CHAPTER 11

M IS FOR MENTAL HEALTH

YOUR MIND IS ESSENTIAL TO YOUR BRAIN

Do not conform to the pattern of this world, but be transformed by the renewing of your mind.

ROMANS 12:2, NIV

DAVID: A TOXIC STEW OF MIND MEDS

When my wife, Tana, and I met 12 years ago, her 62-year-old father, a pastor and seminar leader, lived about four hours away and had become a recluse. After his mental state began deteriorating, his doctor diagnosed him with Alzheimer’s disease and prescribed a new medication, but it just seemed to make him more confused. Tana was deeply concerned about him, so I suggested she let me evaluate him.

David’s scan showed that he did not have Alzheimer’s disease, but rather a condition called pseudodementia, which is depression that masquerades as Alzheimer’s disease. He was also on a toxic combination of psychiatric medications, including Xanax (for anxiety), which can accelerate memory loss. I was alarmed for him and convinced Tana to move him nearby for a few months. When David began our Memory Rescue: BRIGHT MINDS program, he had his important numbers checked —he was overweight; low in thyroid, vitamin D, testosterone, and omega-3s; and had high blood sugar, ferritin, CRP, and homocysteine. Plus he wasn’t sleeping well.

DAVID’S BRIGHT MINDS RISK FACTORS AND INTERVENTIONS

BRIGHT MINDS

DAVID’S RISK FACTORS

INTERVENTIONS

Blood Flow

    

Retirement/Aging

62, no new learning, social isolation

Reengaged in teaching

Inflammation

High CRP and homocysteine; low Omega-3 Index

Omega-3 fatty acids

Genetics

Family history of depression and suicide

  

Head Trauma

    

Toxins

Toxic combination of psychiatric medications

Slowly stopped medications

Mental Health

Major depression

Nutraceuticals for depression

Immunity/Infection Issues

Low vitamin D

Vitamin D3 supplements

Neurohormone Deficiencies

Low testosterone and thyroid

Treat thyroid; weight training; decreased sugar

Diabesity

Overweight, high blood sugar

Weight loss and dietary changes

Sleep Issues

Chronic insomnia

Sleep strategies

DAVID’S “BEFORE” BRAIN SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

Pseudodementia masquerading as Alzheimer’s disease

With targeted treatment —including nutraceuticals to treat his depression and balance his hormones, vitamin D, and blood sugar levels —and support from his daughter, David blossomed. He felt a fresh connection to God when he prayed, and he began to enjoy studying the Bible again. Six months later he taught an all-day seminar at a nearby church. He told me it was as if he had been raised from the dead. We helped him get his life back by taking a BRIGHT MINDS approach to treating his brain. The big benefit to me was that Tana saw firsthand the power of our work and has become a passionate brain warrior for what we do.

BRAIN, MIND, AND MEMORY

Getting your mind right is a critical piece of the puzzle in rescuing and strengthening your memory. Studies have shown that depression, bipolar disorder, schizophrenia, post-traumatic stress disorder (or PTSD) in both veterans and civilians, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), and chronic stress significantly increase the risk of memory problems, inflammation, and vascular and immunity issues.[367] Poor mental health can be very potent. In fact, new research indicates that men who are depressed have as great a risk of suffering a heart attack or heart disease as men who are obese, and people with mental health issues die an average of 10 years earlier than their mentally healthy counterparts.[368]

Anything that negatively affects your mind also negatively affects your brain. Virtually all psychiatric illnesses have a significant brain component to them. Schizophrenia, for example, has been shown to affect the frontal and temporal lobes; depression has been associated with decreased activity in the frontal lobes; and ADD/ADHD is associated with lower activity in the prefrontal cortex, basal ganglia, and cerebellum.

For many years, I suspected there was a link between untreated ADD/ADHD and memory problems. The hallmark symptoms of ADHD are short attention span, distractibility, disorganization, procrastination, restlessness, and impulsivity; those lifelong traits make people vulnerable to important risk factors for memory problems, such as traumatic brain injury (TBI), obesity, depression, alcohol and drug abuse, and smoking.[369] A recent Argentinian study noted a significant increase in adults diagnosed with ADHD and Lewy body dementia, which is also associated with Parkinson’s disease.[370] Both ADHD and Parkinson’s disease are associated with lower levels of the neurotransmitter dopamine. Treating ADHD, naturally or with medication, may decrease these risk factors and help save your memory.

Depression doubles the risk of cognitive impairment in women and quadruples it in men. Kristine Yaffe, MD, and her colleagues at the University of California, San Francisco, School of Medicine studied the association between depression and cognitive decline. They evaluated 5,781 elderly women with tests of mood and memory. At the beginning of the study, 211 had six or more depressive symptoms, but only 16 of those 211 (7.6 percent) were receiving treatment, which meant more than 92 percent of the depressed women were not being treated.[371] Increasing symptoms of depression were associated with worse performance at baseline and follow-up on all tests four years later. Women with three to five depressive symptoms were at 60 percent greater odds for cognitive deterioration, and women with six or more depressive symptoms were 230 percent more likely to have problems! The researchers concluded that depression in older women is associated with both poor cognitive function and subsequent cognitive decline. Some researchers believe that late-life depression may, in fact, be a precursor to Alzheimer’s disease, and one-third of all patients with mild cognitive impairment (MCI) are reported to suffer from depression, which then accelerates the progression to full-blown dementia.[372] It is critical to get depression treated in order to keep your mind.

