Mind & Mood Archive

The pandemic has made it especially hard for people with persistent depressive disorder.

Almost everyone goes through rough mental patches. You may feel down, sad, and lethargic. Most people bounce back with no problem, but if these feelings become more frequent and linger longer, you could have a mild, yet still serious form of depression called persistent depressive disorder (PDD), also known as dysthymia.

Older adults are especially vulnerable to PDD, and more so during the COVID-19 pandemic, says Dr. David Mischoulon, a psychiatrist at Harvard-affiliated Massachusetts General Hospital. "While the COVID pandemic affects everyone, older adults have experienced increased stressors like economic issues, prolonged isolation, and the threat of getting sick, all of which can trigger feelings of anxiety and depression beyond the norm."

In the journals

Researchers are close to finding early cancer with a blood test. They may soon do the same with Alzheimer's disease. A new blood test called p-tau217 has shown great promise in diagnosing people with the disease, according to findings published online July 28, 2020, by JAMA.

The test looks for a specific type of tau protein in the blood. In people with Alzheimer's, tau protein in the brain forms tangles. Accumulation of tau protein tangles along with beta-amyloid deposits is thought to play a key role in how the disease develops.

Here's how to cope when your usual traditions get uprooted.

The holiday season, like just about everything else this year, probably won't look the same as usual. Whether that means going to smaller gatherings without the usual relatives, quarantining when traveling, or staying home entirely, chances are something will be different this year thanks to the COVID-19 pandemic. For many who look forward to a full table at Thanksgiving or a big party on New Year's Eve, these changes are unwelcome, and frankly a little depressing.

In response, people may experience emotions ranging from guilt to loneliness to a feeling of disconnected sadness, says Dr. Hilary Connery, assistant professor of psychiatry at Harvard Medical School.

Many people with anxiety disorders have trouble sleeping. That's a problem. Too little sleep affects mood, contributing to irritability and sometimes depression. Vital functions occur during different stages of sleep that leave you feeling rested and energized or help you learn and forge memories. Sleep usually improves when an anxiety disorder is treated. Practicing good "sleep hygiene" helps, too. Here are some steps to take:

• Go to bed and wake up at the same time every day, even on weekends.
• Daylight helps set sleep patterns, so try to be outdoors while it's light out for 30 minutes a day.
• Exercise regularly (but not too close to bedtime). An afternoon workout is ideal.
• Keep naps short — less than an hour — and forgo napping after 3 p.m.
• Avoid caffeine (found in coffee, many teas, chocolate, and many soft drinks), which can take up to eight hours to wear off. You may need to avoid caffeine entirely if you have panic attacks; many people who experience panic attacks are extra-sensitive to caffeine.
• Review your medications with a doctor to see if you are taking any stimulants, which are a common culprit in keeping people up at night. Sometimes it's possible to switch medicines.
• Avoid alcohol, large meals, foods that induce heartburn, and drinking a lot of fluid for several hours before bedtime.
• If you smoke, quit. Smoking causes many health problems, including compromising sleep in a variety of ways.
• Keep your bedroom cool, dark, and quiet, without distractions like TV or a computer. Avoid using an electronic device to read in bed; the light from the screen can trick your brain into thinking it is daytime. If your mattress is uncomfortable, replace it.
• Reading, listening to music, or relaxing before bed with a hot bath or deep breathing can help you get to sleep.
• If you don't fall asleep within 20 minutes of turning in (or if you wake up and can't fall back to sleep in 20 minutes), get out of bed and do something relaxing until you feel sleepy.

For additional tips and strategies for living with anxiety, buy Coping with Anxiety and Stress Disorders, a Special Health Report from Harvard Medical School. 

