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Disability / chronic illness and depression
Disability / chronic illness and depression- walking on broken glass! STOP IT; It is a time for healing. How life, wellness, and health coaching and holistic and integrative therapies can help? Dr. Miroslav Sarac – Chiron Wise Centaur, holistic and integrative healing center Generally, severe depression first hit people with acquired disability compared with people with hereditary disability. Acquired disability whether it is from a chronic disease, acute disease, severe injury or the late and full expression of genetic syndrome creates extreme, and sudden life-changing conditions with plenty of challenges in the future everyday life and people are adjusting very difficult on acquired disability conditions. Suddenly, either way, disability has the potential to generate very adverse condition such as depression that involves persistent feelings of sadness, uselessness, and hopelessness. Malfunctioning vocational rehabilitation services do not take action immediately, mostly they are prolonging the agony of a newly disabled person, postponing their services even though the majority of funds for their operation are coming from the federal funds (approximately 75%). Disabled people are still heavily dependent on primary caregivers The disabled people are getting heavily reliant on primary caregiver either a spouse/husband, partner, a friend for transportation, paying medical and other bills, provide housing and food, etc. Interestingly, the saving account for the majority of disabled people is getting “dry” very quickly because the first two years in the disability the person is not automatically eligible for Medicare or Medicaid (with some exemptions), so saving account is getting dry very quickly paying individual health insurance premium and medical bills for two years until they get eligible for Medicare or Medicaid. Independent living movement works probably somehow well in a big city metro area where the public transportation is available, and automatically paratransit transportation is possible because of compliance with the ADA-AA. However, if a disabled person lives in the area out of a big city metro area, they became heavily dependent on primary caregiver regarding transportation. The disabled people live in health disparities. Some healthcare providers do not accept Medicare or Medicaid, so predominantly disabled people have insufficient access to health care, either preventive or curative. Homebound lifestyle is one additional contribution to severe depression feeling fatigue, pain with no apparent cause, loss of appetite, a person become easily irritable and forgetful; the altered sleeping pattern is pervasive as well. Life is getting significant stress full of challenges and barriers! Unfortunately, the primary caregiver for disabled person plays the central role in the presence of a person with disability providing for the person the crucial resources for a decent life and advocate for the disabled person daily. Still, there is no specific help or support resources to make the life of the primary caregiver easier and less demanding and stressful. Depression as a co-morbidity in the population of people with disability If we observe better already a person with a disability is getting co-morbidity, and that is depression. According to the Social Security Administration, depression is listed as a disability as well. Thus, already disabled person is getting more disabled with the additional co-morbidity major depressive disorder. Depression isolated by itself is the second most common medical condition listed on Social Security disability applications and worldwide is the leading cause of disability. Comfortable in new social circumstances such as lack of transportation, lack of employment, isolated and home-bound lifestyle lead to dysthymia and severe anhedonia. Why disability leads to depression One of the problems what the majority of disabled people stated is a loss of a life direction or purpose. This devastating loss could quickly open the door for severe depression. Unfortunately, lack of appropriate vocational rehabilitation services significantly contributes to this condition, and it is a primary factor that majority people with disability is losing a life direction and cannot see the explicit purpose of their life in the future. Majority state vocational rehabilitation services are operating by approximately 76% of the federal fund, 18% is a contribution from the state and rest is from Social Security Administration for the program “Ticket to Work” and other donations. Life is getting so complicated and stressful. Over time a person with a disability will express the first signs of decreased self-esteem, lack of confidence is a new phenomenon what we can observe, and the loss of autonomy is devastation factor that significantly contributes to development reduced self-esteem and severe depression. Sadness, grievance, and frustration because of career loss is devastation and very challenging phenomenon in the population of disabled people either with an acquired or hereditary disability. Homebound lifestyle what majority disabled people are facing is an additional contribution to the development of severe depression. Quality of life often decreases; losing independence is evident with homebound lifestyle and heavy dependence on a primary caregiver. Majority disabilities leave people homebound with a few opportunities to interact with others. Sometimes disabled persons are at home alone all day while primary caregiver either spouse, husband, the living partner is at work or another scenario the person with disability confined to an assisted living center where community activities do not match either age or interests and a person with a disability is getting more depressed. Why disability raises depression risk? Depression induced by disability can make the disability even worse. Mostly, depressed, disabled people find difficult to take care of their health, preventive health care, mostly missing intentionally or unintentionally essential physician appointments and an annual checkup with a primary care physician. Additionally, people with disability and depression as their co-morbidity do not take their medications as directed and on time. Usually, in the U.S.A. most of the psychiatrists (approx. 90% according to last statistics) do not accept Medicare and Medicaid or any other health insurance. So if the person is lucky and can see a psychiatrist the appointment is mostly about 10 -15 minutes (currently, psychiatrists are ”drug-shapers”), or even worst option in our reality is a community ambulatory care where most people with disabilities see a nurse practitioner or physician assistant. Unfortunately, more and more psychiatrists in the U.S.A. do not work with health insurances. Instead, they provide mental health care only for “cash.” Untreated or unproperly treated depression in the population of disabled people will eventually lead to the first suicidal thoughts. Some evidence suggests that if the first episode of depression goes untreated, a person with disability and depression as co-morbidity has a 50% chance of experiencing a recurrence. In untreated scenario episode of severe depression can last six months to a year probably. Indeed, disability is challenging and life-altering condition enough to cope with. Developing related depression as co-morbidity to disability will make the life of a disabled person even more difficult and challenging. Psychotherapy is also available and sometimes can be very successful and helpful and sometimes can be an even worst option. Most people are placed into the chronic treatment of CBT (cognitive behavioral therapy) instead of according to the standards 6-16 sessions. However, there is one problem, and that is who will pay for the long-term treatment. Mostly, primary caregivers are paying for psychotherapy sessions or if the psychotherapist accepts Medicare or any other health insurance that would be a perfect option. “A substantial body of research shows that family members who provide care to individuals with chronic or disabling conditions are themselves at risk. Emotional, mental and physical health problems can arise from complex caregiving situations and the strains of caring for frail or disabled relatives” (National Center on Caregiving, 2017). Some research data are available regarding suicide in the population of disabled people. Depressive symptoms frequently occur in people with multiple sclerosis and their rates of suicide thoughts are higher than the general population. Also, the presence of depressive symptoms has a direct influence on the risk of suicide (1 - 6). Generally, physically ill health, disability, and feeling of heavy dependence lead to depression (7 - 9) as well as long-term work disability and absenteeism significantly contribute to depression (10). There is evidence for a direct association between disability and depression, disability and suicidal thoughts or ideation and depression and suicide ideation (11, 12). There is some scientific evidence on how sight loss has an emotional impact and how readjustment may not occur, and suicide may result due to depression and disability (13, 14). Suicidality in the population of people with intellectual disability has been the focus of several investigators (15, 16). Disability affects health-related quality of life and dysphoria symptoms such as helpless, hopeless, worthless, dissatisfaction with life, depression and suicidal ideation, and generally, research data exhibited that physical disability is associated with a higher risk of lifetime suicidal ideation (17 - 20). Additionally, there is fascinating research performed by Fishbain D.A., and colleagues in 2012, preferences for death over disability is associated with passive and active suicidal ideation and actual suicidality in the patients with chronic pain (21). Generally, chronic pain is associated with an elevated risk of suicide (22). Holley J.M. and colleagues in 2014 stated that chronic pain might facilitate the development of a critical risk factor for suicide, fearlessness about death (22). Depression by itself is a disability even without a primary cause of disability, and it is a leading cause of disability globally (23). Coshal S. and colleagues in 2017 stated in their article that one-half of the patients with depression do not receive adequate treatment (23). Klonsky E.D. and colleagues in 2016 published the article where they explained that suicidal behavior is a leading cause of death and disability. Very clearly, they describe the process of development of suicide attempts such as they talked about three distinct steps such as the development of suicidal ideation, and the progression of ideation to suicide attempts. They are two separate entities or distinct phenomena with different explanations and predictors (24). As they explained in their research, depression, hopelessness, most mental diseases, and even impulsivity predict ideation. However, these factors struggle to distinguish who have attempted suicide from those who have only considered suicide — generally, depression even episodic results in lasting disability, distress and burden (25). How life, wellness, and health coaching and holistic and integrative therapies can help? In the last blog related to disability, I was discussing several phases of disability, “the beginning,” “hitting the wall,” “turning around,” “letting go,” “opening up,” “letting in” and “the gift of “healing.” Certainly, in the phase “the beginning” we cannot expect from the disabled person to be cooperative and open for any kind of the treatments for improvements of life, wellness, health. Still, the person is in the state of “shock,” grief, anger, depression, mourning…However, how time passes the person will start to live life with multiple questions such as “what is the purpose and meaning of my life in this condition”, “there is no resources to help me, and they promised to me”, “this is a fake hope, nothing happened after several months”, “I am getting heavily dependent on you, I am so sorry, I am burden”, “I feel hopeless, worthless, helpless” and many more. In this condition, it is essential to approach to the disabled person with a question “what do you feel and think you can work, what would you like to work?” Finding skills and pulling them out “on the surface” is vital in this condition. Even gaining some new skills is an excellent solution. Taking the courses and continuing education courses, certifications, etc.. would be an excellent solution. This will open the “magical door” to the disabled person. Getting out of the house is essential, breaking homebound lifestyle and heavy dependence on a primary caregiver. Taking yoga sessions with mindfulness meditation is extremely helpful (which is very well documented in peer review medical journals). Do not worry even if you cannot doing regular yoga there is yoga in the sitting position, so no excuse for such a thing. Tai Chi and Qi Gong are extremely helpful for balancing body-mind-soul. Regular physician office visits are crucial. Lack of transportation in your area where you live is not a good excuse. Most of the undetected comorbidity is a potential trigger for additional disability and chronic illnesses. Probably the most important thing is finding a reasonable plan on how to spend every day productively. It does not have to be physical work such as gardening, cleaning house, cooking. It could be arts and crafts, creative writing, writing blogs and articles, advocacy work, voluntary contribution in local hospitals, religious and spiritual organizations, churches, and others. Feeling productive is extremely important. A job search should be everyday work for at least one hour. The team at Chiron Wise Centaur can provide you with life, wellness and health coaching, job search and job readiness in disability / chronic illness. Dr. Miroslav Sarac is conducting sessions with disabled people, their families and primary caregivers. References: 1. Tauil CB, Grippe TC, Dias RM, Dias-Carneiro RPC, Carneiro NM, Aguilar ACR, Silva FMD, Bezerra F, Almeida LK, Massarente VL, Giovannelli EC, Tilbery CP, Brandão CO, Santos LMB, Santos-Neto LD. Suicidal ideation, anxiety, and depression in patients with multiple sclerosis. Arq Neuropsiquiatr. 2018 May;76(5):296-301. 2. Lewis VM, Williams K, KoKo C, Woolmore J, Jones C, Powell T. Disability, depression and suicide ideation in people with multiple sclerosis. J Affect Disord. 2017 Jan 15;208:662-669. 3. Moore P, Hirst C, Harding KE, Clarkson H, Pickersgill TP, Robertson NP. Multiple sclerosis relapses and depression. J Psychosom Res. 2012 Oct;73(4):272-6. 4. Pompili M, Forte A, Palermo M, Stefani H, Lamis DA, Serafini G, Amore M, Girardi P. Suicide risk in multiple sclerosis: a systematic review of current literature. J Psychosom Res. 2012 Dec;73(6):411-7. 5. Moore S. Major depression and multiple sclerosis - a case report. J Med Life. 2013 Sep 15;6(3):290-1. 6. Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: an epidemiologic study of a large community sample. Am J Psychiatry. 2002 Nov;159(11):1862-8. 7. Meltzer H, Bebbington P, Brugha T, McManus S, Rai D, Dennis MS, Jenkins R. Physical ill health, disability, dependence, and depression: results from the 2007 national survey of psychiatric morbidity among adults in England. Disabil Health J. 2012 Apr;5(2):102-10. 8. Meltzer H, Brugha T, Dennis MS, Hassiotis A, Jenkis R, McManus S, Rai D, Bebbington. The influence of disability on suicidal behavior. European Journal of Disability Research. 2012. 6: 1, 1 -12. 9. Lecrubier Y. Depressive illness and disability. Eur Neuropsychopharmacol. 2000 Dec;10 Suppl 4: S439-43. 10. Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, Penninx BW, Beekman AT. Long-term work disability and absenteeism in anxiety and depressive disorders. J Affect Disord. 2015 Jun 1;178:121-30. 11. Stensman R, Sundqvist-Stensman UB. Physical disease and disability among 416 suicide cases in Sweden. Scand J Soc Med. 1988;16(3):149-53. 12. Walsh SM, Sage RA. Depression and chronic diabetic foot disability. A case report of a suicide. Clin Podiatr Med Surg. 2002 Oct;19(4):493-508. 13. De Leo D, Hickey PA, Meneghel G, Cantor CH. Blindness, fear of sight loss, and suicide. Psychosomatics. 1999 Jul-Aug;40(4):339-44. 14. Hine TJ, Pitchford NJ, Kingdom FA, Koenekoop R. Blindness and high suicide risk? Psychosomatics. 2000 Jul-Aug;41(4):370-1. 15. Dodd P, Doherty A, Guerin S. A Systematic Review of Suicidality in People with Intellectual Disabilities. Harv Rev Psychiatry. 2016 May-Jun;24(3):202-13. 16. Lunsky Y, Raina P, Burge P. Suicidality among adults with intellectual disability. J Affect Disord. 2012 Nov;140(3):292-5. 17. Båtstad HS, Rudmin FW. Suicidal tendencies as correlates of disability measures. J Health Psychol. 2016 Dec;21(12):3037-3047. 18. Russell D, Turner RJ, Joiner TE. Physical disability and suicidal ideation: a community-based study of risk/protective factors for suicidal thoughts. Suicide Life Threat Behav. 2009 Aug;39(4):440-51. 19. Le Strat Y, Le Foll B, Dubertret C. Major depression and suicide attempts in patients with liver disease in the United States. Liver Int. 2015 Jul;35(7):1910-6. 20. Kerkhof A. Calculating the burden of disease of suicide, attempted suicide, and suicide ideation by estimating disability weights. Crisis. 2012 Jan 1;33(2):63-5. 21. Fishbain DA, Bruns D, Meyer LJ, Lewis JE, Gao J, Disorbio JM. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. Pain Med. 2012 Apr;13(4):552-61. 22. Hooley JM, Franklin JC, Nock MK. Chronic pain and suicide: Understanding the association. Curr Pain Headache Rep. 2014;18(8):435. 23. Coshal S, Saunders J, Matorin AA, Shah AA. Evaluation of Depression and Suicidal Patients in the Emergency Room. Psychiatr Clin North Am. 2017 Sep;40(3):363-377. 24. Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and Suicidal Ideation. Annu Rev Clin Psychol. 2016;12:307-30. 25. Deshpande SS, Kalmegh B, Patil PN, Ghate MR, Sarmukaddam S, Paralikar VP. Stresses and Disability in Depression across Gender. Depress Res Treat. 2014;2014:735307. Read the full article
0 notes
Text
Disability / chronic illness and depression
Disability / chronic illness and depression- walking on broken glass! STOP IT; It is a time for healing. How life, wellness, and health coaching and holistic and integrative therapies can help? Dr. Miroslav Sarac – Chiron Wise Centaur, holistic and integrative healing center Generally, severe depression first hit people with acquired disability compared with people with hereditary disability. Acquired disability whether it is from a chronic disease, acute disease, severe injury or the late and full expression of genetic syndrome creates extreme, and sudden life-changing conditions with plenty of challenges in the future everyday life and people are adjusting very difficult on acquired disability conditions. Suddenly, either way, disability has the potential to generate very adverse condition such as depression that involves persistent feelings of sadness, uselessness, and hopelessness. Malfunctioning vocational rehabilitation services do not take action immediately, mostly they are prolonging the agony of a newly disabled person, postponing their services even though the majority of funds for their operation are coming from the federal funds (approximately 75%). Disabled people are still heavily dependent on primary caregivers The disabled people are getting heavily reliant on primary caregiver either a spouse/husband, partner, a friend for transportation, paying medical and other bills, provide housing and food, etc. Interestingly, the saving account for the majority of disabled people is getting “dry” very quickly because the first two years in the disability the person is not automatically eligible for Medicare or Medicaid (with some exemptions), so saving account is getting dry very quickly paying individual health insurance premium and medical bills for two years until they get eligible for Medicare or Medicaid. Independent living movement works probably somehow well in a big city metro area where the public transportation is available, and automatically paratransit transportation is possible because of compliance with the ADA-AA. However, if a disabled person lives in the area out of a big city metro area, they became heavily dependent on primary caregiver regarding transportation. The disabled people live in health disparities. Some healthcare providers do not accept Medicare or Medicaid, so predominantly disabled people have insufficient access to health care, either preventive or curative. Homebound lifestyle is one additional contribution to severe depression feeling fatigue, pain with no apparent cause, loss of appetite, a person become easily irritable and forgetful; the altered sleeping pattern is pervasive as well. Life is getting significant stress full of challenges and barriers! Unfortunately, the primary caregiver for disabled person plays the central role in the presence of a person with disability providing for the person the crucial resources for a decent life and advocate for the disabled person daily. Still, there is no specific help or support resources to make the life of the primary caregiver easier and less demanding and stressful. Depression as a co-morbidity in the population of people with disability If we observe better already a person with a disability is getting co-morbidity, and that is depression. According to the Social Security Administration, depression is listed as a disability as well. Thus, already disabled person is getting more disabled with the additional co-morbidity major depressive disorder. Depression isolated by itself is the second most common medical condition listed on Social Security disability applications and worldwide is the leading cause of disability. Comfortable in new social circumstances such as lack of transportation, lack of employment, isolated and home-bound lifestyle lead to dysthymia and severe anhedonia. Why disability leads to depression One of the problems what the majority of disabled people stated is a loss of a life direction or purpose. This devastating loss could quickly open the door for severe depression. Unfortunately, lack of appropriate vocational rehabilitation services significantly contributes to this condition, and it is a primary factor that majority people with disability is losing a life direction and cannot see the explicit purpose of their life in the future. Majority state vocational rehabilitation services are operating by approximately 76% of the federal fund, 18% is a contribution from the state and rest is from Social Security Administration for the program “Ticket to Work” and other donations. Life is getting so complicated and stressful. Over time a person with a disability will express the first signs of decreased self-esteem, lack of confidence is a new phenomenon what we can observe, and the loss of autonomy is devastation factor that significantly contributes to development reduced self-esteem and severe depression. Sadness, grievance, and frustration because of career loss is devastation and very challenging phenomenon in the population of disabled people either with an acquired or hereditary disability. Homebound lifestyle what majority disabled people are facing is an additional contribution to the development of severe depression. Quality of life often decreases; losing independence is evident with homebound lifestyle and heavy dependence on a primary caregiver. Majority disabilities leave people homebound with a few opportunities to interact with others. Sometimes disabled persons are at home alone all day while primary caregiver either spouse, husband, the living partner is at work or another scenario the person with disability confined to an assisted living center where community activities do not match either age or interests and a person with a disability is getting more depressed. Why disability raises depression risk? Depression induced by disability can make the disability even worse. Mostly, depressed, disabled people find difficult to take care of their health, preventive health care, mostly missing intentionally or unintentionally essential physician appointments and an annual checkup with a primary care physician. Additionally, people with disability and depression as their co-morbidity do not take their medications as directed and on time. Usually, in the U.S.A. most of the psychiatrists (approx. 90% according to last statistics) do not accept Medicare and Medicaid or any other health insurance. So if the person is lucky and can see a psychiatrist the appointment is mostly about 10 -15 minutes (currently, psychiatrists are ”drug-shapers”), or even worst option in our reality is a community ambulatory care where most people with disabilities see a nurse practitioner or physician assistant. Unfortunately, more and more psychiatrists in the U.S.A. do not work with health insurances. Instead, they provide mental health care only for “cash.” Untreated or unproperly treated depression in the population of disabled people will eventually lead to the first suicidal thoughts. Some evidence suggests that if the first episode of depression goes untreated, a person with disability and depression as co-morbidity has a 50% chance of experiencing a recurrence. In untreated scenario episode of severe depression can last six months to a year probably. Indeed, disability is challenging and life-altering condition enough to cope with. Developing related depression as co-morbidity to disability will make the life of a disabled person even more difficult and challenging. Psychotherapy is also available and sometimes can be very successful and helpful and sometimes can be an even worst option. Most people are placed into the chronic treatment of CBT (cognitive behavioral therapy) instead of according to the standards 6-16 sessions. However, there is one problem, and that is who will pay for the long-term treatment. Mostly, primary caregivers are paying for psychotherapy sessions or if the psychotherapist accepts Medicare or any other health insurance that would be a perfect option. “A substantial body of research shows that family members who provide care to individuals with chronic or disabling conditions are themselves at risk. Emotional, mental and physical health problems can arise from complex caregiving situations and the strains of caring for frail or disabled relatives” (National Center on Caregiving, 2017). Some research data are available regarding suicide in the population of disabled people. Depressive symptoms frequently occur in people with multiple sclerosis and their rates of suicide thoughts are higher than the general population. Also, the presence of depressive symptoms has a direct influence on the risk of suicide (1 - 6). Generally, physically ill health, disability, and feeling of heavy dependence lead to depression (7 - 9) as well as long-term work disability and absenteeism significantly contribute to depression (10). There is evidence for a direct association between disability and depression, disability and suicidal thoughts or ideation and depression and suicide ideation (11, 12). There is some scientific evidence on how sight loss has an emotional impact and how readjustment may not occur, and suicide may result due to depression and disability (13, 14). Suicidality in the population of people with intellectual disability has been the focus of several investigators (15, 16). Disability affects health-related quality of life and dysphoria symptoms such as helpless, hopeless, worthless, dissatisfaction with life, depression and suicidal ideation, and generally, research data exhibited that physical disability is associated with a higher risk of lifetime suicidal ideation (17 - 20). Additionally, there is fascinating research performed by Fishbain D.A., and colleagues in 2012, preferences for death over disability is associated with passive and active suicidal ideation and actual suicidality in the patients with chronic pain (21). Generally, chronic pain is associated with an elevated risk of suicide (22). Holley J.M. and colleagues in 2014 stated that chronic pain might facilitate the development of a critical risk factor for suicide, fearlessness about death (22). Depression by itself is a disability even without a primary cause of disability, and it is a leading cause of disability globally (23). Coshal S. and colleagues in 2017 stated in their article that one-half of the patients with depression do not receive adequate treatment (23). Klonsky E.D. and colleagues in 2016 published the article where they explained that suicidal behavior is a leading cause of death and disability. Very clearly, they describe the process of development of suicide attempts such as they talked about three distinct steps such as the development of suicidal ideation, and the progression of ideation to suicide attempts. They are two separate entities or distinct phenomena with different explanations and predictors (24). As they explained in their research, depression, hopelessness, most mental diseases, and even impulsivity predict ideation. However, these factors struggle to distinguish who have attempted suicide from those who have only considered suicide — generally, depression even episodic results in lasting disability, distress and burden (25). How life, wellness, and health coaching and holistic and integrative therapies can help? In the last blog related to disability, I was discussing several phases of disability, “the beginning,” “hitting the wall,” “turning around,” “letting go,” “opening up,” “letting in” and “the gift of “healing.” Certainly, in the phase “the beginning” we cannot expect from the disabled person to be cooperative and open for any kind of the treatments for improvements of life, wellness, health. Still, the person is in the state of “shock,” grief, anger, depression, mourning…However, how time passes the person will start to live life with multiple questions such as “what is the purpose and meaning of my life in this condition”, “there is no resources to help me, and they promised to me”, “this is a fake hope, nothing happened after several months”, “I am getting heavily dependent on you, I am so sorry, I am burden”, “I feel hopeless, worthless, helpless” and many more. In this condition, it is essential to approach to the disabled person with a question “what do you feel and think you can work, what would you like to work?” Finding skills and pulling them out “on the surface” is vital in this condition. Even gaining some new skills is an excellent solution. Taking the courses and continuing education courses, certifications, etc.. would be an excellent solution. This will open the “magical door” to the disabled person. Getting out of the house is essential, breaking homebound lifestyle and heavy dependence on a primary caregiver. Taking yoga sessions with mindfulness meditation is extremely helpful (which is very well documented in peer review medical journals). Do not worry even if you cannot doing regular yoga there is yoga in the sitting position, so no excuse for such a thing. Tai Chi and Qi Gong are extremely helpful for balancing body-mind-soul. Regular physician office visits are crucial. Lack of transportation in your area where you live is not a good excuse. Most of the undetected comorbidity is a potential trigger for additional disability and chronic illnesses. Probably the most important thing is finding a reasonable plan on how to spend every day productively. It does not have to be physical work such as gardening, cleaning house, cooking. It could be arts and crafts, creative writing, writing blogs and articles, advocacy work, voluntary contribution in local hospitals, religious and spiritual organizations, churches, and others. Feeling productive is extremely important. A job search should be everyday work for at least one hour. The team at Chiron Wise Centaur can provide you with life, wellness and health coaching, job search and job readiness in disability / chronic illness. Dr. Miroslav Sarac is conducting sessions with disabled people, their families and primary caregivers. References: 1. Tauil CB, Grippe TC, Dias RM, Dias-Carneiro RPC, Carneiro NM, Aguilar ACR, Silva FMD, Bezerra F, Almeida LK, Massarente VL, Giovannelli EC, Tilbery CP, Brandão CO, Santos LMB, Santos-Neto LD. Suicidal ideation, anxiety, and depression in patients with multiple sclerosis. Arq Neuropsiquiatr. 2018 May;76(5):296-301. 2. Lewis VM, Williams K, KoKo C, Woolmore J, Jones C, Powell T. Disability, depression and suicide ideation in people with multiple sclerosis. J Affect Disord. 2017 Jan 15;208:662-669. 3. Moore P, Hirst C, Harding KE, Clarkson H, Pickersgill TP, Robertson NP. Multiple sclerosis relapses and depression. J Psychosom Res. 2012 Oct;73(4):272-6. 4. Pompili M, Forte A, Palermo M, Stefani H, Lamis DA, Serafini G, Amore M, Girardi P. Suicide risk in multiple sclerosis: a systematic review of current literature. J Psychosom Res. 2012 Dec;73(6):411-7. 5. Moore S. Major depression and multiple sclerosis - a case report. J Med Life. 2013 Sep 15;6(3):290-1. 6. Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: an epidemiologic study of a large community sample. Am J Psychiatry. 2002 Nov;159(11):1862-8. 7. Meltzer H, Bebbington P, Brugha T, McManus S, Rai D, Dennis MS, Jenkins R. Physical ill health, disability, dependence, and depression: results from the 2007 national survey of psychiatric morbidity among adults in England. Disabil Health J. 2012 Apr;5(2):102-10. 8. Meltzer H, Brugha T, Dennis MS, Hassiotis A, Jenkis R, McManus S, Rai D, Bebbington. The influence of disability on suicidal behavior. European Journal of Disability Research. 2012. 6: 1, 1 -12. 9. Lecrubier Y. Depressive illness and disability. Eur Neuropsychopharmacol. 2000 Dec;10 Suppl 4: S439-43. 10. Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, Penninx BW, Beekman AT. Long-term work disability and absenteeism in anxiety and depressive disorders. J Affect Disord. 2015 Jun 1;178:121-30. 11. Stensman R, Sundqvist-Stensman UB. Physical disease and disability among 416 suicide cases in Sweden. Scand J Soc Med. 1988;16(3):149-53. 12. Walsh SM, Sage RA. Depression and chronic diabetic foot disability. A case report of a suicide. Clin Podiatr Med Surg. 2002 Oct;19(4):493-508. 13. De Leo D, Hickey PA, Meneghel G, Cantor CH. Blindness, fear of sight loss, and suicide. Psychosomatics. 1999 Jul-Aug;40(4):339-44. 14. Hine TJ, Pitchford NJ, Kingdom FA, Koenekoop R. Blindness and high suicide risk? Psychosomatics. 2000 Jul-Aug;41(4):370-1. 15. Dodd P, Doherty A, Guerin S. A Systematic Review of Suicidality in People with Intellectual Disabilities. Harv Rev Psychiatry. 2016 May-Jun;24(3):202-13. 16. Lunsky Y, Raina P, Burge P. Suicidality among adults with intellectual disability. J Affect Disord. 2012 Nov;140(3):292-5. 17. Båtstad HS, Rudmin FW. Suicidal tendencies as correlates of disability measures. J Health Psychol. 2016 Dec;21(12):3037-3047. 18. Russell D, Turner RJ, Joiner TE. Physical disability and suicidal ideation: a community-based study of risk/protective factors for suicidal thoughts. Suicide Life Threat Behav. 2009 Aug;39(4):440-51. 19. Le Strat Y, Le Foll B, Dubertret C. Major depression and suicide attempts in patients with liver disease in the United States. Liver Int. 2015 Jul;35(7):1910-6. 20. Kerkhof A. Calculating the burden of disease of suicide, attempted suicide, and suicide ideation by estimating disability weights. Crisis. 2012 Jan 1;33(2):63-5. 21. Fishbain DA, Bruns D, Meyer LJ, Lewis JE, Gao J, Disorbio JM. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. Pain Med. 2012 Apr;13(4):552-61. 22. Hooley JM, Franklin JC, Nock MK. Chronic pain and suicide: Understanding the association. Curr Pain Headache Rep. 2014;18(8):435. 23. Coshal S, Saunders J, Matorin AA, Shah AA. Evaluation of Depression and Suicidal Patients in the Emergency Room. Psychiatr Clin North Am. 2017 Sep;40(3):363-377. 24. Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and Suicidal Ideation. Annu Rev Clin Psychol. 2016;12:307-30. 25. Deshpande SS, Kalmegh B, Patil PN, Ghate MR, Sarmukaddam S, Paralikar VP. Stresses and Disability in Depression across Gender. Depress Res Treat. 2014;2014:735307. Read the full article
0 notes
Text
Disability / chronic illness and depression