Is It Depression —or Dementia?

This is an important question because these two illnesses can masquerade as each other. In a study of more than 4,500 patients that my colleagues and I published in the Journal of Alzheimer’s Disease, we saw overall lower blood flow to the brains of people with dementia, especially in the hippocampus.[373]

Since most people will never get a brain SPECT or QEEG scan, here are a number of traits you can use as a guide to distinguish between depression and dementia.

MORE LIKELY TO BE DEPRESSION

  1. Prior history of depression or family history of depression
  2. Presence of physical symptoms, such as aches and pains
  3. Pervasive sad or negative feelings
  4. Excessive worry; anxiety and panic
  5. Feelings that life is pointless and not worth living
  6. Loneliness or boredom
  7. Crying for no apparent reason
  8. Difficulty completing simple chores
  9. Lower energy
  10. Suicidal thoughts common

MORE LIKELY TO BE DEMENTIA

  1. Difficulty performing familiar tasks
  2. Problems with words and language; using the wrong words
  3. Disorientation of time and place
  4. Decreased judgment
  5. Memory loss that comes on gradually
  6. Misplacement of things
  7. Problems with abstract thinking
  8. Changes in personality
  9. Loss of initiative, apathy
  10. Suicidal thoughts uncommon

One additional sign: Depression tends to come on more quickly than dementia.

Chronic stress in midlife has been associated with memory problems later on. Brain circuits involved in chronic anxiety and fear extensively overlap in areas associated with Alzheimer’s disease, and chronic stress has been shown to decrease the size of the hippocampus and prefrontal cortex, except when it is paired with a low or low-normal level of the hormone DHEA. Stress is considered a normal part of life when it is occasional and temporary, such as when you feel anxious before an exam or a job interview. When it becomes frequent or chronic, as in prolonged grief, however, it needs to be treated.

CHECKUP FOR MENTAL HEALTH ISSUES

Screen for problems

Given that ADHD, PTSD, depression, bipolar disorder, schizophrenia, and chronic stress are risk factors for memory problems as we age, it is important to screen for them. Older people with depression, unlike younger ones who may complain of a sad or depressed mood, may also show signs of cognitive impairment, such as confusion, memory disturbance, and attention deficits, which may be mistaken for dementia. Complicating the picture, depression may coexist with dementia and exacerbate the problem, increasing the disability.

The questionnaires we use at Amen Clinics will help you determine whether you have the common symptoms of ADHD, depression, bipolar disorder, or PTSD.

Please rate yourself on each of the symptoms listed below using the following scale. If possible, to give yourself the most complete picture, have another person who knows you well (such as a spouse, partner, or parent) rate you as well.

ADHD: If you have four or more symptoms with a score of 3 or 4, consider seeking an evaluation from a psychiatrist or licensed counselor.

  1. ___ 1. trouble sustaining attention or easily distracted
  2. ___ 2. difficulty completing projects
  3. ___ 3. overwhelmed by the tasks of everyday living
  4. ___ 4. trouble maintaining an organized work or living area
  5. ___ 5. inconsistent work performance
  6. ___ 6. poor attention to detail
  7. ___ 7. impulsive decision making
  8. ___ 8. difficulty delaying what you want; having to have needs met immediately
  9. ___ 9. restlessness, fidgeting
  10. ___ 10. comments made to others without considering their impact
  11. ___ 11. impatience; frustration
  12. ___ 12. frequent traffic violations or near accidents

Depression: If you have four or more symptoms with a score of 3 or 4, consider seeking an evaluation from a psychiatrist or licensed counselor.

  1. ___ 1. depressed or sad mood
  2. ___ 2. decreased interest in things that are usually fun, including sex
  3. ___ 3. significant weight gain or loss without trying, or appetite changes
  4. ___ 4. recurrent thoughts of death or suicide
  5. ___ 5. sleep changes, lack of sleep, or marked increase in sleep
  6. ___ 6. physical agitation or feeling “slowed down”
  7. ___ 7. low energy or feelings of tiredness
  8. ___ 8. feelings of worthlessness, helplessness, hopelessness, or guilt
  9. ___ 9. decreased concentration or memory

Bipolar disorder: Includes periods of depression (see questions above) that tend to cycle with the manic symptoms below. If you have three or more of these symptoms along with a score of 3 or 4 in depression, consider seeking an evaluation from a psychiatrist or licensed counselor.

