized that thinness is gaining more value within the African-American culture, just as it has in the Caucasian culture (Hsu, 1987).

Other American ethnic groups also may have higher levels of eating disorders than previously recognized (Pate et al., 1992). A recent study of early adolescent girls found that Hispanic and Asian-American girls showed greater body dissatisfaction than white girls (Robinson et al., 1996). Furthermore, another recent study has reported levels of disordered eating attitudes among rural Appalachian adolescents that are comparable to urban rates (Miller et al., in press). Cultural beliefs that may have protected ethnic groups against eating disorders may be eroding as adolescents acculturate to mainstream American culture (Pumariega, 1986).

The notion that eating disorders are associated with upper socioeconomic status (SES) also has been challenged. Association between anorexia nervosa and upper SES has been poorly demonstrated, and bulimia nervosa may actually have an opposite relationship with SES. In fact, several recent studies have shown that bulimia nervosa was more common in lower SES groups. Thus, any association between wealth and eating disorders requires further study (Gard and Freeman, 1996).

Eating Disorders in Other Countries

Outside the United States, eating disorders have been considered to be much rarer. Across cultures, variations occur in the ideals of beauty. In many non-Western societies, plumpness is considered attractive and desirable, and may be associated with prosperity, fertility, success and economic security (Nassar, 1988). In such cultures, eating disorders are found much less commonly than in Western nations. However, in recent years, cases have been identified in nonindustrialized or premodern populations (Ritenbaugh et al., 1992).

Cultures in which female social roles are restricted appear to have lower rates of eating disorders, reminiscent of the lower rates observed during historical eras in which women lacked choices. For example, some modern affluent Muslim societies limit the social behavior of women according to male dictates; in such societies, eating disorders are virtually unknown. This supports the notion that freedom for women, as well as affluence, are sociocultural factors that may predispose to the development of eating disorders (Bemporad, 1997).

Cross-cultural comparisons of eating disorder cases that have been identified have yielded some important findings. In Hong Kong and India, one of the fundamental characteristics of anorexia nervosa is lacking. In these countries, anorexia is not accompanied by a "fear of fatness" or a desire to be thin; instead, anorexic individuals in these countries have been reported to be motivated by the desire to fast for religious purposes or by eccentric nutritional ideas (Castillo, 1997).

Such religious ideation behind anorexic behavior also was found in the descriptions of saints from the Middle Ages in Western culture, when spiritual purity, rather than thinness, was the ideal (Bemporad, 1996). Thus, the fear of fatness that is required for the diagnosis of anorexia nervosa in the Diagnostic and Statistical Manual, Fourth Edition (American Psychiatric Association) may be a culturally dependent feature (Hsu and Lee, 1993).

Conclusions

Anorexia nervosa has been described as a possible "culture-bound syndrome," with roots in Western cultural values and conflicts (Prince, 1983). Eating disorders may, in fact, be more prevalent within various cultural groups than previously recognized, as such Western values are becoming more widely accepted. Historical and cross-cultural experiences suggest that cultural change, itself, may be associated with increased vulnerability to eating disorders, especially when values about physical aesthetics are involved. Such change may occur across time within a given society, or on an individual level, as when an immigrant moves into a new culture. In addition, cultural factors such as affluence and freedom of choice for women may play a role in the development of these disorders (Bemporad, 1997). Further research of the cultural factors influencing the development of eating disorders is needed.

Dr. Miller is an associate professor at James H. Quillen College of Medicine, East Tennessee State University, and is director of the university psychiatry clinic.

Dr. Pumariega is professor and chair of the department of psychiatry at the James H. Quillen College of Medicine, East Tennessee State University.

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This information sheet has been formulated to assist in the implementation of the NHS and Community Care Act 1990. The contents are, however, applicable to all services, present and future, provided for people with ADHD.

Factors to be considered during assessment of people with ADD/ADHD

ADD/ADHD is a perplexing life-long disability, believed to be caused by organic brain damage rather than emotional trauma. The spectrum of autistic conditions covers a wide range. It varies from profound severity in some through to subtle problems of understanding in others of apparently average or above average intelligence. ADD/ADHD often occurs with other learning difficulties.