Disability / chronic illness and depression- walking on broken glass! STOP IT; It is a time for healing. How life, wellness, and health coaching and holistic and integrative therapies can help? Dr. Miroslav Sarac – Chiron Wise Centaur, holistic and integrative healing center Generally, severe depression first hit people with acquired disability compared with people with hereditary disability. Acquired disability whether it is from a chronic disease, acute disease, severe injury or the late and full expression of genetic syndrome creates extreme, and sudden life-changing conditions with plenty of challenges in the future everyday life and people are adjusting very difficult on acquired disability conditions. Suddenly, either way, disability has the potential to generate very adverse condition such as depression that involves persistent feelings of sadness, uselessness, and hopelessness. Malfunctioning vocational rehabilitation services do not take action immediately, mostly they are prolonging the agony of a newly disabled person, postponing their services even though the majority of funds for their operation are coming from the federal funds (approximately 75%). Disabled people are still heavily dependent on primary caregivers The disabled people are getting heavily reliant on primary caregiver either a spouse/husband, partner, a friend for transportation, paying medical and other bills, provide housing and food, etc. Interestingly, the saving account for the majority of disabled people is getting “dry” very quickly because the first two years in the disability the person is not automatically eligible for Medicare or Medicaid (with some exemptions), so saving account is getting dry very quickly paying individual health insurance premium and medical bills for two years until they get eligible for Medicare or Medicaid. Independent living movement works probably somehow well in a big city metro area where the public transportation is available, and automatically paratransit transportation is possible because of compliance with the ADA-AA. However, if a disabled person lives in the area out of a big city metro area, they became heavily dependent on primary caregiver regarding transportation. The disabled people live in health disparities. Some healthcare providers do not accept Medicare or Medicaid, so predominantly disabled people have insufficient access to health care, either preventive or curative. Homebound lifestyle is one additional contribution to severe depression feeling fatigue, pain with no apparent cause, loss of appetite, a person become easily irritable and forgetful; the altered sleeping pattern is pervasive as well. Life is getting significant stress full of challenges and barriers! Unfortunately, the primary caregiver for disabled person plays the central role in the presence of a person with disability providing for the person the crucial resources for a decent life and advocate for the disabled person daily. Still, there is no specific help or support resources to make the life of the primary caregiver easier and less demanding and stressful. Depression as a co-morbidity in the population of people with disability If we observe better already a person with a disability is getting co-morbidity, and that is depression. According to the Social Security Administration, depression is listed as a disability as well. Thus, already disabled person is getting more disabled with the additional co-morbidity major depressive disorder. Depression isolated by itself is the second most common medical condition listed on Social Security disability applications and worldwide is the leading cause of disability. Comfortable in new social circumstances such as lack of transportation, lack of employment, isolated and home-bound lifestyle lead to dysthymia and severe anhedonia. Why disability leads to depression One of the problems what the majority of disabled people stated is a loss of a life direction or purpose. This devastating loss could quickly open the door for severe depression. Unfortunately, lack of appropriate vocational rehabilitation services significantly contributes to this condition, and it is a primary factor that majority people with disability is losing a life direction and cannot see the explicit purpose of their life in the future. Majority state vocational rehabilitation services are operating by approximately 76% of the federal fund, 18% is a contribution from the state and rest is from Social Security Administration for the program “Ticket to Work” and other donations. Life is getting so complicated and stressful. Over time a person with a disability will express the first signs of decreased self-esteem, lack of confidence is a new phenomenon what we can observe, and the loss of autonomy is devastation factor that significantly contributes to development reduced self-esteem and severe depression. Sadness, grievance, and frustration because of career loss is devastation and very challenging phenomenon in the population of disabled people either with an acquired or hereditary disability. Homebound lifestyle what majority disabled people are facing is an additional contribution to the development of severe depression. Quality of life often decreases; losing independence is evident with homebound lifestyle and heavy dependence on a primary caregiver. Majority disabilities leave people homebound with a few opportunities to interact with others. Sometimes disabled persons are at home alone all day while primary caregiver either spouse, husband, the living partner is at work or another scenario the person with disability confined to an assisted living center where community activities do not match either age or interests and a person with a disability is getting more depressed. Why disability raises depression risk? Depression induced by disability can make the disability even worse. Mostly, depressed, disabled people find difficult to take care of their health, preventive health care, mostly missing intentionally or unintentionally essential physician appointments and an annual checkup with a primary care physician. Additionally, people with disability and depression as their co-morbidity do not take their medications as directed and on time. Usually, in the U.S.A. most of the psychiatrists (approx. 90% according to last statistics) do not accept Medicare and Medicaid or any other health insurance. So if the person is lucky and can see a psychiatrist the appointment is mostly about 10 -15 minutes (currently, psychiatrists are ”drug-shapers”), or even worst option in our reality is a community ambulatory care where most people with disabilities see a nurse practitioner or physician assistant. Unfortunately, more and more psychiatrists in the U.S.A. do not work with health insurances. Instead, they provide mental health care only for “cash.” Untreated or unproperly treated depression in the population of disabled people will eventually lead to the first suicidal thoughts. Some evidence suggests that if the first episode of depression goes untreated, a person with disability and depression as co-morbidity has a 50% chance of experiencing a recurrence. In untreated scenario episode of severe depression can last six months to a year probably. Indeed, disability is challenging and life-altering condition enough to cope with. Developing related depression as co-morbidity to disability will make the life of a disabled person even more difficult and challenging. Psychotherapy is also available and sometimes can be very successful and helpful and sometimes can be an even worst option. Most people are placed into the chronic treatment of CBT (cognitive behavioral therapy) instead of according to the standards 6-16 sessions. However, there is one problem, and that is who will pay for the long-term treatment. Mostly, primary caregivers are paying for psychotherapy sessions or if the psychotherapist accepts Medicare or any other health insurance that would be a perfect option. “A substantial body of research shows that family members who provide care to individuals with chronic or disabling conditions are themselves at risk. Emotional, mental and physical health problems can arise from complex caregiving situations and the strains of caring for frail or disabled relatives” (National Center on Caregiving, 2017). Some research data are available regarding suicide in the population of disabled people. Depressive symptoms frequently occur in people with multiple sclerosis and their rates of suicide thoughts are higher than the general population. Also, the presence of depressive symptoms has a direct influence on the risk of suicide (1 - 6). Generally, physically ill health, disability, and feeling of heavy dependence lead to depression (7 - 9) as well as long-term work disability and absenteeism significantly contribute to depression (10). There is evidence for a direct association between disability and depression, disability and suicidal thoughts or ideation and depression and suicide ideation (11, 12). There is some scientific evidence on how sight loss has an emotional impact and how readjustment may not occur, and suicide may result due to depression and disability (13, 14). Suicidality in the population of people with intellectual disability has been the focus of several investigators (15, 16). Disability affects health-related quality of life and dysphoria symptoms such as helpless, hopeless, worthless, dissatisfaction with life, depression and suicidal ideation, and generally, research data exhibited that physical disability is associated with a higher risk of lifetime suicidal ideation (17 - 20). Additionally, there is fascinating research performed by Fishbain D.A., and colleagues in 2012, preferences for death over disability is associated with passive and active suicidal ideation and actual suicidality in the patients with chronic pain (21). Generally, chronic pain is associated with an elevated risk of suicide (22). Holley J.M. and colleagues in 2014 stated that chronic pain might facilitate the development of a critical risk factor for suicide, fearlessness about death (22). Depression by itself is a disability even without a primary cause of disability, and it is a leading cause of disability globally (23). Coshal S. and colleagues in 2017 stated in their article that one-half of the patients with depression do not receive adequate treatment (23). Klonsky E.D. and colleagues in 2016 published the article where they explained that suicidal behavior is a leading cause of death and disability. Very clearly, they describe the process of development of suicide attempts such as they talked about three distinct steps such as the development of suicidal ideation, and the progression of ideation to suicide attempts. They are two separate entities or distinct phenomena with different explanations and predictors (24). As they explained in their research, depression, hopelessness, most mental diseases, and even impulsivity predict ideation. However, these factors struggle to distinguish who have attempted suicide from those who have only considered suicide — generally, depression even episodic results in lasting disability, distress and burden (25). How life, wellness, and health coaching and holistic and integrative therapies can help? In the last blog related to disability, I was discussing several phases of disability, “the beginning,” “hitting the wall,” “turning around,” “letting go,” “opening up,” “letting in” and “the gift of “healing.” Certainly, in the phase “the beginning” we cannot expect from the disabled person to be cooperative and open for any kind of the treatments for improvements of life, wellness, health. Still, the person is in the state of “shock,” grief, anger, depression, mourning…However, how time passes the person will start to live life with multiple questions such as “what is the purpose and meaning of my life in this condition”, “there is no resources to help me, and they promised to me”, “this is a fake hope, nothing happened after several months”, “I am getting heavily dependent on you, I am so sorry, I am burden”, “I feel hopeless, worthless, helpless” and many more. In this condition, it is essential to approach to the disabled person with a question “what do you feel and think you can work, what would you like to work?” Finding skills and pulling them out “on the surface” is vital in this condition. Even gaining some new skills is an excellent solution. Taking the courses and continuing education courses, certifications, etc.. would be an excellent solution. This will open the “magical door” to the disabled person. Getting out of the house is essential, breaking homebound lifestyle and heavy dependence on a primary caregiver. Taking yoga sessions with mindfulness meditation is extremely helpful (which is very well documented in peer review medical journals). Do not worry even if you cannot doing regular yoga there is yoga in the sitting position, so no excuse for such a thing. Tai Chi and Qi Gong are extremely helpful for balancing body-mind-soul. Regular physician office visits are crucial. Lack of transportation in your area where you live is not a good excuse. Most of the undetected comorbidity is a potential trigger for additional disability and chronic illnesses. Probably the most important thing is finding a reasonable plan on how to spend every day productively. It does not have to be physical work such as gardening, cleaning house, cooking. It could be arts and crafts, creative writing, writing blogs and articles, advocacy work, voluntary contribution in local hospitals, religious and spiritual organizations, churches, and others. Feeling productive is extremely important. A job search should be everyday work for at least one hour. The team at Chiron Wise Centaur can provide you with life, wellness and health coaching, job search and job readiness in disability / chronic illness. Dr. Miroslav Sarac is conducting sessions with disabled people, their families and primary caregivers. References: 1. Tauil CB, Grippe TC, Dias RM, Dias-Carneiro RPC, Carneiro NM, Aguilar ACR, Silva FMD, Bezerra F, Almeida LK, Massarente VL, Giovannelli EC, Tilbery CP, Brandão CO, Santos LMB, Santos-Neto LD. Suicidal ideation, anxiety, and depression in patients with multiple sclerosis. Arq Neuropsiquiatr. 2018 May;76(5):296-301. 2. Lewis VM, Williams K, KoKo C, Woolmore J, Jones C, Powell T. Disability, depression and suicide ideation in people with multiple sclerosis. J Affect Disord. 2017 Jan 15;208:662-669. 3. Moore P, Hirst C, Harding KE, Clarkson H, Pickersgill TP, Robertson NP. Multiple sclerosis relapses and depression. J Psychosom Res. 2012 Oct;73(4):272-6. 4. Pompili M, Forte A, Palermo M, Stefani H, Lamis DA, Serafini G, Amore M, Girardi P. Suicide risk in multiple sclerosis: a systematic review of current literature. J Psychosom Res. 2012 Dec;73(6):411-7. 5. Moore S. Major depression and multiple sclerosis - a case report. J Med Life. 2013 Sep 15;6(3):290-1. 6. Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: an epidemiologic study of a large community sample. Am J Psychiatry. 2002 Nov;159(11):1862-8. 7. Meltzer H, Bebbington P, Brugha T, McManus S, Rai D, Dennis MS, Jenkins R. Physical ill health, disability, dependence, and depression: results from the 2007 national survey of psychiatric morbidity among adults in England. Disabil Health J. 2012 Apr;5(2):102-10. 8. Meltzer H, Brugha T, Dennis MS, Hassiotis A, Jenkis R, McManus S, Rai D, Bebbington. The influence of disability on suicidal behavior. European Journal of Disability Research. 2012. 6: 1, 1 -12. 9. Lecrubier Y. Depressive illness and disability. Eur Neuropsychopharmacol. 2000 Dec;10 Suppl 4: S439-43. 10. Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, Penninx BW, Beekman AT. Long-term work disability and absenteeism in anxiety and depressive disorders. J Affect Disord. 2015 Jun 1;178:121-30. 11. Stensman R, Sundqvist-Stensman UB. Physical disease and disability among 416 suicide cases in Sweden. Scand J Soc Med. 1988;16(3):149-53. 12. Walsh SM, Sage RA. Depression and chronic diabetic foot disability. A case report of a suicide. Clin Podiatr Med Surg. 2002 Oct;19(4):493-508. 13. De Leo D, Hickey PA, Meneghel G, Cantor CH. Blindness, fear of sight loss, and suicide. Psychosomatics. 1999 Jul-Aug;40(4):339-44. 14. Hine TJ, Pitchford NJ, Kingdom FA, Koenekoop R. Blindness and high suicide risk? Psychosomatics. 2000 Jul-Aug;41(4):370-1. 15. Dodd P, Doherty A, Guerin S. A Systematic Review of Suicidality in People with Intellectual Disabilities. Harv Rev Psychiatry. 2016 May-Jun;24(3):202-13. 16. Lunsky Y, Raina P, Burge P. Suicidality among adults with intellectual disability. J Affect Disord. 2012 Nov;140(3):292-5. 17. Båtstad HS, Rudmin FW. Suicidal tendencies as correlates of disability measures. J Health Psychol. 2016 Dec;21(12):3037-3047. 18. Russell D, Turner RJ, Joiner TE. Physical disability and suicidal ideation: a community-based study of risk/protective factors for suicidal thoughts. Suicide Life Threat Behav. 2009 Aug;39(4):440-51. 19. Le Strat Y, Le Foll B, Dubertret C. Major depression and suicide attempts in patients with liver disease in the United States. Liver Int. 2015 Jul;35(7):1910-6. 20. Kerkhof A. Calculating the burden of disease of suicide, attempted suicide, and suicide ideation by estimating disability weights. Crisis. 2012 Jan 1;33(2):63-5. 21. Fishbain DA, Bruns D, Meyer LJ, Lewis JE, Gao J, Disorbio JM. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. Pain Med. 2012 Apr;13(4):552-61. 22. Hooley JM, Franklin JC, Nock MK. Chronic pain and suicide: Understanding the association. Curr Pain Headache Rep. 2014;18(8):435. 23. Coshal S, Saunders J, Matorin AA, Shah AA. Evaluation of Depression and Suicidal Patients in the Emergency Room. Psychiatr Clin North Am. 2017 Sep;40(3):363-377. 24. Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and Suicidal Ideation. Annu Rev Clin Psychol. 2016;12:307-30. 25. Deshpande SS, Kalmegh B, Patil PN, Ghate MR, Sarmukaddam S, Paralikar VP. Stresses and Disability in Depression across Gender. Depress Res Treat. 2014;2014:735307. Read the full article
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Disability / chronic illness and depression
Disability / chronic illness and depression- walking on broken glass! STOP IT; It is a time for healing. How life, wellness, and health coaching and holistic and integrative therapies can help? Dr. Miroslav Sarac – Chiron Wise Centaur, holistic and integrative healing center Generally, severe depression first hit people with acquired disability compared with people with hereditary disability. Acquired disability whether it is from a chronic disease, acute disease, severe injury or the late and full expression of genetic syndrome creates extreme, and sudden life-changing conditions with plenty of challenges in the future everyday life and people are adjusting very difficult on acquired disability conditions. Suddenly, either way, disability has the potential to generate very adverse condition such as depression that involves persistent feelings of sadness, uselessness, and hopelessness. Malfunctioning vocational rehabilitation services do not take action immediately, mostly they are prolonging the agony of a newly disabled person, postponing their services even though the majority of funds for their operation are coming from the federal funds (approximately 75%). Disabled people are still heavily dependent on primary caregivers The disabled people are getting heavily reliant on primary caregiver either a spouse/husband, partner, a friend for transportation, paying medical and other bills, provide housing and food, etc. Interestingly, the saving account for the majority of disabled people is getting “dry” very quickly because the first two years in the disability the person is not automatically eligible for Medicare or Medicaid (with some exemptions), so saving account is getting dry very quickly paying individual health insurance premium and medical bills for two years until they get eligible for Medicare or Medicaid. Independent living movement works probably somehow well in a big city metro area where the public transportation is available, and automatically paratransit transportation is possible because of compliance with the ADA-AA. However, if a disabled person lives in the area out of a big city metro area, they became heavily dependent on primary caregiver regarding transportation. The disabled people live in health disparities. Some healthcare providers do not accept Medicare or Medicaid, so predominantly disabled people have insufficient access to health care, either preventive or curative. Homebound lifestyle is one additional contribution to severe depression feeling fatigue, pain with no apparent cause, loss of appetite, a person become easily irritable and forgetful; the altered sleeping pattern is pervasive as well. Life is getting significant stress full of challenges and barriers! Unfortunately, the primary caregiver for disabled person plays the central role in the presence of a person with disability providing for the person the crucial resources for a decent life and advocate for the disabled person daily. Still, there is no specific help or support resources to make the life of the primary caregiver easier and less demanding and stressful. Depression as a co-morbidity in the population of people with disability If we observe better already a person with a disability is getting co-morbidity, and that is depression. According to the Social Security Administration, depression is listed as a disability as well. Thus, already disabled person is getting more disabled with the additional co-morbidity major depressive disorder. Depression isolated by itself is the second most common medical condition listed on Social Security disability applications and worldwide is the leading cause of disability. Comfortable in new social circumstances such as lack of transportation, lack of employment, isolated and home-bound lifestyle lead to dysthymia and severe anhedonia. Why disability leads to depression One of the problems what the majority of disabled people stated is a loss of a life direction or purpose. This devastating loss could quickly open the door for severe depression. Unfortunately, lack of appropriate vocational rehabilitation services significantly contributes to this condition, and it is a primary factor that majority people with disability is losing a life direction and cannot see the explicit purpose of their life in the future. Majority state vocational rehabilitation services are operating by approximately 76% of the federal fund, 18% is a contribution from the state and rest is from Social Security Administration for the program “Ticket to Work” and other donations. Life is getting so complicated and stressful. Over time a person with a disability will express the first signs of decreased self-esteem, lack of confidence is a new phenomenon what we can observe, and the loss of autonomy is devastation factor that significantly contributes to development reduced self-esteem and severe depression. Sadness, grievance, and frustration because of career loss is devastation and very challenging phenomenon in the population of disabled people either with an acquired or hereditary disability. Homebound lifestyle what majority disabled people are facing is an additional contribution to the development of severe depression. Quality of life often decreases; losing independence is evident with homebound lifestyle and heavy dependence on a primary caregiver. Majority disabilities leave people homebound with a few opportunities to interact with others. Sometimes disabled persons are at home alone all day while primary caregiver either spouse, husband, the living partner is at work or another scenario the person with disability confined to an assisted living center where community activities do not match either age or interests and a person with a disability is getting more depressed. Why disability raises depression risk? Depression induced by disability can make the disability even worse. Mostly, depressed, disabled people find difficult to take care of their health, preventive health care, mostly missing intentionally or unintentionally essential physician appointments and an annual checkup with a primary care physician. Additionally, people with disability and depression as their co-morbidity do not take their medications as directed and on time. Usually, in the U.S.A. most of the psychiatrists (approx. 90% according to last statistics) do not accept Medicare and Medicaid or any other health insurance. So if the person is lucky and can see a psychiatrist the appointment is mostly about 10 -15 minutes (currently, psychiatrists are ”drug-shapers”), or even worst option in our reality is a community ambulatory care where most people with disabilities see a nurse practitioner or physician assistant. Unfortunately, more and more psychiatrists in the U.S.A. do not work with health insurances. Instead, they provide mental health care only for “cash.” Untreated or unproperly treated depression in the population of disabled people will eventually lead to the first suicidal thoughts. Some evidence suggests that if the first episode of depression goes untreated, a person with disability and depression as co-morbidity has a 50% chance of experiencing a recurrence. In untreated scenario episode of severe depression can last six months to a year probably. Indeed, disability is challenging and life-altering condition enough to cope with. Developing related depression as co-morbidity to disability will make the life of a disabled person even more difficult and challenging. Psychotherapy is also available and sometimes can be very successful and helpful and sometimes can be an even worst option. Most people are placed into the chronic treatment of CBT (cognitive behavioral therapy) instead of according to the standards 6-16 sessions. However, there is one problem, and that is who will pay for the long-term treatment. Mostly, primary caregivers are paying for psychotherapy sessions or if the psychotherapist accepts Medicare or any other health insurance that would be a perfect option. “A substantial body of research shows that family members who provide care to individuals with chronic or disabling conditions are themselves at risk. Emotional, mental and physical health problems can arise from complex caregiving situations and the strains of caring for frail or disabled relatives” (National Center on Caregiving, 2017). Some research data are available regarding suicide in the population of disabled people. Depressive symptoms frequently occur in people with multiple sclerosis and their rates of suicide thoughts are higher than the general population. Also, the presence of depressive symptoms has a direct influence on the risk of suicide (1 - 6). Generally, physically ill health, disability, and feeling of heavy dependence lead to depression (7 - 9) as well as long-term work disability and absenteeism significantly contribute to depression (10). There is evidence for a direct association between disability and depression, disability and suicidal thoughts or ideation and depression and suicide ideation (11, 12). There is some scientific evidence on how sight loss has an emotional impact and how readjustment may not occur, and suicide may result due to depression and disability (13, 14). Suicidality in the population of people with intellectual disability has been the focus of several investigators (15, 16). Disability affects health-related quality of life and dysphoria symptoms such as helpless, hopeless, worthless, dissatisfaction with life, depression and suicidal ideation, and generally, research data exhibited that physical disability is associated with a higher risk of lifetime suicidal ideation (17 - 20). Additionally, there is fascinating research performed by Fishbain D.A., and colleagues in 2012, preferences for death over disability is associated with passive and active suicidal ideation and actual suicidality in the patients with chronic pain (21). Generally, chronic pain is associated with an elevated risk of suicide (22). Holley J.M. and colleagues in 2014 stated that chronic pain might facilitate the development of a critical risk factor for suicide, fearlessness about death (22). Depression by itself is a disability even without a primary cause of disability, and it is a leading cause of disability globally (23). Coshal S. and colleagues in 2017 stated in their article that one-half of the patients with depression do not receive adequate treatment (23). Klonsky E.D. and colleagues in 2016 published the article where they explained that suicidal behavior is a leading cause of death and disability. Very clearly, they describe the process of development of suicide attempts such as they talked about three distinct steps such as the development of suicidal ideation, and the progression of ideation to suicide attempts. They are two separate entities or distinct phenomena with different explanations and predictors (24). As they explained in their research, depression, hopelessness, most mental diseases, and even impulsivity predict ideation. However, these factors struggle to distinguish who have attempted suicide from those who have only considered suicide — generally, depression even episodic results in lasting disability, distress and burden (25). How life, wellness, and health coaching and holistic and integrative therapies can help? In the last blog related to disability, I was discussing several phases of disability, “the beginning,” “hitting the wall,” “turning around,” “letting go,” “opening up,” “letting in” and “the gift of “healing.” Certainly, in the phase “the beginning” we cannot expect from the disabled person to be cooperative and open for any kind of the treatments for improvements of life, wellness, health. Still, the person is in the state of “shock,” grief, anger, depression, mourning…However, how time passes the person will start to live life with multiple questions such as “what is the purpose and meaning of my life in this condition”, “there is no resources to help me, and they promised to me”, “this is a fake hope, nothing happened after several months”, “I am getting heavily dependent on you, I am so sorry, I am burden”, “I feel hopeless, worthless, helpless” and many more. In this condition, it is essential to approach to the disabled person with a question “what do you feel and think you can work, what would you like to work?” Finding skills and pulling them out “on the surface” is vital in this condition. Even gaining some new skills is an excellent solution. Taking the courses and continuing education courses, certifications, etc.. would be an excellent solution. This will open the “magical door” to the disabled person. Getting out of the house is essential, breaking homebound lifestyle and heavy dependence on a primary caregiver. Taking yoga sessions with mindfulness meditation is extremely helpful (which is very well documented in peer review medical journals). Do not worry even if you cannot doing regular yoga there is yoga in the sitting position, so no excuse for such a thing. Tai Chi and Qi Gong are extremely helpful for balancing body-mind-soul. Regular physician office visits are crucial. Lack of transportation in your area where you live is not a good excuse. Most of the undetected comorbidity is a potential trigger for additional disability and chronic illnesses. Probably the most important thing is finding a reasonable plan on how to spend every day productively. It does not have to be physical work such as gardening, cleaning house, cooking. It could be arts and crafts, creative writing, writing blogs and articles, advocacy work, voluntary contribution in local hospitals, religious and spiritual organizations, churches, and others. Feeling productive is extremely important. A job search should be everyday work for at least one hour. The team at Chiron Wise Centaur can provide you with life, wellness and health coaching, job search and job readiness in disability / chronic illness. Dr. Miroslav Sarac is conducting sessions with disabled people, their families and primary caregivers. References: 1. Tauil CB, Grippe TC, Dias RM, Dias-Carneiro RPC, Carneiro NM, Aguilar ACR, Silva FMD, Bezerra F, Almeida LK, Massarente VL, Giovannelli EC, Tilbery CP, Brandão CO, Santos LMB, Santos-Neto LD. Suicidal ideation, anxiety, and depression in patients with multiple sclerosis. Arq Neuropsiquiatr. 2018 May;76(5):296-301. 2. Lewis VM, Williams K, KoKo C, Woolmore J, Jones C, Powell T. Disability, depression and suicide ideation in people with multiple sclerosis. J Affect Disord. 2017 Jan 15;208:662-669. 3. Moore P, Hirst C, Harding KE, Clarkson H, Pickersgill TP, Robertson NP. Multiple sclerosis relapses and depression. J Psychosom Res. 2012 Oct;73(4):272-6. 4. Pompili M, Forte A, Palermo M, Stefani H, Lamis DA, Serafini G, Amore M, Girardi P. Suicide risk in multiple sclerosis: a systematic review of current literature. J Psychosom Res. 2012 Dec;73(6):411-7. 5. Moore S. Major depression and multiple sclerosis - a case report. J Med Life. 2013 Sep 15;6(3):290-1. 6. Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: an epidemiologic study of a large community sample. Am J Psychiatry. 2002 Nov;159(11):1862-8. 7. Meltzer H, Bebbington P, Brugha T, McManus S, Rai D, Dennis MS, Jenkins R. Physical ill health, disability, dependence, and depression: results from the 2007 national survey of psychiatric morbidity among adults in England. Disabil Health J. 2012 Apr;5(2):102-10. 8. Meltzer H, Brugha T, Dennis MS, Hassiotis A, Jenkis R, McManus S, Rai D, Bebbington. The influence of disability on suicidal behavior. European Journal of Disability Research. 2012. 6: 1, 1 -12. 9. Lecrubier Y. Depressive illness and disability. Eur Neuropsychopharmacol. 2000 Dec;10 Suppl 4: S439-43. 10. Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, Penninx BW, Beekman AT. Long-term work disability and absenteeism in anxiety and depressive disorders. J Affect Disord. 2015 Jun 1;178:121-30. 11. Stensman R, Sundqvist-Stensman UB. Physical disease and disability among 416 suicide cases in Sweden. Scand J Soc Med. 1988;16(3):149-53. 12. Walsh SM, Sage RA. Depression and chronic diabetic foot disability. A case report of a suicide. Clin Podiatr Med Surg. 2002 Oct;19(4):493-508. 13. De Leo D, Hickey PA, Meneghel G, Cantor CH. Blindness, fear of sight loss, and suicide. Psychosomatics. 1999 Jul-Aug;40(4):339-44. 14. Hine TJ, Pitchford NJ, Kingdom FA, Koenekoop R. Blindness and high suicide risk? Psychosomatics. 2000 Jul-Aug;41(4):370-1. 15. Dodd P, Doherty A, Guerin S. A Systematic Review of Suicidality in People with Intellectual Disabilities. Harv Rev Psychiatry. 2016 May-Jun;24(3):202-13. 16. Lunsky Y, Raina P, Burge P. Suicidality among adults with intellectual disability. J Affect Disord. 2012 Nov;140(3):292-5. 17. Båtstad HS, Rudmin FW. Suicidal tendencies as correlates of disability measures. J Health Psychol. 2016 Dec;21(12):3037-3047. 18. Russell D, Turner RJ, Joiner TE. Physical disability and suicidal ideation: a community-based study of risk/protective factors for suicidal thoughts. Suicide Life Threat Behav. 2009 Aug;39(4):440-51. 19. Le Strat Y, Le Foll B, Dubertret C. Major depression and suicide attempts in patients with liver disease in the United States. Liver Int. 2015 Jul;35(7):1910-6. 20. Kerkhof A. Calculating the burden of disease of suicide, attempted suicide, and suicide ideation by estimating disability weights. Crisis. 2012 Jan 1;33(2):63-5. 21. Fishbain DA, Bruns D, Meyer LJ, Lewis JE, Gao J, Disorbio JM. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. Pain Med. 2012 Apr;13(4):552-61. 22. Hooley JM, Franklin JC, Nock MK. Chronic pain and suicide: Understanding the association. Curr Pain Headache Rep. 2014;18(8):435. 23. Coshal S, Saunders J, Matorin AA, Shah AA. Evaluation of Depression and Suicidal Patients in the Emergency Room. Psychiatr Clin North Am. 2017 Sep;40(3):363-377. 24. Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and Suicidal Ideation. Annu Rev Clin Psychol. 2016;12:307-30. 25. Deshpande SS, Kalmegh B, Patil PN, Ghate MR, Sarmukaddam S, Paralikar VP. Stresses and Disability in Depression across Gender. Depress Res Treat. 2014;2014:735307. Read the full article
0 notes
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Disability / chronic illness and depression
Disability / chronic illness and depression- walking on broken glass! STOP IT; It is a time for healing. How life, wellness, and health coaching and holistic and integrative therapies can help? Dr. Miroslav Sarac – Chiron Wise Centaur, holistic and integrative healing center Generally, severe depression first hit people with acquired disability compared with people with hereditary disability. Acquired disability whether it is from a chronic disease, acute disease, severe injury or the late and full expression of genetic syndrome creates extreme, and sudden life-changing conditions with plenty of challenges in the future everyday life and people are adjusting very difficult on acquired disability conditions. Suddenly, either way, disability has the potential to generate very adverse condition such as depression that involves persistent feelings of sadness, uselessness, and hopelessness. Malfunctioning vocational rehabilitation services do not take action immediately, mostly they are prolonging the agony of a newly disabled person, postponing their services even though the majority of funds for their operation are coming from the federal funds (approximately 75%). Disabled people are still heavily dependent on primary caregivers The disabled people are getting heavily reliant on primary caregiver either a spouse/husband, partner, a friend for transportation, paying medical and other bills, provide housing and food, etc. Interestingly, the saving account for the majority of disabled people is getting “dry” very quickly because the first two years in the disability the person is not automatically eligible for Medicare or Medicaid (with some exemptions), so saving account is getting dry very quickly paying individual health insurance premium and medical bills for two years until they get eligible for Medicare or Medicaid. Independent living movement works probably somehow well in a big city metro area where the public transportation is available, and automatically paratransit transportation is possible because of compliance with the ADA-AA. However, if a disabled person lives in the area out of a big city metro area, they became heavily dependent on primary caregiver regarding transportation. The disabled people live in health disparities. Some healthcare providers do not accept Medicare or Medicaid, so predominantly disabled people have insufficient access to health care, either preventive or curative. Homebound lifestyle is one additional contribution to severe depression feeling fatigue, pain with no apparent cause, loss of appetite, a person become easily irritable and forgetful; the altered sleeping pattern is pervasive as well. Life is getting significant stress full of challenges and barriers! Unfortunately, the primary caregiver for disabled person plays the central role in the presence of a person with disability providing for the person the crucial resources for a decent life and advocate for the disabled person daily. Still, there is no specific help or support resources to make the life of the primary caregiver easier and less demanding and stressful. Depression as a co-morbidity in the population of people with disability If we observe better already a person with a disability is getting co-morbidity, and that is depression. According to the Social Security Administration, depression is listed as a disability as well. Thus, already disabled person is getting more disabled with the additional co-morbidity major depressive disorder. Depression isolated by itself is the second most common medical condition listed on Social Security disability applications and worldwide is the leading cause of disability. Comfortable in new social circumstances such as lack of transportation, lack of employment, isolated and home-bound lifestyle lead to dysthymia and severe anhedonia. Why disability leads to depression One of the problems what the majority of disabled people stated is a loss of a life direction or purpose. This devastating loss could quickly open the door for severe depression. Unfortunately, lack of appropriate vocational rehabilitation services significantly contributes to this condition, and it is a primary factor that majority people with disability is losing a life direction and cannot see the explicit purpose of their life in the future. Majority state vocational rehabilitation services are operating by approximately 76% of the federal fund, 18% is a contribution from the state and rest is from Social Security Administration for the program “Ticket to Work” and other donations. Life is getting so complicated and stressful. Over time a person with a disability will express the first signs of decreased self-esteem, lack of confidence is a new phenomenon what we can observe, and the loss of autonomy is devastation factor that significantly contributes to development reduced self-esteem and severe depression. Sadness, grievance, and frustration because of career loss is devastation and very challenging phenomenon in the population of disabled people either with an acquired or hereditary disability. Homebound lifestyle what majority disabled people are facing is an additional contribution to the development of severe depression. Quality of life often decreases; losing independence is evident with homebound lifestyle and heavy dependence on a primary caregiver. Majority disabilities leave people homebound with a few opportunities to interact with others. Sometimes disabled persons are at home alone all day while primary caregiver either spouse, husband, the living partner is at work or another scenario the person with disability confined to an assisted living center where community activities do not match either age or interests and a person with a disability is getting more depressed. Why disability raises depression risk? Depression induced by disability can make the disability even worse. Mostly, depressed, disabled people find difficult to take care of their health, preventive health care, mostly missing intentionally or unintentionally essential physician appointments and an annual checkup with a primary care physician. Additionally, people with disability and depression as their co-morbidity do not take their medications as directed and on time. Usually, in the U.S.A. most of the psychiatrists (approx. 