Treatment Recommendations for restoring Wellbeing
Recover where you live- Aware Recovery Care.
Velandy Manohar, MD
Medical director- Aware Recovery care- CT.
03 17 21
Key ingredients for my approach to the treatment of Major Depressive Disorder regardless of whether there are medications prescribed.
Let food be thy medicine, thy medicine shall be thy food. Hippocrates
What goes into your shopping Cart will surely go into your Heart. Velandy Manohar, MD
Context for my health promoting recommendations: Factors influencing health Outcomes: Medical Interventions 10%, SDoH 20%, Genetics 30%, Heath compromising behaviors 40%. We can reduce the risk of premature death and improving quality of life.
A diagram used by County Based Health Rankings and Roadmaps (Figure 1) shows the interaction between health outcomes, the SDoH, and policies and programs.
During the 52 weeks of treatment the three teams of treatment staff- Nursing, Family education and Recovery Advisors engage with our patients, family members and our community treatment partners- PCPs, Licensed Therapists of different disciplines who offer effective therapies including EMDR, Mindfulness based and Cog-Beh treatment modalities and Prescribers of MAT as well as Psycho therapeutic interventions including Medications, rTMS, Light Therapy and CAM.
A.
- Dietary choices- Please check out My Plate.Gov. The diagram consists of a circular plate and a cup. The cup represents Dairy of what-ever form. I prefer lower fat form, unsalted and unsweetened products.
The circular plate has 4 quadrants:a. Fruits b. Vegetables c. Protein Sources: [3 ounces- Chicken, Fish, Lean Meat], and d. Whole grain. Each of these constitutes 25 % of the plate. The food on the plate must be supplemented by a cup of Yogurt can be low fat containing live cultures of six specific bacteria. [more on this later.] These meals must provide a minimum of 24 G of Fiber. Develop a habit of shopping and consuming food based on recommendations published in Choosemyplate.Gov website. MGH- Mind, Mood and Memory Vol#13, #2, February 2019 Mediterranean-Style Diet may be best to help fight depression. 2017 Smiles study after 12 weeks the diet group showed greater reduction in symptoms of Depression and Anxiety. In-addition, raw fruits and Vegetables in their uncooked states are helpful to one’s mental health. A study in 2018 Frontiers in Psychology showed that an intake of raw fruits and vegetables is associated with better mental health. These ten Vegetables are particularly helpful: Carrots, Bananas, Apples, Dark Leafy Vegetables, [e.g. spinach] grapefruit and other citrus fruits, fresh berries, Cucumber and Kiwi. Avoid Juices- Consume five servings of fruits and vegetables a day. Include 28-30g of Fiber, Include Probiotic, and Fermented foods in your diet, e.g. Kim Chi, Kombucha, Kefir, Yogurt, Miso, and Sauerkraut.[ Kindly refer to SENSS health promoting acronym on Page 9 and Addendum on Page 11]
2. Address Bowel Dysbiosis effectively starting now and continue to sustain these efforts: Study about Bowel Dysbiosis and the effective countermeasures by studying Dr. David Perlmutter’s- Brain maker- a 8 CD Audio Book published in 2015. The 8th CD has a PDF with charts and tables as well as food plans and recipes. It is vital to start to make the Bowel Biota a more health supporting environment by changing Dietary habits as recommended. The six specific bacterial colonies that need to be making your bowel their habitat is: L. Acidophilus, L. Casei, L. Thermophillus, L. BifidoBacteria, L. Bulgarigus and BB12. These are available in the Stop and shop Yogurt. These six bacteria are labelled on the container.
Study finds high-fiber diet brings significant changes to human gut microbiome | MDLinx
Dietary fiber consists of resistant carbohydrates found in fruits, vegetables and whole grains. Fiber persists in our digestion system, and while not digestible by humans, our gut bacteria can metabolize fiber into short-chain fatty acids and other byproducts critical to human health
- Turmeric 300mg [USP] I BID p.o. daily. It is possible by augmenting the efforts to address significant health threats [by implementing recommendations in F. 1,2 and 3.] posed by the unhealthy micro-organisms which constitute Bowel Biota to the Cardio-Vascular System, Inflammation of Tissues in diverse organisms, intensity and trajectory of Depression, Insulin Resistance, Joint and Skin auto-immune disorders.
