Category Archives: Mental Health

After Natural Disasters, Many Years of Post-Traumatic Stress Can Occur

Satellite image of Hurricane Katrina

Susannah Breslin was a free lance journalist who moved from California to New Orleans in 2003. While living in a neighborhood two blocks west of the Mississippi and six blocks west of the Industrial Canal (which went on to flood the city’s 9th Ward), Hurricane Katrina grew into a Category 5 hurricane with winds clocking in at 125 miles per hour.

On the morning of August 29, the cyclone  made landfall near Buras, Louisiana, a small community located at the bottom of the toe of Louisiana’s boot-like shape.From there, the storm swept across east New Orleans. Continuing north, it slipped over the Louisiana-Mississippi border, and on August 30 it weakened to a tropical depression over the Tennessee Valley.

The storm surge produced massive destruction across multiple states, and New Orleans’ levees were breached catastrophically, flooding an estimated 80-percent of the Crescent City. The hurricane left 1,836 dead and hundreds missing.

Susannah fled to Louisiana the day before Katrina hit and watched the destruction on television with the dozens of people who also fled. She finally returned home to a deserted neighborhood now filled with asbestos and mold, and a celing in her bed. Six months later, Susannah was feeling numb and increasingly disconnected. She was unable to think well and felt enraged and anxious. Sleeping led to thrashing and night terrors about the floods.

She withdrew herself from the rest of the world, often wondering if she was dead; if reality was the real hallucination and she lived in an in-between world.  Four years after Katrina hit, she walked into her kitchen and felt frusterated from a work related issue. Susannah slammed her head into the cupboard with all her might and then hit her hand into a different cabinet.

Susannah had post traumatic stress disorder. She often wondered why she developed it, why her over other individuals who had lost more in the storm.

Katrina damage

Dr. Bessel van der Kolk, a clinical psychiatrist with specialization in PTSD, explained it as, “memories of particular events are remembered as stories that change and deteriorate over time and do not evoke intense emotions and sensations. In contrast, in PTSD the past is relived with immediate sensory and emotional intensity that makes victims feel as if the event were occuring all over again.”

One may experience a traumatic event but is unable to integrate it into a story of their life.

As for those who develop PTSD, it can depend on whether or not one dissociates from the traumatic event. If the event is never fully experienced, it fails to be integrated into a “past-tense” narrative, leaving an individual with an experience playing over and over again.

Certain individuals may not even remember the event while others will have no feelings about it. Some people may act disturbed without knowing why they are behaving that way. And others may use the event to unleash a new path or mindset in life.

Symptoms of PTSD include hyper-vigilance, flashbacks, emotional numbness, night terrors, anger, depression, anxiety, and an exaggerated fight-or-flight response.

Susannah said having PTSD was like looking at life through a pane of smoked glass, that it’s easy for one to become emotionally dead.

With the high number of hurricanes, tornadoes, earthquakes, tsunamis, and mudslides occurring throughout the world, it is possible and normal to develop anxiety stemming from the natural disasters.

If the anxiety becomes debilitating and you find yourself with symptoms similar to Susannah’s, it is time to find outside help. If you do not feel or act like yourself, find a good counselor to help diagnose you and start the proper treatment at Apex.

Addiction Redefined

Addiction is a chronic brain disease, not just bad behavior or bad choices.

The American Society of Addiction Medicine (ASAM) has released a new definition of addiction, highlighting that addiction is a chronic brain disorder and not just a behavioral problem involving excess alcohol, drugs, gambling, or sex.  This marks the first occasion of ASAM stating addiction is not solely related to problematic substance use.

When people witness damaging and compulsive behaviors in friends, family, or public figures, the majority only focus on the actual substance use or behavior as the problem. According to ASAM, these outward behaviors are manifestations of an underlying disease that involves various areas of the brain.  

“At its core, addiction isn’t just a social, moral, or criminal problem. It’s a brain problem whose behaviors manifest in all these other ares,” said Dr. Micheal Miller, former president of ASAM. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”

The new definition resulted from an intensive four year process with more than 80 experts actively working on it, including: top addiction authorities, addiction medicine clinicians, and neuroscience researchers from across the country.

Addiction is described as a primary disease, meaning that it is not the result of other emotional causes or psychiatric problems. Addiction is also recognized as a chronic disease, like cardiovascular disease or diabetes, so therefore it must be treated, managed, and monitored over a life-time.

Two decades of advancements in neuroscience convinced ASAM that addiction needed to be redefined by what is going on in the brain. The disease of addiction affects neurotransmissions and interactions within the reward circuitry of the brain. This leads to addictive behaviors that supplant healthy behaviors, while memories of prior experiences (food, sex, alcohol, drugs) trigger cravings and renewal of addictive behaviors.

The brain circuitry that governs impulse control and judgment is also altered, resulting in the dysfunctional pursuit of rewards like drugs or alcohol. This area of the brain is still developing during teenage years, which may be why early exposure to alcohol or drugs is linked to a greater likelihood of addiction as an adult.