90% according to last statistics) do not accept Medicare and Medicaid or any other health insurance. So if the person is lucky and can see a psychiatrist the appointment is mostly about 10 -15 minutes (currently, psychiatrists are ”drug-shapers”), or even worst option in our reality is a community ambulatory care where most people with disabilities see a nurse practitioner or physician assistant. Unfortunately, more and more psychiatrists in the U.S.A. do not work with health insurances. Instead, they provide mental health care only for “cash.” Untreated or unproperly treated depression in the population of disabled people will eventually lead to the first suicidal thoughts. Some evidence suggests that if the first episode of depression goes untreated, a person with disability and depression as co-morbidity has a 50% chance of experiencing a recurrence. In untreated scenario episode of severe depression can last six months to a year probably. Indeed, disability is challenging and life-altering condition enough to cope with. Developing related depression as co-morbidity to disability will make the life of a disabled person even more difficult and challenging. Psychotherapy is also available and sometimes can be very successful and helpful and sometimes can be an even worst option. Most people are placed into the chronic treatment of CBT (cognitive behavioral therapy) instead of according to the standards 6-16 sessions. However, there is one problem, and that is who will pay for the long-term treatment. Mostly, primary caregivers are paying for psychotherapy sessions or if the psychotherapist accepts Medicare or any other health insurance that would be a perfect option. “A substantial body of research shows that family members who provide care to individuals with chronic or disabling conditions are themselves at risk. Emotional, mental and physical health problems can arise from complex caregiving situations and the strains of caring for frail or disabled relatives” (National Center on Caregiving, 2017). Some research data are available regarding suicide in the population of disabled people. Depressive symptoms frequently occur in people with multiple sclerosis and their rates of suicide thoughts are higher than the general population. Also, the presence of depressive symptoms has a direct influence on the risk of suicide (1 - 6). Generally, physically ill health, disability, and feeling of heavy dependence lead to depression (7 - 9) as well as long-term work disability and absenteeism significantly contribute to depression (10). There is evidence for a direct association between disability and depression, disability and suicidal thoughts or ideation and depression and suicide ideation (11, 12). There is some scientific evidence on how sight loss has an emotional impact and how readjustment may not occur, and suicide may result due to depression and disability (13, 14). Suicidality in the population of people with intellectual disability has been the focus of several investigators (15, 16). Disability affects health-related quality of life and dysphoria symptoms such as helpless, hopeless, worthless, dissatisfaction with life, depression and suicidal ideation, and generally, research data exhibited that physical disability is associated with a higher risk of lifetime suicidal ideation (17 - 20). Additionally, there is fascinating research performed by Fishbain D.A., and colleagues in 2012, preferences for death over disability is associated with passive and active suicidal ideation and actual suicidality in the patients with chronic pain (21). Generally, chronic pain is associated with an elevated risk of suicide (22). Holley J.M. and colleagues in 2014 stated that chronic pain might facilitate the development of a critical risk factor for suicide, fearlessness about death (22). Depression by itself is a disability even without a primary cause of disability, and it is a leading cause of disability globally (23). Coshal S. and colleagues in 2017 stated in their article that one-half of the patients with depression do not receive adequate treatment (23). Klonsky E.D. and colleagues in 2016 published the article where they explained that suicidal behavior is a leading cause of death and disability. Very clearly, they describe the process of development of suicide attempts such as they talked about three distinct steps such as the development of suicidal ideation, and the progression of ideation to suicide attempts. They are two separate entities or distinct phenomena with different explanations and predictors (24). As they explained in their research, depression, hopelessness, most mental diseases, and even impulsivity predict ideation. However, these factors struggle to distinguish who have attempted suicide from those who have only considered suicide — generally, depression even episodic results in lasting disability, distress and burden (25). How life, wellness, and health coaching and holistic and integrative therapies can help? In the last blog related to disability, I was discussing several phases of disability, “the beginning,” “hitting the wall,” “turning around,” “letting go,” “opening up,” “letting in” and “the gift of “healing.” Certainly, in the phase “the beginning” we cannot expect from the disabled person to be cooperative and open for any kind of the treatments for improvements of life, wellness, health. Still, the person is in the state of “shock,” grief, anger, depression, mourning…However, how time passes the person will start to live life with multiple questions such as “what is the purpose and meaning of my life in this condition”, “there is no resources to help me, and they promised to me”, “this is a fake hope, nothing happened after several months”, “I am getting heavily dependent on you, I am so sorry, I am burden”, “I feel hopeless, worthless, helpless” and many more. In this condition, it is essential to approach to the disabled person with a question “what do you feel and think you can work, what would you like to work?” Finding skills and pulling them out “on the surface” is vital in this condition. Even gaining some new skills is an excellent solution. Taking the courses and continuing education courses, certifications, etc.. would be an excellent solution. This will open the “magical door” to the disabled person. Getting out of the house is essential, breaking homebound lifestyle and heavy dependence on a primary caregiver. Taking yoga sessions with mindfulness meditation is extremely helpful (which is very well documented in peer review medical journals). Do not worry even if you cannot doing regular yoga there is yoga in the sitting position, so no excuse for such a thing. Tai Chi and Qi Gong are extremely helpful for balancing body-mind-soul. Regular physician office visits are crucial. Lack of transportation in your area where you live is not a good excuse. Most of the undetected comorbidity is a potential trigger for additional disability and chronic illnesses. Probably the most important thing is finding a reasonable plan on how to spend every day productively. It does not have to be physical work such as gardening, cleaning house, cooking. It could be arts and crafts, creative writing, writing blogs and articles, advocacy work, voluntary contribution in local hospitals, religious and spiritual organizations, churches, and others. Feeling productive is extremely important. A job search should be everyday work for at least one hour. The team at Chiron Wise Centaur can provide you with life, wellness and health coaching, job search and job readiness in disability / chronic illness. Dr. Miroslav Sarac is conducting sessions with disabled people, their families and primary caregivers. References: 1. Tauil CB, Grippe TC, Dias RM, Dias-Carneiro RPC, Carneiro NM, Aguilar ACR, Silva FMD, Bezerra F, Almeida LK, Massarente VL, Giovannelli EC, Tilbery CP, Brandão CO, Santos LMB, Santos-Neto LD. Suicidal ideation, anxiety, and depression in patients with multiple sclerosis. Arq Neuropsiquiatr. 2018 May;76(5):296-301. 2. Lewis VM, Williams K, KoKo C, Woolmore J, Jones C, Powell T. Disability, depression and suicide ideation in people with multiple sclerosis. J Affect Disord. 2017 Jan 15;208:662-669. 3. Moore P, Hirst C, Harding KE, Clarkson H, Pickersgill TP, Robertson NP. Multiple sclerosis relapses and depression. J Psychosom Res. 2012 Oct;73(4):272-6. 4. Pompili M, Forte A, Palermo M, Stefani H, Lamis DA, Serafini G, Amore M, Girardi P. Suicide risk in multiple sclerosis: a systematic review of current literature. J Psychosom Res. 2012 Dec;73(6):411-7. 5. Moore S. Major depression and multiple sclerosis - a case report. J Med Life. 2013 Sep 15;6(3):290-1. 6. Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: an epidemiologic study of a large community sample. Am J Psychiatry. 2002 Nov;159(11):1862-8. 7. Meltzer H, Bebbington P, Brugha T, McManus S, Rai D, Dennis MS, Jenkins R. Physical ill health, disability, dependence, and depression: results from the 2007 national survey of psychiatric morbidity among adults in England. Disabil Health J. 2012 Apr;5(2):102-10. 8. Meltzer H, Brugha T, Dennis MS, Hassiotis A, Jenkis R, McManus S, Rai D, Bebbington. The influence of disability on suicidal behavior. European Journal of Disability Research. 2012. 6: 1, 1 -12. 9. Lecrubier Y. Depressive illness and disability. Eur Neuropsychopharmacol. 2000 Dec;10 Suppl 4: S439-43. 10. Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, Penninx BW, Beekman AT. Long-term work disability and absenteeism in anxiety and depressive disorders. J Affect Disord. 2015 Jun 1;178:121-30. 11. Stensman R, Sundqvist-Stensman UB. Physical disease and disability among 416 suicide cases in Sweden. Scand J Soc Med. 1988;16(3):149-53. 12. Walsh SM, Sage RA. Depression and chronic diabetic foot disability. A case report of a suicide. Clin Podiatr Med Surg. 2002 Oct;19(4):493-508. 13. De Leo D, Hickey PA, Meneghel G, Cantor CH. Blindness, fear of sight loss, and suicide. Psychosomatics. 1999 Jul-Aug;40(4):339-44. 14. Hine TJ, Pitchford NJ, Kingdom FA, Koenekoop R. Blindness and high suicide risk? Psychosomatics. 2000 Jul-Aug;41(4):370-1. 15. Dodd P, Doherty A, Guerin S. A Systematic Review of Suicidality in People with Intellectual Disabilities. Harv Rev Psychiatry. 2016 May-Jun;24(3):202-13. 16. Lunsky Y, Raina P, Burge P. Suicidality among adults with intellectual disability. J Affect Disord. 2012 Nov;140(3):292-5. 17. Båtstad HS, Rudmin FW. Suicidal tendencies as correlates of disability measures. J Health Psychol. 2016 Dec;21(12):3037-3047. 18. Russell D, Turner RJ, Joiner TE. Physical disability and suicidal ideation: a community-based study of risk/protective factors for suicidal thoughts. Suicide Life Threat Behav. 2009 Aug;39(4):440-51. 19. Le Strat Y, Le Foll B, Dubertret C. Major depression and suicide attempts in patients with liver disease in the United States. Liver Int. 2015 Jul;35(7):1910-6. 20. Kerkhof A. Calculating the burden of disease of suicide, attempted suicide, and suicide ideation by estimating disability weights. Crisis. 2012 Jan 1;33(2):63-5. 21. Fishbain DA, Bruns D, Meyer LJ, Lewis JE, Gao J, Disorbio JM. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. Pain Med. 2012 Apr;13(4):552-61. 22. Hooley JM, Franklin JC, Nock MK. Chronic pain and suicide: Understanding the association. Curr Pain Headache Rep. 2014;18(8):435. 23. Coshal S, Saunders J, Matorin AA, Shah AA. Evaluation of Depression and Suicidal Patients in the Emergency Room. Psychiatr Clin North Am. 2017 Sep;40(3):363-377. 24. Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and Suicidal Ideation. Annu Rev Clin Psychol. 2016;12:307-30. 25. Deshpande SS, Kalmegh B, Patil PN, Ghate MR, Sarmukaddam S, Paralikar VP. Stresses and Disability in Depression across Gender. Depress Res Treat. 2014;2014:735307. Read the full article
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About Maya
I am a long-time astrologer and spiritual practitioner and have been serving the international clientele for over 20 years (predominantly in Europe and the U.S.A.). My specialties in astrology are applied astrology to your life changes straight from astrology into your reality as well as traditional astrological services, natal (birth) charts, yearly forecast, transit forecast. I strictly follow The Code of Ethics in my practice as an astrological consultant. I will provide you with my analysis in the written form via email. Please feel free to ask any questions or concerns if you have. I would like to share with you some essential quotes of Carl Gustav Jung regarding astrology: “Astrology would be a large scale example of synchronism if it had at its disposal thoroughly tested findings. But at least there are some facts adequately tested and fortified by a wealth of statistics which make the astrological problem even worthy of philosophical investigation. It is assured of recognition from psychology, without further restrictions, because astrology represents the summation of all the psychological knowledge of antiquity.” – C.G. Jung “As I am a psychologist, I’m chiefly interested in the particular light the horoscope sheds on certain complications in character. In cases of difficult psychological diagnosis, I usually get a horoscope in order to have a further point of view from an entirely different angle. I must say that I have very often found that the astrological data elucidated certain points which I otherwise would have been unable to understand.” - C.G. Jung Click the button to go to my consultation. Applied Astrology Read the full article
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Drug-Herb Interaction
Are you using herbal medicines as a primary or supplemental treatment, and are you aware of possible issues of drug-herb interactions? Recently, I was listening to the lecture of professor Dr. Bill J. Gurley titled as “Clinically relevant herb-drug interactions: past, present, and future” at the National Center for Complementary and Integrative Health, National Institutes of Health of the U.S.A. I was impressed with the presentation from one pharmacy professor who is highly specialized in the field of pharmacokinetics and pharmacodynamics of the conventional medications and supplemental herbal products. After the lecture, I started wondering what we really know about herbal remedies or their combination with conventional prescription medications as a part of complementary treatment. Indeed, we know about herbal medicine a lot, but how about their combination with conventional therapeutics in the form of complementary therapy. Did we learn something from the case ephedra (Ephedra sinica)? Clearly was stated in the lecture that for example ephedra (Ephedra sinica) was used in Traditional Chinese Medicine for over 5000 years for treatment of asthma and nasal congestion for only 7 – 10 days and that’s it, either a patient is healed or not, but not chronic use of ephedra was considering and proper treatment by ephedra in Traditional Chinese Medicine. However, in the U.S.A. from 1994 until 2004 ephedra was using chronically as a potent stimulant, not as a remedy for bronchial asthma, nasal congestion, cold, flu, fever, cough, and wheezing. In response to substantially collected evidence of adverse effects and deaths related to ephedra, the U.S. Food and Drug Administration (FDA) banned the sale of supplements containing ephedrine alkaloids in 2004. Ephedrine is a potent sympathomimetic that stimulates alpha, beta one and beta two adrenergic receptors as well. It excites and stimulates the sympathetic nervous system, causes tremendous vasoconstriction and cardiac stimulation, and produces effects similar to those of epinephrine (adrenalin). Ephedra extracts that do not contain ephedrine have not been banned by the FDA and are still sold legally today. Yet, Chinese and other people who know how properly to use ephedra, use it effectively to cure some acute diseases in a short period, NOT chronically. Do we really use herbal remedies correctly in our Western culture and conventional treatment with prescription medications and then we call that complementary treatment? Do we take into consideration numerous factors regarding the combination of conventional medicines and herbal remedies in complementary therapy such as characteristics of the patient, gender, age, ethnicity, co-morbidity, frailty, infrequent genotypes, and others? Also, the fact that majority currently available dietary and supplemental herbal remedies are products containing multiple herbal components, that their formulation is utilizing highly concentrated herbal (botanical) extracts which is not a proper way of preparing herbal remedies in alternative medicine, that many commercially available supplemental herbal products have the presence of numerous phytochemicals that have not been tested for pharmacological activities. These facts do not “sound” like a traditional herbal therapy and their proper use as a supplemental therapy in the form of complementary treatment along with conventional therapy by using prescribed medications. What is the level of the current clinical evidence? The next surprise, when I was searching for the scientific literature data, results of clinical studies regarding using herbal remedies as a supplement therapy to conventional therapeutics, calling that complementary treatment, mostly they are isolated case studies or case series, case reports, and results of in vitro analysis performed on cell cultures expressing human genes (for example). Mostly, clinical evidence has been on the level of incomplete case studies, case reports, an adverse event unlikely from a pharmacological viewpoint, case report providing some evidence for interaction, however, other cases not entirely excluded, case series, some pharmacokinetic trials in patients or healthy people, there are numerous contradictory data, or adverse events are highlighted by case reports but not confirmed by clinical trials or mega clinical trials. Mostly authors were taken rights to generalize, and it is very well known that generalization is acceptable only if you perform experimental clinical research design. No doubt, scientifically, case studies are a useful “tool” to set up a future hypothesis in clinical research and to conduct further research in that particular field. Complementary medicine is teamwork between conventional (Western medicine) specialist and alternative herbal medicine specialist Well, where we are regarding understanding herbal medicine, do we really appreciate them, maybe we misuse them, how properly they should be used, how they can be applied as an additional therapy with conventional medications in the form of complementary medicine. Also, there is one more question, if we do not know how to use them properly, why we do not leave to the patient to make a decision either to use herbal medicine (correctly) or conventional drugs to treat their diseases or provide prescription authorities with additional education regarding a complementary approach for therapy. Certainly, complementary medicine is teamwork. Indeed, the “street” is with two directions, two-way street, not one. It looks like some bigger picture is behind all these facts. Current clinical evidence of interactions between herbal (botanical) and conventional medications Herbal medicines have been well known to people of the world, European countries, America, Russia, China, India, Arabic countries for centuries. Currently, Western herbal medications can be classified into two categories, botanical-derived conventional medicines, and dietary supplements. Intensive interest in herbal medicine has overgrown in all countries during the past two decades. Due to cultural diversities in the EU and Russia, traditional herbal remedies of other regions, particularly Chinese Traditional and Ayurvedic medicines, are also popular (Sammons H.M. et al., 2016). The typical scenario today is a combination of herbal medicines used in conjunction with conventional drugs in the form of complementary treatment, and this condition may give rise to the potential of harmful herb-drug interactions. Some clinically critical herb-drug interactions have been reported in the literature, but many of them are from case studies, case reports, and limited clinical observations or literature search and review of published case reports. Common herbal medicines that exhibited some interactions with conventional medications (prescription medications) include St John's wort (Hypericum perforatum), ginger (Zingiber officinale) ginkgo (Ginkgo biloba), ginseng (Panax ginseng), and garlic (Allium sativum). St John's wort could significantly reduce the area under the plasma concentration-time curve, and blood concentrations of conventional medications prescribed by medical specialists such as cyclosporine, midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline. The standard drugs that interact with herbal medicines include warfarin, midazolam, digoxin, amitriptyline, indinavir, cyclosporine, tacrolimus, and irinotecan. Herbal medicines may interact with medications at the intestine, liver, kidneys, and targets of action. Most of them are actually substrates for specific metabolizing enzymes such as cytochrome P450s and P-glycoprotein. Well, the underlying mechanisms for most reported herb-drug interactions are not fully understood, and pharmacokinetic and pharmacodynamic events are implicated in many of these interactions, but not fully understand and investigated. In particular, enzyme induction and inhibition may play an essential role in the occurrence of some herb-drug interactions. Because herb-drug interactions can significantly affect circulating levels of conventional medications and, hence, alter the clinical outcome, the identification of herb-drug interactions has essential implications (Chen X.W. et al., 2012). Clinical consequences of herbal/botanical medicine-drug interactions depend on a variety of factors, such as the co-administered drugs, the patient characteristics, general a patient condition, the origin of the herbal medicines, the composition of their constituents and the applied dosage regimens. Definitely, to optimize the proper use of herbal medicines, further controlled studies are urgently needed to explore their potential for interactions with conventional drugs and to delineate the underlying mechanisms (Shi S. et al., 2012, Singh D., 2012). Various clinical and other medical literature reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. For example, The World Health Organisation indicated that approximately 80% of the Asian and African populations rely on traditional herbal medicine as the primary method for treatments of various diseases (Neergheen-Bhujun V.S., 2013). The use of botanical/herbal dietary supplements has grown steadily over the last 20 years despite incomplete information regarding active constituents, their actual concentration in the final product, mechanisms of action, efficacy, and safety. An essential but under-investigated safety concern is the potential for popular botanical/herbal dietary supplements to interfere with the absorption, transport, and metabolism of conventional medications prescribed with prescription authorities. Clinical trials of drug-botanical interactions should be the gold standard and are usually carried out only when indicated by unexpected consumer side effects or, preferably, by predictive preclinical in vitro studies. For example, phase one clinical trials have confirmed preclinical studies, and clinical case reports that St. John's wort (Hypericum perforatum) induces CYP3A4/CYP3A5. However, clinical studies of most botanicals that were predicted to interact with drugs have shown no clinically significant effects. For example, clinical trials did not substantiate preclinical predictions that milk thistle (Silybum marianum) would inhibit CYP1A2, CYP2C9, CYP2D6, CYP2E1, and CYP3A4 (Sprouse A.A., 2016). The complementary use of medications and herbal/botanical products is becoming increasingly prevalent over the last decade as a highly concentrated supplemental product (Cho H.J. et al., 2015). Herb-induced enzyme inhibition and induction may result in enhanced and decreased tissue, plasma, bile, and urine, drug concentrations, leading to a change in a conventional medication's pharmacokinetic parameters and resulting in the improper treatment of patients and potentially severe side effects (Li B. et al., 2016). Cytochrome P450 enzymes metabolize a large number of FDA-approved pharmaceuticals (conventional medications) and herbal supplements. This metabolism of medicines and supplements can be augmented by concomitant use. The xenobiotic receptors androstane receptor (CAR) and the pregnane X receptor (PXR) could respond to xenobiotics by increasing the expression of a large number of genes that are involved in the metabolism of xenobiotics, including CYP450s. Conversely, but not exclusively, many xenobiotics can inhibit the activity of CYP450s enzymes. Induction of the expression or inhibition of the action of CYP450s enzymes can result in drug-drug interactions and toxicity (Brewer C.T.et al., 2017). Herbal medications and herbal dietary supplement and other nutritional supplements are highly prevalent among older people. Herbal medications and other dietary supplements (herbal, vitamin-minerals and probiotics) are highly prevalent and popular in the population of older people. Physicians, particularly primary care physicians are often unaware that their patients use herbal remedies and other nutritional supplements concomitantly with conventional medicines. Herbal remedies and other dietary supplements contribute to high rates of polypharmacy, particularly among older people with multimorbidity. Herbal medicines and other nutritional supplements can interact with conventional drugs and be associated with a range of adverse, side effects - events. Physicians should be patient-centered, and non-judgmental when initiating discussions about herbal medicines and other dietary supplements. It is vital to maintain and develop patient empowerment and self-management skills (Pitkälä K.H. et al., 2016). In addition to conventional medicine prescribed by a physician(s), many patients regularly use alternative therapies in the form of self-directed complementary treatment. Communication between patients and providers about complementary therapy use is not consistent. There is an extreme demand for interventions in health care that provide timely, integrative communication support. Delivering herb-drug-disease alerts through multiple channels could help meet critical patient information needs (Christensen C.M. et al., 2017). It is important to state that conventional medicine specialists should make a necessary consultation with an alternative medicine specialist if the patient is determined to complementary treatment. Clinical professionals and specialists as well as alternative medicine specialists should enhance risk management on herbal-medication interactions such as increasing awareness of potential changes in therapeutic risk and benefits, inquiring patients about all currently used conventional medicines and herbal medicines and supplements, automatically detecting highly substantial significant herbal/medication interaction by computerized reminder system, selecting the alternatives, adjusting dose, reviewing the appropriateness of physician orders, educating patients to monitor for drug-interaction symptoms, and paying attention to follow-up visit and consultation (Zhang X.L. 2017). Severe herb-drug interactions were noted for Hypericum perforatum and Viscum album. The most severe interactions resulted in transplant rejection, delayed emergence from anesthesia, cardiovascular collapse, renal and liver toxicity, cardiotoxicity, bradycardia, hypovolaemic shock, inflammatory reactions with organ fibrosis and death. Moderately severe interactions were noted for Ginkgo biloba, Panax ginseng, Piper methysticum, Serenoa repens, and Camellia sinensis. The most commonly interacting drugs were antiplatelet agents and anticoagulants (Posadzki P. et al., 2013). Although (unfortunately) several studies on pharmacokinetic and pharmacodynamic herb-drug interactions have been conducted in healthy volunteers, there is tremendous uncertainty on the validity of these studies. Unfortunately, a qualitative review and a meta-analysis were performed to establish the clinical evidence of these interaction studies. According to the literature data, out of 4026 screened abstracts, 32 studies were included in the qualitative analysis. The meta-analysis was performed on only eleven additional studies (Awortwe C. et al., 2019). Many patients treated with cardiovascular medication like to drink green tea, either as a part of their cultural tradition or persuaded of its beneficial effects for general wellness and health. Green tea may affect the pharmacokinetics and pharmacodynamics of many cardiovascular medications and compounds. Some recent data showed that green tea and some cardiovascular medications make interactions and drug interactions were reported for rosuvastatin, sildenafil, and tacrolimus. Putative mechanisms involve inhibitory effects of green tea “catechins at the intestinal level on influx transporters OATP1A2 or OATP2B1 for rosuvastatin, on CYP3A for sildenafil and both CYP3A and the efflux transporter p-glycoprotein for tacrolimus. These interactions, which add to those previously described with simvastatin, nadolol, and warfarin, might lead, in some cases, to reduced drug efficacy or risk of drug toxicity. Oddly, available data on green tea interaction with cardiovascular substances with a pretty narrow therapeutic index, such as warfarin and tacrolimus are derived from single case reports. Conversely, green tea interactions with simvastatin, rosuvastatin, nadolol, and sildenafil were documented through pharmacokinetic studies” (Werba J.P. et al., 2018). There is substantial interest lately, in the use of herbs for the treatment of hypertension and cardiovascular disease. “Herbs and other botanicals contain numerous phytochemicals that have been effective in the treatment of cardiovascular diseases and hypertension. Accumulating scientific evidence provides a reason for the use of herbs by health practitioners for treating their patients. The rationale for this expanding use of herbs is the belief of patients in a "holistic medicine" and that herbs are natural, safe, and effective. However, there are reasons for concern with the use of herbs, because they are not regulated or supervised carefully and their use could lead to severe complications or interactions with their combination with traditional medicines. Also, their use is associated with significant out of pocket expenses, because their use is not compensated by health insurance providers” (Chrysant SG et al., 2017). Malongane F. and colleagues stated 2017 in their article: “Tea is one of the most widely consumed non-alcoholic beverages in the world next to the water. It is classified as Camellia sinensis and non-Camellia sinensis (herbal teas). The common bioactive compounds found mainly in green teas are flavan-3-ols (catechins) (also called flavanols), proanthocyanidins (tannins) and flavonols. Black tea contains theaflavins and thearubigins, and white tea contains l-theanine and gamma-aminobutyric acid (GABA), while herbal teas contain diverse polyphenols. Phytochemicals in tea exhibit antimicrobial, anti-diabetic and anti-cancer activities that are perceived to help manage chronic diseases linked to lifestyle. Many of these phytochemicals are reported to be biologically active when combined. Knowledge of the synergistic interactions of tea with other teas or herbs in terms of biological activities will be of benefit for therapeutic enhancement. There is evidence that various types of teas act synergistically in exhibiting health benefits to humans, improving consumer acceptance and economic value. Similar observations have been made when teas and herbs or medicinal drugs were combined.” (Malongane F et al., 2017). St. John's wort is a common medicinal herb used for the treatment of mild to moderate depression. Hyperforin, one of the main components of St. John wort, it plays an essential role in the induction of cytochrome P450 enzymes and P-glycoprotein transporter, and consequentially affects the pharmacokinetics of various drugs. Several clinical studies are demonstrating the interaction of St. John wort with the metabolism of conventional drugs which may cause life-threatening events such as probably serotonin syndrome if it is used in combination with SSRI antidepressant therapy (Soleymani S et al., 2017). Asher G.N. and colleagues in one article published in 2017 stated: “Nearly 25% of U.S. adults report concurrently taking prescription medication with a dietary supplement. Some supplements, such as St. John's wort and goldenseal, are known to cause clinically significant drug interactions and should be avoided by most patients receiving any pharmacologic therapy. However, many other supplements are predicted to cause interactions based only on in vitro studies that have not been confirmed or have been refuted in human clinical trials. Some supplements may cause interactions with a few medications but are likely to be safe with other medications (e.g., curcumin, echinacea, garlic, Asian ginseng, green tea extract, kava kava). Some supplements have a low likelihood of drug interactions and, with certain caveats, can safely be taken with most medications (e.g., black cohosh, cranberry, ginkgo, milk thistle, American ginseng, saw palmetto, valerian). Clinicians should consult reliable dietary supplement resources, or clinical pharmacists or pharmacologists, to help assess the safety of specific herbal supplement-drug combinations. Because most patients do not disclose supplement use to clinicians, the most crucial strategy for detecting herb-drug interactions is to develop a trusting relationship that encourages patients to discuss their dietary supplement use” (Asher GN et al., 2017). Izzo A.A. and colleagues published data in 2016 and stated: “Systematic reviews/meta-analyses suggest preliminary or satisfactory clinical evidence for agnus castus (Vitex agnus castus) for premenstrual complaints, flaxseed (Linum usitatissimum) for hypertension, feverfew (Tanacetum partenium) for migraine prevention, ginger (Zingiber officinalis) for pregnancy-induced nausea, ginseng (Panax ginseng) for improving fasting glucose levels as well as phytoestrogens and St John's wort (Hypericum perforatum) for the relief of some symptoms in menopause. However, firm conclusions of efficacy cannot be generally drawn. On the other hand, inconclusive evidence of effectiveness or contradictory results have been reported for Aloe vera in the treatment of psoriasis, cranberry (Vaccinium macrocarpon) in cystitis prevention, ginkgo (Ginkgo biloba) for tinnitus and intermittent claudication, echinacea (Echinacea spp.) for the prevention of common cold and pomegranate (Punica granatum) for the prevention/treatment of cardiovascular diseases. A critical evaluation of the clinical data regarding the adverse effects has shown that herbal remedies are generally better tolerated than synthetic medications. Nevertheless, potentially dangerous adverse effects, including herb-drug interactions, have been described. This suggests the need to be vigilant when using herbal remedies, particularly in specific conditions, such as during pregnancy and in the pediatric population” (Izzo AA et al., 2016). Ginkgo biloba leaf extracts are popular herbal remedies for the treatment of Alzheimer's dementia, tinnitus, vertigo (Meniere’s disease), and peripheral arterial disease Unger M., in an article published in 2013 stated: “As ginkgo biloba leaf are taken regularly by older people, who are likely to also use multiple other drugs for the treatment of, e.g., hypertension, diabetes, rheumatism or heart failure, potential herb-drug interactions are of interest.” (Unger M., 2013). The statement that many people have the mistaken notion that being natural, all herbs and foods are safe; this is not so. Why? The market is full of highly concentrated dietary, supplemental products from botanical/herbal sources, aromatherapy, vitamins-minerals additional products, and probiotics. Indeed, these forms of herbal remedies are far different than the herbal remedies supposed to be administered, they are diverse, concentrated and really in combination with conventional medicines compete for metabolism with our xenobiotic metabolizing enzymes from a family of cytochrome CYP450 s and others. The patient should decide in consultation with a traditional/conventional medicine specialist (Western medicine) or alternative medicine specialist what treatment would be the best option for a patient. Complementary aspect should be conducted carefully with synchronized administration of conventional medicine with alternative medicine, and a pharmacist should be a great source of knowledge with their knowledge of pharmacokinetics and pharmacodynamics as well as pharmacognosy. Unfortunately, many people use Internet resources for consultation and so-called self-healing instead of using practices of conventional medicine specialists and alternative medicine specialists. Also, as you can see from this short review, there are no reliable scientific data of herbal/medicine interaction and side effects, all data are from isolated case reports with suspicion of conflict of interests. During the last twenty years, the practice of herbalism and production of highly concentrated herbal remedies as supplemental products has become mainstream throughout the world. This is due to removing to the recognition of the value of conventional medical practice in the world. Herbal remedies traditionally are mixtures of more than one active ingredient or single herbal source as a tincture or tea, and they should be administered for a certain period NOT chronically as explained on the case of ephedra. No doubt, the possibility of herb-drug interactions is theoretically higher than drug-drug interactions because synthetic drugs usually contain a single chemical entity even it is not scientifically confirmed. As Hussain M.S., explained in the article published in 2011: “Case reports and clinical studies have highlighted the existence of some clinically significant interactions, although cause-and-effect relationships have not always been established. Herbs and drugs may interact either pharmacokinetically or pharmacodynamically. The predominant mechanism for this interaction is the inhibition of cytochrome P-450 3A4 in the small intestine; result in a significant reduction of drug pre-systemic metabolism. An additional mechanism is the inhibition of P-glycoprotein, a transporter that carries drug from the enterocyte back to the gut lumen, result in a further increase in the fraction of drug absorbed. Some herbal products (e.g., St. John's wort) have been shown to lower the plasma concentration (and the pharmacological effect) of some conventional drugs including cyclosporine, indinavir, irinotecan, nevirapine, oral contraceptives, and digoxin” (Hussain MS., 2011). Dr. Miroslav Sarac – Chiron Wise Centaur – holistic and integrative healing center References Sammons HM, Gubarev MI, Krepkova LV, Bortnikova VV, Corrick F, Job KM, Sherwin CM, Enioutina EY. Herbal medicines: challenges in the modern world. Part 2. European Union and Russia. Expert Rev Clin Pharmacol. 2016 Aug;9(8):1117-27. Chen XW1, Sneed KB, Pan SY, Cao C, Kanwar JR, Chew H, Zhou SF. Herb-drug interactions and mechanistic and clinical considerations. Curr Drug Metab. 2012 Jun 1;13(5):640-51. Shi S1, Klotz U. Drug interactions with herbal medicines. Clin Pharmacokinet. 2012 Feb 1;51(2):77-104. Singh D1, Gupta R, Saraf SA. Herbs-are they safe enough? An overview. Crit Rev Food Sci Nutr. 2012;52(10):876-98. Neergheen-Bhujun V.S. Underestimating the toxicological challenges associated with the use of herbal medicinal products in developing countries. Biomed Res Int. 2013;2013:804086. Sprouse A.A, van Breemen R.B. Pharmacokinetic Interactions between Drugs and Botanical Dietary Supplements. Drug Metab Dispos. 2016 Feb;44(2):162-71. Cho H.J, Yoon I.S. Pharmacokinetic interactions of herbs with cytochrome p450 and p-glycoprotein. Evid Based Complement Alternat Med. 2015;2015:736431. Li B, Zhao B, Liu Y, Tang M, Lüe B, Luo Z, Zhai H. Herb-drug enzyme-mediated interactions and the associated experimental methods: a review. J Tradit Chin Med. 2016 Jun;36(3):392-408. Pitkälä KH, Suominen MH, Bell JS, Strandberg TE. Herbal medications and other dietary supplements. A clinical review for physicians caring for older people. Ann Med. 2016 Dec;48(8):586-602. Brewer CT, Chen T. Hepatotoxicity of Herbal Supplements Mediated by Modulation of Cytochrome P450. Int J Mol Sci. 2017 Nov 8;18(11). Christensen CM, Morris RS, Kapsandoy SC, Archer M, Kuang J, Shane-McWhorter L, Bray BE, Zeng-Treitler Q. Patient needs and preferences for herb-drug-disease interaction alerts: a structured interview study. BMC Complement Altern Med. 2017 May 19;17(1):272. Zhang XL, Chen M, Zhu LL, Zhou Q. Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management. Evid Based Complement Alternat Med. 2017;2017:9296404. Posadzki P1, Watson L, Ernst E. Herb-drug interactions: an overview of systematic reviews. Br J Clin Pharmacol. 2013 Mar;75(3):603-18. Awortwe C, Bruckmueller H, Cascorbi I. Interaction of herbal products with prescribed medications: A systematic review and meta-analysis. Pharmacol Res. 2019 Mar;141:397-408. Werba JP, Misaka S, Giroli MG, Shimomura K, Amato M, Simonelli N, Vigo L, Tremoli E. Update of green tea interactions with cardiovascular drugs and putative mechanisms. J Food Drug Anal. 2018 Apr;26(2S):S72-S77. Chrysant SG, Chrysant GS. Herbs Used for the Treatment of Hypertension and their Mechanism of Action. Curr Hypertens Rep. 2017 Sep 18;19(9):77. Malongane F, McGaw LJ, Mudau FN. The synergistic potential of various teas, herbs and therapeutic drugs in health improvement: a review. J Sci Food Agric. 2017 Nov;97(14):4679-4689. Soleymani S, Bahramsoltani R, Rahimi R, Abdollahi M. Clinical risks of St John's Wort (Hypericum perforatum) co-administration. Expert Opin Drug Metab Toxicol. 2017 Oct;13(10):1047-1062. Asher GN, Corbett AH, Hawke RL. Common Herbal Dietary Supplement-Drug Interactions. Am Fam Physician. 2017 Jul 15;96(2):101-107. Izzo AA, Hoon-Kim S, Radhakrishnan R, Williamson EM. A Critical Approach to Evaluating Clinical Efficacy, Adverse Events and Drug Interactions of Herbal Remedies. Phytother Res. 2016 May;30(5):691-700. Unger M. Pharmacokinetic drug interactions involving Ginkgo biloba. Drug Metab Rev. 2013 Aug;45(3):353-85. Hussain MS. Patient counseling about herbal-drug interactions. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):152-63. Read the full article