- Deplin [L-Methyl Folate] 15 mg p.o. /day: This form of Folic Acid crosses into the Brain and facilitates the regeneration of NAD- Nicotinamide Adenine Dinucleotide by supplementing the actions of the key enzyme Methylene Tetra Hydro Folate Reductase [MTHFR]. Some individuals are at risk of not being able to provide the chemical radicles to serve the purpose of regenerating NAD because of the gene Alleles coding for MTHFR they inherited. NAD plays a key role in the repair of RNA. This is important because RNA controls the functions of the Mitochondria – the powerhouses in the cell and the functions of Tri Monoamine Modulator. [this refers to the monoamines- DA, NE and 5HT]
There are Bi-Directional Neural, Endocrine and Immune system interactions between the Bowel and the Brain and components of the Immune System. There 100,000 nerve connection in the Abdomen. The Vagus nerve [ Sensory and Motor branches as well as the Sympathetic Nervous system affect the type and intensity as well as consequences of our responses to Stress and inflammatory Cytokines e.g. TNF alpha, IL1 B and IL 6. In addition, it is important to consider the fact that Adipocytes and the Bowel Biota are packed with more genes than the ones packed into our 23 pairs of Chromosomes we inherit form our parents which greatly magnifies its impact on our health and wellbeing.
5. Plant Sterols: Plant sterols are a group of substances made in plants. Plant sterols are found in the highest amounts in foods like vegetable oils, nuts, and seeds. Plant sterols are used as medicine in combination with Cholesterol lowering drugs and Fat lowering diets. When taken in people who are also following a low-fat or cholesterol-lowering diet, plant sterols can reduce total and "bad" low-density lipoprotein (LDL) cholesterol more than the diet alone. Plant sterols don't decrease blood fats called triglycerides or increase "good" high-density lipoprotein (HDL) cholesterol levels.
Adults: By mouth:
For reducing cholesterol levels in adults with an inherited tendency toward high cholesterol (familial hypercholesterolemia): 1.6-1.8 grams of plant sterols per day for 8-26 weeks have been used.
For high cholesterol: 200 mg to 9 grams of plant sterols per day have been tried. However, doses above 2-3 grams per day don't seem to work any better than 2-3 grams per day.
Children: By mouth:
For reducing cholesterol levels in children with an inherited tendency toward high cholesterol (familial hypercholesterolemia): 1.6-2.3 grams of plant sterols per day have been used in children 6-16 years-old.
Plant sterols are usually taken along with a low-fat diet
B. Psychotherapies:
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001454
Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis. PLOS Jürgen Barth and colleagues Published: May 28, 2013.
Seven Kinds of Psychotherapy Help Depression Study Says. By Laurie Sue Brockway
“Psychotherapy is effective to treat depression and there are several treatments available with comparable efficacy,” said lead researcher Jürgen Barth, Senior Researcher, from the University of Bern, Institute of Social and Preventive Medicine, in Switzerland. “Pharmacological treatments are also effective, but side effects and patient preferences have to be included in treatment decisions. Psychotherapy is one additional treatment option with moderate to large effects.
The myriad therapy models and approaches available sometimes make the choice of therapy confusing or even intimidating to the consumer. Researchers looked at multiple kinds of therapies and concluded they all offered help. They also assessed that psychotherapy is underutilized and stigmatized, making many people shy about seeking help.
“There is strong support (from other studies) that psychotherapy is underutilized. The recommendation of a psychotherapeutic intervention is highly stigmatized," said Barth. "Public health interventions and campaigns should work on this. And we totally agree that psychotherapy has often the touch of 'magic,' 'myths,' and 'art work.” However, psychotherapy is a health care intervention, which can be learned, which is effective and can be delivered to a lot of patients.”
The seven specific therapies that were included and compared in this study are: Interpersonal psychotherapy, behavioral activation, cognitive behavioral therapy, problem solving therapy, psychodynamic therapy, social skills training, and supportive counseling. Barth said these were the models that showed up most frequently in the literature they analyzed and that the popularity of these seven selected therapies is likely driven by health policy, health insurance issues, and availability of treatment in specific countries.
The therapies are described this way:
Behavioral activation (ACT) attempts to help depressed people reengage in their lives through focused activation strategies. It attempts to counter patterns of avoidance, withdrawal, and inactivity and may include scheduling pleasurable events.