News briefs

Probiotic supplements containing helpful bacteria and yeast are marketed as a way to maintain a diverse mix of healthy gut microbes. Now, a review published online July 6, 2020, by BMJ Nutrition, Prevention & Health suggests that probiotic supplements may help relieve depression symptoms. Scientists evaluated seven clinical trials from the past 15 years, which tested a total of 12 different strains of helpful bacteria. One trial in the review tested a "prebiotic," a type of plant fiber that provides food for gut bacteria. Scientists concluded that 11 of these probiotics, either alone or combined with prebiotics, were potentially useful for relieving symptoms of depression, perhaps by reducing inflammation that could affect brain function. The studies were small and short-term, but taken together, they suggest a gut-based approach to maintaining emotional well-being is worth pursuing. In the meantime, talk therapy, exercise, and medications remain the most effective approaches to treat depression. To support your gut health without expensive probiotic supplements, enjoy foods that naturally contain probiotics, such as yogurt, kefir, and sauerkraut. The prebiotic powers of whole grains also may support a healthy gut.

Image: LightFieldStudios/Getty Images

People who regularly worried about the future and dwelled on the past saw larger drops in cognition and had more harmful brain proteins than those who didn't.

Chronic worrying or ruminating could be bad for your brain. A study published online June 7, 2020, by Alzheimer's & Dementia linked these negative thinking patterns to brain changes that could be associated with Alzheimer's disease.

Study authors found that older adults who regularly engaged in what the authors called repetitive negative thinking were more likely to experience cognitive decline, including memory problems, than those who didn't. They also had higher levels of the proteins beta-amyloid and tau in their brains. The accumulation of these proteins, which create damaging clumps known as plaques and tangles in the brain, is a hallmark of Alzheimer's that begins in the earliest stages of the disease — even before an individual experiences visible symptoms of dementia.

The trials and challenges of this year are weighing heavily on many people, but attempting to employ positive psychology to put personal struggles in context, and accepting the ups and downs life brings, can ultimately increase positive feelings and provide perspective.

With the introduction of benzodiazepines such as chlordiazepoxide (Librium) and diazepam (Valium) in the early 1960s, a new era in the treatment of insomnia and anxiety began. The benzodiazepines were more effective and far safer than the older drugs — barbiturates, meprobamate, and glutethimide — that had been prescribed for these purposes. For many years, benzodiazepines continued to be the most popular prescription tranquilizers and sedatives. Since the mid-1980s, new alternatives have been assuming some of these roles, but benzodiazepines are not about to leave the stage.

More than a dozen benzodiazepines are available by prescription. Benzodiazepines have a common basic chemical structure, and they all increase activity at receptors for the neurotransmitter gamma-aminobutyric acid (GABA). This transmitter inhibits the activity of neurons, slowing down the brain and nervous system. Benzodiazepines differ mainly in how quickly they are absorbed, how long their effects last, and how long they take to leave the body.

The condition tends to strike many older adults, but there are ways to counter its paralyzing effects.

More and more, do you find yourself fighting feelings of worry? Do you feel increasingly anxious and tense? Do you obsess about things that may or may not happen? If so, you may be one of the millions who suffer from anxiety.

Anxiety can develop from many uncontrollable factors, such as genetics, personality, and life events, but the main issue for many older men is that they have too much time on their hands, according to Dr. Cornelia Cremens, a psychiatrist with Harvard-affiliated Massachusetts General Hospital.

Shifting your thinking and practicing deep breathing can help when you're stuck in an intense emotional moment.

At some point, we've all gotten stuck in a "meltdown" moment — an overwhelming feeling of anger or stress that was difficult to shake off. "Feeling overwhelmed makes it harder to identify ways to get unstuck; the options seem limited, which can create a sense of hopelessness or despair. Additionally, negative memories may come to mind more readily, and we may filter out useful ways of viewing the situation at hand," says Abby Altman, an associate psychologist at Harvard-affiliated Brigham and Women's Hospital.

But there are ways to shift your focus and break out of extremely emotional moments. Take note of the following tips so you can put them to work if a meltdown strikes.