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Drug-Herb Interaction
Are you using herbal medicines as a primary or supplemental treatment, and are you aware of possible issues of drug-herb interactions? Recently, I was listening to the lecture of professor Dr. Bill J. Gurley titled as “Clinically relevant herb-drug interactions: past, present, and future” at the National Center for Complementary and Integrative Health, National Institutes of Health of the U.S.A. I was impressed with the presentation from one pharmacy professor who is highly specialized in the field of pharmacokinetics and pharmacodynamics of the conventional medications and supplemental herbal products. After the lecture, I started wondering what we really know about herbal remedies or their combination with conventional prescription medications as a part of complementary treatment. Indeed, we know about herbal medicine a lot, but how about their combination with conventional therapeutics in the form of complementary therapy. Did we learn something from the case ephedra (Ephedra sinica)? Clearly was stated in the lecture that for example ephedra (Ephedra sinica) was used in Traditional Chinese Medicine for over 5000 years for treatment of asthma and nasal congestion for only 7 – 10 days and that’s it, either a patient is healed or not, but not chronic use of ephedra was considering and proper treatment by ephedra in Traditional Chinese Medicine. However, in the U.S.A. from 1994 until 2004 ephedra was using chronically as a potent stimulant, not as a remedy for bronchial asthma, nasal congestion, cold, flu, fever, cough, and wheezing. In response to substantially collected evidence of adverse effects and deaths related to ephedra, the U.S. Food and Drug Administration (FDA) banned the sale of supplements containing ephedrine alkaloids in 2004. Ephedrine is a potent sympathomimetic that stimulates alpha, beta one and beta two adrenergic receptors as well. It excites and stimulates the sympathetic nervous system, causes tremendous vasoconstriction and cardiac stimulation, and produces effects similar to those of epinephrine (adrenalin). Ephedra extracts that do not contain ephedrine have not been banned by the FDA and are still sold legally today. Yet, Chinese and other people who know how properly to use ephedra, use it effectively to cure some acute diseases in a short period, NOT chronically. Do we really use herbal remedies correctly in our Western culture and conventional treatment with prescription medications and then we call that complementary treatment? Do we take into consideration numerous factors regarding the combination of conventional medicines and herbal remedies in complementary therapy such as characteristics of the patient, gender, age, ethnicity, co-morbidity, frailty, infrequent genotypes, and others? Also, the fact that majority currently available dietary and supplemental herbal remedies are products containing multiple herbal components, that their formulation is utilizing highly concentrated herbal (botanical) extracts which is not a proper way of preparing herbal remedies in alternative medicine, that many commercially available supplemental herbal products have the presence of numerous phytochemicals that have not been tested for pharmacological activities. These facts do not “sound” like a traditional herbal therapy and their proper use as a supplemental therapy in the form of complementary treatment along with conventional therapy by using prescribed medications. What is the level of the current clinical evidence? The next surprise, when I was searching for the scientific literature data, results of clinical studies regarding using herbal remedies as a supplement therapy to conventional therapeutics, calling that complementary treatment, mostly they are isolated case studies or case series, case reports, and results of in vitro analysis performed on cell cultures expressing human genes (for example). Mostly, clinical evidence has been on the level of incomplete case studies, case reports, an adverse event unlikely from a pharmacological viewpoint, case report providing some evidence for interaction, however, other cases not entirely excluded, case series, some pharmacokinetic trials in patients or healthy people, there are numerous contradictory data, or adverse events are highlighted by case reports but not confirmed by clinical trials or mega clinical trials. Mostly authors were taken rights to generalize, and it is very well known that generalization is acceptable only if you perform experimental clinical research design. No doubt, scientifically, case studies are a useful “tool” to set up a future hypothesis in clinical research and to conduct further research in that particular field. Complementary medicine is teamwork between conventional (Western medicine) specialist and alternative herbal medicine specialist Well, where we are regarding understanding herbal medicine, do we really appreciate them, maybe we misuse them, how properly they should be used, how they can be applied as an additional therapy with conventional medications in the form of complementary medicine. Also, there is one more question, if we do not know how to use them properly, why we do not leave to the patient to make a decision either to use herbal medicine (correctly) or conventional drugs to treat their diseases or provide prescription authorities with additional education regarding a complementary approach for therapy. Certainly, complementary medicine is teamwork. Indeed, the “street” is with two directions, two-way street, not one. It looks like some bigger picture is behind all these facts. Current clinical evidence of interactions between herbal (botanical) and conventional medications Herbal medicines have been well known to people of the world, European countries, America, Russia, China, India, Arabic countries for centuries. Currently, Western herbal medications can be classified into two categories, botanical-derived conventional medicines, and dietary supplements. Intensive interest in herbal medicine has overgrown in all countries during the past two decades. Due to cultural diversities in the EU and Russia, traditional herbal remedies of other regions, particularly Chinese Traditional and Ayurvedic medicines, are also popular (Sammons H.M. et al., 2016). The typical scenario today is a combination of herbal medicines used in conjunction with conventional drugs in the form of complementary treatment, and this condition may give rise to the potential of harmful herb-drug interactions. Some clinically critical herb-drug interactions have been reported in the literature, but many of them are from case studies, case reports, and limited clinical observations or literature search and review of published case reports. Common herbal medicines that exhibited some interactions with conventional medications (prescription medications) include St John's wort (Hypericum perforatum), ginger (Zingiber officinale) ginkgo (Ginkgo biloba), ginseng (Panax ginseng), and garlic (Allium sativum). St John's wort could significantly reduce the area under the plasma concentration-time curve, and blood concentrations of conventional medications prescribed by medical specialists such as cyclosporine, midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline. The standard drugs that interact with herbal medicines include warfarin, midazolam, digoxin, amitriptyline, indinavir, cyclosporine, tacrolimus, and irinotecan. Herbal medicines may interact with medications at the intestine, liver, kidneys, and targets of action. Most of them are actually substrates for specific metabolizing enzymes such as cytochrome P450s and P-glycoprotein. Well, the underlying mechanisms for most reported herb-drug interactions are not fully understood, and pharmacokinetic and pharmacodynamic events are implicated in many of these interactions, but not fully understand and investigated. In particular, enzyme induction and inhibition may play an essential role in the occurrence of some herb-drug interactions. Because herb-drug interactions can significantly affect circulating levels of conventional medications and, hence, alter the clinical outcome, the identification of herb-drug interactions has essential implications (Chen X.W. et al., 2012). Clinical consequences of herbal/botanical medicine-drug interactions depend on a variety of factors, such as the co-administered drugs, the patient characteristics, general a patient condition, the origin of the herbal medicines, the composition of their constituents and the applied dosage regimens. Definitely, to optimize the proper use of herbal medicines, further controlled studies are urgently needed to explore their potential for interactions with conventional drugs and to delineate the underlying mechanisms (Shi S. et al., 2012, Singh D., 2012). Various clinical and other medical literature reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. For example, The World Health Organisation indicated that approximately 80% of the Asian and African populations rely on traditional herbal medicine as the primary method for treatments of various diseases (Neergheen-Bhujun V.S., 2013). The use of botanical/herbal dietary supplements has grown steadily over the last 20 years despite incomplete information regarding active constituents, their actual concentration in the final product, mechanisms of action, efficacy, and safety. An essential but under-investigated safety concern is the potential for popular botanical/herbal dietary supplements to interfere with the absorption, transport, and metabolism of conventional medications prescribed with prescription authorities. Clinical trials of drug-botanical interactions should be the gold standard and are usually carried out only when indicated by unexpected consumer side effects or, preferably, by predictive preclinical in vitro studies. For example, phase one clinical trials have confirmed preclinical studies, and clinical case reports that St. John's wort (Hypericum perforatum) induces CYP3A4/CYP3A5. However, clinical studies of most botanicals that were predicted to interact with drugs have shown no clinically significant effects. For example, clinical trials did not substantiate preclinical predictions that milk thistle (Silybum marianum) would inhibit CYP1A2, CYP2C9, CYP2D6, CYP2E1, and CYP3A4 (Sprouse A.A., 2016). The complementary use of medications and herbal/botanical products is becoming increasingly prevalent over the last decade as a highly concentrated supplemental product (Cho H.J. et al., 2015). Herb-induced enzyme inhibition and induction may result in enhanced and decreased tissue, plasma, bile, and urine, drug concentrations, leading to a change in a conventional medication's pharmacokinetic parameters and resulting in the improper treatment of patients and potentially severe side effects (Li B. et al., 2016). Cytochrome P450 enzymes metabolize a large number of FDA-approved pharmaceuticals (conventional medications) and herbal supplements. This metabolism of medicines and supplements can be augmented by concomitant use. The xenobiotic receptors androstane receptor (CAR) and the pregnane X receptor (PXR) could respond to xenobiotics by increasing the expression of a large number of genes that are involved in the metabolism of xenobiotics, including CYP450s. Conversely, but not exclusively, many xenobiotics can inhibit the activity of CYP450s enzymes. Induction of the expression or inhibition of the action of CYP450s enzymes can result in drug-drug interactions and toxicity (Brewer C.T.et al., 2017). Herbal medications and herbal dietary supplement and other nutritional supplements are highly prevalent among older people. Herbal medications and other dietary supplements (herbal, vitamin-minerals and probiotics) are highly prevalent and popular in the population of older people. Physicians, particularly primary care physicians are often unaware that their patients use herbal remedies and other nutritional supplements concomitantly with conventional medicines. Herbal remedies and other dietary supplements contribute to high rates of polypharmacy, particularly among older people with multimorbidity. Herbal medicines and other nutritional supplements can interact with conventional drugs and be associated with a range of adverse, side effects - events. Physicians should be patient-centered, and non-judgmental when initiating discussions about herbal medicines and other dietary supplements. It is vital to maintain and develop patient empowerment and self-management skills (Pitkälä K.H. et al., 2016). In addition to conventional medicine prescribed by a physician(s), many patients regularly use alternative therapies in the form of self-directed complementary treatment. Communication between patients and providers about complementary therapy use is not consistent. There is an extreme demand for interventions in health care that provide timely, integrative communication support. Delivering herb-drug-disease alerts through multiple channels could help meet critical patient information needs (Christensen C.M. et al., 2017). It is important to state that conventional medicine specialists should make a necessary consultation with an alternative medicine specialist if the patient is determined to complementary treatment. Clinical professionals and specialists as well as alternative medicine specialists should enhance risk management on herbal-medication interactions such as increasing awareness of potential changes in therapeutic risk and benefits, inquiring patients about all currently used conventional medicines and herbal medicines and supplements, automatically detecting highly substantial significant herbal/medication interaction by computerized reminder system, selecting the alternatives, adjusting dose, reviewing the appropriateness of physician orders, educating patients to monitor for drug-interaction symptoms, and paying attention to follow-up visit and consultation (Zhang X.L. 2017). Severe herb-drug interactions were noted for Hypericum perforatum and Viscum album. The most severe interactions resulted in transplant rejection, delayed emergence from anesthesia, cardiovascular collapse, renal and liver toxicity, cardiotoxicity, bradycardia, hypovolaemic shock, inflammatory reactions with organ fibrosis and death. Moderately severe interactions were noted for Ginkgo biloba, Panax ginseng, Piper methysticum, Serenoa repens, and Camellia sinensis. The most commonly interacting drugs were antiplatelet agents and anticoagulants (Posadzki P. et al., 2013). Although (unfortunately) several studies on pharmacokinetic and pharmacodynamic herb-drug interactions have been conducted in healthy volunteers, there is tremendous uncertainty on the validity of these studies. Unfortunately, a qualitative review and a meta-analysis were performed to establish the clinical evidence of these interaction studies. According to the literature data, out of 4026 screened abstracts, 32 studies were included in the qualitative analysis. The meta-analysis was performed on only eleven additional studies (Awortwe C. et al., 2019). Many patients treated with cardiovascular medication like to drink green tea, either as a part of their cultural tradition or persuaded of its beneficial effects for general wellness and health. Green tea may affect the pharmacokinetics and pharmacodynamics of many cardiovascular medications and compounds. Some recent data showed that green tea and some cardiovascular medications make interactions and drug interactions were reported for rosuvastatin, sildenafil, and tacrolimus. Putative mechanisms involve inhibitory effects of green tea “catechins at the intestinal level on influx transporters OATP1A2 or OATP2B1 for rosuvastatin, on CYP3A for sildenafil and both CYP3A and the efflux transporter p-glycoprotein for tacrolimus. These interactions, which add to those previously described with simvastatin, nadolol, and warfarin, might lead, in some cases, to reduced drug efficacy or risk of drug toxicity. Oddly, available data on green tea interaction with cardiovascular substances with a pretty narrow therapeutic index, such as warfarin and tacrolimus are derived from single case reports. Conversely, green tea interactions with simvastatin, rosuvastatin, nadolol, and sildenafil were documented through pharmacokinetic studies” (Werba J.P. et al., 2018). There is substantial interest lately, in the use of herbs for the treatment of hypertension and cardiovascular disease. “Herbs and other botanicals contain numerous phytochemicals that have been effective in the treatment of cardiovascular diseases and hypertension. Accumulating scientific evidence provides a reason for the use of herbs by health practitioners for treating their patients. The rationale for this expanding use of herbs is the belief of patients in a "holistic medicine" and that herbs are natural, safe, and effective. However, there are reasons for concern with the use of herbs, because they are not regulated or supervised carefully and their use could lead to severe complications or interactions with their combination with traditional medicines. Also, their use is associated with significant out of pocket expenses, because their use is not compensated by health insurance providers” (Chrysant SG et al., 2017). Malongane F. and colleagues stated 2017 in their article: “Tea is one of the most widely consumed non-alcoholic beverages in the world next to the water. It is classified as Camellia sinensis and non-Camellia sinensis (herbal teas). The common bioactive compounds found mainly in green teas are flavan-3-ols (catechins) (also called flavanols), proanthocyanidins (tannins) and flavonols. Black tea contains theaflavins and thearubigins, and white tea contains l-theanine and gamma-aminobutyric acid (GABA), while herbal teas contain diverse polyphenols. Phytochemicals in tea exhibit antimicrobial, anti-diabetic and anti-cancer activities that are perceived to help manage chronic diseases linked to lifestyle. Many of these phytochemicals are reported to be biologically active when combined. Knowledge of the synergistic interactions of tea with other teas or herbs in terms of biological activities will be of benefit for therapeutic enhancement. There is evidence that various types of teas act synergistically in exhibiting health benefits to humans, improving consumer acceptance and economic value. Similar observations have been made when teas and herbs or medicinal drugs were combined.” (Malongane F et al., 2017). St. John's wort is a common medicinal herb used for the treatment of mild to moderate depression. Hyperforin, one of the main components of St. John wort, it plays an essential role in the induction of cytochrome P450 enzymes and P-glycoprotein transporter, and consequentially affects the pharmacokinetics of various drugs. Several clinical studies are demonstrating the interaction of St. John wort with the metabolism of conventional drugs which may cause life-threatening events such as probably serotonin syndrome if it is used in combination with SSRI antidepressant therapy (Soleymani S et al., 2017). Asher G.N. and colleagues in one article published in 2017 stated: “Nearly 25% of U.S. adults report concurrently taking prescription medication with a dietary supplement. Some supplements, such as St. John's wort and goldenseal, are known to cause clinically significant drug interactions and should be avoided by most patients receiving any pharmacologic therapy. However, many other supplements are predicted to cause interactions based only on in vitro studies that have not been confirmed or have been refuted in human clinical trials. Some supplements may cause interactions with a few medications but are likely to be safe with other medications (e.g., curcumin, echinacea, garlic, Asian ginseng, green tea extract, kava kava). Some supplements have a low likelihood of drug interactions and, with certain caveats, can safely be taken with most medications (e.g., black cohosh, cranberry, ginkgo, milk thistle, American ginseng, saw palmetto, valerian). Clinicians should consult reliable dietary supplement resources, or clinical pharmacists or pharmacologists, to help assess the safety of specific herbal supplement-drug combinations. Because most patients do not disclose supplement use to clinicians, the most crucial strategy for detecting herb-drug interactions is to develop a trusting relationship that encourages patients to discuss their dietary supplement use” (Asher GN et al., 2017). Izzo A.A. and colleagues published data in 2016 and stated: “Systematic reviews/meta-analyses suggest preliminary or satisfactory clinical evidence for agnus castus (Vitex agnus castus) for premenstrual complaints, flaxseed (Linum usitatissimum) for hypertension, feverfew (Tanacetum partenium) for migraine prevention, ginger (Zingiber officinalis) for pregnancy-induced nausea, ginseng (Panax ginseng) for improving fasting glucose levels as well as phytoestrogens and St John's wort (Hypericum perforatum) for the relief of some symptoms in menopause. However, firm conclusions of efficacy cannot be generally drawn. On the other hand, inconclusive evidence of effectiveness or contradictory results have been reported for Aloe vera in the treatment of psoriasis, cranberry (Vaccinium macrocarpon) in cystitis prevention, ginkgo (Ginkgo biloba) for tinnitus and intermittent claudication, echinacea (Echinacea spp.) for the prevention of common cold and pomegranate (Punica granatum) for the prevention/treatment of cardiovascular diseases. A critical evaluation of the clinical data regarding the adverse effects has shown that herbal remedies are generally better tolerated than synthetic medications. Nevertheless, potentially dangerous adverse effects, including herb-drug interactions, have been described. This suggests the need to be vigilant when using herbal remedies, particularly in specific conditions, such as during pregnancy and in the pediatric population” (Izzo AA et al., 2016). Ginkgo biloba leaf extracts are popular herbal remedies for the treatment of Alzheimer's dementia, tinnitus, vertigo (Meniere’s disease), and peripheral arterial disease Unger M., in an article published in 2013 stated: “As ginkgo biloba leaf are taken regularly by older people, who are likely to also use multiple other drugs for the treatment of, e.g., hypertension, diabetes, rheumatism or heart failure, potential herb-drug interactions are of interest.” (Unger M., 2013). The statement that many people have the mistaken notion that being natural, all herbs and foods are safe; this is not so. Why? The market is full of highly concentrated dietary, supplemental products from botanical/herbal sources, aromatherapy, vitamins-minerals additional products, and probiotics. Indeed, these forms of herbal remedies are far different than the herbal remedies supposed to be administered, they are diverse, concentrated and really in combination with conventional medicines compete for metabolism with our xenobiotic metabolizing enzymes from a family of cytochrome CYP450 s and others. The patient should decide in consultation with a traditional/conventional medicine specialist (Western medicine) or alternative medicine specialist what treatment would be the best option for a patient. Complementary aspect should be conducted carefully with synchronized administration of conventional medicine with alternative medicine, and a pharmacist should be a great source of knowledge with their knowledge of pharmacokinetics and pharmacodynamics as well as pharmacognosy. Unfortunately, many people use Internet resources for consultation and so-called self-healing instead of using practices of conventional medicine specialists and alternative medicine specialists. Also, as you can see from this short review, there are no reliable scientific data of herbal/medicine interaction and side effects, all data are from isolated case reports with suspicion of conflict of interests. During the last twenty years, the practice of herbalism and production of highly concentrated herbal remedies as supplemental products has become mainstream throughout the world. This is due to removing to the recognition of the value of conventional medical practice in the world. Herbal remedies traditionally are mixtures of more than one active ingredient or single herbal source as a tincture or tea, and they should be administered for a certain period NOT chronically as explained on the case of ephedra. No doubt, the possibility of herb-drug interactions is theoretically higher than drug-drug interactions because synthetic drugs usually contain a single chemical entity even it is not scientifically confirmed. As Hussain M.S., explained in the article published in 2011: “Case reports and clinical studies have highlighted the existence of some clinically significant interactions, although cause-and-effect relationships have not always been established. Herbs and drugs may interact either pharmacokinetically or pharmacodynamically. The predominant mechanism for this interaction is the inhibition of cytochrome P-450 3A4 in the small intestine; result in a significant reduction of drug pre-systemic metabolism. An additional mechanism is the inhibition of P-glycoprotein, a transporter that carries drug from the enterocyte back to the gut lumen, result in a further increase in the fraction of drug absorbed. Some herbal products (e.g., St. John's wort) have been shown to lower the plasma concentration (and the pharmacological effect) of some conventional drugs including cyclosporine, indinavir, irinotecan, nevirapine, oral contraceptives, and digoxin” (Hussain MS., 2011). Dr. Miroslav Sarac – Chiron Wise Centaur – holistic and integrative healing center References Sammons HM, Gubarev MI, Krepkova LV, Bortnikova VV, Corrick F, Job KM, Sherwin CM, Enioutina EY. Herbal medicines: challenges in the modern world. Part 2. European Union and Russia. Expert Rev Clin Pharmacol. 2016 Aug;9(8):1117-27. Chen XW1, Sneed KB, Pan SY, Cao C, Kanwar JR, Chew H, Zhou SF. Herb-drug interactions and mechanistic and clinical considerations. Curr Drug Metab. 2012 Jun 1;13(5):640-51. Shi S1, Klotz U. Drug interactions with herbal medicines. Clin Pharmacokinet. 2012 Feb 1;51(2):77-104. Singh D1, Gupta R, Saraf SA. Herbs-are they safe enough? An overview. Crit Rev Food Sci Nutr. 2012;52(10):876-98. Neergheen-Bhujun V.S. Underestimating the toxicological challenges associated with the use of herbal medicinal products in developing countries. Biomed Res Int. 2013;2013:804086. Sprouse A.A, van Breemen R.B. Pharmacokinetic Interactions between Drugs and Botanical Dietary Supplements. Drug Metab Dispos. 2016 Feb;44(2):162-71. Cho H.J, Yoon I.S. Pharmacokinetic interactions of herbs with cytochrome p450 and p-glycoprotein. Evid Based Complement Alternat Med. 2015;2015:736431. Li B, Zhao B, Liu Y, Tang M, Lüe B, Luo Z, Zhai H. Herb-drug enzyme-mediated interactions and the associated experimental methods: a review. J Tradit Chin Med. 2016 Jun;36(3):392-408. Pitkälä KH, Suominen MH, Bell JS, Strandberg TE. Herbal medications and other dietary supplements. A clinical review for physicians caring for older people. Ann Med. 2016 Dec;48(8):586-602. Brewer CT, Chen T. Hepatotoxicity of Herbal Supplements Mediated by Modulation of Cytochrome P450. Int J Mol Sci. 2017 Nov 8;18(11). Christensen CM, Morris RS, Kapsandoy SC, Archer M, Kuang J, Shane-McWhorter L, Bray BE, Zeng-Treitler Q. Patient needs and preferences for herb-drug-disease interaction alerts: a structured interview study. BMC Complement Altern Med. 2017 May 19;17(1):272. Zhang XL, Chen M, Zhu LL, Zhou Q. Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management. Evid Based Complement Alternat Med. 2017;2017:9296404. Posadzki P1, Watson L, Ernst E. Herb-drug interactions: an overview of systematic reviews. Br J Clin Pharmacol. 2013 Mar;75(3):603-18. Awortwe C, Bruckmueller H, Cascorbi I. Interaction of herbal products with prescribed medications: A systematic review and meta-analysis. Pharmacol Res. 2019 Mar;141:397-408. Werba JP, Misaka S, Giroli MG, Shimomura K, Amato M, Simonelli N, Vigo L, Tremoli E. Update of green tea interactions with cardiovascular drugs and putative mechanisms. J Food Drug Anal. 2018 Apr;26(2S):S72-S77. Chrysant SG, Chrysant GS. Herbs Used for the Treatment of Hypertension and their Mechanism of Action. Curr Hypertens Rep. 2017 Sep 18;19(9):77. Malongane F, McGaw LJ, Mudau FN. The synergistic potential of various teas, herbs and therapeutic drugs in health improvement: a review. J Sci Food Agric. 2017 Nov;97(14):4679-4689. Soleymani S, Bahramsoltani R, Rahimi R, Abdollahi M. Clinical risks of St John's Wort (Hypericum perforatum) co-administration. Expert Opin Drug Metab Toxicol. 2017 Oct;13(10):1047-1062. Asher GN, Corbett AH, Hawke RL. Common Herbal Dietary Supplement-Drug Interactions. Am Fam Physician. 2017 Jul 15;96(2):101-107. Izzo AA, Hoon-Kim S, Radhakrishnan R, Williamson EM. A Critical Approach to Evaluating Clinical Efficacy, Adverse Events and Drug Interactions of Herbal Remedies. Phytother Res. 2016 May;30(5):691-700. Unger M. Pharmacokinetic drug interactions involving Ginkgo biloba. Drug Metab Rev. 2013 Aug;45(3):353-85. Hussain MS. Patient counseling about herbal-drug interactions. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):152-63. Read the full article
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Drug-Herb Interaction
Are you using herbal medicines as a primary or supplemental treatment, and are you aware of possible issues of drug-herb interactions? Recently, I was listening to the lecture of professor Dr. Bill J. Gurley titled as “Clinically relevant herb-drug interactions: past, present, and future” at the National Center for Complementary and Integrative Health, National Institutes of Health of the U.S.A. I was impressed with the presentation from one pharmacy professor who is highly specialized in the field of pharmacokinetics and pharmacodynamics of the conventional medications and supplemental herbal products. After the lecture, I started wondering what we really know about herbal remedies or their combination with conventional prescription medications as a part of complementary treatment. Indeed, we know about herbal medicine a lot, but how about their combination with conventional therapeutics in the form of complementary therapy. Did we learn something from the case ephedra (Ephedra sinica)? Clearly was stated in the lecture that for example ephedra (Ephedra sinica) was used in Traditional Chinese Medicine for over 5000 years for treatment of asthma and nasal congestion for only 7 – 10 days and that’s it, either a patient is healed or not, but not chronic use of ephedra was considering and proper treatment by ephedra in Traditional Chinese Medicine. However, in the U.S.A. from 1994 until 2004 ephedra was using chronically as a potent stimulant, not as a remedy for bronchial asthma, nasal congestion, cold, flu, fever, cough, and wheezing. In response to substantially collected evidence of adverse effects and deaths related to ephedra, the U.S. Food and Drug Administration (FDA) banned the sale of supplements containing ephedrine alkaloids in 2004. Ephedrine is a potent sympathomimetic that stimulates alpha, beta one and beta two adrenergic receptors as well. It excites and stimulates the sympathetic nervous system, causes tremendous vasoconstriction and cardiac stimulation, and produces effects similar to those of epinephrine (adrenalin). Ephedra extracts that do not contain ephedrine have not been banned by the FDA and are still sold legally today. Yet, Chinese and other people who know how properly to use ephedra, use it effectively to cure some acute diseases in a short period, NOT chronically. Do we really use herbal remedies correctly in our Western culture and conventional treatment with prescription medications and then we call that complementary treatment? Do we take into consideration numerous factors regarding the combination of conventional medicines and herbal remedies in complementary therapy such as characteristics of the patient, gender, age, ethnicity, co-morbidity, frailty, infrequent genotypes, and others? Also, the fact that majority currently available dietary and supplemental herbal remedies are products containing multiple herbal components, that their formulation is utilizing highly concentrated herbal (botanical) extracts which is not a proper way of preparing herbal remedies in alternative medicine, that many commercially available supplemental herbal products have the presence of numerous phytochemicals that have not been tested for pharmacological activities. These facts do not “sound” like a traditional herbal therapy and their proper use as a supplemental therapy in the form of complementary treatment along with conventional therapy by using prescribed medications. What is the level of the current clinical evidence? The next surprise, when I was searching for the scientific literature data, results of clinical studies regarding using herbal remedies as a supplement therapy to conventional therapeutics, calling that complementary treatment, mostly they are isolated case studies or case series, case reports, and results of in vitro analysis performed on cell cultures expressing human genes (for example). Mostly, clinical evidence has been on the level of incomplete case studies, case reports, an adverse event unlikely from a pharmacological viewpoint, case report providing some evidence for interaction, however, other cases not entirely excluded, case series, some pharmacokinetic trials in patients or healthy people, there are numerous contradictory data, or adverse events are highlighted by case reports but not confirmed by clinical trials or mega clinical trials. Mostly authors were taken rights to generalize, and it is very well known that generalization is acceptable only if you perform experimental clinical research design. No doubt, scientifically, case studies are a useful “tool” to set up a future hypothesis in clinical research and to conduct further research in that particular field. Complementary medicine is teamwork between conventional (Western medicine) specialist and alternative herbal medicine specialist Well, where we are regarding understanding herbal medicine, do we really appreciate them, maybe we misuse them, how properly they should be used, how they can be applied as an additional therapy with conventional medications in the form of complementary medicine. Also, there is one more question, if we do not know how to use them properly, why we do not leave to the patient to make a decision either to use herbal medicine (correctly) or conventional drugs to treat their diseases or provide prescription authorities with additional education regarding a complementary approach for therapy. Certainly, complementary medicine is teamwork. Indeed, the “street” is with two directions, two-way street, not one. It looks like some bigger picture is behind all these facts. Current clinical evidence of interactions between herbal (botanical) and conventional medications Herbal medicines have been well known to people of the world, European countries, America, Russia, China, India, Arabic countries for centuries. Currently, Western herbal medications can be classified into two categories, botanical-derived conventional medicines, and dietary supplements. Intensive interest in herbal medicine has overgrown in all countries during the past two decades. Due to cultural diversities in the EU and Russia, traditional herbal remedies of other regions, particularly Chinese Traditional and Ayurvedic medicines, are also popular (Sammons H.M. et al., 2016). The typical scenario today is a combination of herbal medicines used in conjunction with conventional drugs in the form of complementary treatment, and this condition may give rise to the potential of harmful herb-drug interactions. Some clinically critical herb-drug