People with ADD/ADHD have a disability characterised by a triad of impairments as follows:

• absence or impairment of two-way social interaction
• absence or impairment of comprehension and the use of language and non-verbal communication
• absence or impairment of true flexible imaginative activity, with the substitute of a narrow range of repetitive, stereotyped pursuits

This disability leads to related problems which may include:

• resistance to change
• obsession or ritualistic behaviour
• high levels of anxiety
• lack of motivation
• inability to transfer skills from one setting to another
• vulnerability, and susceptibility to exploitation
• depression
• challenging behaviour
• self injury

Additional Specifications for the Provision of Care Services for People with ADD/ADHD

People with ADD/ADHD need and the service should provide:

1. individual and detailed IPPs (Individual Pro- gramme Plans)
2. detailed and specific strategies to achieve social interaction, communication and independence skills
   highly planned structured activity
3. appropriate staff levels to implement the strategies and provide staff support in all areas
4. an appropriate physical environment

The service and the staff should provide:

1. consistency and stability in the environment and in all interaction
2. continuous external motivation and positive intervention

The service also needs to provide:

1. a support system to handle and relieve staff stress
2. specialised staff training providing both an induction programme and an ongoing pro- gramme to reinforce and update the needed staff skills

The staff role is crucial in enabling people with ADD/ADHD to participate more fully in everyday life. Staff need a thorough understanding of the underlying impairment and to be attuned to the way the person with ADD/ADHD sees the world.

The staff training programmes should aim to provide:

1. an ability to understand and interpret the verbal or non-verbal communications of the person with ADD/ADHD
2. an ability to translate situations, events and concepts, into language that can be understood and grasped by the person with ADD/ADHD
3. a sensitivity in the recognition of anxiety levels
4. skills in the managemen

NHS and Community Care Act 1990

1. t and reduction of challenging behaviour
2. recognition of the value of repetitive reinforcement and the ability to make careful use of structure in order to counteract the lack of motivation inherent in this disability

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medical.problems.associated.with.anorexia.and.bulimia

The most common reason for death amongst those with anorexia is heart failure, while the most common reason amongst those with bulimia is rupturing in the intestinal area as well as heart failure. Unfortunately, because eating disorders are constantly glamorized by society, many aren't even aware of the internal and external damage that inevitably occurs from these self-destructive demons. Hopefully this list of medical complications will help you or someone you know see just why it's a grEAT idea to get help ASAP.

anorexia

Thermoregulatory problems: Loss of body fat creates it so that the body has no way of insulating and keeping heat anymore. For the person with anorexia it seems like everyday, even if it is 85 degrees, is freezing. This can also be due to electrolyte disturbances from not eating properly.

Decreased eye movement

Insomnia: Mostly due from electrolytic disturbances and hormonal problems

Anemia: Poor blood from not enough iron; causes lack of vitality and problems with bruising frequently

Dental erosion: Yes, your teeth will rot with anorexia even if you do not purge. Most of those with anorexia do not get enough calcium in their diets and because of this the body begins to find calcium elsewhere and takes it out of body parts such as the bones but also the teeth. The teeth are stripped of the calcium and become weak.

Delayed gastric emptying: The tone of the stomach area becomes poor and weak so that it cannot produce the power to push out whatever food the person with anorexia does eat. This can lead to a lot of toxins building up inside which also weakens the immune system and leaves the person with anorexia susceptible to many more viruses.

Diarrhea: Also from the delayed gastric emptying, but can also be because of laxative abuse.

Dehydration

Acidosis:Blood becomes too acidic, which can lead to other sicknesses

Osteoporosis: Bones become significantly weakened, leaving the person with anorexia susceptible to broken bones from just falling out of bed.

Bradycardia: Slow/irregular heart beat.

Dysrhythmia: Heart out of rythm; sudden death

Edema: Occurs from not eating properly and also purging; there is a water retention imbalance which causes the feet and hands to swell

Ulcers

Amenorrhea: Indicates a failure of hypothalamic-pituitary-gonadal interaction to produce cyclic changes in the endometrium resulting in menses. In other words the periods stop or do not start. Primary amenorrhea is the absence of menarche by age 16 and Secondary amenorrhea is the absence of menarche for more than 3 months.

Metabolic problems - Hypocalcemia: Low blood glucose levels from too low of weight and malnutrition. Signs of this include listlessness, jitteriness, and seizures.

Lanugo: A soft downy hair/fur begins to grow to try to insulate heat because the body does not have enough calories to burn to produce heat.