There has been a longtime controversy if people with addiction have choice over anti-social and dangerous behaviors. Dr. Raju Hajela, chair member of the ASAM committee, stated that “the disease creates distortions in thinking, feelings and perceptions, which drives people to behave in ways that aren’t understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”

“Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary.”

Dr. Miller added, “Many chronic diseas require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addiction to medical or surgical interventions. So, we have to stop moralizing, blaming, controlling, or smirking at the person with the disease of addiction and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment.”

SAMHSA recently worked with the behavioral health field to develop a working definiton of recovery that captures the common experiences of those in recovery.

Some of the guiding principles are:

  • Recovery is person-driven
  • Recovery occurs via many pathways
  • Recovery is holistic
  • Recovery is supported by peers and allies
  • Recovery is supported through relationships and social networks
  • Recovery is culturally based and influenced
  • Recovery is supported by addressing trauma
  • Recovery involves individual, family, and community strengths and responsibility
  • Recovery is based on respect
  • Recovery emerges from hope

Addiction treatment, including therapy or Suboxone, is offered at Apex Behavioral Heatlh. Dr. Chung, Dr. Ramesh, and Dr. Kwon are our Suboxone providers.

I Think I’m Depressed – What Now?

Many people have a hard time accepting that they may be depressed. They feel some level of shame or embarrassment, which is unfounded considering that depression is a disease. If you had cancer, wouldn’t you go to a doctor?

Depression hits people of all ages and races. Currently, there are an estimated 15 million people in the US suffering from depression. Realistically, that number is probably higher than what’s reported. Regardless, 2/3 people don’t get any sort of treatment for depression, which is a waste because depression is a treatable illness.

Nobody knows what causes depression. You may be able to identify a trigger, or a stressful event like divorce or death of a loved one as causing your depression, but it may have existed prior.  There is no one reason why depression sets in; however, stress, hormones, and genetics can increase the risk. 

The longer depression lasts, the worse your symptoms may get and the harder it will be to treat.

Without treating depression, people can struggle for months or years feeling absolutely miserable. If you do decide to seek treatment, there are a lot of effective and proven ways to treat depression. Doctors will try psychotherapy or antidepressant medication. Studies have found that combined treatment of therapy and medication works better than medication on its own.

Lifestyle changes can help depression, which is something you and your therapist can talk over. Managing stress, getting enough sleep, eating healthy, and exercising have all been shown to help. The important thing is that there are many options out there.

Some people are appropriately apprehensive when it comes to taking medication. Common worries include if the drugs will change one’s personality, or concerns regarding the side effects. The doctor will inform you about potential side effects. Regarding altering your personality, depression has already put you in a fog and the medication may help you return to your original self.

For those that are interested, antidepressants work by making the nerve cells form stronger and healthier connections to specific parts of the brain. The most common antidepressants are called SSRIs. These types of drugs can take weeks or months to be effective.

Therapy has been shown to have more lasting benefits than medication. Talking to a stranger about the problems bothering you may make you feel uncomfortable. It’s important to remember that therapists are a skilled professional and they will not judge you. Everything is confidential!

Cognitive behavioral therapy helps you see how your own thought patterns can contribute to your depression and it teaches practical ways to change them.

Many people seek a holistic approach to treat depression. There’s the view that if it comes from the Earth, it is natural, and therefore less harmful. However, natural supplements have side effects as well. You should talk to a doctor or do extensive research before taking them. The evidence is unclear if natural herbs actually work or not. Supplements like fish oil and folic acid may have some benefits, but other supplements really don’t do anything.

So how does one start treatment? You can get a referral from your family doctor or call the 1-800 number on the back of your insurance card and they will find you a mental health provider. The American Psychological Association and the American Psychiatric Association also have online locators. Some family doctors prescribe antidepressants but finding a psychiatrist (someone who specializes in mental disorders as opposed to general medicine) will be more beneficial for treatment.

Physical symptoms of depression can include: headaches, back pain, muscle aches, joint pain, chest pain, digestive problems, exhaustion & fatigue, sleeping problems, change in appetite or weight, dizziness or lightheadedness.

Benefits of treating depression include: better sleep, better libido, pain or discomfort relief, improved health, better work performance, better memory, happier home life, healthier lifestyle, increased sense of control, decreased future depression, and stronger ties with family.

Some people avoid getting treatment for the following reasons:

  • “I’ll snap out of it if I give it time.”  You can’t snap out of being depressed. Having the blues may pass, but clinical depression will linger and get worse if it is not treated.
  • “‘I don’t want to take antidepressants.” Psychotherapy is always an option. Cognitive behavioral therapy deals with your thoughts and feelings now; it works to improve your thought pattern and your quality of life.
  • “I don’t feel sad all the time. Why do I need treatment?” Sometimes, people with depression see their clinical physician for ailments like muscle pain or sleeping problems, not knowing that they are symptoms of depression. You don’t need to be crying all the time to be depressed.
  • “I’m embarrassed to talk to my doctor about it.”  Depression is not something to be ashamed of, it is a common medical condition. Your doctor has already treated patients just like you.

You can always voice your concerns to your therapist or doctor and they will work with you to make you feel more comfortable. Apex Behavioral Health is always available to help treat your depression. Make an appointment and help yourself!