interactions have been reported in the literature, but many of them are from case studies, case reports, and limited clinical observations or literature search and review of published case reports. Common herbal medicines that exhibited some interactions with conventional medications (prescription medications) include St John's wort (Hypericum perforatum), ginger (Zingiber officinale) ginkgo (Ginkgo biloba), ginseng (Panax ginseng), and garlic (Allium sativum). St John's wort could significantly reduce the area under the plasma concentration-time curve, and blood concentrations of conventional medications prescribed by medical specialists such as cyclosporine, midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline. The standard drugs that interact with herbal medicines include warfarin, midazolam, digoxin, amitriptyline, indinavir, cyclosporine, tacrolimus, and irinotecan. Herbal medicines may interact with medications at the intestine, liver, kidneys, and targets of action. Most of them are actually substrates for specific metabolizing enzymes such as cytochrome P450s and P-glycoprotein. Well, the underlying mechanisms for most reported herb-drug interactions are not fully understood, and pharmacokinetic and pharmacodynamic events are implicated in many of these interactions, but not fully understand and investigated. In particular, enzyme induction and inhibition may play an essential role in the occurrence of some herb-drug interactions. Because herb-drug interactions can significantly affect circulating levels of conventional medications and, hence, alter the clinical outcome, the identification of herb-drug interactions has essential implications (Chen X.W. et al., 2012). Clinical consequences of herbal/botanical medicine-drug interactions depend on a variety of factors, such as the co-administered drugs, the patient characteristics, general a patient condition, the origin of the herbal medicines, the composition of their constituents and the applied dosage regimens. Definitely, to optimize the proper use of herbal medicines, further controlled studies are urgently needed to explore their potential for interactions with conventional drugs and to delineate the underlying mechanisms (Shi S. et al., 2012, Singh D., 2012). Various clinical and other medical literature reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. For example, The World Health Organisation indicated that approximately 80% of the Asian and African populations rely on traditional herbal medicine as the primary method for treatments of various diseases (Neergheen-Bhujun V.S., 2013). The use of botanical/herbal dietary supplements has grown steadily over the last 20 years despite incomplete information regarding active constituents, their actual concentration in the final product, mechanisms of action, efficacy, and safety. An essential but under-investigated safety concern is the potential for popular botanical/herbal dietary supplements to interfere with the absorption, transport, and metabolism of conventional medications prescribed with prescription authorities. Clinical trials of drug-botanical interactions should be the gold standard and are usually carried out only when indicated by unexpected consumer side effects or, preferably, by predictive preclinical in vitro studies. For example, phase one clinical trials have confirmed preclinical studies, and clinical case reports that St. John's wort (Hypericum perforatum) induces CYP3A4/CYP3A5. However, clinical studies of most botanicals that were predicted to interact with drugs have shown no clinically significant effects. For example, clinical trials did not substantiate preclinical predictions that milk thistle (Silybum marianum) would inhibit CYP1A2, CYP2C9, CYP2D6, CYP2E1, and CYP3A4 (Sprouse A.A., 2016). The complementary use of medications and herbal/botanical products is becoming increasingly prevalent over the last decade as a highly concentrated supplemental product (Cho H.J. et al., 2015). Herb-induced enzyme inhibition and induction may result in enhanced and decreased tissue, plasma, bile, and urine, drug concentrations, leading to a change in a conventional medication's pharmacokinetic parameters and resulting in the improper treatment of patients and potentially severe side effects (Li B. et al., 2016). Cytochrome P450 enzymes metabolize a large number of FDA-approved pharmaceuticals (conventional medications) and herbal supplements. This metabolism of medicines and supplements can be augmented by concomitant use. The xenobiotic receptors androstane receptor (CAR) and the pregnane X receptor (PXR) could respond to xenobiotics by increasing the expression of a large number of genes that are involved in the metabolism of xenobiotics, including CYP450s. Conversely, but not exclusively, many xenobiotics can inhibit the activity of CYP450s enzymes. Induction of the expression or inhibition of the action of CYP450s enzymes can result in drug-drug interactions and toxicity (Brewer C.T.et al., 2017). Herbal medications and herbal dietary supplement and other nutritional supplements are highly prevalent among older people. Herbal medications and other dietary supplements (herbal, vitamin-minerals and probiotics) are highly prevalent and popular in the population of older people. Physicians, particularly primary care physicians are often unaware that their patients use herbal remedies and other nutritional supplements concomitantly with conventional medicines. Herbal remedies and other dietary supplements contribute to high rates of polypharmacy, particularly among older people with multimorbidity. Herbal medicines and other nutritional supplements can interact with conventional drugs and be associated with a range of adverse, side effects - events. Physicians should be patient-centered, and non-judgmental when initiating discussions about herbal medicines and other dietary supplements. It is vital to maintain and develop patient empowerment and self-management skills (Pitkälä K.H. et al., 2016). In addition to conventional medicine prescribed by a physician(s), many patients regularly use alternative therapies in the form of self-directed complementary treatment. Communication between patients and providers about complementary therapy use is not consistent. There is an extreme demand for interventions in health care that provide timely, integrative communication support. Delivering herb-drug-disease alerts through multiple channels could help meet critical patient information needs (Christensen C.M. et al., 2017). It is important to state that conventional medicine specialists should make a necessary consultation with an alternative medicine specialist if the patient is determined to complementary treatment. Clinical professionals and specialists as well as alternative medicine specialists should enhance risk management on herbal-medication interactions such as increasing awareness of potential changes in therapeutic risk and benefits, inquiring patients about all currently used conventional medicines and herbal medicines and supplements, automatically detecting highly substantial significant herbal/medication interaction by computerized reminder system, selecting the alternatives, adjusting dose, reviewing the appropriateness of physician orders, educating patients to monitor for drug-interaction symptoms, and paying attention to follow-up visit and consultation (Zhang X.L. 2017). Severe herb-drug interactions were noted for Hypericum perforatum and Viscum album. The most severe interactions resulted in transplant rejection, delayed emergence from anesthesia, cardiovascular collapse, renal and liver toxicity, cardiotoxicity, bradycardia, hypovolaemic shock, inflammatory reactions with organ fibrosis and death. Moderately severe interactions were noted for Ginkgo biloba, Panax ginseng, Piper methysticum, Serenoa repens, and Camellia sinensis. The most commonly interacting drugs were antiplatelet agents and anticoagulants (Posadzki P. et al., 2013). Although (unfortunately) several studies on pharmacokinetic and pharmacodynamic herb-drug interactions have been conducted in healthy volunteers, there is tremendous uncertainty on the validity of these studies. Unfortunately, a qualitative review and a meta-analysis were performed to establish the clinical evidence of these interaction studies. According to the literature data, out of 4026 screened abstracts, 32 studies were included in the qualitative analysis. The meta-analysis was performed on only eleven additional studies (Awortwe C. et al., 2019). Many patients treated with cardiovascular medication like to drink green tea, either as a part of their cultural tradition or persuaded of its beneficial effects for general wellness and health. Green tea may affect the pharmacokinetics and pharmacodynamics of many cardiovascular medications and compounds. Some recent data showed that green tea and some cardiovascular medications make interactions and drug interactions were reported for rosuvastatin, sildenafil, and tacrolimus. Putative mechanisms involve inhibitory effects of green tea “catechins at the intestinal level on influx transporters OATP1A2 or OATP2B1 for rosuvastatin, on CYP3A for sildenafil and both CYP3A and the efflux transporter p-glycoprotein for tacrolimus. These interactions, which add to those previously described with simvastatin, nadolol, and warfarin, might lead, in some cases, to reduced drug efficacy or risk of drug toxicity. Oddly, available data on green tea interaction with cardiovascular substances with a pretty narrow therapeutic index, such as warfarin and tacrolimus are derived from single case reports. Conversely, green tea interactions with simvastatin, rosuvastatin, nadolol, and sildenafil were documented through pharmacokinetic studies” (Werba J.P. et al., 2018). There is substantial interest lately, in the use of herbs for the treatment of hypertension and cardiovascular disease. “Herbs and other botanicals contain numerous phytochemicals that have been effective in the treatment of cardiovascular diseases and hypertension. Accumulating scientific evidence provides a reason for the use of herbs by health practitioners for treating their patients. The rationale for this expanding use of herbs is the belief of patients in a "holistic medicine" and that herbs are natural, safe, and effective. However, there are reasons for concern with the use of herbs, because they are not regulated or supervised carefully and their use could lead to severe complications or interactions with their combination with traditional medicines. Also, their use is associated with significant out of pocket expenses, because their use is not compensated by health insurance providers” (Chrysant SG et al., 2017). Malongane F. and colleagues stated 2017 in their article: “Tea is one of the most widely consumed non-alcoholic beverages in the world next to the water. It is classified as Camellia sinensis and non-Camellia sinensis (herbal teas). The common bioactive compounds found mainly in green teas are flavan-3-ols (catechins) (also called flavanols), proanthocyanidins (tannins) and flavonols. Black tea contains theaflavins and thearubigins, and white tea contains l-theanine and gamma-aminobutyric acid (GABA), while herbal teas contain diverse polyphenols. Phytochemicals in tea exhibit antimicrobial, anti-diabetic and anti-cancer activities that are perceived to help manage chronic diseases linked to lifestyle. Many of these phytochemicals are reported to be biologically active when combined. Knowledge of the synergistic interactions of tea with other teas or herbs in terms of biological activities will be of benefit for therapeutic enhancement. There is evidence that various types of teas act synergistically in exhibiting health benefits to humans, improving consumer acceptance and economic value. Similar observations have been made when teas and herbs or medicinal drugs were combined.” (Malongane F et al., 2017). St. John's wort is a common medicinal herb used for the treatment of mild to moderate depression. Hyperforin, one of the main components of St. John wort, it plays an essential role in the induction of cytochrome P450 enzymes and P-glycoprotein transporter, and consequentially affects the pharmacokinetics of various drugs. Several clinical studies are demonstrating the interaction of St. John wort with the metabolism of conventional drugs which may cause life-threatening events such as probably serotonin syndrome if it is used in combination with SSRI antidepressant therapy (Soleymani S et al., 2017). Asher G.N. and colleagues in one article published in 2017 stated: “Nearly 25% of U.S. adults report concurrently taking prescription medication with a dietary supplement. Some supplements, such as St. John's wort and goldenseal, are known to cause clinically significant drug interactions and should be avoided by most patients receiving any pharmacologic therapy. However, many other supplements are predicted to cause interactions based only on in vitro studies that have not been confirmed or have been refuted in human clinical trials. Some supplements may cause interactions with a few medications but are likely to be safe with other medications (e.g., curcumin, echinacea, garlic, Asian ginseng, green tea extract, kava kava). Some supplements have a low likelihood of drug interactions and, with certain caveats, can safely be taken with most medications (e.g., black cohosh, cranberry, ginkgo, milk thistle, American ginseng, saw palmetto, valerian). Clinicians should consult reliable dietary supplement resources, or clinical pharmacists or pharmacologists, to help assess the safety of specific herbal supplement-drug combinations. Because most patients do not disclose supplement use to clinicians, the most crucial strategy for detecting herb-drug interactions is to develop a trusting relationship that encourages patients to discuss their dietary supplement use” (Asher GN et al., 2017). Izzo A.A. and colleagues published data in 2016 and stated: “Systematic reviews/meta-analyses suggest preliminary or satisfactory clinical evidence for agnus castus (Vitex agnus castus) for premenstrual complaints, flaxseed (Linum usitatissimum) for hypertension, feverfew (Tanacetum partenium) for migraine prevention, ginger (Zingiber officinalis) for pregnancy-induced nausea, ginseng (Panax ginseng) for improving fasting glucose levels as well as phytoestrogens and St John's wort (Hypericum perforatum) for the relief of some symptoms in menopause. However, firm conclusions of efficacy cannot be generally drawn. On the other hand, inconclusive evidence of effectiveness or contradictory results have been reported for Aloe vera in the treatment of psoriasis, cranberry (Vaccinium macrocarpon) in cystitis prevention, ginkgo (Ginkgo biloba) for tinnitus and intermittent claudication, echinacea (Echinacea spp.) for the prevention of common cold and pomegranate (Punica granatum) for the prevention/treatment of cardiovascular diseases. A critical evaluation of the clinical data regarding the adverse effects has shown that herbal remedies are generally better tolerated than synthetic medications. Nevertheless, potentially dangerous adverse effects, including herb-drug interactions, have been described. This suggests the need to be vigilant when using herbal remedies, particularly in specific conditions, such as during pregnancy and in the pediatric population” (Izzo AA et al., 2016). Ginkgo biloba leaf extracts are popular herbal remedies for the treatment of Alzheimer's dementia, tinnitus, vertigo (Meniere’s disease), and peripheral arterial disease Unger M., in an article published in 2013 stated: “As ginkgo biloba leaf are taken regularly by older people, who are likely to also use multiple other drugs for the treatment of, e.g., hypertension, diabetes, rheumatism or heart failure, potential herb-drug interactions are of interest.” (Unger M., 2013). The statement that many people have the mistaken notion that being natural, all herbs and foods are safe; this is not so. Why? The market is full of highly concentrated dietary, supplemental products from botanical/herbal sources, aromatherapy, vitamins-minerals additional products, and probiotics. Indeed, these forms of herbal remedies are far different than the herbal remedies supposed to be administered, they are diverse, concentrated and really in combination with conventional medicines compete for metabolism with our xenobiotic metabolizing enzymes from a family of cytochrome CYP450 s and others. The patient should decide in consultation with a traditional/conventional medicine specialist (Western medicine) or alternative medicine specialist what treatment would be the best option for a patient. Complementary aspect should be conducted carefully with synchronized administration of conventional medicine with alternative medicine, and a pharmacist should be a great source of knowledge with their knowledge of pharmacokinetics and pharmacodynamics as well as pharmacognosy. Unfortunately, many people use Internet resources for consultation and so-called self-healing instead of using practices of conventional medicine specialists and alternative medicine specialists. Also, as you can see from this short review, there are no reliable scientific data of herbal/medicine interaction and side effects, all data are from isolated case reports with suspicion of conflict of interests. During the last twenty years, the practice of herbalism and production of highly concentrated herbal remedies as supplemental products has become mainstream throughout the world. This is due to removing to the recognition of the value of conventional medical practice in the world. Herbal remedies traditionally are mixtures of more than one active ingredient or single herbal source as a tincture or tea, and they should be administered for a certain period NOT chronically as explained on the case of ephedra. No doubt, the possibility of herb-drug interactions is theoretically higher than drug-drug interactions because synthetic drugs usually contain a single chemical entity even it is not scientifically confirmed. As Hussain M.S., explained in the article published in 2011: “Case reports and clinical studies have highlighted the existence of some clinically significant interactions, although cause-and-effect relationships have not always been established. Herbs and drugs may interact either pharmacokinetically or pharmacodynamically. The predominant mechanism for this interaction is the inhibition of cytochrome P-450 3A4 in the small intestine; result in a significant reduction of drug pre-systemic metabolism. An additional mechanism is the inhibition of P-glycoprotein, a transporter that carries drug from the enterocyte back to the gut lumen, result in a further increase in the fraction of drug absorbed. Some herbal products (e.g., St. John's wort) have been shown to lower the plasma concentration (and the pharmacological effect) of some conventional drugs including cyclosporine, indinavir, irinotecan, nevirapine, oral contraceptives, and digoxin” (Hussain MS., 2011). Dr. Miroslav Sarac – Chiron Wise Centaur – holistic and integrative healing center References Sammons HM, Gubarev MI, Krepkova LV, Bortnikova VV, Corrick F, Job KM, Sherwin CM, Enioutina EY. Herbal medicines: challenges in the modern world. Part 2. European Union and Russia. Expert Rev Clin Pharmacol. 2016 Aug;9(8):1117-27. Chen XW1, Sneed KB, Pan SY, Cao C, Kanwar JR, Chew H, Zhou SF. Herb-drug interactions and mechanistic and clinical considerations. Curr Drug Metab. 2012 Jun 1;13(5):640-51. Shi S1, Klotz U. Drug interactions with herbal medicines. Clin Pharmacokinet. 2012 Feb 1;51(2):77-104. Singh D1, Gupta R, Saraf SA. Herbs-are they safe enough? An overview. Crit Rev Food Sci Nutr. 2012;52(10):876-98. Neergheen-Bhujun V.S. Underestimating the toxicological challenges associated with the use of herbal medicinal products in developing countries. Biomed Res Int. 2013;2013:804086. Sprouse A.A, van Breemen R.B. Pharmacokinetic Interactions between Drugs and Botanical Dietary Supplements. Drug Metab Dispos. 2016 Feb;44(2):162-71. Cho H.J, Yoon I.S. Pharmacokinetic interactions of herbs with cytochrome p450 and p-glycoprotein. Evid Based Complement Alternat Med. 2015;2015:736431. Li B, Zhao B, Liu Y, Tang M, Lüe B, Luo Z, Zhai H. Herb-drug enzyme-mediated interactions and the associated experimental methods: a review. J Tradit Chin Med. 2016 Jun;36(3):392-408. Pitkälä KH, Suominen MH, Bell JS, Strandberg TE. Herbal medications and other dietary supplements. A clinical review for physicians caring for older people. Ann Med. 2016 Dec;48(8):586-602. Brewer CT, Chen T. Hepatotoxicity of Herbal Supplements Mediated by Modulation of Cytochrome P450. Int J Mol Sci. 2017 Nov 8;18(11). Christensen CM, Morris RS, Kapsandoy SC, Archer M, Kuang J, Shane-McWhorter L, Bray BE, Zeng-Treitler Q. Patient needs and preferences for herb-drug-disease interaction alerts: a structured interview study. BMC Complement Altern Med. 2017 May 19;17(1):272. Zhang XL, Chen M, Zhu LL, Zhou Q. Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management. Evid Based Complement Alternat Med. 2017;2017:9296404. Posadzki P1, Watson L, Ernst E. Herb-drug interactions: an overview of systematic reviews. Br J Clin Pharmacol. 2013 Mar;75(3):603-18. Awortwe C, Bruckmueller H, Cascorbi I. Interaction of herbal products with prescribed medications: A systematic review and meta-analysis. Pharmacol Res. 2019 Mar;141:397-408. Werba JP, Misaka S, Giroli MG, Shimomura K, Amato M, Simonelli N, Vigo L, Tremoli E. Update of green tea interactions with cardiovascular drugs and putative mechanisms. J Food Drug Anal. 2018 Apr;26(2S):S72-S77. Chrysant SG, Chrysant GS. Herbs Used for the Treatment of Hypertension and their Mechanism of Action. Curr Hypertens Rep. 2017 Sep 18;19(9):77. Malongane F, McGaw LJ, Mudau FN. The synergistic potential of various teas, herbs and therapeutic drugs in health improvement: a review. J Sci Food Agric. 2017 Nov;97(14):4679-4689. Soleymani S, Bahramsoltani R, Rahimi R, Abdollahi M. Clinical risks of St John's Wort (Hypericum perforatum) co-administration. Expert Opin Drug Metab Toxicol. 2017 Oct;13(10):1047-1062. Asher GN, Corbett AH, Hawke RL. Common Herbal Dietary Supplement-Drug Interactions. Am Fam Physician. 2017 Jul 15;96(2):101-107. Izzo AA, Hoon-Kim S, Radhakrishnan R, Williamson EM. A Critical Approach to Evaluating Clinical Efficacy, Adverse Events and Drug Interactions of Herbal Remedies. Phytother Res. 2016 May;30(5):691-700. Unger M. Pharmacokinetic drug interactions involving Ginkgo biloba. Drug Metab Rev. 2013 Aug;45(3):353-85. Hussain MS. Patient counseling about herbal-drug interactions. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):152-63. Read the full article
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Can holistic and integrative therapy help disabled people?
What is a disability, can we leisurely define it; disability as a “phenomenon”? Dr. Miroslav Sarac – Chiron Wise Centaur – holistic and integrative healing center Unfortunately, disability either acquired or hereditary is the leading health and social problem in many countries including well-developed countries. It represents the significant health-social challenges of this era. As of now, as is, the healthcare system and social system is very oppressive, inadequate and inappropriate to meet the needs and challenges of the people living with disabilities. What is desperately needed is a fundamental shift in prospective approach with the application of complementary, alternative, holistic, integrative and functional treatments where the subjective experience of the disabled person is of central concern. Yes, subjective and personal experience! Life, wellness and health coaching for the disabled people are necessary and of urgent need. Some disabled people are with vocational rehabilitation services for years, not months as it should be. Actually, the primary goal of their existence, primary function and mission are to prepare and find employment for the disabled people (funded for their operation predominantly from federal resources about 75%). It looks like each disabled person is getting stuck in one of the phases, either in “the very beginning”, “hitting the wall”, “turning around”, “letting go”, “opening up”, “letting in”, and “the end of “healing” process” (1). The phase “hitting the wall” is the phase where most of the disabled people are giving up all malfunction services and so-called “independent living” where they realize that they are actually in reality heavily dependent on their family or primary caregiver for the rest of their life. All care and everyday living are on the primary caregiver’s shoulder, family and friends… Finally, we reached the point that life, wellness, and health coaching specifically designed for disabled people are “a must.” Most of the disabled people (if they can afford) are chronically placed in psychotherapeutic sessions with CBT (cognitive behavioral therapy), yes, chronically for years, instead of as CBT standards proposed 6 -16 sessions and that’s it. No achievements, no improvements, then a psychotherapist should take another way of therapy. CBT strictly focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Well, it sounds good, but after a short period, another challenge is coming. Severe depression is a common co-morbidity of the disabled people which is “coming” silently but persistently, stay as a shadow following the disabled person who desperately wants to find a new way of life, meaning, and purpose of life as a disabled person, employment, lost dignity…a coming poverty, a new monster. Not a problem, here are antidepressant therapeutics widely available and readily prescribed even from primary care physicians. After changing six or more different forms of antidepressant therapeutics, no expected improvements or so little with frequent relapses. Some disabled people also do not know they have treatment-resistant depression; social factors are not improved, home-bound lifestyle is still in existence and persistent, and the disabled person is falling into a severe episode of depression. Definitely, integrative, functional approach in the treatment of the disabled people is promising including holistic, alternative or complementary therapy in the form of applied intensive life, wellness, and health coaching; finding a new way of life, meaning, and purpose of life, objectively approaching a job search, employment, getting back lost dignity, fighting depression and anxiety and symptoms of post-traumatic stress disorder getting disabled. Certainly, disabled people also deserve to find and feel the greatest love of all in their lives as all other people do. What is a disability? Millions of people live with a visible or invisible disability, acquired or hereditary disability, physical, mental, intellectual, cognitive, developmental or sensory disability, disability with comorbidity and without comorbidity, nearly one in five people, currently almost 49 million people have a disability in the U.S.A. According to the data from the World Bank “one billion people or 15% of the world’s population experience, some form of disability and disability prevalence is higher for developing countries. One-fifth of the estimated global total, or between 110 million and 190 million people, experience significant disabilities” (2). Disability is not a category of disease; it is a condition caused by physical, sensory, cognitive and mental disorders that cause significant limitation in one or more major life activities. According to the Americans with Disability Act “major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating and working (Americans with Disability Act).” Probably, much better statement about disability we can find in the World Report on Disability, World Health Organization (WHO) stated: “Many people with disabilities do not have equal access to health care, education, and employment opportunities, do not receive the disability-related services that they require, and experience exclusion from everyday life activities. Following the entry into force of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), disability increasingly understood as a human rights issue. Disability is also an important development issue with an increasing body of evidence showing that persons with disabilities experience worse socioeconomic outcomes and poverty than persons without disabilities.” (3). It is imperative to understand disability as a phenomenon, fully. Yes, I would say the phenomenon. Defining disability is exceptionally complicated. A long time, I was searching for one good definition of disability. Probably, one of the best descriptions of disability is from the World Health Organization; it stated: “Disability is complex, dynamic, multidimensional, and contested. Over recent decades, the disabled people’s movement together with numerous researchers from the social and health sciences have identified the role of social and physical barriers in disability. The transition from an individual, medical perspective to a structural, social perspective has described as the shift from a “medical model” to a “social model” in which people viewed as being disabled by society rather than by their bodies” (3 - 8). Indeed, this statement provides a much better description of what disability is and how disability is transforming from a medical model into a social model. However, I did not stop searching for a better explanation and a better definition of disability. Leonardi M. and colleagues in 2006 in their article published in the Lancet stated: “Disability promoted as a “bio-psycho-social model,” it represents a workable compromise between medical and social models. Disability is the umbrella term for impairments, activity limitations, and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors)” (9). Generalization about “disability” or “people with disabilities” can mislead and any form of generalization should be avoided seriously. Persons with disabilities have diverse personal factors with differences in gender, age, socioeconomic status, sexuality, ethnicity, or cultural heritage; a unique culture. Each has his or her preferences and subjective responses to disability (10). A broad range of international documents has highlighted that limitation is a human rights issue, including the World Program of Action Concerning Disabled People (1982), the Convention on the Rights of the Child (1989), and the Standard Rules on the Equalization of Opportunities for People with Disabilities (1993). More than 40 nations adopted disability discrimination legislation during the 1990s (11). According to Harris J. and the article published in 2015 the Americans with Disability Act as it is stated the marquee civil rights legislation for people with disabilities expresses a national approach to disability that recognizes the role of society in its construction, maintenance, and potential remedy. But its mission is incomplete, and it has not generated the types of interactions between people with disabilities and nondisabled people empirically shown to deconstruct deeply entrenched social stigma (12). Disability as a phenomenon is very complicated, from a biological, medical, social, psychological point of view. As Sen A. in 2009 stated in his book: “Disability is a development issue, because of its bi-directional link to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability” (13). It looks like the definition of disability is not entirely reached, and still, the question of how disability supposed to be defined is fraught with political, ethical and philosophical complexities (14). How disabled people get even more impaired than actually, they are? Predominantly, disability is associated with some co-morbidities, and one of them is severe depression. Depression by itself, a separate entity is a form of disability. So, people with a disability who developed depression as co-morbidity are more disabled. Some previous research exhibited that co-morbid depression and chronic physical conditions associated with disability (15). Unfortunately, there is a substantial lack of data on disability and suicide in the U.S.A. There is a small number of national data on studies related to this topic. Some studies reaffirmed that disability is the risk factor of depression by using longitudinal data (16). Certainly, home-bound lifestyle, lack of employment, lack of transportation, malfunctioning or not provided services by vocational rehabilitation and social services, heavy dependence on a primary caregiver, the majority of disabled people will over a specified period develop the first signs and symptoms of depression and even suicidal ideation. Overall, significant indicators for increased suicidal risk in the population of disabled people are unemployed for an extended period, profound social isolation due to the homebound lifestyle and lack of transportation, significant change in health status because the majority of the disabled people require frequent medical attention and treatments. Progressively, due to lack of proper access to healthcare providers (even some primary care physicians do not want to accept Medicare and Medicaid insurance). Lack of mental health support and help either because they cannot afford due to overly expensive treatments and office visits or lack of mental health care providers locally, severe depression will be accompanied by suicidal thoughts or ideation in disability. Unproperly treated or untreated depression eventually in combination with the unbearable social status and life under the limit of poverty of the disabled people will convert into devastation condition of major depressive disorder with frequent suicidal thoughts. Majority disabled people are oppressed by ableism too, living as disabled people in a society that hates disability, or a society, the community, suffers from great stigma and taboo regarding disability. Overall, disability and its functional limitation in daily living activities have associated with suicide in the population of the disabled people (17). Still, there is a substantial lack of research data regarding what category of disabled people are more prone to develop severe depression, people with acquired disability or hereditary, and people with visible or invisible disability. Disabled people who suffer from suicidal ideation deserve to be seen by a therapist who “speaks” their language and understand their experience, thus cultural competency related to disability is a “must” for all healthcare professionals including pharmacists in the retail setting, social workers, psychologist and psychotherapists, rehabilitation counselors and our primary caregivers. There is a lack of research data what is the response of primary caregiver on a disabled person with developed depression as comorbidity and vice versa. Unfortunately, despite a substantial lack of national data on suicide and disability in the U.S. some studies have been shown that there is a substantially higher suicide rate in the population of disabled people with certain disabilities such as multiple sclerosis, spinal cord injuries and intellectual disability (18). As Giannini M. and colleagues in 2010 stated: “It is imperative that U.S. researchers and policymakers address the substantial gaps in knowledge that remain to help create a clear understanding of suicide in the disability population, especially targeting children and youth ages 10 to 24 and other at-risk age cohorts”. It sounds like a “wake up call” but still, since 2010 we do not have some significant contribution regarding research in this field. One of the possible reasons for such a condition is the fact that suicidologists are not able to find the data regarding the suicide rate in the population of disabled people, the data are hidden, or there is a lack of proper evidence regarding this particular issue. As one disabled person said: “Happy spring, I am “celebrating.” What? Six years of unsuccessful services with vocational rehabilitation services, still no job for me, with master’s and two doctoral degrees and numerous national and international certifications in the vocational evaluation process they made me an office clerk that even GED would be challenging for me, a home-bound lifestyle, severe disability, and heavy dependence on a primary caregiver…for them, I am “a low expectation and high liability.” I am “celebrating” a full five years in CBT (cognitive behavioral therapy) paying out of pocket. My potentially successful suicide was prevented by my primary caregiver, not a psychiatrist, not a psychotherapist, not a rehabilitation counselor…but holistic therapy helped me to make a balance in my body-mind-soul and found a “healthier” myself.” This blog is the first blog in the series of three blogs dedicated to disability, disabled people and how holistic therapy, life, wellness, and health coaching can help disabled people to live productive life finding “the greatest love of all.” References: 1. Lindsey E. The gift of healing in chronic illness/disability. J Holist Nurs. 1995 Dec;13(4):287-305. 2. http://www.worldbank.org/en/topic/disability 3. WHO Library Cataloguing-in-Publication Data World report on disability 2011. 4. Charlton J. Nothing about us without us: disability, oppression, and empowerment. Berkeley, University of California Press, 1998. 5. Driedger D. The last civil rights movement. London, Hurst, 1989. 6. Barnes C. Disabled people in Britain and discrimination. London, Hurst, 1991. 7. McConachie H et al. Participation of disabled children: how should it be characterized and measured? Disability and Rehabilitation, 2006,28:1157-1164. 8. Oliver M. The politics of disablement. Basingstoke, Macmillan and St Martin’s Press, 1990. 9. Leonardi M et al. MHADIE Consortium. The definition of disability: what is in a name? Lancet, 2006,368:1219-1221. 10. Learning lessons: defining, representing and measuring disability. London, Disability Rights Commission, 2007. 11. Quinn G et al. The current use and future potential of United Nations human rights instruments in the context of disability. New York and Geneva, United Nations, 2002b (http://www.icrpd.net/ratification/documents/en/Extras/Quinn%20 Degener%20study%20for%20OHCHR.pdf, accessed 21 Sept 2010). 12. Harris J. Processing disability. Am Univ Law Rev, 2015; 64 (3), 457-533. 13. Sen A. The idea of justice. Cambridge, The Belknap Press of Harvard University Press, 2009. 14. Sisti D.A. Naturalism and the social model of disability: allied or antithetical? J Med Ethics 2015, 41 (7): 553-556. https://www.dol.gov/ofccp/regs/compliance/faqs/ADAfaqs.htm 15. Deschenes SS, Burns RJ, Schmitz N. Associations between depression, chronic physical conditions and disability in a community sample: a focus on the persistence of depression. J Affect Disord. 2015; 179: 6-13. 16. Noh JW, Kwon Y.D, Park J, Oh IH, Kim J. Relationship between physical disability and depression by gender: A panel regression model. PLoS ONE 11 (11): e0166238. 17. Kaplan MS, McFarland BH, Huguet N, Newsom JT. Physical illness, functional limitations, and suicide risk: A population-based study. Am J Orthopsychiatry. 2007; 77 (1): 56-60. 18. Giannini MJ, Kreshover S, Elias E, Bergmark BA, Plummer C, O’Keefe E. Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis. Disabil Health J. 2010 Apr;3(2):74-8. 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Can holistic and integrative therapy help disabled people?
