"Stepped care treatment for depression and anxiety in primary care: A randomized control trial"

In this blog I will discuss an important Research published in July 2011, Netherland, about the relevance of a better managed and structured non-pharmacologycal treatment in primary health for depression and anxiety disorders. I have talked in previous posts that treatment is very important in order to reduce symptoms and eventually curing these mental diseases. This Study aims to examine the effectiveness of a "Stepped base model in primary care via a randomized controlled trial for patients with depressive moods and anxiety disorders. Moreover, it also aims to track the reduction of symptoms, recovery and speed of recovery. So, this Stepped care model could provide a solution for the problem of applying effective evidence-based care for depression and anxiety in primary care through its objective of initiating interventions at the right time and as adequately as possible.

The methodology consisted in randomizing 60 patients out of 120, aged 18-65 for a different kind of assestment model, rather than the primary usual care.The main and core elements of the Stepped care model is the presence of a care manager who is responsible for managing the care that the patient receives. Also, the establishment of a more integrated cooperation between primary care and especialized mental health care. This model is based in four steps. The first step is the one of "watchful waiting" where the patient gets no treatment for four weeks in order to see if he/she recovers in that time. If this is not the case (patient still has symptoms), we progress to the second step which is that of "guided self help" where the patient gets treatment but he/she works on his/her own. In all stages, patient is always being monitored. If this does not work for the patient, he/she gets to step number three: "face to face problem solving". In this step, the patient gets short psychological interventions. FInally, it there is no improvement, the four and final step is "pharmacotherapy and referral for a specialized mental health care". The sample size was 120 patients, who were randomly divided into two groups and one group was given the care as usual whereas the other 60 were treated under the Stepped model. Patients were monitored every eight weeks.


The results of this study were that the symptoms of depression and anxiety decreased overtime for both goups. However, there was no statistically significant difference between the two groups. The largest, but not significant, effect (d = -0.21) was found for anxiety. In both groups approximately 48% of the patients were recovered from their DSM-IV diagnosis at the final 6 months assessment. In other words, there was no difference between using the model or the care as usual.

In summary the Study could not demonstrate that stepped care for depression and anxiety in general practice was more effective than care as usual. This model, with recruitment through screening in patients with mild disorders is not a good methodology. For further research on stepped care we recommend recruitment of patients via referral of the GP. Studies on care models and complex interventions are of increasing importance because they provide effective health care.

I think that this study is relevant because we learn that it really does not matter the different ways of assesing a patient but what matters is the willingness of a doctor and patient to commit and work as a team in order to alliviate the problem. We can see with this research that even though half of the sample were being more monitored, the symptoms were equally reduced for them than for the other group where this close monitoring did not happen. With this result, we can also conclude that it is on each person to seak for the best treatment for them, sometimes what works for some will not work for everyone and it is important that communication between patient and doctor is effective to properly decide on the best way of treatment.

References:
1. Wike Seekles1, Annemieke van Straten1, Aartjan Beekman, Harm van Marwijk, Pim Cuijpers1,. July 2011. "Stepped care treatment for depression and anxiety in primary care A randomized controlled trial". Retrieved fromhttp://www.trialsjournal.com/content/pdf/1745-6215-12-171.pdf

EXERCISING THE BODY KEEPS THE MIND FIT

In this post I will talk about how exercise and physical activity are closely related to mental health. What if one therapy could help ward off addiction, depression, stress and even Alzheimer's, all that while keeping you slim and feeling great? What if mental-health "treatment" is as close as your own two feet -- exercise.
"Exercise improves blood flow to the brain, it helps the body detoxify, it puts you on a better cycle of physical behavior, and it leads decreased stress. It also improves thinking and mental function and decreases your tendency toward addiction," said Dr. Marc Siegel, an internist at New York University Medical Center and an associate professor of medicine at the NYU School of Medicine in New York City. With each new study, experts are getting a better understanding of the intimate connection between the health of the body and that of the mind. And exercise -- the body's key method of staying healthy -- appears to be crucial to mental health, too. For example, "there's evidence that exercise is maybe the best non-pharmacological antidepressant -- studies have shown that it works better than some drugs. It's also a great anti-anxiety intervention," said James Maddux, a professor of psychology at George Mason University in Fairfax, Va., and an expert on the mind-body health connection. Aerobic exercise such as running or swimming can lead to a healthy release of the body's natural opiates, neurochemicals called endorphins. These are natural stress-busters, Siegel said, but exercise's impact on stress goes "way beyond endorphins."
Exercise is a ritualistic activity that redirects your energy, stress is a build-up of inactivity, of over-thinking without release, but exercise gives you a physical release that diminishes that psychic frustration.
For many people, exercise also provides a valuable sense of control over their physical health. "It's that sense of a loss of control that can lead to stress, And physical activity - especially when individuals join sports clubs, teams or have workout partners - also increases socialization, which has been proven to boost mental and physical health and increase lifespan. I would like to share this video in which we are explained what happens in our brain when we exercise.