  1. ___ 1. periods of an elevated, high, or irritable mood
  2. ___ 2. periods of very high self-esteem or grandiose thinking
  3. ___ 3. periods of decreased need for sleep without feeling tired
  4. ___ 4. periods of talkativeness or pressure to keep talking
  5. ___ 5. racing thoughts or frequent jumping from one subject to another
  6. ___ 6. frequent distractions because of irrelevant things
  7. ___ 7. marked increase in activity level
  8. ___ 8. excessive involvement in pleasurable activities with painful consequences (affairs, gambling, etc.)

PTSD: If you have four or more symptoms with a score of 3 or 4, consider seeking an evaluation from a psychiatrist or licensed counselor.

  1. ___ 1. recurrent and upsetting thoughts of a past traumatic event (flashbacks of an accident, fire, molestation, etc.)
  2. ___ 2. recurrent distressing dreams of a past upsetting event
  3. ___ 3. a sense of reliving a past upsetting event
  4. ___ 4. a sense of panic or fear of events that resemble an upsetting past event
  5. ___ 5. effort spent avoiding thoughts or feelings associated with a past trauma
  6. ___ 6. persistent avoidance of activities/situations that cause remembrance of an upsetting event
  7. ___ 7. inability to recall an important aspect of a past upsetting event
  8. ___ 8. marked decreased interest in important activities
  9. ___ 9. feelings of detachment or distance from others
  10. ___ 10. feelings of numbness or restrictions in your feelings
  11. ___ 11. feeling that your future is shortened
  12. ___ 12. quick startle
  13. ___ 13. feeling like you’re always watching for bad things to happen
  14. ___ 14. marked physical response to events that remind you of a past upsetting event (e.g., sweating when getting in a car if you have been in a car accident)

PRESCRIPTION FOR REDUCING YOUR MENTAL HEALTH RISK

The Strategies

  1. Get treated. Early treatment is essential to stave off the ravages of psychiatric illnesses. Our work with SPECT teaches us that with appropriate treatment, the brain becomes more balanced and works much more efficiently. Treatment does not necessarily mean psychiatric drugs. At Amen Clinics, we prefer natural treatments whenever possible. A healthy diet; exercise; omega-3 fatty acids EPA and DHA and other supplements; as well as meditation and cognitive-behavioral therapy have been shown to help a wide variety of mental health issues. But if these strategies don’t work or faster results are needed, medications are important to consider. Work with a skilled mental health professional —because your brain depends on it. Here are potential treatments to boost mental health if you are suffering from one of these issues:
  2. Try these 25 research-proven tips. Use them to lower stress and boost your level of happiness and overall mental health.
Bright Minds Tip icon

Do a loving-kindness meditation (see page 178). It’s a proven way to improve your mood and memory.

Loving-Kindness Meditation

Loving-kindness meditation (LKM), which aims to foster feelings of goodwill, kindness, and warmth toward others, boosts positive emotions and decreases negative ones,[406] according to scientific studies. LKM has also been shown to decrease pain, migraine headaches, and symptoms of PTSD and social prejudice.[407] It also increases gray matter in the emotional processing areas of the brain and expands social connectedness.[408]

Meditation and prayer are my two favorite things to combat stress. They only take a few minutes. While prayer is addressed to God, LKM is first practiced toward yourself and then toward other people. If you have difficulty loving yourself, it will be harder to be loving and compassionate toward others.

Let me walk you through a loving-kindness meditation. Sit quietly in a comfortable position, close your eyes, breathe naturally, and repeat phrases such as: 

After you repeat the phrases several times, direct them to someone you are thankful for:

Next, visualize someone you feel neutral about and repeat the phrases again.

Finally, visualize someone you don’t like or are angry with, such as an ex-spouse or someone who has hurt you, and repeat the phrases again.

As difficult as this exercise can be, it can lead to forgiveness and love, two healing emotions.

The Nutraceuticals

TO ADDRESS ADHD

TO ADDRESS DEPRESSION

TO ADDRESS BIPOLAR DISORDER

TO ADDRESS STRESS

The Foods

AVOID (OR LIMIT):

CONSIDER ADDING:

PICK ONE HEALTHY BRIGHT MINDS HABIT TO START TODAY

  1. Start every day with the phrase “Today is going to be a great day.”
  2. Write down three things you are grateful for each day.
  3. Take saffron, which has been found to help both mood and memory.
  4. If you have trouble focusing, consider a high-protein, lower-carbohydrate diet.
  5. Eat up to eight fruits and vegetables a day; there is a direct correlation between eating more produce and feeling happier. Tomatoes, for instance, have been shown to help mood.
  6. Begin practicing the loving-kindness meditation.
  7. Take a walk in nature.
  8. Pray to release your worries and to rejoice over the good things around you.
  9. If natural interventions are not effective, work with a local therapist or psychiatrist.
  10. Kill the ANTs. Whenever you feel mad, sad, nervous, or out of control, write down your negative thoughts and learn to talk back to them.