Cognitive behavioral therapy is aimed at evaluating, challenging, and modifying a patient’s dysfunctional beliefs and teaches patients new ways of coping with stressful situations through short-term therapy that includes homework assignments.
Interpersonal psychotherapy (IPT) is a brief and highly structured psychotherapy that focuses on problem areas and addresses interpersonal issues in depression.
Problem-solving therapy (PST) aims to define a patient's problems, propose multiple solutions for each problem, and then select, implement, and evaluate the best solution.
Psychodynamic therapy (DYN) focuses on past unresolved conflicts and the impact they have on a person's current situation.
Social skills training (SST) clients are taught skills that help to build and maintain healthy relationships based on honesty and respect.
Supportive counseling (SUP) is defined as any unstructured therapy without specific psychological techniques other than those common to all approaches, such as helping people to ventilate their experiences and emotions and offering empathy.
Getting Beyond Medication as a Singular Solution
Our modern culture has become accustom to trying to “fix depression” with medication, often skipping over therapy altogether. Patients may not think to ask their doctors about therapeutic interventions.
“Therapy is not easy. It is not quick, and it cannot 'fix' every problem or issue,” said Reiss. “Psychotropic medications can rather quickly suppress symptoms, but medication cannot even begin to address psycho-social issues, family/relationship issues or personality/character issues. The general, culturally-accepted and understandable wish for a 'quick fix' has led to an over-valuation of psychopharmacological intervention – which definitely can be helpful but is rarely definitive.”
“He said the best approach may be both therapy and medicine. “There is very strong evidence, both from formal studies and through clinically experience, that the most effective treatment is a combination of appropriate psychotherapeutic intervention well-integrated with judicious prescription of psychotropic medications,” said Reiss.
“Unfortunately, mental health care is more complex than a solution in a bottle. Even with effective medications, mental health difficulties often involve unhealthy thought processes, emotional factors, and behavioral patterns that serve to maintain the problem.”
“Even if medication can effective manage the problem for a period of time, “she added, “without therapy to learn what about their functioning is maladaptive and how to develop more adaptive patterns, the individual is not likely to maintain any therapeutic gains.”
C. Exercise
1. Walking: A total of 30 minutes a day or a minimum of 3.5 hours a week is also very useful in mood management and improving Insulin related physical and mental consequences of Insulin resistance. Depression for various reasons aggravates Insulin resistance and can contribute metabolic syndrome just as Schizophrenia does leading to increased Dementia and premature deaths due heart and vascular consequences. Exercises have positive effects on Brain opiates.
D. Assessment
Please remember to use PHQ - 9 at baseline and every 4- 6 weeks and evaluate total score, score on Question 9 [suicidal intent] and self- assessment of perceived disease burden on patient’s life activities is very helpful to identify suicide risk and intervene to improve mood if the trend is towards a relapse.
E. Exposure to Sun and Light Boxes. Exercising, walking, running or performing Tai Chi in the Sunlight between 6-8AM can be health promoting measures.
The decision to use a Light Box is best if a Physician, APRN are involved in the research and decision-making process involved in leasing or purchasing the Light Box.
It is vitally important to design your individualized game plan starting now before the need arises for active treatment with medications or other interventions for depression as the days are getting shorter and light exposure is much less available currently of the year.
Check with your Psychiatrist, or Mental Health APRN or PCP about the initiation of intervention by exposure to specific therapeutic Light Boxes.
The Light therapy used for treating Skin diseases e.g. Psoriasis is very different form light sources used for treating Mood disorders. The Light source for Depression should have UV and blue light blocked as much as possible.
The Light Box exposure treatment can be part of a basket of strategies including components listed above. Everyone must take the initiative to design an effective combination of counter- measures to avoid emotional, behavioral and cognitive disorders. It may be possible to reduce doses of anti-depressants if the daily exposure to 10,000 Lux light at 24 inches begins to take effect and improve concentration, cognitions, sleepiness, Low energy and mood.
There are three Key Elements of exposures to Light Boxes that determine the outcomes.
- Intensity of Light: This is expressed as Lux. The most effective brightness is 10,000 Lux. This needs to be absorbed at 24 inches. Think of using a UV screen and goggles for blue light to get the best results from the longer wave band of the light transmitted from the Light Box.