Regular workouts may even help smokers beat their addiction, researchers say.
For example, one study from Brown University found that women looking to quit smoking who engaged in a vigorous exercise program were more than twice as likely to have stayed away from cigarettes for at least one year, compared to women who simply took part in a smoking-cessation program without exercise.
The Brown team believes that exercise may have helped smokers deal with the stress of quitting. As an added bonus, the study also found that exercising ex-smokers were able to stave off much of the weight gain typically associated with quitting smoking.
One recent U.S. study found that seniors who engaged in some form of minimal exercise at least three days a week cut their risk of developing Alzheimer's and other forms of dementia by as much as 30 percent to 40 percent.
So, the advice from experts: Get out there, and get active.

In conclusion,exercise is clearly a discipline or ritualistic activity that you can use to break your cycle of worry and get on a path toward better health.
Finally, I would like to share another video where Professor Nelson explains that exercise helps your brain!.





References:
1. Brawly L.R. April 2006. Research update. retrieved from: http://www.alcoa.ca/research_u_docs/2006_04apr_en_update.pdf
2. Government of Alberta. 2001. Active living and mental health. Retrieved from: http://www.healthyalberta.com/ActiveLiving/552.htm
3. Health Canada. March 2011. Physical activity. Retrieved from: http://www.hc-sc.gc.ca/hl-vs/physactiv/index-eng.php
4. Manning Rubin, October 2003. Keep your brain alive. Retrieved from: http://www.keepyourbrainalive.com/exercise.html
5. Rubenstein Ben, April 2010. How to exercise your brain. Retrieved from: http://www.wikihow.com/Exercise-Your-Brain

Medication drugs vs therapy, an ongoing controversy

When we talk about anxiety disorders it is inevitable to talk about treatment, how can we cure this illness? what is the best approach to it? The scientific literature suggests that, in the treatment of anxiety disorders, that psychological interventions can be very effective. However, there are some patients where they aren't working optimally and introducing medication can be quite effective. Having said that, if you are to face the decision on how to treat an anxiety disorder there are important things to consider when questioning what treatment to use.

Treating anxiety disorders with medication is a practice that has a long history. Yet, nowadays, this type of treatment has become very controversial because of the numerous side effects which anti-anxiety and antidepressant drugs may have. Another reason which has limited the prescription of these drugs is the fact that tolerance to them can be easily developed. There are some cases in which the positive results for which the anti-anxiety drugs are prescribed are overstepped by the numerous side effects. People taking this type of drugs may experience dizziness, drowsiness, memory problems and confusion. Also the patients may become addictive to those substances or may experience depressive states.Benzodiazepines may even produce the side effects similar to those conditions for which they have been prescribed in the first placeThis means that a patient suffering from anxiety can fall deeper in this condition because of the medication that was supposed to cure him. The elder people are more prone to this type of side effects.There have been cases in which people who took this type of drugs have taken additional medication without the doctor’s advice and died because of the toxic combination. Also, elderly people and pregnant women are strongly advised not to take antidepressants. However, it is necessary to note that they are not used for curing the condition, but rather to alleviate some of its symptoms.
When it comes to treating anxiety disorders, research shows that therapy is usually the most effective option. That’s because anxiety therapy–unlike anxiety medication–treats more than just the symptoms of the problem. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways; and develop better coping and problem-solving skills. Therapy gives you the tools to overcome anxiety and teaches you how to use them.
Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.Cognitive behavioral therapy addresses negative patterns and distortions in the way we look at the world and ourselves.The basic premise of cognitive behavioral therapy is that our thoughts–not external events–affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation.

