How to Maintain Your Mental Health During the Pandemic

The battle we are waging against the Covid-19 pandemic has turned the whole world upside down. This period of our lives has passed more slowly than we could have imagined. In Guatemala, the economic, family, physical and emotional impact has us anxious, stressed and overwhelmed. We have been filled with fear of an uncertain future. But we are not alone, the insecurity and fear we share with hundreds of countries across the planet.

Covid-19 is a complex clinical syndrome caused by a coronavirus that is characterized by a hyper-inflammatory response and a hypercoagulable state of the blood that is highly lethal for the elderly and for patients with certain risk factors. In most children and young people the clinical picture is generally more benign, although serious cases and deaths have also been reported in these two groups.

The balance of the battle worldwide is staggering, almost one hundred million cases and two million deaths. The US ranks scandalously first in morbidity and mortality. But this pandemic is not a life sentence. When it does, we will come out on top and rise up stronger, more resilient, and with a greater appreciation of the precious gift of life.

At all times and particularly during this relentless struggle, let me remind you of the paramount importance of taking care of ourselves. Taking care of oneself is not a selfish principle, it is not attending to one’s own interest without measure, but it obeys a purely altruistic interest. Maintaining your emotional, mental, and physical well-being is crucial to helping your family, young children, partners and co-workers, and the community at large. Anxiety, stress and fear cause strong emotions in children, adults and the elderly. Learning to disentangle yourself from such emotions is vital and imperative to shorten the damage they can cause in the short or long term.

Based on my professional experience, I share below a list of reactions to fear that I have observed occur frequently:

• Anxiety or Panic
• Excessive concern about your health or that of others

Our physical body also pays the consequences for anxiety and stress:

How to Practice Self Care

It is very important not to fall into harmful habits, such as spending all day in bed, stopping
eat at your usual times and increase the use of alcohol, caffeine or tobacco.

Pay careful attention to the following positive action ideas:

It is worth mentioning that not everything has been negative as a result of this pandemic. Among the positive events we have the following:

1. Health: Governments worldwide have realized the need to spend less on military weapons and invest more in the public health sector. The new regulations have improved personal hygiene, public hygiene expectations in banks, supermarkets and in means of transport such as trains and airlines.

2. The Environment: Planet Earth has been given the opportunity to take a deep breath. Carbon emissions decreased remarkably. China, the country with the largest carbon footprint in the world, reduced its emissions by 25%.
The canals in Venice have been cleaned up considerably. In some places they have turned crystalline and fish have started to reappear.

3. Education: A vital sector that has been transforming before our eyes from master classes to online classes. Initial skepticism has changed to surprise and enthusiasm as it has clearly been shown to be very doable and student response has been very positive across the board.

4. Our Lifestyle: We have spent less on ceremonies and extravagant parties. There is more solidarity with those who have been most affected by the loss of work, health and well-being and by the loss of their loved ones. We’ve had more time to reconnect with family and friends. We’ve had more time to reconsider our priorities.

We Guatemalans must be able to change a baby’s diaper, build a shelter, cook a good beef broth, write or recite a poem, clean a wound, give orders, receive orders, care for the sick, comfort a dying person, ride a horse, solve an equation, clean a chicken coop, use a computer, play chess, cross a river, change a tire, fight bravely and die with dignity. If we can do this, the next virus is going to run our errands for us!

Guatemala, land of colors, where the green palm trees show us the color of the
hope!

Dr. Edgar Castillo Armas
General and Pediatric Psychiatry
Central California TMS Center

COVID -19 An opportunity?

Taking care of my health (not only in time of COVID-19)

The global situation related to COVID-19 undoubtedly represents an unprecedented challenge. This phenomenon compromises all of us in one way or another, but the way in which it affects us is different for each one of us.

As mental health professionals we want to share five recommendations aimed at turning the current scenario into an opportunity for personal growth. Our objective is to communicate that these are some tools that we can continue practicing once the period of confinement is over. Therefore, this is a time when with effort and dedication, we can acquire new habits that will promote our well-being.