Decreased cardica muscle, mass chamber size, and output: This often leads to cardiac arrest

Hypkalemia: Deficiency of potassium

Dry skin

Brittle nails

Weak hair that often falls out: Along with dry skin and brittle nails this consequence is a result of not enough fat in the diet.

Urinary tract infections: Decreased fluid intake is the cause of this.

Loss of potassium: Can result in diminished reflexes, fatigue, and cardiac arrythmias.

bulimia

Thermoregulatory problems: Those with bulimia also have this problem. Electrolytic imbalances from purging usually cause the person with bulimia to have erratic temperature changes, so that one minute they are feeling warm and the next getting shivers and cold chills.

Insomnia: Mostly due from electrolytic disturbances and hormonal problems

Anemia: Purging wipes out precious iron from the person with bulimia's system.

Dental erosion: If the person with bulimia does not come forward about their problem, then most likely their dentist will spot it. The acid in our intestines that digests our food comes up when the person with bulimia purges, slowly deteriorating the enamel that protects the teeth. A dentist is able to spot this easily for the fact that many of them have had to go through specific courses when in dentistry school, which has given them a list of problems with the teeth caused specifically from repeated vomiting. The way the food and acid splash up against the teeth leaves a certain pattern that is the trademark of repeated vomiting. The constant erosion of the teeth usually leads to the enamel slewing off, and as a result, lots of cavities. It's not uncommon to hear of someone with bulimia to end up dealing with more than one root canal in their lifetime.

Ruptured blood vessels in the eyes

Paratoid swelling: Glands in the throat and mouth become irritated and swell.

Esophageal tears: The constant heaving of stomach acid eventually causes the stomach lining to wear off. The added pressure from purging also adds into this, and the person with bulimia stands a great risk of tearing their esophagus which leads to hemorraging and even rupturing of the esophagus.

Delayed gastric emptying: The tone of the stomach area becomes poor and weak so that it cannot produce the power to push out whatever food someone with bulimia eats. This can lead to a lot of toxins building up inside the body which also weakens the immune system and leaves the person susceptible to many viruses.

Chronic diarrhea and/or constipation : Those with bulimia often abuse laxatives, which can cause them to forever have diarrhea. In severe cases the person eventually loses all control over their bowels as well, forcing them to have to wear some form of a diaper.

Dehydration

Acidosis: Blood gets too acidic which can lead to other sicknesses

Osteoporosis : Bones become significantly weakened, leaving the person susceptible to broken bones from just falling out of bed.

Bradycardia: From purging, things called electrolytes become imbalanced. Electrolytes help control your heart's beat among other things, and once they are off balance your heart rate will suffer - most likely dropping too low.

Dysrhythmia: Sudden death from potassium levels being too low.

Edema: Bloating and water retention

Ulcers: The stomach lining slews off the more you throw up. Pretty soon the stomach has no protection against its acids, and the stomach acid starts to burn holes through the stomach. Eventually an ulcer forms and often becomes infected (think puss and germs - not pretty).

Amenorrhea: Some people think that you can only lose your period if you are underweight, but this is not true. Purging can seriously mess up a person's hormones which can lead to missing periods.

Metabolic problems - Hypocalcemia

Hypokalemia

Dry skin

Brittle nails

Urinary tract infections: Dehydration is common in those with bulimia, and bladder infections can become an often problem.

Loss of potassium : Purging, laxative, and diuretic abuse is a big factor into this. All three of these things causes vital fluids to be lost and creates the potassium levels of those with bulimia to drop dangerously low, setting them up for heart failure.

Chronic sore throat: Not fun to wake up every morning feeling like you have strep throat.

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I'm finally realizing that recovery is about being rather than doing.

When I am being love, my heart is full and giving.

When I am being serenity, my heart is peaceful and relaxed.

When I am being kindness, my heart extends itself to others.

When I am being compassionate, my heart hurts with another's pain.

When I am being affirmation, my heart speaks the language of encouragement and unconditional acceptance.

When I am being peace, my heart has a calming affect on my environment.

When I am being meditation, my heart is attuned to God's creative force.

When I am being joy, my heart sings and dances with lightness.

When I am being emotionally present, my heart is unified with another's.

When I am being thoughtfulness, my heart makes choices based on awareness and wisdom.

When I am being courage, my heart thrills to life's unexpected pleasures.

When I am being forgiveness, my heart is able to make amends.

When I am simply being, my heart is whole; my life is wonderful.

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