- Duration: Check with Manufacturers guidelines and your Doctor’s advice on how much Lux is delivered at 24 inches. If this is feasible reliably then you need to be exposed only for 30 minutes between 6-8AM. Lower Light exposure will necessitate longer exposure.
- Timing: For most Individuals exposure to the 10,000 Lux from a light Box and or Natural Sunlight for a half an hour [or longer for Natural Sunshine] is most beneficial when this occurs between 6-8AM. There are other strategies to manage body clock disruptions with people working on rotating shifts or those who have sleep phase advance and begin to fall asleep in the late afternoon.
Do not start Light therapy if you have diseases [including your Skin and Eyes] that increase Light sensitivity, or you are taking medications that do the same.
It is prudent to avoid the use of Light Boxes if there are reasons to believe that your mood disorder could be a Bi-polar disorder e.g. Family history of Bi Polar disorder, or Personal history of Post-Partum Depression, or a switch to a Bi-Polar syndrome after taking an Antidepressant or Stimulants or Steroids. Schizo-Affective disorder- Bipolar disorder. It can be helpful for treating SAD and Major Depressive disorder.
F. With or without being paired with music Mindfulness Yoga, Tai Chi, can make positive changes in outlook.
G. Please see on page 3 of the Addiction Psychiatrist assessment form that I have been using and find a list of I think of 5 lifelong practices that may include some of elements mentioned in Sections which are very helpful practices for self-management of mood and cognition.
H. If there are no medical disorders like Cardio-Vascular disorders and Thyroid disease and patient is clean and sober it may be a good strategy to add a combination of Venlafaxine and Wellbutrin because these modulate the brain chemicals I mentioned in section III. It is very important to strike the right dose without generating distressing and even dangerous side effects. This combination may have less impotence and obesity risk. It is very important not to start and stop these meds and keep switching and experimenting. It is important to participate in Integrated Care model of care with our Community Partners.
Sometimes if there is Treatment Resistant Depression, we need to make a measured decision and consider options outside of endless consecutive and concomitant combos of 3-4 medications by obtaining genomic Testing to optimize the choice of medications. Combos of Ice cream flavors is good especially in summer for Baskin Robbins bout endless changes are bad metabolic, mentally, educationally, vocationally and socially for patient prefer to avoid Abilify at low dose unless there is documented Treatment resistant depression. Likewise, Seroquel and the interesting combination of Zyprexa and Prozac in the very same pill can help people who have serious depression gnawing away at them from head to toe isolating and demolishing their lives and relationships.
I. rTMS. This is proven treatment for MDD. It is NOT Electroshock treatment. It is done at an office in a recliner. Dr. Okasha in Norwich, CT is experienced with rTMS. Dr. Lori Calabrese also offers this treatment. There are people in Yale and Hartford hospital/ Institute of Living who offer rTMS.
J. IV infusion of Ketamine. Is an exceptionally fast way of relieving symptom of Major Depression. Dr. Lori Calabrese does this kind of treatment.
K. We will need a panel of treaters 1. Achieving and maintaining sobriety including weed. 2. PCP to guide and sustain health promoting efforts. 3. Prescribing MH clinician including specific experts to manage Medication Assisted Treatment of Addiction Disorders, 4. Personal Recovery Coach, 5. Personal trainer etc. for safely negotiating heathy exertions, 6. finding concierge type person to schedule and get patient in volunteering, taking care of pets, habitat for humanity, clearing ground for parks etc., acting or pursuing some attractive- relatively speaking activities.
L. Neuroimaging may help in determining the best first-line treatment for patients with major depressive disorder (MDD), a new study suggests.
Results showed that pretreatment brain activity in the right anterior insula on positron emission tomography (PET) predicted whether depressed patients would best achieve remission with an antidepressant or cognitive-behavioral therapy (CBT).
"Our goal is to develop reliable biomarkers that match an individual patient to the treatment option most likely to be successful, while also avoiding those that will be ineffective," Helen Mayberg, MD, of Emory University in Atlanta, Georgia, who worked on the study, said in a statement.
The study, funded by the National Institutes of Health, was published online June 12 in JAMA Psychiatry.