Organized routine, clear mind. As a first suggestion, we recommend prioritizing our activities, writing down chores and trying to stick as closely as possible to the schedules we establish. In this way, we will not only feel more productive, but in fact, we will be.
Let’s release endorphins in thirty minutes. By spending at least half an hour a day doing some physical activity, with time and practice we can experience a sense of well-being and keep our bodies moving.
Ritual and sleep conditions. To get a more restful sleep, we suggest setting a specific time to sleep and another to get out of bed. Likewise, we recommend restricting the use of electronic devices at least thirty minutes before bedtime, so a strategy that will help us fall asleep better is to read a book or physical document for pleasure. By following these recommendations we will be avoiding having problems that deprive us of a well-deserved rest. In addition to focusing on the quality of sleep, if you want to check how many hours of sleep are recommended according to your age, you can check the following link: https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times.
In addition, we recommend keeping a journal in which we identify our thoughts, emotions, and learning. Why is this important? Surely you have noticed that during certain moments you feel overwhelmed by a particular emotion, but later you feel completely different. By keeping track of our emotions, we will be more in touch with ourselves. This documentation will even be the best reference so that in the future we can review our notes that narrate how we live and overcome this situation. We even suggest that in this record you write down something new that you learned during the day. We see here another opportunity for personal growth.
Social networks are valuable tools to maintain our personal ties. Thus, we suggest a healthy virtual sociability, which includes asking about our loved ones, sharing the strategies we use and the concerns we have. This last point is especially relevant because waiting for mental health problems like anxiety or depression to go away on their own can lead to worsening symptoms. For this reason we can encourage asking for help when we need it. Learning to request support is an act of courage and humility, this being a recommendation that allows us to discover new tools and forge stronger human ties. In the long term, this action will be useful for us to be more aware of ourselves and also be more willing to help others when they need it.

The five shared suggestions can be opportunities to grow as people. The actions we take today will largely represent the memories we will have of this period. It is our responsibility to fight to create better habits that not only help us overcome the crisis, but also help us grow as people. We are ready to help you! Write us to find out how we can support you.

Bibliography

Mayo Clinic (2020). COVID-19 and your mental health. USA. Recovered from
https://www.mayoclinic.org/es-es/diseases-conditions/coronavirus/in-depth/mental-health-covid-19/art-20482731.

National Sleep Foundation (2015). National Sleep Foundation Recommends – New Sleep Times. Distrito de Columbia, Estados Unidos. Recuperado de https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times.

Alternatives under development for the treatment of resistant depression

Dr. Edgar Castillo Armas. Fresno, Calif.
Lecture given at the Clinical Conversation, October 29, 2019

One of the myths that exist in psychiatry is that mental illness or psychiatric illness is caused by an internal chemical imbalance. It is a myth that has persisted for many years and has been spread by psychiatric circles and other professional mental health groups. It’s a myth, because the American Psychiatric Association and others have never said that’s true. In 1978, the American Psychiatric Association issued a statement stating that psychiatric disorders result from the complex interaction of physical, psychological, and social factors, and that their treatment must be directed toward each of these three areas.

However, the pharmaceutical industry frequently presents an extrapolation of pharmacological studies applying them to pathophysiology, which cannot be done directly, because the neurotransmitter theory is quite limited and the results of interventions based on this theory cannot modify the neurotransmitter theory. basic causes of depression, but above all favor the improvement of certain symptoms found in severe clinical depression. In short, there is no mental health professional who can claim to have a universal understanding of clinical depression. Even with scientific advances to date, an absolute explanation is beyond comprehension. It is necessary to return to basic elements of human nature and explore in detail obvious but forgotten ideas that connect the essence of existential melancholy with the alteration of brain mechanisms.

Science and its technological advances explain to us that genetic vulnerability, traumatic brain accidents, inflammation, acute and chronic stress of physical and psychological origin, and alteration of brain circuits all contribute to the clinical expression of depression; however, the lack of effectiveness of the treatments needs explanation. For this, it is necessary to continue the investigation and resort to the social disciplines that were the framework of the brain disease that causes the greatest disability, a serious comorbidity and alarming suicide rates.

Clinical depression is a highly prevalent brain disease that causes enormous physical and mental disability worldwide. Clinical depression affects 350 million people in the world. The comorbidity of depression, which affects other organs and systems, has been demonstrated in mortality studies, pointing to cardiovascular disease as the most common cause of accelerated death in depression.

The connection between suicide, alcohol use and depression is well established and occurs in alarming numbers. There are more than 40 antidepressant medications that are used alone or in combination with mood stabilizers and antipsychotics. But referral rates remain well below 50%.
One reason that partially explains this outright failure is that primary treatment efforts have been aimed at being monoaminergic (serotonin, norepinephrine, dopamine).

Recently, there has been renewed attention to the role of other neurotransmitter and endocrine systems such as acetylcholine, glutamate, neurosteroids, and the endogenous opioid system in the core symptoms of depression.

Ketamine

Ketamine, in addition to blocking NMDA (N-methyl-D-aspartate) receptors, activates opioid peptides and receptors and therefore shows a very rapid antidepressant effect.

Endogenous Opioid System

Activation of the endogenous opioid system is strongly associated with positive behaviors and is modulated by positive experiences such as exercise, social interaction, laughter, gastronomic pleasure, and music.

This system also contributes to positive mood regulation, social rewards, such as enjoyment of certain activities, and resilience.

