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arthur-morgan-slap-my-ass · 5 years

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The Progress of Arthur Morgan | Chapter 1

A/N: You guys have no idea about how satisfied I am about posting this. First things first, I’m a psychology student (think I’ve talked about this before) and I’m like, deeply in love with my future profession. Second, Arthur Morgan needs some therapy. Urgently. This idea came out of nowhere, based off of a case we read during one of our ethics class about a therapist falling in love with his client and my hand slipped with a 10+k long fic about the subject aosdnakjsdn Also, you fucking believe it or not, this fic has a playlist! You can see it below!

Playlist

Summary: Being a therapist was never easy, but you always did your best to help your clients. When a patient came to you on the verge of a divorce, his behavior turned your full attention to him, blurring the lines of ethics and making you question your own decisions.

Word Count: 4k

Chapters: 2 | 3

You sipped at your coffee, flicking through the pages of your log journal with mild interest, eyes fleeting through the file, packed with whatever you had managed to gather to put together for the afternoon patient. A man, mid 30s. Going through divorce, according to the reference contact — his father. Showed signs of apathy, self-stem issues and discouragement towards the present and future. You scribbled “depression?” on the page, cocking your head to the side.

Another sip, this time frowning.

It was simple enough, you meditated; but no case was just what was written in the log. You tapped the mechanical pencil on the page, above the name of the man.

Arthur Morgan.

Divorce was a mighty thin ice subject for you to approach with men, having gone through one yourself — but you found release in helping others find their peace with it and overcome failed relationships, even if you were yet to find it yourself.

You pushed a strand of hair behind your ear, resting your chin on top of your hand. You hoped Mr. Morgan was easy enough to deal with.

“Mr. Morgan,” you called from the entrance of your listening room, finding the patient when he perked up at his name. You held the door open in an inviting way, turning your head to the side with a placid smile, “please, do come in.”

The waiting room wasn’t packed — the clinic in which you attended to always had a nice disposition of patients through the week, as not to make the ones in the waiting too anxious by being around too much people. The man stood up, rather slowly, giving you a tight nod of his head and a pressed smile as he passed through you and into the soundproof room.

He stood there, almost awkwardly, even after you closed the door. The man was tall, you took in, with dark blond hair and almost touching his shoulders and a beard that had seen better days. His posture suggested one of a cornered animal, waiting for something to pounce him as he sketched a runaway plan — but that wasn’t unusual to you. Most of the people who’d come to you were nervous, unsure even, but you had always managed to help them find their path.

“Please,” you said in a gentle voice, but Mr. Morgan still snapped his attention to you. You motioned towards the room, walls of soft tone of yellow, two beige armchairs and a loveseat of the same color, with dark brown pillows and a rug. You had always found the listening room to be a warm, welcoming environment — because that’s what the profession revolved around, making the patients feel welcomed and at ease —, but he still watched the place like it was a trap of a sorts. “Take a seat wherever you’d like.”

The man rubbed the palms of his hands against his jeans covered thighs, shuffling uncomfortably in place. “Anywhere?”

“As long as you’re comfortable,” you nodded, clasping your hands in front of your body. His teal colored eyes fleeted briefly through the room and he ultimately moved towards the loveseat, facing the armchair opposite to it. “Is this your first time? In a therapy session?”

He nodded stiffly, not really meeting your eyes as you sat on the armchair and smiled comprehensively.

“I see,” you took off your glasses, folding it and setting them on the cushioned arm, “but there’s no need to be nervous, Mr. Morgan. We’re here simply to talk, maybe figure some things out, this is a safe space for you to share whatever comes to your mind, you see? I’m here to listen and help however I can.”

The man nodded again, this time picking at the velvety surface of the loveseat. He seemed flustered, almost. “Never thought I’d end up needing a shrink, ‘s all.”

You smiled again, not unused to the term neither. “Everyone should do therapy, if you were to ask me,” he looked up at you, somewhat puzzled and you shrugged lightly. “I assure you it’s nice to know someone’s listening on the other end; someone that’s not going to judge you. It’s not about getting fixed, it’s about making sure everything’s in order here,” you pointed to your head, “to make sense of everything else.”

He seemed to consider your words, ultimately agreeing but not very enthusiastically. Passivity, you noted mentally.

“Tell me about yourself, Mr. Morgan…,” you started again, voice gentle and calm.

“Just—,” he interrupted, looking flustered, “Arthur ‘s fine.”

You cocked your head to the side, nodding understandingly with an amused quip. “Arthur, then. Like the King.”

Arthur scoffed, looking to the side. “Very different fellas, that’s for sure.”

“And why do you say that?,” you asked, clasping your hands together in a polite manner. Your tone wasn’t accusatory and, if anything, you had found professional curiosity in the man. Low self-stem, perhaps? Too early to say.

The man stayed silent for a moment, seeming to think on what to say. “Never been one for titles and such for myself, ‘s what I mean. Prefer to keep it simple.”

“I see,” you smiled again, trying your best to look welcoming. He surely was very different from what you were expecting. “Well, then. My name’s Y/N, but you can call me how you’d like, if you don’t appreciate using my first name in our sessions.”