They used fluorine-18 fluorodeoxyglucose (FDG) PET to measure brain glucose metabolism at rest in a group of patients with MDD prior to random assignment to Escitalopram (10 - 20 mg/day) or 16 sessions of CBT for 12 weeks
The role of the anterior insula in major depression is well established. The anterior insula is known to be important in regulating emotional states, self-awareness, decision-making, and other thinking tasks. Changes in insula activity have been observed in studies of various depression treatments, including medication, mindfulness training, vagal nerve stimulation, and deep brain stimulation.
Dr. Mayberg has received consulting and intellectual property licensing fees from St. Jude Medical. A complete list of author disclosures is given in the original article.
JAMA Psychiatry. Published online June 12, 2013. Full article
M. Strengthening Vagal Tone to augment recovery and improves quality of life. The Vagus nerve is the prime component of the parasympathetic nervous system which regulates the “rest-and-digest” or “tend-and-befriend” responses. On the flip side, to maintain homeostasis, the sympathetic nervous system drives the “fight-or-flight” response. Healthy Vagal Tone Is Part of a Feedback Loop Linked to Positive Emotions.
Healthy vagal tone is indicated by a slight increase of heart rate when you inhale, and a decrease of heart rate when you exhale. Deep diaphragmatic breathing—with a long, slow exhale—is key to stimulating the Vagus nerve and slowing heart rate and blood pressure, especially in times of performance anxiety A higher vagal tone index is linked to physical and psychological well-being. Conversely, a low vagal tone index is associated with inflammation, Depression, negative moods, loneliness, heart attacks, and stroke. Clinical and experimental studies indicate that Stress and Depression are associated with the up-regulation of the immune system, including increased production of pro-inflammatory Cytokines. When administered to patients or laboratory animals, cytokines have been found to induce typical symptoms of depression. Therefore some cases of low mood, low energy, and lack of motivation may be due to elevated levels of cytokine proteins. The Vagus nerve can inhibit the production of these Cytokines by directly influencing the function of T cells in the Spleen.
N. There are Bi-Directional Neural, Endocrine and Immune system interactions between the Bowel, the Brain including the Hypothalamus, Pituitary gland, Limbic system, Endocrine system, and components of the Immune System. There 100,000 nerve connection in the Abdomen. The Vagus nerve [ Sensory and Motor branches as well as the Sympathetic Nervous system affect the type and intensity as well as consequences of our responses to Stress and inflammatory Cytokines e.g. TNF alpha, IL1 B and IL 6. In addition, it is important to consider the fact that Adipocytes and the Bowel Biota are packed with more genes than the ones packed into our 23 pairs of Chromosomes we inherit form our parents which greatly magnifies its impact on our health and wellbeing.
- A 2010 study, “How Positive Emotions Build Physical Health: Perceived Positive Social Connections Account for the Upward Spiral Between Positive Emotions and Vagal Tone,” was published in Psychological Science. Barbara Fredrickson and Bethany Kok honed in on the Vagus nerve and discovered that a high Vagal tone index was part of a feedback loop between positive emotions, physical health, and positive social connections. Their research suggests that positive emotions, robust social connections, and physical health influence one another in a self-sustaining upward spiral dynamic and feedback loop that scientists are just beginning to understand.
Healthy vagal tone is indicated by a slight increase of heart rate when you inhale, and a decrease of heart rate when you exhale. Deep diaphragmatic breathing—with a long, slow exhale—is key to stimulating the Vagus nerve and slowing heart rate and blood pressure, especially in times of performance anxiety. Frederickson and Kok used a Loving-Kindness Meditation (LKM) technique to help participants become better at self-generating positive emotions. However, they also found that simply reflecting on positive social connections and working to improve close-knit human bonds also caused improvements in Vagal tone.
Thus, we return to the Contextual frame of reference upon which these ten recommendations are founded*. It is increasingly accepted by the Medical Community and the public that these two organ systems the Brain [and Nervous System] and the Bowel influence each other in many ways. Stress and Bidirectional Neural Immune interactions involving these Organ Systems play significant roles in the development of Obesity, Heart Disease, Cancer, Depression and Type II Diabetes by affecting the Pancreas.