Neuro-Steroids

The neuro-steroid brexanolone has recently been approved by the FDA in the US as a treatment for postpartum depression. This steroid is chemically identical to allopregnanolone, an endogenous human hormone, and potentiates GABAergic action. Controlled clinical studies have established that, after a 60-hour intravenous infusion, administered over two and a half days, treatment with this compound results in marked improvement in symptoms of postpartum depression. The treatment, while still considerably onerous, has been reported with few side effects and virtually no serious risk.

Trans-Cranial Magnetic Stimulation

Since the early 1990s it has been known that repetitive magnetic stimulation of the brain resulted in cortical arousal. This has been in line with research results showing decreased prefrontal lobe activity in the brains of patients with symptoms of clinical depression. The obvious conclusion that needed to be demonstrated was that, using transcranial magnetic stimulation, the function of that region could be reactivated. A better understanding of the complexity of brain function and its relationship to other body systems is expanding the psychiatrist’s equipment for more effective treatment of depression.

It is no longer enough to use monoaminergic neurotransmitter theory alone to adopt a diagnostic/therapeutic algorithm that results in successful management of treatment interventions.
Promising new areas of research and exploration are signaling the waning era of monoamines and helping to disprove the myth of chemical imbalance as the cause of mental illness.

Interventions for the treatment of depression, without drugs.

These treatments have been shown to be effective for mood disorders and are supported by scientific evidence.

1. Exercise. The last thing a depressed person wants is to exercise, but it is well known that physical activity improves mood and provides a sense of well-being. This is accomplished in part by increasing certain neurotransmitters in the brain, further regulating the stress response.

2. Bright Light Therapy. This treatment involves using bright light to treat the symptoms of depression. Sleep disorders are a symptom present in depression and other mood disorders. This therapy helps regulate the circadian rhythm, activates and increases melatonin activity, and increases serotonin levels. Regulating the sleep pattern helps the person feel better.

3. Cognitive Behavioral Therapy (CBT). This is a type of “talk” therapy, as well as “behavioral” therapy, which involves assigning tasks to the patient. His focus is changing negative thought patterns, learning to redefine problems and finding new ways to deal with them.

4. Behavioral activation therapy (TAC). It is a type of Cognitive Behavioral Therapy, which has proven to be very effective for the treatment of depression. Guide the patient towards the understanding that his emotions are the result of his actions. He has helped patients with depression to identify activities that add meaning to their lives, such as reading, listening to music, doing volunteer work, visiting family and friends, etc. The patient is asked to perform these activities without expecting an improvement in his or her mood in return.

5. Training with Mindfulness. It consists of being intentionally attentive to what we do, without judging. Patients are taught to be attentive in simple things or activities of daily living. Mindfulness is practiced by eating, walking, paying attention to your breath, connecting with your senses, resting between activities, listening attentively with your heart and mind, and “losing yourself” doing what you enjoy most.

6. Transcranial Magnetic Stimulation (TMS). During the EMT session a magnetic coil is placed over the scalp in the left dorsolateral prefrontal region of the brain. This area is known as the humor area. Electromagnetic pulses pass through the skull to stimulate nerve cells, without causing pain. TMS helps normalize brain activity in circuits involved in depression. The treatment is non-invasive and anesthesia is not needed. In October 2008 the US Food and Drug Administration (FDA) approved the use of the first EMT equipment for the treatment of Major Depression.

Postpartum depression

Serena Williams talks about postpartum depression in an emotional message posted online

Serena Williams posted an emotional message on her social media in which she spoke candidly about motherhood and touched on postpartum depression.

“Last week was not easy for me. Not only was I coming to terms with some difficult personal things, but I was just in a [sad] slump. Mostly, I felt that I was not a good mother, “begins by saying the professional tennis player, who had complications in the delivery of her baby, in her writing published on her Instagram account.

The athlete opened up about postpartum emotions. “I read several articles that said that postpartum emotions can last up to three years if left untreated. I prefer better communication. Talking things through with my mom, my sisters, and my friends let me know that my feelings are totally normal. It’s totally normal to feel like I’m not doing enough for my baby,” she said.

Willams indicated that because of his profession he works a lot, that he has been with his daughter every day. Although she was honest when she said no for as long as she wanted. “We have all been there. I work hard, I train, and I try to be the best athlete that I can be. However, that means that even though I’ve been with her every day of her life, I’m not around as much as I’d like to be. Most of you mothers deal with the same thing. Whether you’re staying at home or working outside, finding that balance with kids is a true art. You are the true heroines. I’m here to tell you: if you’re having a tough day or week, that’s okay, so am I! There is always a tomorrow!” he said.

Fuente: People en Español