What is a disability, can we leisurely define it; disability as a “phenomenon”? Unfortunately, disability either acquired or hereditary is the leading health and social problem in many countries including well-developed countries. It represents the significant health-social challenges of this era. As of now, as is, the healthcare system and social system is very oppressive, inadequate and inappropriate to meet the needs and challenges of the people living with disabilities. What is desperately needed is a fundamental shift in prospective approach with the application of complementary, alternative, holistic, integrative and functional treatments where the subjective experience of the disabled person is of central concern. Yes, subjective and personal experience! Life, wellness and health coaching for the disabled people are necessary and of urgent need. Some disabled people are with vocational rehabilitation services for years, not months as it should be. Actually, the primary goal of their existence, primary function and mission are to prepare and find employment for the disabled people (funded for their operation predominantly from federal resources about 75%). It looks like each disabled person is getting stuck in one of the phases, either in “the very beginning”, “hitting the wall”, “turning around”, “letting go”, “opening up”, “letting in”, and “the end of “healing” process” (1). The phase “hitting the wall” is the phase where most of the disabled people are giving up all malfunction services and so-called “independent living” where they realize that they are actually in reality heavily dependent on their family or primary caregiver for the rest of their life. All care and everyday living are on the primary caregiver’s shoulder, family and friends… Finally, we reached the point that life, wellness, and health coaching specifically designed for disabled people are “a must.” Most of the disabled people (if they can afford) are chronically placed in psychotherapeutic sessions with CBT (cognitive behavioral therapy), yes, chronically for years, instead of as CBT standards proposed 6 -16 sessions and that’s it. No achievements, no improvements, then a psychotherapist should take another way of therapy. CBT strictly focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Well, it sounds good, but after a short period, another challenge is coming. Severe depression is a common co-morbidity of the disabled people which is “coming” silently but persistently, stay as a shadow following the disabled person who desperately wants to find a new way of life, meaning, and purpose of life as a disabled person, employment, lost dignity…a coming poverty, a new monster. Not a problem, here are antidepressant therapeutics widely available and readily prescribed even from primary care physicians. After changing six or more different forms of antidepressant therapeutics, no expected improvements or so little with frequent relapses. Some disabled people also do not know they have treatment-resistant depression; social factors are not improved, home-bound lifestyle is still in existence and persistent, and the disabled person is falling into a severe episode of depression. Definitely, integrative, functional approach in the treatment of the disabled people is promising including holistic, alternative or complementary therapy in the form of applied intensive life, wellness, and health coaching; finding a new way of life, meaning, and purpose of life, objectively approaching a job search, employment, getting back lost dignity, fighting depression and anxiety and symptoms of post-traumatic stress disorder getting disabled. Certainly, disabled people also deserve to find and feel the greatest love of all in their lives as all other people do. What is a disability? Millions of people live with a visible or invisible disability, acquired or hereditary disability, physical, mental, intellectual, cognitive, developmental or sensory disability, disability with comorbidity and without comorbidity, nearly one in five people, currently almost 49 million people have a disability in the U.S.A. According to the data from the World Bank “one billion people or 15% of the world’s population experience, some form of disability and disability prevalence is higher for developing countries. One-fifth of the estimated global total, or between 110 million and 190 million people, experience significant disabilities” (2). Disability is not a category of disease; it is a condition caused by physical, sensory, cognitive and mental disorders that cause significant limitation in one or more major life activities. According to the Americans with Disability Act “major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating and working (Americans with Disability Act).” Probably, much better statement about disability we can find in the World Report on Disability, World Health Organization (WHO) stated: “Many people with disabilities do not have equal access to health care, education, and employment opportunities, do not receive the disability-related services that they require, and experience exclusion from everyday life activities. Following the entry into force of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), disability increasingly understood as a human rights issue. Disability is also an important development issue with an increasing body of evidence showing that persons with disabilities experience worse socioeconomic outcomes and poverty than persons without disabilities.” (3). It is imperative to understand disability as a phenomenon, fully. Yes, I would say the phenomenon. Defining disability is exceptionally complicated. A long time, I was searching for one good definition of disability. Probably, one of the best descriptions of disability is from the World Health Organization; it stated: “Disability is complex, dynamic, multidimensional, and contested. Over recent decades, the disabled people’s movement together with numerous researchers from the social and health sciences have identified the role of social and physical barriers in disability. The transition from an individual, medical perspective to a structural, social perspective has described as the shift from a “medical model” to a “social model” in which people viewed as being disabled by society rather than by their bodies” (3 - 8). Indeed, this statement provides a much better description of what disability is and how disability is transforming from a medical model into a social model. However, I did not stop searching for a better explanation and a better definition of disability. Leonardi M. and colleagues in 2006 in their article published in the Lancet stated: “Disability promoted as a “bio-psycho-social model,” it represents a workable compromise between medical and social models. Disability is the umbrella term for impairments, activity limitations, and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors)” (9). Generalization about “disability” or “people with disabilities” can mislead and any form of generalization should be avoided seriously. Persons with disabilities have diverse personal factors with differences in gender, age, socioeconomic status, sexuality, ethnicity, or cultural heritage; a unique culture. Each has his or her preferences and subjective responses to disability (10). A broad range of international documents has highlighted that limitation is a human rights issue, including the World Program of Action Concerning Disabled People (1982), the Convention on the Rights of the Child (1989), and the Standard Rules on the Equalization of Opportunities for People with Disabilities (1993). More than 40 nations adopted disability discrimination legislation during the 1990s (11). According to Harris J. and the article published in 2015 the Americans with Disability Act as it is stated the marquee civil rights legislation for people with disabilities expresses a national approach to disability that recognizes the role of society in its construction, maintenance, and potential remedy. But its mission is incomplete, and it has not generated the types of interactions between people with disabilities and nondisabled people empirically shown to deconstruct deeply entrenched social stigma (12). Disability as a phenomenon is very complicated, from a biological, medical, social, psychological point of view. As Sen A. in 2009 stated in his book: “Disability is a development issue, because of its bi-directional link to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability” (13). It looks like the definition of disability is not entirely reached, and still, the question of how disability supposed to be defined is fraught with political, ethical and philosophical complexities (14). How disabled people get even more impaired than actually, they are? Predominantly, disability is associated with some co-morbidities, and one of them is severe depression. Depression by itself, a separate entity is a form of disability. So, people with a disability who developed depression as co-morbidity are more disabled. Some previous research exhibited that co-morbid depression and chronic physical conditions associated with disability (15). Unfortunately, there is a substantial lack of data on disability and suicide in the U.S.A. There is a small number of national data on studies related to this topic. Some studies reaffirmed that disability is the risk factor of depression by using longitudinal data (16). Certainly, home-bound lifestyle, lack of employment, lack of transportation, malfunctioning or not provided services by vocational rehabilitation and social services, heavy dependence on a primary caregiver, the majority of disabled people will over a specified period develop the first signs and symptoms of depression and even suicidal ideation. Overall, significant indicators for increased suicidal risk in the population of disabled people are unemployed for an extended period, profound social isolation due to the homebound lifestyle and lack of transportation, significant change in health status because the majority of the disabled people require frequent medical attention and treatments. Progressively, due to lack of proper access to healthcare providers (even some primary care physicians do not want to accept Medicare and Medicaid insurance). Lack of mental health support and help either because they cannot afford due to overly expensive treatments and office visits or lack of mental health care providers locally, severe depression will be accompanied by suicidal thoughts or ideation in disability. Unproperly treated or untreated depression eventually in combination with the unbearable social status and life under the limit of poverty of the disabled people will convert into devastation condition of major depressive disorder with frequent suicidal thoughts. Majority disabled people are oppressed by ableism too, living as disabled people in a society that hates disability, or a society, the community, suffers from great stigma and taboo regarding disability. Overall, disability and its functional limitation in daily living activities have associated with suicide in the population of the disabled people (17). Still, there is a substantial lack of research data regarding what category of disabled people are more prone to develop severe depression, people with acquired disability or hereditary, and people with visible or invisible disability. Disabled people who suffer from suicidal ideation deserve to be seen by a therapist who “speaks” their language and understand their experience, thus cultural competency related to disability is a “must” for all healthcare professionals including pharmacists in the retail setting, social workers, psychologist and psychotherapists, rehabilitation counselors and our primary caregivers. There is a lack of research data what is the response of primary caregiver on a disabled person with developed depression as comorbidity and vice versa. Unfortunately, despite a substantial lack of national data on suicide and disability in the U.S. some studies have been shown that there is a substantially higher suicide rate in the population of disabled people with certain disabilities such as multiple sclerosis, spinal cord injuries and intellectual disability (18). As Giannini M. and colleagues in 2010 stated: “It is imperative that U.S. researchers and policymakers address the substantial gaps in knowledge that remain to help create a clear understanding of suicide in the disability population, especially targeting children and youth ages 10 to 24 and other at-risk age cohorts”. It sounds like a “wake up call” but still, since 2010 we do not have some significant contribution regarding research in this field. One of the possible reasons for such a condition is the fact that suicidologists are not able to find the data regarding the suicide rate in the population of disabled people, the data are hidden, or there is a lack of proper evidence regarding this particular issue. As one disabled person said: “Happy spring, I am “celebrating.” What? Six years of unsuccessful services with vocational rehabilitation services, still no job for me, with master’s and two doctoral degrees and numerous national and international certifications in the vocational evaluation process they made me an office clerk that even GED would be challenging for me, a home-bound lifestyle, severe disability, and heavy dependence on a primary caregiver…for them, I am “a low expectation and high liability.” I am “celebrating” a full five years in CBT (cognitive behavioral therapy) paying out of pocket. My potentially successful suicide was prevented by my primary caregiver, not a psychiatrist, not a psychotherapist, not a rehabilitation counselor…but holistic therapy helped me to make a balance in my body-mind-soul and found a “healthier” myself.” This blog is the first blog in the series of three blogs dedicated to disability, disabled people and how holistic therapy, life, wellness, and health coaching can help disabled people to live productive life finding “the greatest love of all.” Dr. Miroslav Sarac – Chiron Wise Centaur – holistic and integrative healing center References: 1. Lindsey E. The gift of healing in chronic illness/disability. J Holist Nurs. 1995 Dec;13(4):287-305. 2. http://www.worldbank.org/en/topic/disability 3. WHO Library Cataloguing-in-Publication Data World report on disability 2011. 4. Charlton J. Nothing about us without us: disability, oppression, and empowerment. Berkeley, University of California Press, 1998. 5. Driedger D. The last civil rights movement. London, Hurst, 1989. 6. Barnes C. Disabled people in Britain and discrimination. London, Hurst, 1991. 7. McConachie H et al. Participation of disabled children: how should it be characterized and measured? Disability and Rehabilitation, 2006,28:1157-1164. 8. Oliver M. The politics of disablement. Basingstoke, Macmillan and St Martin’s Press, 1990. 9. Leonardi M et al. MHADIE Consortium. The definition of disability: what is in a name? Lancet, 2006,368:1219-1221. 10. Learning lessons: defining, representing and measuring disability. London, Disability Rights Commission, 2007. 11. Quinn G et al. The current use and future potential of United Nations human rights instruments in the context of disability. New York and Geneva, United Nations, 2002b (http://www.icrpd.net/ratification/documents/en/Extras/Quinn%20 Degener%20study%20for%20OHCHR.pdf, accessed 21 Sept 2010). 12. Harris J. Processing disability. Am Univ Law Rev, 2015; 64 (3), 457-533. 13. Sen A. The idea of justice. Cambridge, The Belknap Press of Harvard University Press, 2009. 14. Sisti D.A. Naturalism and the social model of disability: allied or antithetical? J Med Ethics 2015, 41 (7): 553-556. https://www.dol.gov/ofccp/regs/compliance/faqs/ADAfaqs.htm 15. Deschenes SS, Burns RJ, Schmitz N. Associations between depression, chronic physical conditions and disability in a community sample: a focus on the persistence of depression. J Affect Disord. 2015; 179: 6-13. 16. Noh JW, Kwon Y.D, Park J, Oh IH, Kim J. Relationship between physical disability and depression by gender: A panel regression model. PLoS ONE 11 (11): e0166238. 17. Kaplan MS, McFarland BH, Huguet N, Newsom JT. Physical illness, functional limitations, and suicide risk: A population-based study. Am J Orthopsychiatry. 2007; 77 (1): 56-60. 18. Giannini MJ, Kreshover S, Elias E, Bergmark BA, Plummer C, O’Keefe E. Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis. Disabil Health J. 2010 Apr;3(2):74-8. Read the full article
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conventional, complementary, alternative, holistic, integrative, and functional healing (medicine)
Are you still confused about what the actual meaning of conventional, complementary, alternative, holistic, integrative, and functional healing (medicine) is? Indeed, finding a healthier you and your family, your loved one will make you happy. Did you ask yourself recently how well are you, but really? Being healthy at every age is our goal. It should also be our primary goal. However, almost every day we are met with some terms which we do not understand such as complementary, conventional, alternative, holistic healing (medicine). Even recently we are finding terms such as integrative, and functional healing (medicine). Well, enough is enough; it is too much. It is imperative knowing all those terms because the part of the decision on your treatment is up to you as well, and not just your healthcare provider. Generally, you have probably realized some substantial differences between your healthcare providers, from one to the second one, some are maximalists, some minimalists, some are more technology oriented (forcing medications), some are naturalists, some are doubters and some are firm believers. Moreover, when they are all combined, they represent the six medical mindsets in our healthcare. All of these professionals can struggle from one “disease,” and that is because of a lack of decision-making skills. The art of medical decision-making is a set of complex skills, and it leads to one phenomenon, and that is medical specialists can disagree. Each professional has a different mindset. Complementary treatments include fusion of conventional therapies with some additional natural products including body and mind practices. If your healthcare provider recommends to you a combination of some conventional therapies with some supplemental (dietary), botanical products that mean he/she is conducting complementary treatment, complementary treatments include fusion of conventional therapies with some additional natural products including body and mind practices. The panel of natural products can be extremely wide as it contains, vitamins and minerals, botanical extracts, medicinal herbs, probiotics, special diets, homeopathy. Mind and body practices are broad-spectrum activities and treatments such as meditation, progressive relaxation, deep breathing, yoga, Tai Chi, Qi Gong, massage, and others. That would be a complementary treatment for your condition or disease, a fusion of conventional (Western medicine practice, including pharmacy) and alternative healing therapies. Many healthcare providers use this treatment. In Europe, with your antibiotic treatment, you will get advice to use probiotics immediately, or even some psychiatrists suggest that antidepressant therapy could be more effective if you for example practice meditation or any type of body and mind practice such as Tai Chi, Qi Gong, or yoga. Then your treatment is so-called complementary, and your healthcare provider is conducting complementary therapy or treatment for your condition or disease. Alternative therapy does not use conventional (Western medicine) treatment. In other words that means during your treatment you use only alternative therapies such as herbal-botanical (supplemental) remedies, aromatherapy, remedies of traditional Chinese medicine, Ayurveda therapy, homeopathy, special diets. However, alternative and therapies use many mind and body practices during the healing process such as yoga, meditation, Tai Chi, Qi Gong, massage, deep breathing treatments, progressive relaxation, guided imagery, and some chiropractic and osteopathic manipulations, acupuncture, hypnotherapy, Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration and others. Integrative healthcare brings conventional and alternative approaches to a much broader spectrum – it emphasizes a holistic, patient-centered and individualized approach to healthcare and wellness This approach is different. It does not only treat your acute or chronic disease, but it tries to bring the balance and healing to your body, mind and soul/spirit. It includes a broad spectrum to treat the whole person and not only focus on one organ or organ system. This approach can be very demanding because it involves mental health, emotional, spiritual, social and community aspects. It is very complex and requires a well-coordinated team of conventional and alternative healing providers. These approach in the treatment brought good results in treatments of many conditions and diseases such as pain management, symptoms management in the cancer patients and cancer survivors, and I would add depression, major depressive disorder and treatment-resistant depression. What is functional medicine? How can this approach help us? You may also hear for the term functional medicine, but you are not sure what that means exactly, besides terms like complementary, conventional, alternative, holistic and integrative. This term “functional medicine” sometimes refers to a concept similar to integrative healthcare, but it may also apply to an approach that more closely resembles naturopathy. Naturopathic practitioners use many different treatment approaches such as stress reduction, herbalism, and dietary supplements, homeopathy, psychotherapy and counseling, dietary and lifestyle changes. Some practitioners of functional medicine use other methods as well. Often, functional medicine specialist may refer patients to conventional healthcare providers and specialties of conventional Western medicine treatment. It is important to state that, functional medicine focuses on the optimal functioning of the body, organ systems, and its organs, and it involves systems of holistic or alternative medicine. And… finally holistic healing (medicine)! Why is this healing unique? Holistic healing (medicine) seriously considers the whole person, not just body or mind. It is healing that brings to the person, properly functioning body, mind, spirit/soul in the quest for optimal, balanced wellness and health. Directly, it is bringing balance between body, mind, and soul to function appropriately and synchronized. Holistic practitioners can use the treatment of conventional medicine combined with an alternative with an emphasis on spiritual, mental, social factors as contributing factors for treating condition or disease. Why is holistic healing (medicine) different from all other forms? Holistic treatment involves fixing the cause of the state, not only alleviating the symptoms, the patient is a person and not disease; all people have inner healing power. Holistic healing (medicine) is teamwork, including holistic practitioner, a patient, and it considering explorations of all aspects of a patient’s life, mental status, spiritual, social and other factors. We hope that we have helped you gain a better understanding of some of the terms and what they mean to us and how to find a healthier you in the 21st century. Respectfully, Chiron – Wise Centaur Team Read the full article
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CODE OF ETHICS – Chiron – Wise Centaur
The Code of Ethics for Tarot and Astrological Analyses / Consultations and predictions: 1. We will serve the best interests of our clients, conducting our professional activities without causing or intending to cause harm. 2. We will treat all our clients equally, regardless of their origin, race, religion, gender, age, or sexual preference. 3. We will honestly represent our qualifications, including educational credentials and levels of certification. 4. We will keep confidential the names of clients and all information shared or discussed during readings unless otherwise requested by the client or required by a court of law. 5. We will refer clients to a licensed professional for the advice of a legal, financial, medical, or psychological nature that we are not qualified to provide. 6. We will respect our client's right to refuse or terminate a reading at any time, regardless of prior consent. 7. We cannot and will not attempt to predict the future, give out winning lottery numbers, or interpret any reading to represent death, disease or divorce, thereby avoiding self-fulfilling prophecies and/or instilling fear in a client. 8. We will only offer consultation and predictions and astrological analysis for spiritual guidance, and will always keep in mind that the client has free will and must make choices on their own. We do not make their decisions for them. 9. We will give our full attention to each client and listen attentively to what is being said, to accurately assess the situation they are detailing with and thereby give them a useful and supportive Tarot cards consultation and predictions and astrological experience. 10. We will assist our clients in seeing the path they are on and offer through the cartomancy and astrology advice to manifest positive solutions to their concerns. 11. All clients will be given complete honesty in what is seen in the cards and astrological analysis. Even unpleasant news may be needed to shed light on what is coming and how best to handle the situations. 12. We will not provide consultations for anyone under the age of 21 without a specific call or written notice of consent from the parents. 14. All readings and analyses, as well as consultations, will be offered in a warm, genuine, professional, honest and compassionate way. 15. We are a professional; please treat us as such if you want us to answer you. 16. Everyone is welcome here so long as they are polite. 17. The client can ask about our abilities and how we work. 18. The client can share his / her problems here, take and give an opinion. 19. We reserve the right to terminate any consultation or predictions at anytime that the reader/astrologer is placed in combative position. NOTE You can also find our code of ethics page listen on the menu. Read the full article
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Meditation - Part 2
How can meditation help as a source of alternative and holistic therapy for certain diseases and medical conditions? Dr. Miroslav Sarac, Chiron Wise Centaur – holistic and integrative healing center Scientific medical (conventional), complementary, integrative and functional medicine provided substantial research data related to meditation as a part of holistic or complementary treatment in many pathological conditions. Recent scientific medical research data showed that meditation could be an excellent addition to conventional medicine as a complementary, integrative treatment for many medical conditions and diseases such as pre-surgical and post-surgical treatment, major depressive disorder, depression and treatment-resistant depression, hypertension (particularly systolic), obesity, multiple sclerosis, in geriatric depression, post-traumatic stress disorder, diabetes, Alzheimer’s disease, and bodily distress syndrome. I collected recent data just in the past several years. Recently, Packiasabapathy S. and colleagues exhibited in their research that cardiac surgical procedures are associated with postoperative neurological complications such as cognitive decline and delirium, which can complicate recovery and impair quality of life. Peri-operative depression and anxiety may be associated with increased mortality after cardiac surgeries. Proper preparation for cardiac surgery is an emerging concept that includes pre-operative interventions to reduce post-operative complications potentially. While most current preparatory interventions focus on optimizing physical health, mind-body interventions are an area of growing interest. Preoperative mind-body interventions such as Isha Kriya meditation may hold significant potential to improve postsurgical outcomes (Packiasabapathy S. et al., 2019). Mindfulness meditation is increasingly incorporated into mental health interventions including major depressive disorder Mindfulness meditation is increasingly integrated into mental health interventions, and theoretical concepts associated with it have influenced basic research on psychopathology (Wielgosz J. et al., 2018). Major depressive disorder (MDD) is one of the principal causes of disability in the world, no doubt about that. Major depressive patients that do not respond to the first and second drugs are about 67% and 33%, respectively (Turakitwanakan W. et al., 2017). According to Tolahunase M.R. and colleagues, there is growing evidence suggesting that both genetic and environmental factors modulate treatment outcome in, a highly heterogeneous, major depressive disorder (MDD) (Tolahunase MR et al., 2018). Specifically, the genetic analysis of a 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms have been strongly linked to the pathogenesis of major depressive disorder, and antidepressant treatment response. In patients with MDD who have 5-HTTLPR and MTHFR 677C>T polymorphisms and less likely to respond to medications (SSRIs) (Tolahunase MR et al., 2018). Evidence on whether meditation's core aspect of building and nurturing calm and peace serves as a mood stabilizer for current and recurrent episodes of depression through the acute and maintenance phases of treating bipolar disorder II affected patients. Meditation helped alleviate guilt, depressed mood, and helplessness-hopelessness significant concerns in patients who suffer from depression (Pandya S.P., 2018). Wahbeh H. and colleagues found that late-life depression (LLD) is a disorder causing severe disability and conventional antidepressant therapeutics are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability (HRV), an important prognostic marker for the development of subsequent cardiovascular disease (Ionson E. et al., 2018). Older adults, a rapidly growing population in the United States, have fewer physiological reserves and are more likely to be affected by stress, making them especially susceptible to depression symptoms. Meditation offers promising potential as an effective treatment (Wahbeh H. et al., 2018). Several authors had provided us with incredibly valuable results regarding meditation and its positive influence on hypertension Several authors had provided us with incredibly useful results regarding meditation and its impact on hypertension. Benefits of mindfulness meditation in reducing and controlling blood pressure and stress in patients with arterial hypertension were described from Ponte Márquez PH and colleagues in 2018 (Ponte Márquez PH et al., 2018). Even though numerous advances in the prevention and treatment of atherosclerosis, cardiovascular diseases are available in conventional medicine (Western medicine), all these diseases remain a leading cause of morbidity, disability, and mortality. Some holistic, alternative therapies, inexpensive and affordable interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of the high interest of complementary medicine. Numerous scientific medical studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may be a potentially attractive, cost-effective adjunct to more traditional medical therapies, simply as a complementary treatment. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk (Levine G.N. et al., 2017). The practice of meditation every day or several times per week, if adequately applied along with the conventional antihypertensive therapeutics, could substantially alleviate the burden of stroke in the U.S. To design an effective meditation program, policy-makers may prioritize funding to the programs that aim to encourage older individuals to practice meditation. Also, recently Ambavane R.A. and colleagues reported that meditation exhibited promise in clinical trials in reducing systolic hypertension, one of the main risk factors for stroke (Ambavane R.A. et al., 2019). Meditation as a supplement therapy in neuropsychiatric diseases Pathophysiologically, neuroinflammation is a complex process involving both the peripheral circulation and the central nervous system and is considered to underlie many neurological and psychiatric disorders including depression, anxiety, schizophrenia, and pain. Also recently, Lurie D.I. and colleagues explained that stressors including early-life adversity, psychosocial stress, and infection appear to prime microglia toward a pro-inflammatory phenotype (Lurie D.I., 2018). Subsequent inflammatory challenges then drive an exaggerated neuroinflammatory response involving the upregulation of pro-inflammatory mediators that are associated with CNS dysfunction. Several pharmacologic inhibitors of pro-inflammatory cytokines including (tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) exhibit good clinical efficacy in terms of improving neuroinflammatory processes. Mind/body and plant (herbal)-based interventions and treatments such as yoga, breathing exercises, meditation, and herbs/spices have also been demonstrated to reduce pro-inflammatory cytokines and have a positive impact on depression, anxiety, cognition, and pain. As the intricate connections between the immune system and the nervous system continue to be elucidated, successful therapies for reducing neuroinflammation will likely involve an integrated approach combining drug therapy with non-pharmacologic interventions (Lurie D.I., 2018). Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD) Generally, we can define transcendental meditation as a mental technique using a mantra to facilitate meditation. Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD), but its clinical efficacy remains to be clarified. Indeed, further clinical studies are necessary for this field. Kang S.S. and colleagues exhibited in 2018. results of evaluating the acceptability, preliminary effectiveness, and neurophysiology of transcendental meditation for veterans with PTSD (Kang S.S. et al., 2018). In the same study, from baseline to posttreatment, participants reported reductions in PTSD symptoms, experiential avoidance, and depressive and somatic symptoms, as well as increases on measures of mindfulness and quality of life (Kang S.S. et al., 2018). Psycho-affective conditions or traits such as stress, depression, severe anxiety, and neuroticism are known to affect normal patterns of sleep, cognition and mental health and well-being in aging populations and to be associated with increased risk for Alzheimer's disease (AD). Mental training for stress reduction and emotional and attentional regulation through meditation practice might help reduce these adverse factors. So far, studies on the impact of meditation practice on the brain and cognition in aging are scarce and have limitations but the findings are encouraging, showing a positive effect of meditation training on cognition, perception, especially on attention and memory, and on brain structure and function primarily in frontal and limbic structures and insula (Chételat G. et al., 2018). Diabetes is associated with significant psychological distress, can meditation help? Diabetes is associated with significant chronic psychological distress. There is one of the most important interventions to ensure the physical and emotional as well as psychosocial wellbeing of individuals living with diabetes. Meditation-based strategies have been evaluated for their complementary role in several chronic disorders including depression, anxiety, obesity, hypertension, cardiovascular disease, and diabetes. The practice of meditation is associated with a reduction in stress and negative emotions and improvements in patient attitude, health-related behavior, and coping skills. There is increased parasympathetic activity with a decrease in sympathetic vascular tone, stress hormones, and inflammatory markers. Additionally, several studies including Priya G. and colleagues in 2018 evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated some modest improvements in body weight, glycemic control, and control of blood pressure. Mindfulness meditation-based interventions can lead to improvements across all domains of holistic care - biological, psychological, spiritual and social. Priya G. and colleagues proposed that most of the studies have been of relatively short duration and included small numbers of patients – human subjects, meditation strategies, and the practice could be useful holistic, alternative and complementary treatments to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing (Priya G. et al., 2018). Mindfulness in Motion proved to be a possible program yielding positive results to improve quality-of-life outcomes for people with multiple sclerosis Many scientific findings show that mindfulness-oriented meditation improves a person's mental health, positively influencing even practitioners' personality profiles as well. Unfortunately, a limited number of studies are beginning to show that this type of meditation may also be a helpful therapeutic holistic and complementary option for persons with multiple sclerosis (MS) (Crescentini C. et al., 2018). Gilbertson R.M. and colleagues in a published article in 2017 stated that due to the uncertainty in disease progression associated with multiple sclerosis, and the multiplicity of mental and physical symptoms related to that particular disease, programming that addresses anxiety, depression, and fatigue is a crucial area of future research in MS disease management. Mindfulness in Motion proved to be a possible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS (Gilbertson R.M. et al., 2017). Yoga has been an object researched in hundreds of randomized controlled clinical trials as a viable antihypertensive lifestyle therapy, reducing stress, improving symptoms of depression Cramer A. and colleagues in 2017 published data regarding yoga. They stated that as a traditional, alternative health care system, yoga combines physical activity, breathing techniques, and meditation as well. It is increasingly used as a preventive or therapeutic means as a complementary, alternative and holistic therapy. So far, it is essential to state that yoga has been an object researched in hundreds of randomized controlled clinical trials. Positive effects of practicing yoga are especially found for chronic pain conditions, hypertension, depression and in supportive cancer care. While there are case reports of serious adverse events associated with yoga, the risk seems to be extremely low and comparable to other forms of physical activity. Yoga can be considered as a safe and useful adjunct, supplement therapy for some conditions (Cramer H., 2017). Results indicate that yoga is a viable antihypertensive lifestyle therapy that produces the most significant blood pressure benefits when breathing techniques and meditation/mental relaxation are included (Wu Y et al., 2019). Meditation has been exhibited to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness Always was a great concern about how to make a better life to patients who are under dialysis. Their extreme conditions such as coping with the stress and anxiety caused by end-stage kidney disease symptoms and dialysis treatment, their restrictions, and social, financial, family and other significant stressors, consumes many people afflicted with kidney disease or end-stage kidney disease. Meditation has been shown to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness (Bennett P.N. et al., 2018). Generally, cardiovascular diseases continue to be the leading cause of morbidity, disability, and mortality around the world. Yoga, as a powerful combination of physical postures, breathing exercises, and meditation, has gained increasing recognition as a form of mind-body practice. Recently, in 2019 Wells R.E. and colleagues showed fascinating results of their research regarding migraine. Although many studies had significant methodological challenges that limit interpretation and possible generalization, several studies reported decreased headache frequency, improved quality of life, or less effective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as a treatment for medication-overuse headache after the offending medication is withdrawn. Wells R.E. and colleagues stated: ” While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new study is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids to ensure safety given their hepatotoxicity. Physical therapy continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, except the life-threatening danger of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, physical therapy, exercise, chiropractic manipulation, and acupuncture.” The American Academy of Neurology and American Headache Society (https://www.aafp.org/afp/2013/0415/p584.html) are currently updating the guidelines for integrative treatment options for migraine so that additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build a therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care (Wells R.E. et al., 2019). Bodily distress syndrome or bodily stress is the term which according to its definition unifying numerous and various conditions such as fibromyalgia, chronic fatigue syndrome, and somatization disorder. Bodily distress syndrome patients may have been ill and in high risk for a social decline five and ten years before they received a proper diagnosis and treatment. The social and economic consequences of bodily distress syndrome are significant, and mindfulness therapy may have a potential to improve function significantly, quality of life and symptoms, prevent a social decline and reduce societal costs (Fjorback LO, 2012). Spirituality has a significant role in the lives of most palliative and hospice patients It was nice to read an article written by Steinhorn D.M. and colleagues regarding spirituality. Spirituality has a substantial role in the lives of most palliative and hospice patients whether or not they officially belong to a particular religion or spiritual tradition. As a result, the palliative and hospice care teams are frequently called upon to additionally support families who are experiencing their extremely challenging time and extreme struggling to make sense of their lives during a healthcare crisis. While conventional and everyday religious practices and services provide a useful resource of comfort and support for many of palliative and hospice patients, a significant number of palliative and hospice patients do not have an active religious community to which to turn and service for end-of-life spiritual care and support. Interestingly, over twenty years, more people in Western countries identify themselves as spiritual but not necessarily religious, and do not belong to an organized religious community. For patients who express a strong spiritual connection or sense of “something greater” or “a higher power,” there are limited available resources (Steinhorn D.M. et al., 2017). There is a significant health issue with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs. According to the results, Spadaro K.C. and colleagues meditation enhanced weight loss by 2.8 kg potentially through more significant improvements in eating behaviors and dietary restraint (Spadaro K.C. et al., 2017). Yoga and meditation are getting very popular among the general public and as topics of research as well Benefits associated with practicing yoga have been found on physical / body health, mental health, and cognitive performance. Clinical studies and theories that would possibly clarify better the underlying mechanisms are still lacking. Gerritsen R.J.S. and colleagues in 2018 provided us with data and explanations regarding various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline, in turn, could parsimoniously explain the physical and mental benefits of meditative practices through changes in autonomic balance. Gerritsen R.J.S. and colleagues proposed a neurophysiological model that describes how these specific respiration styles could operate, by physically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation. The vagal nerve, as a proponent of the parasympathetic nervous system, is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition (Gerritsen R.J.S. et al., 2018). Burnout and stress in healthcare practitioners are increasing; emergency department staff are particularly susceptible to such poor outcomes Mantra meditation could contribute to improved well-being. Lynch J. and colleagues showed that emergency department staff described the demands of their work and voiced a need for a workplace well-being program. Their results suggest that mantra meditation might represent a viable tool to develop attention and awareness, improve emotion regulation and improve their capacity to cope with stress, which may impact their workplace well-being, more comprehensive health service, patient safety and quality of care. Support from the organization is considered to be integral to the embedding of a workplace well-being program, such as the practice of meditation into their daily lives (Lynch J. et al., 2018). Interestingly, numerous studies show that personal spirituality developed through prayer positively influences mental health. Larrivee D. and colleagues published an exciting article in 2018. The authors stated that phenomenological and neuroscientific studies of mindfulness, an Eastern meditative prayer form, reveal significant health benefits now yielding important insights useful for guiding treatment of psychological disorders. By contrast, and despite its practice for millennia, Christian meditation is mainly unrepresented in studies of clinical efficacy. Resemblances between mindfulness and disciplinary acts in Christian meditation taken from the ancient Greek tradition of askesis suggest that Christian meditation will prove similarly beneficial; furthermore, psychological and neuroscientific studies indicate that its retention of a dialogical and transcendent praxis will additionally benefit social and existential psychotherapy. This paper thus argues that survey of contemplative meditation for its therapeutic potential is warranted (Larrivee D. et al., 2018). Not all authors agree that meditation is beneficial as an alternative and holistic therapy Farias M and colleagues published an article in 2016, and they tried to explain that meditation does not have any benefits. The authors stated: “The excitement about the application of mindfulness meditation in mental health settings has led to the proliferation of literature permeated by a lack of conceptual and methodological self-criticism. In this article, we raise two major concerns. First, we consider the range of individual differences within the experience of meditation; although some people may benefit from its practice, others will not be affected in any substantive way, and some individuals may suffer moderate to serious adverse effects. Second, we address the insufficient or inconclusive evidence for its benefits, particularly when mindfulness-based interventions are compared with other activities or treatments. We end with suggestions on how to improve the quality of research into mindfulness interventions and outline key issues for clinicians considering referring patients for these interventions” (Farias M, et al., 2016). Van Dam N.T. and colleagues stated in their article published in 2018 that in the last twenty years, mindfulness meditation has gone from being a fringe topic of scientific investigation to be an occasional replacement for psychotherapy, a tool of corporate well-being, widely implemented educational practice, and "key to building more resilient soldiers." Further authors stated that “the mindfulness movement and empirical evidence supporting it have not gone without criticism. Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed.” Addressing such concerns, the present article discusses the difficulties of defining mindfulness, delineates the proper scope of research into mindfulness practices, and illustrates crucial methodological issues for interpreting results from investigations of mindfulness. For doing so, the authors draw on their diverse areas of expertise to review the present state of mindfulness research, comprehensively summarizing what we do and do not know, while providing a prescriptive agenda for contemplative science, with a particular focus on assessment, mindfulness training, possible adverse effects, and intersection with brain imaging. Our goals are to inform interested scientists, the news media, and the public, to minimize harm, curb poor research practices, and staunch the flow of misinformation about the benefits, costs, and prospects of mindfulness meditation (Van Dam NT, et al., 2018). What is meditation research? Loizzo J. in one article published in 2014 stated: “Although perspectives like the one shared here may not be common in today's research circles and literature, I believe there is nothing new or controversial in what I have shared. Rather, I submit that the simple anthropology of respecting traditional know-how and practical expertise has been a secret ingredient to successful meditation research for decades. In a sense, I am simply suggesting that our young field has proven its rigor and relevance enough that we are ready to enter a new phase of open, rigorous, and systematic interdisciplinary dialogue with traditional contemplative science. My vision for the future of the field is that such an open, mutually respectful, and rigorous partnership promises to speed the advancement and align the direction of our field toward optimal science and maximal human benefit, as much or more than any conventional line of advancement through technical breakthroughs and new methodologies” (Loizzo J., 2014). References: Packiasabapathy S, Susheela AT, Mueller A, Patxot M, Gasangwa DV, O'Gara B2, Shaefi S, Marcantonio ER, Yeh GY, Subramaniam B. Guided meditation as an adjunct to enhance postoperative recovery after cardiac surgery: study protocol for a prospective randomized controlled feasibility trial. Trials. 2019 Jan 11;20(1):39. Wielgosz J, Goldberg SB, Kral TRA, Dunne JD, Davidson RJ. Mindfulness Meditation and Psychopathology. Annu Rev Clin Psychol. 2018 Dec 10. doi: 10.1146/annurev-clinpsy-021815-093423. Turakitwanakan W, Pongpaplud P, Kitporntheranunt M. The Effect of Home Buddhist Mindfulness Meditation on Depressive Symptom in Major Depressive Patients. J Med Assoc Thai. 2017 Nov;99 Suppl 8:S171-S178. Tolahunase MR, Sagar R, Dada R. 5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial. Indian J Psychiatry. 2018 Oct-Dec;60(4):410-426. Pandya SP. Meditation for treating adults with bipolar disorder II: A multi-city study. Clin Psychol Psychother. 2018 Dec 10. Ionson E, Limbachia J, Rej S, Puka K, Newman RI, Wetmore S, Burhan AM, Vasudev A. Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression. Br J Psychiatry. 2018 Nov 28:1-7. Wahbeh H, Nelson M. iRest Meditation for Older Adults with Depression Symptoms: A Pilot Study. Int J Yoga Therap. 2018 Oct 24. Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, Matas-Pericas L, Filella-Agullo D, Ruiz-Herrerias M, Soler-Ribaudi J, Roca-Cusachs Coll A, Arroyo-Díaz JA. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J Hum Hypertens. 2018 Nov 13. Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC Jr; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2017 Sep 28;6(10). Ambavane RA, Khademi A, Zhang D, Shi L. Modeling the Impact of Transcendental Meditation on Stroke Incidence and Mortality. J Stroke Cerebrovasc Dis. 2019 Mar;28(3):577-586. Lurie DI. An Integrative Approach to Neuroinflammation in Psychiatric disorders and Neuropathic Pain. J Exp Neurosci. 2018 Aug 13;12:1179069518793639. Kang SS, Erbes CR, Lamberty GJ, Thuras P, Sponheim SR, Polusny MA, Moran AC, Van Voorhis AC, Lim KO. Transcendental meditation for veterans with post-traumatic stress disorder. Psychol Trauma. 2018 Nov;10(6):675-680. Chételat G, Lutz A, Arenaza-Urquijo E, Collette F, Klimecki O, Marchant N. Why could meditation practice help promote mental health and well-being in aging? Alzheimers Res Ther. 2018 Jun 22;10(1):57. Priya G, Kalra S. Mind-Body Interactions and Mindfulness Meditation in Diabetes. Eur Endocrinol. 2018 Apr;14(1):35-41. Crescentini C, Matiz A, Cimenti M, Pascoli E, Eleopra R, Fabbro F. Effect of Mindfulness Meditation on Personality and Psychological Well-being in Patients with Multiple Sclerosis. Int J MS Care. 2018 May-Jun;20(3):101-108. Gilbertson RM, Klatt MD. Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study. Int J MS Care. 2017 Sep-Oct;19(5):225-231. Cramer H. Where and How does Yoga Work? - A Scientific Overview. Dtsch Med Wochenschr. 2017 Dec;142(25):1925-1929. Wu Y, Johnson BT, Acabchuk RL, Chen S, Lewis HK, Livingston J, Park CL, Pescatello LS. Yoga as Antihypertensive Lifestyle Therapy: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2019 Feb 6. pii: S0025-6196(18)30939-X. Bennett PN, Ngo T, Kalife C, Schiller B. Improving wellbeing in patients undergoing dialysis: Can meditation help? Semin Dial. 2018 Jan;31(1):59-64. Guddeti RR, Dang G, Williams MA, Alla VM. Role of Yoga in Cardiac Disease and Rehabilitation. J Cardiopulm Rehabil Prev. 2018 Nov 27. Wells RE, Beuthin J, Granetzke L. Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years. Curr Pain Headache Rep. 2019 Feb 21;23(2):10. Steinhorn DM, Din J, Johnson A. Healing, spirituality and integrative medicine. Ann Palliat Med. 2017 Jul;6(3):237-247. Upchurch DM, Johnson PJ. Gender Differences in Prevalence, Patterns, Purposes, and Perceived Benefits of Meditation Practices in the United States. J Womens Health (Larchmt). 2019 Feb;28(2):135-142. Spadaro KC, Davis KK, Sereika SM, Gibbs BB, Jakicic JM, Cohen SM. Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial. J Complement Integr Med. 2017 Dec 5;15(2). Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci. 2018 Oct 9;12:397. Lynch J, Prihodova L, Dunne PJ, O'Leary C, Breen R, Carroll Á, Walsh C, McMahon G, White B. Mantra meditation programme for emergency department staff: a qualitative study. BMJ Open. 2018 Sep 24;8(9):e020685. Donald JN, Sahdra BK, Van Zanden B, Duineveld JJ, Atkins PWB, Marshall SL, Ciarrochi J. Does your mindfulness benefit others? A systematic review and meta-analysis of the link between mindfulness and prosocial behaviour. Br J Psychol. 2019 Feb;110(1):101-125. Larrivee D, Echarte L. Contemplative Meditation and Neuroscience: Prospects for Mental Health. J Relig Health. 2018 Jun;57(3):960-978. Farias M, Wikholm C. Has the science of mindfulness lost its mind? BJPsych Bull. 2016 Dec;40(6):329-332. Van Dam NT, van Vugt MK, Vago DR, Schmalzl L, Saron CD, Olendzki A, Meissner T, Lazar SW, Kerr CE, Gorchov J, Fox KCR, Field BA, Britton WB, Brefczynski-Lewis JA, Meyer DE. Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation. Perspect Psychol Sci. 2018 Jan;13(1):36-61. Loizzo J. Meditation research, past, present, and future: perspectives from the Nalanda contemplative science tradition. Ann N Y Acad Sci. 2014 Jan;1307:43-54. Fjorback LO. Mindfulness and bodily distress. Dan Med J. 2012 Nov;59(11):B4547. Read the full article
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Meditation - Part 2
How can meditation help as a source of alternative and holistic therapy for certain diseases and medical conditions? Dr. Miroslav Sarac, Chiron Wise Centaur – holistic and integrative healing center Scientific medical (conventional), complementary, integrative and functional medicine provided substantial research data related to meditation as a part of holistic or complementary treatment in many pathological conditions. Recent scientific medical research data showed that meditation could be an excellent addition to conventional medicine as a complementary, integrative treatment for many medical conditions and diseases such as pre-surgical and post-surgical treatment, major depressive disorder, depression and treatment-resistant depression, hypertension (particularly systolic), obesity, multiple sclerosis, in geriatric depression, post-traumatic stress disorder, diabetes, Alzheimer’s disease, and bodily distress syndrome. I collected recent data just in the past several years. Recently, Packiasabapathy S. and colleagues exhibited in their research that cardiac surgical procedures are associated with postoperative neurological complications such as cognitive decline and delirium, which can complicate recovery and impair quality of life. Peri-operative depression and anxiety may be associated with increased mortality after cardiac surgeries. Proper preparation for cardiac surgery is an emerging concept that includes pre-operative interventions to reduce post-operative complications potentially. While most current preparatory interventions focus on optimizing physical health, mind-body interventions are an area of growing interest. Preoperative mind-body interventions such as Isha Kriya meditation may hold significant potential to improve postsurgical outcomes (Packiasabapathy S. et al., 2019). Mindfulness meditation is increasingly incorporated into mental health interventions including major depressive disorder Mindfulness meditation is increasingly integrated into mental health interventions, and theoretical concepts associated with it have influenced basic research on psychopathology (Wielgosz J. et al., 2018). Major depressive disorder (MDD) is one of the principal causes of disability in the world, no doubt about that. Major depressive patients that do not respond to the first and second drugs are about 67% and 33%, respectively (Turakitwanakan W. et al., 2017). According to Tolahunase M.R. and colleagues, there is growing evidence suggesting that both genetic and environmental factors modulate treatment outcome in, a highly heterogeneous, major depressive disorder (MDD) (Tolahunase MR et al., 2018). Specifically, the genetic analysis of a 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms have been strongly linked to the pathogenesis of major depressive disorder, and antidepressant treatment response. In patients with MDD who have 5-HTTLPR and MTHFR 677C>T polymorphisms and less likely to respond to medications (SSRIs) (Tolahunase MR et al., 2018). Evidence on whether meditation's core aspect of building and nurturing calm and peace serves as a mood stabilizer for current and recurrent episodes of depression through the acute and maintenance phases of treating bipolar disorder II affected patients. Meditation helped alleviate guilt, depressed mood, and helplessness-hopelessness significant concerns in patients who suffer from depression (Pandya S.P., 2018). Wahbeh H. and colleagues found that late-life depression (LLD) is a disorder causing severe disability and conventional antidepressant therapeutics are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability (HRV), an important prognostic marker for the development of subsequent cardiovascular disease (Ionson E. et al., 2018). Older adults, a rapidly growing population in the United States, have fewer physiological reserves and are more likely to be affected by stress, making them especially susceptible to depression symptoms. Meditation offers promising potential as an effective treatment (Wahbeh H. et al., 2018). Several authors had provided us with incredibly valuable results regarding meditation and its positive influence on hypertension Several authors had provided us with incredibly useful results regarding meditation and its impact on hypertension. Benefits of mindfulness meditation in reducing and controlling blood pressure and stress in patients with arterial hypertension were described from Ponte Márquez PH and colleagues in 2018 (Ponte Márquez PH et al., 2018). Even though numerous advances in the prevention and treatment of atherosclerosis, cardiovascular diseases are available in conventional medicine (Western medicine), all these diseases remain a leading cause of morbidity, disability, and mortality. Some holistic, alternative therapies, inexpensive and affordable interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of the high interest of complementary medicine. Numerous scientific medical studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may be a potentially attractive, cost-effective adjunct to more traditional medical therapies, simply as a complementary treatment. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk (Levine G.N. et al., 2017). The practice of meditation every day or several times per week, if adequately applied along with the conventional antihypertensive therapeutics, could substantially alleviate the burden of stroke in the U.S. To design an effective meditation program, policy-makers may prioritize funding to the programs that aim to encourage older individuals to practice meditation. Also, recently Ambavane R.A. and colleagues reported that meditation exhibited promise in clinical trials in reducing systolic hypertension, one of the main risk factors for stroke (Ambavane R.A. et al., 2019). Meditation as a supplement therapy in neuropsychiatric diseases Pathophysiologically, neuroinflammation is a complex process involving both the peripheral circulation and the central nervous system and is considered to underlie many neurological and psychiatric disorders including depression, anxiety, schizophrenia, and pain. Also recently, Lurie D.I. and colleagues explained that stressors including early-life adversity, psychosocial stress, and infection appear to prime microglia toward a pro-inflammatory phenotype (Lurie D.I., 2018). Subsequent inflammatory challenges then drive an exaggerated neuroinflammatory response involving the upregulation of pro-inflammatory mediators that are associated with CNS dysfunction. Several pharmacologic inhibitors of pro-inflammatory cytokines including (tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) exhibit good clinical efficacy in terms of improving neuroinflammatory processes. Mind/body and plant (herbal)-based interventions and treatments such as yoga, breathing exercises, meditation, and herbs/spices have also been demonstrated to reduce pro-inflammatory cytokines and have a positive impact on depression, anxiety, cognition, and pain. As the intricate connections between the immune system and the nervous system continue to be elucidated, successful therapies for reducing neuroinflammation will likely involve an integrated approach combining drug therapy with non-pharmacologic interventions (Lurie D.I., 2018). Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD) Generally, we can define transcendental meditation as a mental technique using a mantra to facilitate meditation. Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD), but its clinical efficacy remains to be clarified. Indeed, further clinical studies are necessary for this field. Kang S.S. and colleagues exhibited in 2018. results of evaluating the acceptability, preliminary effectiveness, and neurophysiology of transcendental meditation for veterans with PTSD (Kang S.S. et al., 2018). In the same study, from baseline to posttreatment, participants reported reductions in PTSD symptoms, experiential avoidance, and depressive and somatic symptoms, as well as increases on measures of mindfulness and quality of life (Kang S.S. et al., 2018). Psycho-affective conditions or traits such as stress, depression, severe anxiety, and neuroticism are known to affect normal patterns of sleep, cognition and mental health and well-being in aging populations and to be associated with increased risk for Alzheimer's disease (AD). Mental training for stress reduction and emotional and attentional regulation through meditation practice might help reduce these adverse factors. So far, studies on the impact of meditation practice on the brain and cognition in aging are scarce and have limitations but the findings are encouraging, showing a positive effect of meditation training on cognition, perception, especially on attention and memory, and on brain structure and function primarily in frontal and limbic structures and insula (Chételat G. et al., 2018). Diabetes is associated with significant psychological distress, can meditation help? Diabetes is associated with significant chronic psychological distress. There is one of the most important interventions to ensure the physical and emotional as well as psychosocial wellbeing of individuals living with diabetes. Meditation-based strategies have been evaluated for their complementary role in several chronic disorders including depression, anxiety, obesity, hypertension, cardiovascular disease, and diabetes. The practice of meditation is associated with a reduction in stress and negative emotions and improvements in patient attitude, health-related behavior, and coping skills. There is increased parasympathetic activity with a decrease in sympathetic vascular tone, stress hormones, and inflammatory markers. Additionally, several studies including Priya G. and colleagues in 2018 evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated some modest improvements in body weight, glycemic control, and control of blood pressure. Mindfulness meditation-based interventions can lead to improvements across all domains of holistic care - biological, psychological, spiritual and social. Priya G. and colleagues proposed that most of the studies have been of relatively short duration and included small numbers of patients – human subjects, meditation strategies, and the practice could be useful holistic, alternative and complementary treatments to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing (Priya G. et al., 2018). Mindfulness in Motion proved to be a possible program yielding positive results to improve quality-of-life outcomes for people with multiple sclerosis Many scientific findings show that mindfulness-oriented meditation improves a person's mental health, positively influencing even practitioners' personality profiles as well. Unfortunately, a limited number of studies are beginning to show that this type of meditation may also be a helpful therapeutic holistic and complementary option for persons with multiple sclerosis (MS) (Crescentini C. et al., 2018). Gilbertson R.M. and colleagues in a published article in 2017 stated that due to the uncertainty in disease progression associated with multiple sclerosis, and the multiplicity of mental and physical symptoms related to that particular disease, programming that addresses anxiety, depression, and fatigue is a crucial area of future research in MS disease management. Mindfulness in Motion proved to be a possible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS (Gilbertson R.M. et al., 2017). Yoga has been an object researched in hundreds of randomized controlled clinical trials as a viable antihypertensive lifestyle therapy, reducing stress, improving symptoms of depression Cramer A. and colleagues in 2017 published data regarding yoga. They stated that as a traditional, alternative health care system, yoga combines physical activity, breathing techniques, and meditation as well. It is increasingly used as a preventive or therapeutic means as a complementary, alternative and holistic therapy. So far, it is essential to state that yoga has been an object researched in hundreds of randomized controlled clinical trials. Positive effects of practicing yoga are especially found for chronic pain conditions, hypertension, depression and in supportive cancer care. While there are case reports of serious adverse events associated with yoga, the risk seems to be extremely low and comparable to other forms of physical activity. Yoga can be considered as a safe and useful adjunct, supplement therapy for some conditions (Cramer H., 2017). Results indicate that yoga is a viable antihypertensive lifestyle therapy that produces the most significant blood pressure benefits when breathing techniques and meditation/mental relaxation are included (Wu Y et al., 2019). Meditation has been exhibited to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness Always was a great concern about how to make a better life to patients who are under dialysis. Their extreme conditions such as coping with the stress and anxiety caused by end-stage kidney disease symptoms and dialysis treatment, their restrictions, and social, financial, family and other significant stressors, consumes many people afflicted with kidney disease or end-stage kidney disease. Meditation has been shown to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness (Bennett P.N. et al., 2018). Generally, cardiovascular diseases continue to be the leading cause of morbidity, disability, and mortality around the world. Yoga, as a powerful combination of physical postures, breathing exercises, and meditation, has gained increasing recognition as a form of mind-body practice. Recently, in 2019 Wells R.E. and colleagues showed fascinating results of their research regarding migraine. Although many studies had significant methodological challenges that limit interpretation and possible generalization, several studies reported decreased headache frequency, improved quality of life, or less effective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as a treatment for medication-overuse headache after the offending medication is withdrawn. Wells R.E. and colleagues stated: ” While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new study is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids to ensure safety given their hepatotoxicity. Physical therapy continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, except the life-threatening danger of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, physical therapy, exercise, chiropractic manipulation, and acupuncture.” The American Academy of Neurology and American Headache Society (https://www.aafp.org/afp/2013/0415/p584.html) are currently updating the guidelines for integrative treatment options for migraine so that additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build a therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care (Wells R.E. et al., 2019). Bodily distress syndrome or bodily stress is the term which according to its definition unifying numerous and various conditions such as fibromyalgia, chronic fatigue syndrome, and somatization disorder. Bodily distress syndrome patients may have been ill and in high risk for a social decline five and ten years before they received a proper diagnosis and treatment. The social and economic consequences of bodily distress syndrome are significant, and mindfulness therapy may have a potential to improve function significantly, quality of life and symptoms, prevent a social decline and reduce societal costs (Fjorback LO, 2012). Spirituality has a significant role in the lives of most palliative and hospice patients It was nice to read an article written by Steinhorn D.M. and colleagues regarding spirituality. Spirituality has a substantial role in the lives of most palliative and hospice patients whether or not they officially belong to a particular religion or spiritual tradition. As a result, the palliative and hospice care teams are frequently called upon to additionally support families who are experiencing their extremely challenging time and extreme struggling to make sense of their lives during a healthcare crisis. While conventional and everyday religious practices and services provide a useful resource of comfort and support for many of palliative and hospice patients, a significant number of palliative and hospice patients do not have an active religious community to which to turn and service for end-of-life spiritual care and support. Interestingly, over twenty years, more people in Western countries identify themselves as spiritual but not necessarily religious, and do not belong to an organized religious community. For patients who express a strong spiritual connection or sense of “something greater” or “a higher power,” there are limited available resources (Steinhorn D.M. et al., 2017). There is a significant health issue with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs. According to the results, Spadaro K.C. and colleagues meditation enhanced weight loss by 2.8 kg potentially through more significant improvements in eating behaviors and dietary restraint (Spadaro K.C. et al., 2017). Yoga and meditation are getting very popular among the general public and as topics of research as well Benefits associated with practicing yoga have been found on physical / body health, mental health, and cognitive performance. Clinical studies and theories that would possibly clarify better the underlying mechanisms are still lacking. Gerritsen R.J.S. and colleagues in 2018 provided us with data and explanations regarding various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline, in turn, could parsimoniously explain the physical and mental benefits of meditative practices through changes in autonomic balance. Gerritsen R.J.S. and colleagues proposed a neurophysiological model that describes how these specific respiration styles could operate, by physically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation. The vagal nerve, as a proponent of the parasympathetic nervous system, is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition (Gerritsen R.J.S. et al., 2018). Burnout and stress in healthcare practitioners are increasing; emergency department staff are particularly susceptible to such poor outcomes Mantra meditation could contribute to improved well-being. Lynch J. and colleagues showed that emergency department staff described the demands of their work and voiced a need for a workplace well-being program. Their results suggest that mantra meditation might represent a viable tool to develop attention and awareness, improve emotion regulation and improve their capacity to cope with stress, which may impact their workplace well-being, more comprehensive health service, patient safety and quality of care. Support from the organization is considered to be integral to the embedding of a workplace well-being program, such as the practice of meditation into their daily lives (Lynch J. et al., 2018). Interestingly, numerous studies show that personal spirituality developed through prayer positively influences mental health. Larrivee D. and colleagues published an exciting article in 2018. The authors stated that phenomenological and neuroscientific studies of mindfulness, an Eastern meditative prayer form, reveal significant health benefits now yielding important insights useful for guiding treatment of psychological disorders. By contrast, and despite its practice for millennia, Christian meditation is mainly unrepresented in studies of clinical efficacy. Resemblances between mindfulness and disciplinary acts in Christian meditation taken from the ancient Greek tradition of askesis suggest that Christian meditation will prove similarly beneficial; furthermore, psychological and neuroscientific studies indicate that its retention of a dialogical and transcendent praxis will additionally benefit social and existential psychotherapy. This paper thus argues that survey of contemplative meditation for its therapeutic potential is warranted (Larrivee D. et al., 2018). Not all authors agree that meditation is beneficial as an alternative and holistic therapy Farias M and colleagues published an article in 2016, and they tried to explain that meditation does not have any benefits. The authors stated: “The excitement about the application of mindfulness meditation in mental health settings has led to the proliferation of literature permeated by a lack of conceptual and methodological self-criticism. In this article, we raise two major concerns. First, we consider the range of individual differences within the experience of meditation; although some people may benefit from its practice, others will not be affected in any substantive way, and some individuals may suffer moderate to serious adverse effects. Second, we address the insufficient or inconclusive evidence for its benefits, particularly when mindfulness-based interventions are compared with other activities or treatments. We end with suggestions on how to improve the quality of research into mindfulness interventions and outline key issues for clinicians considering referring patients for these interventions” (Farias M, et al., 2016). Van Dam N.T. and colleagues stated in their article published in 2018 that in the last twenty years, mindfulness meditation has gone from being a fringe topic of scientific investigation to be an occasional replacement for psychotherapy, a tool of corporate well-being, widely implemented educational practice, and "key to building more resilient soldiers." Further authors stated that “the mindfulness movement and empirical evidence supporting it have not gone without criticism. Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed.” Addressing such concerns, the present article discusses the difficulties of defining mindfulness, delineates the proper scope of research into mindfulness practices, and illustrates crucial methodological issues for interpreting results from investigations of mindfulness. For doing so, the authors draw on their diverse areas of expertise to review the present state of mindfulness research, comprehensively summarizing what we do and do not know, while providing a prescriptive agenda for contemplative science, with a particular focus on assessment, mindfulness training, possible adverse effects, and intersection with brain imaging. Our goals are to inform interested scientists, the news media, and the public, to minimize harm, curb poor research practices, and staunch the flow of misinformation about the benefits, costs, and prospects of mindfulness meditation (Van Dam NT, et al., 2018). What is meditation research? Loizzo J. in one article published in 2014 stated: “Although perspectives like the one shared here may not be common in today's research circles and literature, I believe there is nothing new or controversial in what I have shared. Rather, I submit that the simple anthropology of respecting traditional know-how and practical expertise has been a secret ingredient to successful meditation research for decades. In a sense, I am simply suggesting that our young field has proven its rigor and relevance enough that we are ready to enter a new phase of open, rigorous, and systematic interdisciplinary dialogue with traditional contemplative science. My vision for the future of the field is that such an open, mutually respectful, and rigorous partnership promises to speed the advancement and align the direction of our field toward optimal science and maximal human benefit, as much or more than any conventional line of advancement through technical breakthroughs and new methodologies” (Loizzo J., 2014). References: Packiasabapathy S, Susheela AT, Mueller A, Patxot M, Gasangwa DV, O'Gara B2, Shaefi S, Marcantonio ER, Yeh GY, Subramaniam B. Guided meditation as an adjunct to enhance postoperative recovery after cardiac surgery: study protocol for a prospective randomized controlled feasibility trial. Trials. 2019 Jan 11;20(1):39. Wielgosz J, Goldberg SB, Kral TRA, Dunne JD, Davidson RJ. Mindfulness Meditation and Psychopathology. Annu Rev Clin Psychol. 2018 Dec 10. doi: 10.1146/annurev-clinpsy-021815-093423. Turakitwanakan W, Pongpaplud P, Kitporntheranunt M. The Effect of Home Buddhist Mindfulness Meditation on Depressive Symptom in Major Depressive Patients. J Med Assoc Thai. 2017 Nov;99 Suppl 8:S171-S178. Tolahunase MR, Sagar R, Dada R. 5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial. Indian J Psychiatry. 2018 Oct-Dec;60(4):410-426. Pandya SP. Meditation for treating adults with bipolar disorder II: A multi-city study. Clin Psychol Psychother. 2018 Dec 10. Ionson E, Limbachia J, Rej S, Puka K, Newman RI, Wetmore S, Burhan AM, Vasudev A. Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression. Br J Psychiatry. 2018 Nov 28:1-7. Wahbeh H, Nelson M. iRest Meditation for Older Adults with Depression Symptoms: A Pilot Study. Int J Yoga Therap. 2018 Oct 24. Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, Matas-Pericas L, Filella-Agullo D, Ruiz-Herrerias M, Soler-Ribaudi J, Roca-Cusachs Coll A, Arroyo-Díaz JA. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J Hum Hypertens. 2018 Nov 13. Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC Jr; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2017 Sep 28;6(10). Ambavane RA, Khademi A, Zhang D, Shi L. Modeling the Impact of Transcendental Meditation on Stroke Incidence and Mortality. J Stroke Cerebrovasc Dis. 2019 Mar;28(3):577-586. Lurie DI. An Integrative Approach to Neuroinflammation in Psychiatric disorders and Neuropathic Pain. J Exp Neurosci. 2018 Aug 13;12:1179069518793639. Kang SS, Erbes CR, Lamberty GJ, Thuras P, Sponheim SR, Polusny MA, Moran AC, Van Voorhis AC, Lim KO. Transcendental meditation for veterans with post-traumatic stress disorder. Psychol Trauma. 2018 Nov;10(6):675-680. Chételat G, Lutz A, Arenaza-Urquijo E, Collette F, Klimecki O, Marchant N. Why could meditation practice help promote mental health and well-being in aging? Alzheimers Res Ther. 2018 Jun 22;10(1):57. Priya G, Kalra S. Mind-Body Interactions and Mindfulness Meditation in Diabetes. Eur Endocrinol. 2018 Apr;14(1):35-41. Crescentini C, Matiz A, Cimenti M, Pascoli E, Eleopra R, Fabbro F. Effect of Mindfulness Meditation on Personality and Psychological Well-being in Patients with Multiple Sclerosis. Int J MS Care. 2018 May-Jun;20(3):101-108. Gilbertson RM, Klatt MD. Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study. Int J MS Care. 2017 Sep-Oct;19(5):225-231. Cramer H. Where and How does Yoga Work? - A Scientific Overview. Dtsch Med Wochenschr. 2017 Dec;142(25):1925-1929. Wu Y, Johnson BT, Acabchuk RL, Chen S, Lewis HK, Livingston J, Park CL, Pescatello LS. Yoga as Antihypertensive Lifestyle Therapy: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2019 Feb 6. pii: S0025-6196(18)30939-X. Bennett PN, Ngo T, Kalife C, Schiller B. Improving wellbeing in patients undergoing dialysis: Can meditation help? Semin Dial. 2018 Jan;31(1):59-64. Guddeti RR, Dang G, Williams MA, Alla VM. Role of Yoga in Cardiac Disease and Rehabilitation. J Cardiopulm Rehabil Prev. 2018 Nov 27. Wells RE, Beuthin J, Granetzke L. Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years. Curr Pain Headache Rep. 2019 Feb 21;23(2):10. Steinhorn DM, Din J, Johnson A. Healing, spirituality and integrative medicine. Ann Palliat Med. 2017 Jul;6(3):237-247. Upchurch DM, Johnson PJ. Gender Differences in Prevalence, Patterns, Purposes, and Perceived Benefits of Meditation Practices in the United States. J Womens Health (Larchmt). 2019 Feb;28(2):135-142. Spadaro KC, Davis KK, Sereika SM, Gibbs BB, Jakicic JM, Cohen SM. Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial. J Complement Integr Med. 2017 Dec 5;15(2). Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci. 2018 Oct 9;12:397. Lynch J, Prihodova L, Dunne PJ, O'Leary C, Breen R, Carroll Á, Walsh C, McMahon G, White B. Mantra meditation programme for emergency department staff: a qualitative study. BMJ Open. 2018 Sep 24;8(9):e020685. Donald JN, Sahdra BK, Van Zanden B, Duineveld JJ, Atkins PWB, Marshall SL, Ciarrochi J. Does your mindfulness benefit others? A systematic review and meta-analysis of the link between mindfulness and prosocial behaviour. Br J Psychol. 2019 Feb;110(1):101-125. Larrivee D, Echarte L. Contemplative Meditation and Neuroscience: Prospects for Mental Health. J Relig Health. 2018 Jun;57(3):960-978. Farias M, Wikholm C. Has the science of mindfulness lost its mind? BJPsych Bull. 2016 Dec;40(6):329-332. Van Dam NT, van Vugt MK, Vago DR, Schmalzl L, Saron CD, Olendzki A, Meissner T, Lazar SW, Kerr CE, Gorchov J, Fox KCR, Field BA, Britton WB, Brefczynski-Lewis JA, Meyer DE. Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation. Perspect Psychol Sci. 2018 Jan;13(1):36-61. Loizzo J. Meditation research, past, present, and future: perspectives from the Nalanda contemplative science tradition. Ann N Y Acad Sci. 2014 Jan;1307:43-54. Fjorback LO. Mindfulness and bodily distress. Dan Med J. 2012 Nov;59(11):B4547. Read the full article
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Meditation - Part 2
How can meditation help as a source of alternative and holistic therapy for certain diseases and medical conditions? Dr. Miroslav Sarac, Chiron Wise Centaur – holistic and integrative healing center Scientific medical (conventional), complementary, integrative and functional medicine provided substantial research data related to meditation as a part of holistic or complementary treatment in many pathological conditions. Recent scientific medical research data showed that meditation could be an excellent addition to conventional medicine as a complementary, integrative treatment for many medical conditions and diseases such as pre-surgical and post-surgical treatment, major depressive disorder, depression and treatment-resistant depression, hypertension (particularly systolic), obesity, multiple sclerosis, in geriatric depression, post-traumatic stress disorder, diabetes, Alzheimer’s disease, and bodily distress syndrome. I collected recent data just in the past several years. Recently, Packiasabapathy S. and colleagues exhibited in their research that cardiac surgical procedures are associated with postoperative neurological complications such as cognitive decline and delirium, which can complicate recovery and impair quality of life. Peri-operative depression and anxiety may be associated with increased mortality after cardiac surgeries. Proper preparation for cardiac surgery is an emerging concept that includes pre-operative interventions to reduce post-operative complications potentially. While most current preparatory interventions focus on optimizing physical health, mind-body interventions are an area of growing interest. Preoperative mind-body interventions such as Isha Kriya meditation may hold significant potential to improve postsurgical outcomes (Packiasabapathy S. et al., 2019). Mindfulness meditation is increasingly incorporated into mental health interventions including major depressive disorder Mindfulness meditation is increasingly integrated into mental health interventions, and theoretical concepts associated with it have influenced basic research on psychopathology (Wielgosz J. et al., 2018). Major depressive disorder (MDD) is one of the principal causes of disability in the world, no doubt about that. Major depressive patients that do not respond to the first and second drugs are about 67% and 33%, respectively (Turakitwanakan W. et al., 2017). According to Tolahunase M.R. and colleagues, there is growing evidence suggesting that both genetic and environmental factors modulate treatment outcome in, a highly heterogeneous, major depressive disorder (MDD) (Tolahunase MR et al., 2018). Specifically, the genetic analysis of a 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms have been strongly linked to the pathogenesis of major depressive disorder, and antidepressant treatment response. In patients with MDD who have 5-HTTLPR and MTHFR 677C>T polymorphisms and less likely to respond to medications (SSRIs) (Tolahunase MR et al., 2018). Evidence on whether meditation's core aspect of building and nurturing calm and peace serves as a mood stabilizer for current and recurrent episodes of depression through the acute and maintenance phases of treating bipolar disorder II affected patients. Meditation helped alleviate guilt, depressed mood, and helplessness-hopelessness significant concerns in patients who suffer from depression (Pandya S.P., 2018). Wahbeh H. and colleagues found that late-life depression (LLD) is a disorder causing severe disability and conventional antidepressant therapeutics are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability (HRV), an important prognostic marker for the development of subsequent cardiovascular disease (Ionson E. et al., 2018). Older adults, a rapidly growing population in the United States, have fewer physiological reserves and are more likely to be affected by stress, making them especially susceptible to depression symptoms. Meditation offers promising potential as an effective treatment (Wahbeh H. et al., 2018). Several authors had provided us with incredibly valuable results regarding meditation and its positive influence on hypertension Several authors had provided us with incredibly useful results regarding meditation and its impact on hypertension. Benefits of mindfulness meditation in reducing and controlling blood pressure and stress in patients with arterial hypertension were described from Ponte Márquez PH and colleagues in 2018 (Ponte Márquez PH et al., 2018). Even though numerous advances in the prevention and treatment of atherosclerosis, cardiovascular diseases are available in conventional medicine (Western medicine), all these diseases remain a leading cause of morbidity, disability, and mortality. Some holistic, alternative therapies, inexpensive and affordable interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of the high interest of complementary medicine. Numerous scientific medical studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may be a potentially attractive, cost-effective adjunct to more traditional medical therapies, simply as a complementary treatment. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk (Levine G.N. et al., 2017). The practice of meditation every day or several times per week, if adequately applied along with the conventional antihypertensive therapeutics, could substantially alleviate the burden of stroke in the U.S. To design an effective meditation program, policy-makers may prioritize funding to the programs that aim to encourage older individuals to practice meditation. Also, recently Ambavane R.A. and colleagues reported that meditation exhibited promise in clinical trials in reducing systolic hypertension, one of the main risk factors for stroke (Ambavane R.A. et al., 2019). Meditation as a supplement therapy in neuropsychiatric diseases Pathophysiologically, neuroinflammation is a complex process involving both the peripheral circulation and the central nervous system and is considered to underlie many neurological and psychiatric disorders including depression, anxiety, schizophrenia, and pain. Also recently, Lurie D.I. and colleagues explained that stressors including early-life adversity, psychosocial stress, and infection appear to prime microglia toward a pro-inflammatory phenotype (Lurie D.I., 2018). Subsequent inflammatory challenges then drive an exaggerated neuroinflammatory response involving the upregulation of pro-inflammatory mediators that are associated with CNS dysfunction. Several pharmacologic inhibitors of pro-inflammatory cytokines including (tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) exhibit good clinical efficacy in terms of improving neuroinflammatory processes. Mind/body and plant (herbal)-based interventions and treatments such as yoga, breathing exercises, meditation, and herbs/spices have also been demonstrated to reduce pro-inflammatory cytokines and have a positive impact on depression, anxiety, cognition, and pain. As the intricate connections between the immune system and the nervous system continue to be elucidated, successful therapies for reducing neuroinflammation will likely involve an integrated approach combining drug therapy with non-pharmacologic interventions (Lurie D.I., 2018). Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD) Generally, we can define transcendental meditation as a mental technique using a mantra to facilitate meditation. Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD), but its clinical efficacy remains to be clarified. Indeed, further clinical studies are necessary for this field. Kang S.S. and colleagues exhibited in 2018. results of evaluating the acceptability, preliminary effectiveness, and neurophysiology of transcendental meditation for veterans with PTSD (Kang S.S. et al., 2018). In the same study, from baseline to posttreatment, participants reported reductions in PTSD symptoms, experiential avoidance, and depressive and somatic symptoms, as well as increases on measures of mindfulness and quality of life (Kang S.S. et al., 2018). Psycho-affective conditions or traits such as stress, depression, severe anxiety, and neuroticism are known to affect normal patterns of sleep, cognition and mental health and well-being in aging populations and to be associated with increased risk for Alzheimer's disease (AD). Mental training for stress reduction and emotional and attentional regulation through meditation practice might help reduce these adverse factors. So far, studies on the impact of meditation practice on the brain and cognition in aging are scarce and have limitations but the findings are encouraging, showing a positive effect of meditation training on cognition, perception, especially on attention and memory, and on brain structure and function primarily in frontal and limbic structures and insula (Chételat G. et al., 2018). Diabetes is associated with significant psychological distress, can meditation help? Diabetes is associated with significant chronic psychological distress. There is one of the most important interventions to ensure the physical and emotional as well as psychosocial wellbeing of individuals living with diabetes. Meditation-based strategies have been evaluated for their complementary role in several chronic disorders including depression, anxiety, obesity, hypertension, cardiovascular disease, and diabetes. The practice of meditation is associated with a reduction in stress and negative emotions and improvements in patient attitude, health-related behavior, and coping skills. There is increased parasympathetic activity with a decrease in sympathetic vascular tone, stress hormones, and inflammatory markers. Additionally, several studies including Priya G. and colleagues in 2018 evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated some modest improvements in body weight, glycemic control, and control of blood pressure. Mindfulness meditation-based interventions can lead to improvements across all domains of holistic care - biological, psychological, spiritual and social. Priya G. and colleagues proposed that most of the studies have been of relatively short duration and included small numbers of patients – human subjects, meditation strategies, and the practice could be useful holistic, alternative and complementary treatments to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing (Priya G. et al., 2018). Mindfulness in Motion proved to be a possible program yielding positive results to improve quality-of-life outcomes for people with multiple sclerosis Many scientific findings show that mindfulness-oriented meditation improves a person's mental health, positively influencing even practitioners' personality profiles as well. Unfortunately, a limited number of studies are beginning to show that this type of meditation may also be a helpful therapeutic holistic and complementary option for persons with multiple sclerosis (MS) (Crescentini C. et al., 2018). Gilbertson R.M. and colleagues in a published article in 2017 stated that due to the uncertainty in disease progression associated with multiple sclerosis, and the multiplicity of mental and physical symptoms related to that particular disease, programming that addresses anxiety, depression, and fatigue is a crucial area of future research in MS disease management. Mindfulness in Motion proved to be a possible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS (Gilbertson R.M. et al., 2017). Yoga has been an object researched in hundreds of randomized controlled clinical trials as a viable antihypertensive lifestyle therapy, reducing stress, improving symptoms of depression Cramer A. and colleagues in 2017 published data regarding yoga. They stated that as a traditional, alternative health care system, yoga combines physical activity, breathing techniques, and meditation as well. It is increasingly used as a preventive or therapeutic means as a complementary, alternative and holistic therapy. So far, it is essential to state that yoga has been an object researched in hundreds of randomized controlled clinical trials. Positive effects of practicing yoga are especially found for chronic pain conditions, hypertension, depression and in supportive cancer care. While there are case reports of serious adverse events associated with yoga, the risk seems to be extremely low and comparable to other forms of physical activity. Yoga can be considered as a safe and useful adjunct, supplement therapy for some conditions (Cramer H., 2017). Results indicate that yoga is a viable antihypertensive lifestyle therapy that produces the most significant blood pressure benefits when breathing techniques and meditation/mental relaxation are included (Wu Y et al., 2019). Meditation has been exhibited to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness Always was a great concern about how to make a better life to patients who are under dialysis. Their extreme conditions such as coping with the stress and anxiety caused by end-stage kidney disease symptoms and dialysis treatment, their restrictions, and social, financial, family and other significant stressors, consumes many people afflicted with kidney disease or end-stage kidney disease. Meditation has been shown to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness (Bennett P.N. et al., 2018). Generally, cardiovascular diseases continue to be the leading cause of morbidity, disability, and mortality around the world. Yoga, as a powerful combination of physical postures, breathing exercises, and meditation, has gained increasing recognition as a form of mind-body practice. Recently, in 2019 Wells R.E. and colleagues showed fascinating results of their research regarding migraine. Although many studies had significant methodological challenges that limit interpretation and possible generalization, several studies reported decreased headache frequency, improved quality of life, or less effective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as a treatment for medication-overuse headache after the offending medication is withdrawn. Wells R.E. and colleagues stated: ” While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new study is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids to ensure safety given their hepatotoxicity. Physical therapy continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, except the life-threatening danger of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, physical therapy, exercise, chiropractic manipulation, and acupuncture.” The American Academy of Neurology and American Headache Society (https://www.aafp.org/afp/2013/0415/p584.html) are currently updating the guidelines for integrative treatment options for migraine so that additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build a therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care (Wells R.E. et al., 2019). Bodily distress syndrome or bodily stress is the term which according to its definition unifying numerous and various conditions such as fibromyalgia, chronic fatigue syndrome, and somatization disorder. Bodily distress syndrome patients may have been ill and in high risk for a social decline five and ten years before they received a proper diagnosis and treatment. The social and economic consequences of bodily distress syndrome are significant, and mindfulness therapy may have a potential to improve function significantly, quality of life and symptoms, prevent a social decline and reduce societal costs (Fjorback LO, 2012). Spirituality has a significant role in the lives of most palliative and hospice patients It was nice to read an article written by Steinhorn D.M. and colleagues regarding spirituality. Spirituality has a substantial role in the lives of most palliative and hospice patients whether or not they officially belong to a particular religion or spiritual tradition. As a result, the palliative and hospice care teams are frequently called upon to additionally support families who are experiencing their extremely challenging time and extreme struggling to make sense of their lives during a healthcare crisis. While conventional and everyday religious practices and services provide a useful resource of comfort and support for many of palliative and hospice patients, a significant number of palliative and hospice patients do not have an active religious community to which to turn and service for end-of-life spiritual care and support. Interestingly, over twenty years, more people in Western countries identify themselves as spiritual but not necessarily religious, and do not belong to an organized religious community. For patients who express a strong spiritual connection or sense of “something greater” or “a higher power,” there are limited available resources (Steinhorn D.M. et al., 2017). There is a significant health issue with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs. According to the results, Spadaro K.C. and colleagues meditation enhanced weight loss by 2.8 kg potentially through more significant improvements in eating behaviors and dietary restraint (Spadaro K.C. et al., 2017). Yoga and meditation are getting very popular among the general public and as topics of research as well Benefits associated with practicing yoga have been found on physical / body health, mental health, and cognitive performance. Clinical studies and theories that would possibly clarify better the underlying mechanisms are still lacking. Gerritsen R.J.S. and colleagues in 2018 provided us with data and explanations regarding various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline, in turn, could parsimoniously explain the physical and mental benefits of meditative practices through changes in autonomic balance. Gerritsen R.J.S. and colleagues proposed a neurophysiological model that describes how these specific respiration styles could operate, by physically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation. The vagal nerve, as a proponent of the parasympathetic nervous system, is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition (Gerritsen R.J.S. et al., 2018). Burnout and stress in healthcare practitioners are increasing; emergency department staff are particularly susceptible to such poor outcomes Mantra meditation could contribute to improved well-being. Lynch J. and colleagues showed that emergency department staff described the demands of their work and voiced a need for a workplace well-being program. Their results suggest that mantra meditation might represent a viable tool to develop attention and awareness, improve emotion regulation and improve their capacity to cope with stress, which may impact their workplace well-being, more comprehensive health service, patient safety and quality of care. Support from the organization is considered to be integral to the embedding of a workplace well-being program, such as the practice of meditation into their daily lives (Lynch J. et al., 2018). Interestingly, numerous studies show that personal spirituality developed through prayer positively influences mental health. Larrivee D. and colleagues published an exciting article in 2018. The authors stated that phenomenological and neuroscientific studies of mindfulness, an Eastern meditative prayer form, reveal significant health benefits now yielding important insights useful for guiding treatment of psychological disorders. By contrast, and despite its practice for millennia, Christian meditation is mainly unrepresented in studies of clinical efficacy. Resemblances between mindfulness and disciplinary acts in Christian meditation taken from the ancient Greek tradition of askesis suggest that Christian meditation will prove similarly beneficial; furthermore, psychological and neuroscientific studies indicate that its retention of a dialogical and transcendent praxis will additionally benefit social and existential psychotherapy. This paper thus argues that survey of contemplative meditation for its therapeutic potential is warranted (Larrivee D. et al., 2018). Not all authors agree that meditation is beneficial as an alternative and holistic therapy Farias M and colleagues published an article in 2016, and they tried to explain that meditation does not have any benefits. The authors stated: “The excitement about the application of mindfulness meditation in mental health settings has led to the proliferation of literature permeated by a lack of conceptual and methodological self-criticism. In this article, we raise two major concerns. First, we consider the range of individual differences within the experience of meditation; although some people may benefit from its practice, others will not be affected in any substantive way, and some individuals may suffer moderate to serious adverse effects. Second, we address the insufficient or inconclusive evidence for its benefits, particularly when mindfulness-based interventions are compared with other activities or treatments. We end with suggestions on how to improve the quality of research into mindfulness interventions and outline key issues for clinicians considering referring patients for these interventions” (Farias M, et al., 2016). Van Dam N.T. and colleagues stated in their article published in 2018 that in the last twenty years, mindfulness meditation has gone from being a fringe topic of scientific investigation to be an occasional replacement for psychotherapy, a tool of corporate well-being, widely implemented educational practice, and "key to building more resilient soldiers." Further authors stated that “the mindfulness movement and empirical evidence supporting it have not gone without criticism. Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed.” Addressing such concerns, the present article discusses the difficulties of defining mindfulness, delineates the proper scope of research into mindfulness practices, and illustrates crucial methodological issues for interpreting results from investigations of mindfulness. For doing so, the authors draw on their diverse areas of expertise to review the present state of mindfulness research, comprehensively summarizing what we do and do not know, while providing a prescriptive agenda for contemplative science, with a particular focus on assessment, mindfulness training, possible adverse effects, and intersection with brain imaging. Our goals are to inform interested scientists, the news media, and the public, to minimize harm, curb poor research practices, and staunch the flow of misinformation about the benefits, costs, and prospects of mindfulness meditation (Van Dam NT, et al., 2018). What is meditation research? Loizzo J. in one article published in 2014 stated: “Although perspectives like the one shared here may not be common in today's research circles and literature, I believe there is nothing new or controversial in what I have shared. Rather, I submit that the simple anthropology of respecting traditional know-how and practical expertise has been a secret ingredient to successful meditation research for decades. In a sense, I am simply suggesting that our young field has proven its rigor and relevance enough that we are ready to enter a new phase of open, rigorous, and systematic interdisciplinary dialogue with traditional contemplative science. My vision for the future of the field is that such an open, mutually respectful, and rigorous partnership promises to speed the advancement and align the direction of our field toward optimal science and maximal human benefit, as much or more than any conventional line of advancement through technical breakthroughs and new methodologies” (Loizzo J., 2014). References: Packiasabapathy S, Susheela AT, Mueller A, Patxot M, Gasangwa DV, O'Gara B2, Shaefi S, Marcantonio ER, Yeh GY, Subramaniam B. Guided meditation as an adjunct to enhance postoperative recovery after cardiac surgery: study protocol for a prospective randomized controlled feasibility trial. Trials. 2019 Jan 11;20(1):39. Wielgosz J, Goldberg SB, Kral TRA, Dunne JD, Davidson RJ. Mindfulness Meditation and Psychopathology. Annu Rev Clin Psychol. 2018 Dec 10. doi: 10.1146/annurev-clinpsy-021815-093423. Turakitwanakan W, Pongpaplud P, Kitporntheranunt M. The Effect of Home Buddhist Mindfulness Meditation on Depressive Symptom in Major Depressive Patients. J Med Assoc Thai. 2017 Nov;99 Suppl 8:S171-S178. Tolahunase MR, Sagar R, Dada R. 5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial. Indian J Psychiatry. 2018 Oct-Dec;60(4):410-426. Pandya SP. Meditation for treating adults with bipolar disorder II: A multi-city study. Clin Psychol Psychother. 2018 Dec 10. Ionson E, Limbachia J, Rej S, Puka K, Newman RI, Wetmore S, Burhan AM, Vasudev A. Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression. Br J Psychiatry. 2018 Nov 28:1-7. Wahbeh H, Nelson M. iRest Meditation for Older Adults with Depression Symptoms: A Pilot Study. Int J Yoga Therap. 2018 Oct 24. Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, Matas-Pericas L, Filella-Agullo D, Ruiz-Herrerias M, Soler-Ribaudi J, Roca-Cusachs Coll A, Arroyo-Díaz JA. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J Hum Hypertens. 2018 Nov 13. Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC Jr; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2017 Sep 28;6(10). Ambavane RA, Khademi A, Zhang D, Shi L. Modeling the Impact of Transcendental Meditation on Stroke Incidence and Mortality. J Stroke Cerebrovasc Dis. 2019 Mar;28(3):577-586. Lurie DI. An Integrative Approach to Neuroinflammation in Psychiatric disorders and Neuropathic Pain. J Exp Neurosci. 2018 Aug 13;12:1179069518793639. Kang SS, Erbes CR, Lamberty GJ, Thuras P, Sponheim SR, Polusny MA, Moran AC, Van Voorhis AC, Lim KO. Transcendental meditation for veterans with post-traumatic stress disorder. Psychol Trauma. 2018 Nov;10(6):675-680. Chételat G, Lutz A, Arenaza-Urquijo E, Collette F, Klimecki O, Marchant N. Why could meditation practice help promote mental health and well-being in aging? Alzheimers Res Ther. 2018 Jun 22;10(1):57. Priya G, Kalra S. Mind-Body Interactions and Mindfulness Meditation in Diabetes. Eur Endocrinol. 2018 Apr;14(1):35-41. Crescentini C, Matiz A, Cimenti M, Pascoli E, Eleopra R, Fabbro F. Effect of Mindfulness Meditation on Personality and Psychological Well-being in Patients with Multiple Sclerosis. Int J MS Care. 2018 May-Jun;20(3):101-108. Gilbertson RM, Klatt MD. Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study. Int J MS Care. 2017 Sep-Oct;19(5):225-231. Cramer H. Where and How does Yoga Work? - A Scientific Overview. Dtsch Med Wochenschr. 2017 Dec;142(25):1925-1929. Wu Y, Johnson BT, Acabchuk RL, Chen S, Lewis HK, Livingston J, Park CL, Pescatello LS. Yoga as Antihypertensive Lifestyle Therapy: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2019 Feb 6. pii: S0025-6196(18)30939-X. Bennett PN, Ngo T, Kalife C, Schiller B. Improving wellbeing in patients undergoing dialysis: Can meditation help? Semin Dial. 2018 Jan;31(1):59-64. Guddeti RR, Dang G, Williams MA, Alla VM. Role of Yoga in Cardiac Disease and Rehabilitation. J Cardiopulm Rehabil Prev. 2018 Nov 27. Wells RE, Beuthin J, Granetzke L. Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years. Curr Pain Headache Rep. 2019 Feb 21;23(2):10. Steinhorn DM, Din J, Johnson A. Healing, spirituality and integrative medicine. Ann Palliat Med. 2017 Jul;6(3):237-247. Upchurch DM, Johnson PJ. Gender Differences in Prevalence, Patterns, Purposes, and Perceived Benefits of Meditation Practices in the United States. J Womens Health (Larchmt). 2019 Feb;28(2):135-142. Spadaro KC, Davis KK, Sereika SM, Gibbs BB, Jakicic JM, Cohen SM. Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial. J Complement Integr Med. 2017 Dec 5;15(2). Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci. 2018 Oct 9;12:397. Lynch J, Prihodova L, Dunne PJ, O'Leary C, Breen R, Carroll Á, Walsh C, McMahon G, White B. Mantra meditation programme for emergency department staff: a qualitative study. BMJ Open. 2018 Sep 24;8(9):e020685. Donald JN, Sahdra BK, Van Zanden B, Duineveld JJ, Atkins PWB, Marshall SL, Ciarrochi J. Does your mindfulness benefit others? A systematic review and meta-analysis of the link between mindfulness and prosocial behaviour. Br J Psychol. 2019 Feb;110(1):101-125. Larrivee D, Echarte L. Contemplative Meditation and Neuroscience: Prospects for Mental Health. J Relig Health. 2018 Jun;57(3):960-978. Farias M, Wikholm C. Has the science of mindfulness lost its mind? BJPsych Bull. 2016 Dec;40(6):329-332. Van Dam NT, van Vugt MK, Vago DR, Schmalzl L, Saron CD, Olendzki A, Meissner T, Lazar SW, Kerr CE, Gorchov J, Fox KCR, Field BA, Britton WB, Brefczynski-Lewis JA, Meyer DE. Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation. Perspect Psychol Sci. 2018 Jan;13(1):36-61. Loizzo J. Meditation research, past, present, and future: perspectives from the Nalanda contemplative science tradition. Ann N Y Acad Sci. 2014 Jan;1307:43-54. Fjorback LO. Mindfulness and bodily distress. Dan Med J. 2012 Nov;59(11):B4547. Read the full article
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Meditation - Part 2
How can meditation help as a source of alternative and holistic therapy for certain diseases and medical conditions? Dr. Miroslav Sarac, Chiron Wise Centaur – holistic and integrative healing center Scientific medical (conventional), complementary, integrative and functional medicine provided substantial research data related to meditation as a part of holistic or complementary treatment in many pathological conditions. Recent scientific medical research data showed that meditation could be an excellent addition to conventional medicine as a complementary, integrative treatment for many medical conditions and diseases such as pre-surgical and post-surgical treatment, major depressive disorder, depression and treatment-resistant depression, hypertension (particularly systolic), obesity, multiple sclerosis, in geriatric depression, post-traumatic stress disorder, diabetes, Alzheimer’s disease, and bodily distress syndrome. I collected recent data just in the past several years. Recently, Packiasabapathy S. and colleagues exhibited in their research that cardiac surgical procedures are associated with postoperative neurological complications such as cognitive decline and delirium, which can complicate recovery and impair quality of life. Peri-operative depression and anxiety may be associated with increased mortality after cardiac surgeries. Proper preparation for cardiac surgery is an emerging concept that includes pre-operative interventions to reduce post-operative complications potentially. While most current preparatory interventions focus on optimizing physical health, mind-body interventions are an area of growing interest. Preoperative mind-body interventions such as Isha Kriya meditation may hold significant potential to improve postsurgical outcomes (Packiasabapathy S. et al., 2019). Mindfulness meditation is increasingly incorporated into mental health interventions including major depressive disorder Mindfulness meditation is increasingly integrated into mental health interventions, and theoretical concepts associated with it have influenced basic research on psychopathology (Wielgosz J. et al., 2018). Major depressive disorder (MDD) is one of the principal causes of disability in the world, no doubt about that. Major depressive patients that do not respond to the first and second drugs are about 67% and 33%, respectively (Turakitwanakan W. et al., 2017). According to Tolahunase M.R. and colleagues, there is growing evidence suggesting that both genetic and environmental factors modulate treatment outcome in, a highly heterogeneous, major depressive disorder (MDD) (Tolahunase MR et al., 2018). Specifically, the genetic analysis of a 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms have been strongly linked to the pathogenesis of major depressive disorder, and antidepressant treatment response. In patients with MDD who have 5-HTTLPR and MTHFR 677C>T polymorphisms and less likely to respond to medications (SSRIs) (Tolahunase MR et al., 2018). Evidence on whether meditation's core aspect of building and nurturing calm and peace serves as a mood stabilizer for current and recurrent episodes of depression through the acute and maintenance phases of treating bipolar disorder II affected patients. Meditation helped alleviate guilt, depressed mood, and helplessness-hopelessness significant concerns in patients who suffer from depression (Pandya S.P., 2018). Wahbeh H. and colleagues found that late-life depression (LLD) is a disorder causing severe disability and conventional antidepressant therapeutics are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability (HRV), an important prognostic marker for the development of subsequent cardiovascular disease (Ionson E. et al., 2018). Older adults, a rapidly growing population in the United States, have fewer physiological reserves and are more likely to be affected by stress, making them especially susceptible to depression symptoms. Meditation offers promising potential as an effective treatment (Wahbeh H. et al., 2018). Several authors had provided us with incredibly valuable results regarding meditation and its positive influence on hypertension Several authors had provided us with incredibly useful results regarding meditation and its impact on hypertension. Benefits of mindfulness meditation in reducing and controlling blood pressure and stress in patients with arterial hypertension were described from Ponte Márquez PH and colleagues in 2018 (Ponte Márquez PH et al., 2018). Even though numerous advances in the prevention and treatment of atherosclerosis, cardiovascular diseases are available in conventional medicine (Western medicine), all these diseases remain a leading cause of morbidity, disability, and mortality. Some holistic, alternative therapies, inexpensive and affordable interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of the high interest of complementary medicine. Numerous scientific medical studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may be a potentially attractive, cost-effective adjunct to more traditional medical therapies, simply as a complementary treatment. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk (Levine G.N. et al., 2017). The practice of meditation every day or several times per week, if adequately applied along with the conventional antihypertensive therapeutics, could substantially alleviate the burden of stroke in the U.S. To design an effective meditation program, policy-makers may prioritize funding to the programs that aim to encourage older individuals to practice meditation. Also, recently Ambavane R.A. and colleagues reported that meditation exhibited promise in clinical trials in reducing systolic hypertension, one of the main risk factors for stroke (Ambavane R.A. et al., 2019). Meditation as a supplement therapy in neuropsychiatric diseases Pathophysiologically, neuroinflammation is a complex process involving both the peripheral circulation and the central nervous system and is considered to underlie many neurological and psychiatric disorders including depression, anxiety, schizophrenia, and pain. Also recently, Lurie D.I. and colleagues explained that stressors including early-life adversity, psychosocial stress, and infection appear to prime microglia toward a pro-inflammatory phenotype (Lurie D.I., 2018). Subsequent inflammatory challenges then drive an exaggerated neuroinflammatory response involving the upregulation of pro-inflammatory mediators that are associated with CNS dysfunction. Several pharmacologic inhibitors of pro-inflammatory cytokines including (tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) exhibit good clinical efficacy in terms of improving neuroinflammatory processes. Mind/body and plant (herbal)-based interventions and treatments such as yoga, breathing exercises, meditation, and herbs/spices have also been demonstrated to reduce pro-inflammatory cytokines and have a positive impact on depression, anxiety, cognition, and pain. As the intricate connections between the immune system and the nervous system continue to be elucidated, successful therapies for reducing neuroinflammation will likely involve an integrated approach combining drug therapy with non-pharmacologic interventions (Lurie D.I., 2018). Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD) Generally, we can define transcendental meditation as a mental technique using a mantra to facilitate meditation. Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD), but its clinical efficacy remains to be clarified. Indeed, further clinical studies are necessary for this field. Kang S.S. and colleagues exhibited in 2018. results of evaluating the acceptability, preliminary effectiveness, and neurophysiology of transcendental meditation for veterans with PTSD (Kang S.S. et al., 2018). In the same study, from baseline to posttreatment, participants reported reductions in PTSD symptoms, experiential avoidance, and depressive and somatic symptoms, as well as increases on measures of mindfulness and quality of life (Kang S.S. et al., 2018). Psycho-affective conditions or traits such as stress, depression, severe anxiety, and neuroticism are known to affect normal patterns of sleep, cognition and mental health and well-being in aging populations and to be associated with increased risk for Alzheimer's disease (AD). Mental training for stress reduction and emotional and attentional regulation through meditation practice might help reduce these adverse factors. So far, studies on the impact of meditation practice on the brain and cognition in aging are scarce and have limitations but the findings are encouraging, showing a positive effect of meditation training on cognition, perception, especially on attention and memory, and on brain structure and function primarily in frontal and limbic structures and insula (Chételat G. et al., 2018). Diabetes is associated with significant psychological distress, can meditation help? Diabetes is associated with significant chronic psychological distress. There is one of the most important interventions to ensure the physical and emotional as well as psychosocial wellbeing of individuals living with diabetes. Meditation-based strategies have been evaluated for their complementary role in several chronic disorders including depression, anxiety, obesity, hypertension, cardiovascular disease, and diabetes. The practice of meditation is associated with a reduction in stress and negative emotions and improvements in patient attitude, health-related behavior, and coping skills. There is increased parasympathetic activity with a decrease in sympathetic vascular tone, stress hormones, and inflammatory markers. Additionally, several studies including Priya G. and colleagues in 2018 evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated some modest improvements in body weight, glycemic control, and control of blood pressure. Mindfulness meditation-based interventions can lead to improvements across all domains of holistic care - biological, psychological, spiritual and social. Priya G. and colleagues proposed that most of the studies have been of relatively short duration and included small numbers of patients – human subjects, meditation strategies, and the practice could be useful holistic, alternative and complementary treatments to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing (Priya G. et al., 2018). Mindfulness in Motion proved to be a possible program yielding positive results to improve quality-of-life outcomes for people with multiple sclerosis Many scientific findings show that mindfulness-oriented meditation improves a person's mental health, positively influencing even practitioners' personality profiles as well. Unfortunately, a limited number of studies are beginning to show that this type of meditation may also be a helpful therapeutic holistic and complementary option for persons with multiple sclerosis (MS) (Crescentini C. et al., 2018). Gilbertson R.M. and colleagues in a published article in 2017 stated that due to the uncertainty in disease progression associated with multiple sclerosis, and the multiplicity of mental and physical symptoms related to that particular disease, programming that addresses anxiety, depression, and fatigue is a crucial area of future research in MS disease management. Mindfulness in Motion proved to be a possible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS (Gilbertson R.M. et al., 2017). Yoga has been an object researched in hundreds of randomized controlled clinical trials as a viable antihypertensive lifestyle therapy, reducing stress, improving symptoms of depression Cramer A. and colleagues in 2017 published data regarding yoga. They stated that as a traditional, alternative health care system, yoga combines physical activity, breathing techniques, and meditation as well. It is increasingly used as a preventive or therapeutic means as a complementary, alternative and holistic therapy. So far, it is essential to state that yoga has been an object researched in hundreds of randomized controlled clinical trials. Positive effects of practicing yoga are especially found for chronic pain conditions, hypertension, depression and in supportive cancer care. While there are case reports of serious adverse events associated with yoga, the risk seems to be extremely low and comparable to other forms of physical activity. Yoga can be considered as a safe and useful adjunct, supplement therapy for some conditions (Cramer H., 2017). Results indicate that yoga is a viable antihypertensive lifestyle therapy that produces the most significant blood pressure benefits when breathing techniques and meditation/mental relaxation are included (Wu Y et al., 2019). Meditation has been exhibited to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness Always was a great concern about how to make a better life to patients who are under dialysis. Their extreme conditions such as coping with the stress and anxiety caused by end-stage kidney disease symptoms and dialysis treatment, their restrictions, and social, financial, family and other significant stressors, consumes many people afflicted with kidney disease or end-stage kidney disease. Meditation has been shown to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness (Bennett P.N. et al., 2018). Generally, cardiovascular diseases continue to be the leading cause of morbidity, disability, and mortality around the world. Yoga, as a powerful combination of physical postures, breathing exercises, and meditation, has gained increasing recognition as a form of mind-body practice. Recently, in 2019 Wells R.E. and colleagues showed fascinating results of their research regarding migraine. Although many studies had significant methodological challenges that limit interpretation and possible generalization, several studies reported decreased headache frequency, improved quality of life, or less effective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as a treatment for medication-overuse headache after the offending medication is withdrawn. Wells R.E. and colleagues stated: ” While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new study is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids to ensure safety given their hepatotoxicity. Physical therapy continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, except the life-threatening danger of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, physical therapy, exercise, chiropractic manipulation, and acupuncture.” The American Academy of Neurology and American Headache Society (https://www.aafp.org/afp/2013/0415/p584.html) are currently updating the guidelines for integrative treatment options for migraine so that additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build a therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care (Wells R.E. et al., 2019). Bodily distress syndrome or bodily stress is the term which according to its definition unifying numerous and various conditions such as fibromyalgia, chronic fatigue syndrome, and somatization disorder. Bodily distress syndrome patients may have been ill and in high risk for a social decline five and ten years before they received a proper diagnosis and treatment. The social and economic consequences of bodily distress syndrome are significant, and mindfulness therapy may have a potential to improve function significantly, quality of life and symptoms, prevent a social decline and reduce societal costs (Fjorback LO, 2012). Spirituality has a significant role in the lives of most palliative and hospice patients It was nice to read an article written by Steinhorn D.M. and colleagues regarding spirituality. Spirituality has a substantial role in the lives of most palliative and hospice patients whether or not they officially belong to a particular religion or spiritual tradition. As a result, the palliative and hospice care teams are frequently called upon to additionally support families who are experiencing their extremely challenging time and extreme struggling to make sense of their lives during a healthcare crisis. While conventional and everyday religious practices and services provide a useful resource of comfort and support for many of palliative and hospice patients, a significant number of palliative and hospice patients do not have an active religious community to which to turn and service for end-of-life spiritual care and support. Interestingly, over twenty years, more people in Western countries identify themselves as spiritual but not necessarily religious, and do not belong to an organized religious community. For patients who express a strong spiritual connection or sense of “something greater” or “a higher power,” there are limited available resources (Steinhorn D.M. et al., 2017). There is a significant health issue with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs. According to the results, Spadaro K.C. and colleagues meditation enhanced weight loss by 2.8 kg potentially through more significant improvements in eating behaviors and dietary restraint (Spadaro K.C. et al., 2017). Yoga and meditation are getting very popular among the general public and as topics of research as well Benefits associated with practicing yoga have been found on physical / body health, mental health, and cognitive performance. Clinical studies and theories that would possibly clarify better the underlying mechanisms are still lacking. Gerritsen R.J.S. and colleagues in 2018 provided us with data and explanations regarding various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline, in turn, could parsimoniously explain the physical and mental benefits of meditative practices through changes in autonomic balance. Gerritsen R.J.S. and colleagues proposed a neurophysiological model that describes how these specific respiration styles could operate, by physically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation. The vagal nerve, as a proponent of the parasympathetic nervous system, is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition (Gerritsen R.J.S. et al., 2018). Burnout and stress in healthcare practitioners are increasing; emergency department staff are particularly susceptible to such poor outcomes Mantra meditation could contribute to improved well-being. Lynch J. and colleagues showed that emergency department staff described the demands of their work and voiced a need for a workplace well-being program. Their results suggest that mantra meditation might represent a viable tool to develop attention and awareness, improve emotion regulation and improve their capacity to cope with stress, which may impact their workplace well-being, more comprehensive health service, patient safety and quality of care. Support from the organization is considered to be integral to the embedding of a workplace well-being program, such as the practice of meditation into their daily lives (Lynch J. et al., 2018). Interestingly, numerous studies show that personal spirituality developed through prayer positively influences mental health. Larrivee D. and colleagues published an exciting article in 2018. The authors stated that phenomenological and neuroscientific studies of mindfulness, an Eastern meditative prayer form, reveal significant health benefits now yielding important insights useful for guiding treatment of psychological disorders. By contrast, and despite its practice for millennia, Christian meditation is mainly unrepresented in studies of clinical efficacy. Resemblances between mindfulness and disciplinary acts in Christian meditation taken from the ancient Greek tradition of askesis suggest that Christian meditation will prove similarly beneficial; furthermore, psychological and neuroscientific studies indicate that its retention of a dialogical and transcendent praxis will additionally benefit social and existential psychotherapy. This paper thus argues that survey of contemplative meditation for its therapeutic potential is warranted (Larrivee D. et al., 2018). Not all authors agree that meditation is beneficial as an alternative and holistic therapy Farias M and colleagues published an article in 2016, and they tried to explain that meditation does not have any benefits. The authors stated: “The excitement about the application of mindfulness meditation in mental health settings has led to the proliferation of literature permeated by a lack of conceptual and methodological self-criticism. In this article, we raise two major concerns. First, we consider the range of individual differences within the experience of meditation; although some people may benefit from its practice, others will not be affected in any substantive way, and some individuals may suffer moderate to serious adverse effects. Second, we address the insufficient or inconclusive evidence for its benefits, particularly when mindfulness-based interventions are compared with other activities or treatments. We end with suggestions on how to improve the quality of research into mindfulness interventions and outline key issues for clinicians considering referring patients for these interventions” (Farias M, et al., 2016). Van Dam N.T. and colleagues stated in their article published in 2018 that in the last twenty years, mindfulness meditation has gone from being a fringe topic of scientific investigation to be an occasional replacement for psychotherapy, a tool of corporate well-being, widely implemented educational practice, and "key to building more resilient soldiers." Further authors stated that “the mindfulness movement and empirical evidence supporting it have not gone without criticism. Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed.” Addressing such concerns, the present article discusses the difficulties of defining mindfulness, delineates the proper scope of research into mindfulness practices, and illustrates crucial methodological issues for interpreting results from investigations of mindfulness. For doing so, the authors draw on their diverse areas of expertise to review the present state of mindfulness research, comprehensively summarizing what we do and do not know, while providing a prescriptive agenda for contemplative science, with a particular focus on assessment, mindfulness training, possible adverse effects, and intersection with brain imaging. Our goals are to inform interested scientists, the news media, and the public, to minimize harm, curb poor research practices, and staunch the flow of misinformation about the benefits, costs, and prospects of mindfulness meditation (Van Dam NT, et al., 2018). What is meditation research? Loizzo J. in one article published in 2014 stated: “Although perspectives like the one shared here may not be common in today's research circles and literature, I believe there is nothing new or controversial in what I have shared. Rather, I submit that the simple anthropology of respecting traditional know-how and practical expertise has been a secret ingredient to successful meditation research for decades. In a sense, I am simply suggesting that our young field has proven its rigor and relevance enough that we are ready to enter a new phase of open, rigorous, and systematic interdisciplinary dialogue with traditional contemplative science. My vision for the future of the field is that such an open, mutually respectful, and rigorous partnership promises to speed the advancement and align the direction of our field toward optimal science and maximal human benefit, as much or more than any conventional line of advancement through technical breakthroughs and new methodologies” (Loizzo J., 2014). References: Packiasabapathy S, Susheela AT, Mueller A, Patxot M, Gasangwa DV, O'Gara B2, Shaefi S, Marcantonio ER, Yeh GY, Subramaniam B. 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