For most people, what they consume - eat, drink, inhale, chew affects their Emotions, Behavioral patterns and Thinking faculties in real time and over longer spans of their lives. Therefore, we are offering a health promoting protocol consisting of 10 tasks you can commit to making these activities part of your life starting today and play an active role in promoting your health and do what you can with the assistance of your family to reduce the risk of Accidental Deaths and Overdoses, Heart Disease, Cancer, Stroke COPD. [See above]
The best results will accrue to those who pursue health promoting goals if this combination of strategies is adopted and implemented.
S: Social connections with people who provide warm wafting wind beneath your wings.
E: Exercise: three types/ options: stretching, strengthening, walking running, swimming. Total time minimum 150 minutes a week
N: Nutrition: Consider adopting the diet from My Plate.Gov plus the Yogurt with the six healthy bacteria. [Please refer to Addendum on Page 11]
S: Stress management: Deep breathing, Yoga, Meditation, Metta – Loving Kindness prayer, Tai Chi etc. Stress management becomes more effective if self- care and social connectivity are combined with health promoting choices with respect to Nutrition and Exercise and adoption of a Positive Psychology mind set which will build resilience.
I offer two sets of Resources:
- Immune System Resources
- Immune System Problems: Signs and Symptoms (webmd.com)
- What Doctors Do to Boost Their Immune Systems (webmd.com)
- Most Common Infectious Diseases in the U.S. in Pictures (webmd.com)
- The Human Immune System Explained (webmd.com)
- Inflammation Resources
- Top 5 Blood Tests For Inflammation - DrJockers.com
5 Ways To Reduce Inflammation Quickly - DrJockers.com
- 5 Ways To Reduce Inflammation Quickly.
S: Self- Care/Self -Compassion can be experienced by adopting and practicing various Buddhist chants, and meditations from other faith traditions including Christianity e.g. Gregorian Chants as well as Hindu, Jain, Muslim and Sikh prayers, massage, healthy Sleep hygiene while eschewing smoking Tobacco, Alcohol, other drugs of abuse with the use of specific formulations of Cannabis-derived Alkaloids for medical reasons being an exception that I have come to accept. I leave it up to my readers to make their own informed decisions on this Drug.
I offer educational materials at all different levels to enhance the level of engagement and effectiveness in practicing the different forms of Contemplative strategies of integrating mind – body process involved in health and wellbeing, illness and dis-ease, resilience and recovery.
1. The Mind of a Meditator- Contemplative Practices that extend back thousands of years show a multitude of benefits for both body and mind. By Ricard. M., Lutz. A., Davidson. R.J. Page 39, Nov. 2014, Scientific American.com
2. Practicing Mindfulness: An Introduction to Mindfulness, by Muesse. M.W. Copy Right- The Teaching Company.2011. The Great Courses. 24 lecture, CD or DVD, Guide book and optional Course transcript.
3. The Science of Mindfulness: A Research- Based Path to Well-being by Siegel. R.D., Copyright 2014. The Great Courses. 24 Lectures CD or DVD with Course Guidebook and or Course Transcript.
4. Quieting Reflex: This is a useful book if you want to fairly quickly learn and use successfully in various everyday situations. It is fairly easy to teach and learn and use. “The technique, says Stroebel, whose book QR: The Quieting Reflex (G.P. Putnam's Sons, $12.95) has just been released, is more complicated than it sounds. This isn't a six-second fix for stress," Stroebel warns. "You have to make a commitment to learn QR, which takes adults about six months before it becomes authentic." (Children, he says, have less accumulated stress and need only half that time.). It is important to note that the late Dr. C. Stroebel MD is acquaintance and colleague. The first step, he says, is for the tension sufferer to be aware of his own condition. "Many people have become so used to stress," he observes, "They don't know when it's happening." Second, the subject should say to himself, "Alert mind, and calm body." This, Stroebel explains, "arouses your sense of self-mastery and shows your brain it doesn't have to be at the mercy of a body that's always in passing gear." Third, smile inwardly to relax facial muscles. Fourth, relax the temporomandibular joint (the jaw's hinge) and inhale while counting to three, imagining the air coming in through the soles of the feet. Next, attempt to feel the air coming up through the legs and into the stomach and abdomen. Finally, he should exhale, letting his jaw, tongue and shoulders go limp and feeling the warmth and heaviness leave the body. Charles Stroebel received a Ph.D. in physiological psychology from Minnesota in 1961 and received his M.D. from Yale in 1973. His remedy for the torment he'd been through: a six-second exercise he calls the Quieting Reflex. He developed it in 1974 after experimenting with both Transcendental Meditation and biofeedback” Mary Vespa, June 21, 1982 Vol 17, No. 24. People