In conclusion I agree that Behavioral therapy treatment may have better long time benefits than medication drugs. I think that the approach should be with therapy treatment, since we learn how to cope with all the difficulties we are experiencing and progressively we start thinking and acting in a way that decreases stress and anxiety. On the other hand, medication drugs only alleviate the symptoms and we can grow dependent on them or we can even develop tolerance, moreover second effects can overstep the positive effects on the drugs and affect our daily activities.

References:
1.http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/anxiety-anxieux-eng.php
2.http://publications.cpa-apc.org/browse/documents/67

Anxiety disorders, What can we trust online?

More and more we are getting used to finding all our concerns and answers from the web. As it is easy and fast to do, and probably just a matter of typing a key word on Google to come up with thousands of web pages addressing our matter of concern. But, how can we tell how reliable a website is? When referring to health in particular, it is primordial to learn how to differentiate from a trustworthy web page from one that lacks credibility.Now a days everybody is able to introduce information of any kind to the web and, unfortunately most of them have lucrative objectives when doing so.Having said that, in this post I am going to address information about anxiety disorders found in a website lacking credibility and I will give important reasons as of why is it the case it lacks credibility and I will counter that website with a credible one.



To start, take a look at this website, the author claims to have an immediate cure for anxiety disorders and attacks, an e-book called "Panic away". The first thing lacking credibility is the layout of the site, it looks like it is something that a kid could do using some basic knowledge of blogging, right away the author refers to "personal experience" and talks about how he found the cure and how he wants to share it with people so we can save thousands of dollars. He directs us to a website where a video starts, and he gives some more information about this miraculous cure. He claims that anxiety disorders are not a mental illness. He then addresses that his cure can get rid of anxiety disorders in 7 minutes, moreover he says that the regular treatment such as drugs and therapy do not work at all to cure anxiety disorders. He finishes the video offering a great price for his e-book and how people can not miss this opportunity. After reading and listening all the information he offers, we can not tell who this person is, what kind of educational background he has and even worse, what kind of references he has to support his claims.

Now, take a look at this website instead, the Public Health agency of Canada, first thing to notice is the website termination, .gc.ca, a site supported by the Canadian government. Second we can notice at the bottom the formal references and resources this web page has used. We can trust that is credible one and a good source of information too. We can find out after researching the website that anxiety disorder is considered a mental illness and the cure for this is a progressive treatment either with medication or therapy (cognitive) or both.

To conclude, we need to be careful on what we trust from the web, this is only one example from maybe thousands out there. Identifying a credible source of information is important in order for us to take advantage of this essential tool of the Internet to accurately respond our answers and concerns.

My first post - Introduction and topic

My name is Andrea de la Flor, I am a 24 year old fourth year Economics student at Simon Fraser University. I am originally from Lima, Peru and have been living in Vancouver for three years now. My professional passion is Economic Development, as I plan in the future to apply my knowledge and experience gained in Canada to develop policies for the economic and social growth of my country, Peru. I am creating this blog to talk and research about a very important component of health, that of mental health, in particular, anxiety disorders. My target audience are college/university students that have a higher level of stress and anxiety due to normal student worries, from exams to personal/relationships, finance, uncertainty of the future and for some, the stress embedded in coming to a new country and having to adapt to it. Being a student, I have gone through many anxiety periods throughout my university years and I know it can get very challenging so I decided to give my target audience not only more reliable information on what anxiety really means and what causes it but also good ways of dealing and coping with it in our daily lifes. Lastly, I would like to provide ways of preventing this type of mental disorders.
As we know, mental health now a days is a big part of our general health, as defined by the World Health Organization, health means not only the absence of disease but a complete state of mental, social and psychological well being. From these blog posts I expect to learn about anxiety disorders, what causes them? What kind of anxiety disorders are we faced with while attending school? How and why some people react differently under the same events and circumstances, is it genetics? Is it related with physical health? Why do some people stress out a lot more than others when writing a final exam or breaking up with a boyfriend/girlfriend or when losing a loved one? What does it depend on? Moreover, I expect to learn how to recognize reliable information since there is a lot out there we infer every day. Finally, I want to learn of ways on how to manage stress and anxiety more efficiently and if there is any way of preventing it to assure ourselves of a long, and well enjoyed life.
To finish this post, I would like to share my main message which is that anxiety disorders are becoming more and more common among students and we not only need to know what causes the different types of disorders and how to treat them, but most importantly, we need to know how to prevent it. We need to be more aware of the importance of mental health to be able to enjoy our life fully.