5. One of the best single books on the process of recovery from Depressive Disorders {Depression is not an Unitary Disorder] is this book by a pioneer in Integrative Medicine –James Gordon, MD – Director of CMBM- The Center for Mind-Body Medicine. A non-drug approach to the treatment of depression is the focus of Unstuck: Your Guide to the Seven-Stage Journey out of Depression. In his latest book Gordon outlines his preferred depression treatment—a “healing journey” that includes “mind-body” techniques such as meditation, guided imagery, physical exercise, and acupuncture. This book will challenge the prevailing “medical model” of depression and the widespread, even epidemic, use of chemical antidepressants. This narrow model of diagnosis and treatment insists that those who feel helpless and hopeless, unhappy and uncertain have a disease, like insulin-dependent diabetes, that requires a pharmacologic treatment. I’ll offer you evidence that strongly suggests that this model is poorly justified, largely inappropriate, limited and limiting, and, often enough, dangerous to your physical, emotional, and spiritual health. James Gordon, MD.I advocates a multimodal approach including the judicious and focused use of Medications of various categories. (I don’t select a medication based on the name of a category of drugs to which it is assigned, e.g. Anti-Anxiety, Anti-Psychotic, and Anti-Depressant. VM)
Velandy Manohar MD
Medical Director- Aware Recovery Care, President- In-Home Addiction Treatment, PC.
Distinguished Life Fellow- Am. Psychiatric Association [APA]
Member Governance Committee of Consumer Advisory Board- Office of Health Strategy-CT
CT State Medical Society: Member: Quality of Care, Ethics and Disaster Preparedness Committees,
Founding Member- Psychotherapy Caucus- Am Psychiatric Society, Steering Committee member until 2018
Founding Member- Community Resilience Collaborative-Mx. County-CT
Steering Committee- National Physician Alliance- CT
Addendum:
A.
- MDD is comorbid Factor in multiple chronic disorders Including Cardiovascular, Hypertension, Stroke, Type 2 DM and Cognitive Decline.
Let food be thy medicine, thy medicine shall be thy food. Hippocrates
What goes into your Grocery Cart will surely go into your Heart. Velandy Manohar, MD
https://www.ncbi.nlm.nih.gov/pubmed/16512963
Public Health Nutr. 2006 Feb;9(1A):152-7.
Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. AHEI
CONCLUSIONS:
The AHEI was twice as strong at predicting major chronic disease and CVD risk compared to the original HEI, suggesting that major chronic disease risk can be further reduced with more comprehensive and detailed dietary guidance.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147775/
World J Psychiatry. 2018 Sep 20; 8(3): 97–104.
Published online 2018 Sep 20. doi: 10.5498/wjp.v8.i3.97 PMCID: PMC6147775 PMID: 30254980
Antidepressant foods: An evidence-based nutrient profiling system for depression
RESULTS
- Twelve Antidepressant Nutrients relate to the prevention and treatment of depressive disorders:
Folate, [There is evidence in support for use of Deplin [L-Methyl Folate 15 mg/day for alleviating Depression]
Vitamin B 1, Vitamin A, Vitamin B6, Vitamin B12, Vitamin C, Iron, Magnesium, Potassium, Selenium,
Long-chain omega-3 fatty acids (EPA and DHA),
The highest scoring foods were:
Bivalves such as oysters and mussels,
Various seafoods, and Organ meats for animal foods.
- The highest scoring plant foods were:
Leafy greens, Lettuces,
Peppers, and
Cruciferous vegetables.
CONCLUSION
The AFS is based on a nutrient profiling system devised to identify foods with the highest nutrient density of nutrients with clinical evidence to support their role in depressive disorders. This list of foods and food categories with the highest density of the 12 Antidepressant Nutrients, the Antidepressant Foods, should be considered by researchers in the design of future intervention studies and clinicians as dietary options to support prevention and recovery from depression disorders
B.
I offer you these links to become familiar with diets that can be helpful to achieve good health and maintain your functional capacity physically emotionally and Cognitively
- MDD is comorbid Factor in multiple chronic disorders Including Cardiovascular, Hypertension, Stroke, Type 2 DM and Cognitive Decline.
https://www.ncbi.nlm.nih.gov/pubmed/16512963
Public Health Nutr. 2006 Feb;9(1A):152-7.
Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. AHEI
CONCLUSIONS:
The AHEI was twice as strong at predicting major chronic disease and CVD risk compared to the original HEI, suggesting that major chronic disease risk can be further reduced with more comprehensive and detailed dietary guidance.
2. MDD is comorbid Factor in multiple chronic disorders Including Cardiovascular, Hypertension, Stroke, Type 2 DM and Cognitive Decline
https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
Dietary Approaches to Stop Hypertension DASH
DASH is a flexible and balanced eating plan that helps create a heart-healthy eating style for life.
The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:
- Eating vegetables, fruits, and whole grains
- Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
- Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
- Limiting sugar-sweetened beverages and sweets.
- Health.harvard.edu/blog/the-dash-diet-a-great-way-to-eat-foods-that-are-healthy-and-delicious-2019072517326
- . and Cognitive decline
Mediterranean Diet Am. Heart Assoc
https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/mediterranean-diet
Mediterranean diet is a generic term based on the typical eating habits in the countries that border the Mediterranean Sea. Elements include dairy products, fish and poultry being more common than red meat; fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds; use of olive oil; wine consumed in low to moderate amounts. These diets have similarities to the American Heart Association's dietary recommendations, except a relatively high percentage of calories in Mediterranean-style diets come from fat.
What is the "Mediterranean" diet?
There's no one "Mediterranean" diet. At least 16 countries border the Mediterranean Sea. Diets vary between these countries and also between regions within a country. Many differences in culture, ethnic background, religion, economy and agricultural production result in different diets. But the common Mediterranean dietary pattern has these characteristics:
- high consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
- olive oil is an important monounsaturated fat source
- dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
- eggs are consumed zero to four times a week
- wine is consumed in low to moderate amounts
The Final Word
Research continues to show the Mediterranean Diet, based on healthy foods and physical activity, is the best prescription for a long, healthy life. It is an excellent, enjoyable diet plan that is easy to follow, and flexible.
- MDD is comorbid Factor in multiple chronic disorders Including Cardiovascular, Hypertension, Stroke, Type 2 DM and Cognitive Decline.
https://health.usnews.com/best-diet/flexitarian-diet
What is The Flexitarian Diet?
Flexitarian is a marriage of two words: flexible and vegetarian. The term was coined more than a decade ago, and in her 2009 book, "The Flexitarian Diet: The Mostly Vegetarian Way to Lose Weight, Be Healthier, Prevent Disease and Add Years to Your Life," registered dietitian Dawn Jackson Blatner says you don't have to eliminate meat completely to reap the health benefits associated with vegetarianism – you can be a vegetarian most of the time, but still chow down on a burger or steak when the urge hits. By eating more plants and less meat, it’s suggested that adherents to the diet will not only lose weight but can improve their overall health, lowering their rate of heart disease, diabetes and cancer, and live longer as a result.
5. MDD is comorbid factor in Cognitive Decline irrespective of other comorbid factors.
https://health.usnews.com/best-diet/mind-diet
What is MIND Diet?
This diet has been reviewed by U.S. News' team of expert panelists. Learn more »
The MIND diet takes two proven diets – DASH and Mediterranean – and zeroes in on the foods in each that specifically affect brain health, which may lower your risk of mental decline, according to initial research.
And though there’s no surefire way to prevent Alzheimer’s disease, eating healthful mainstays such as leafy greens, nuts and berries may lower a person’s risk of developing the progressive brain disorder.
The MIND diet, which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay, was developed by Martha Clare Morris, a nutritional epidemiologist at Rush University Medical Center, through a study funded by the National Institute on Aging and published online February 2015.
The study found the MIND diet lowered Alzheimer's risk by about 35% for people who followed it moderately well and up to 53% for those who adhered to it rigorously. And while more study is still needed to better understand the long-term impact of the diet, her team’s second paper on the MIND diet notes that it’s superior to the DASH and Mediterranean diets for preventing cognitive decline.
Velandy Manohar, MD