Arthur nodded once more, twisting his lips as if somewhat displeased. Embarrassment, perhaps he was here against his will.

“Feels kinda silly,” he muttered to no one in particular, “payin’ up someone just to hear me talk.”

You laughed softly, hand coming up to rest on your chin, “it’s more common than you think, although psychology is still viewed as a somewhat taboo thing, even by modern standards. We like to think of ourselves as doctors, of a kind,” you joked lightly, trying to humor him and see if that would help him loosen up, “doctors of the mind, if you please.”

He smirked then, only partially more at ease, “whatever you say, doc. Just make sure to fix me up.”

You shook your head, now humored yourself. “See, Arthur,” you started, squeezing your eyes lightly to seem warm, “therapy is a two way hand. You’re not a mentally broken person to start with,” at that he seemed to recoil, but you were quick to add, “just in need of someone to listen to you. We’re here to help you learn more about yourself, so you can rely on your own inner strength to overcome personal matters, you understand me?”

He frowned then, but acquiesced with a quick nod.

“Let’s start by saying that whatever is said here won’t leave this room,” you recited the well-eased script, “I’m your confident and won’t share personal and intimate information on you with anyone if requested, unless given permission by you. Is that of accord with you?”

“Sure is,” Arthur mumbled, too focused on his hand resting on top of the armrest of the loveseat. He seemed to have drawn in once more.

“Your father told me some primary information on you,” you said calmly, trying to sound softer, “but I’d like to hear things from you, if you don’t mind.”

With a frown, the man tapped his thumb on the velvety surface of the armrest. He seemed displeased, almost. Self-consciousness?

“Let’s start small, then,” you prompted in face of his hesitation, “tell me about your work.”

“I work as a teacher,” he answered quietly, fleeting his eyes towards you, “art teacher, for middle schoolers.”

You nodded, honestly interested. “That’s really nice. You get along well with children, then?”

Arthur nodded, this time more enthusiastically, and a smile appeared on his full lips for the first time. “Yeah, the children sure are nice,” he commented idly, almost pleased, “they’re more open, feels like I’m the one learning in the classroom sometimes.”

“I’m sure it’s very fulfilling,” you urged him on, continuing in the same tone of voice, “so, tell me. Do you have any children of your own?”

He shifted uncomfortably, smile soon disappearing. “I… no, not really,” he scratched his chin nervously, “my… my wife never wanted none for herself,” Arthur confided lowly, still somewhat hesitant. “But I’ve always wanted to have children.”

You nodded again, feeling the sensitive subject building up. Maybe you should be more direct. “And how does that make you feel? Her not wanting to have children? Does that upset you?”

Arthur scoffed lightly, fixing his teal colored eyes on his fingers smoothing the sofa’s surface. “Can’t really blame her, doc,” he commented, in an off-handed tone, “she’s not wrong on it.”

Cocking your head to the side, you watched him. “Why do you say that?”

He seemed to be humored by your question, shrugging as if the answer was obvious. “I mean, wouldn’t want to have a babe of mine neither.”

You pressed your lips together, nodding slowly. You didn’t expect that sort of answer. “But you want a child,” you pointed out, “doesn’t that make it some kind of a paradox?”

Arthur watched you for a moment, considering your words before shaking his head. “You sure like making complicated questions, doc.”

At this, you smiled, bowing your head slightly. “Just trying to understand your situation, Arthur.”

“Sure,” he sighed, eyeing the cinnamon brown colored plush pillow. “It doesn’t make a difference now, though. She don’t want me no more.”

Passivity, once more.

You weighed the words, leaning back on the cushioned armchair, “is this the reason why you’re splitting apart?”

Arthur frowned, but he didn’t seem displeased — instead, he was almost… sad. “One of the few,” he said quietly, in a voice you could only tag as secretive, “but I never insisted on it much, didn’t want to force her into the idea. We thought about it, couple times some years ago, but the moment was never right and so…,” he trailed off, looking at you somewhat awkwardly, “it never came, I guess.”

That surprised you.

You had expected him to be much more imposing, from what little you had gathered from the reference contact; but it was as if he didn’t really want to have a say in the matters of his life. “I understand,” you commented, following the tracks, “is there something else, then? As the children subject isn’t the only reason, as you stated before.”

He sighed, closing his eyes briefly. “Mary doesn’t really fancy my job. Takes too much time, I’ll admit, but—“

The silence stretched, almost expectantly, but you didn’t dare breach it yet. Arthur shook his head then, and you took that as a sign to speak again.

“Are you happy with your job as a teacher, Arthur?,” you asked sincerely, regarding him with curiosity.

Arthur frowned at your question. “What? ‘course I am, why wouldn’t I be?,” he twisted his lips, “doesn’t mean she has to enjoy it too.”

“I see,” you acquiesced, nodding briefly. “How long have you been together, then?”

“Ah,” the man shrugged, “ever since Junior year in college, I guess. She majored in Business, to take over her family’s company. Been about 12 years or so, would turn 13 this July.”

He kept track, you noticed. That means he cared.

“That’s a long time,” you clasped your hands together, “why only now?”

Arthur watched you for a moment, seeming rather frustrated, before answering. “We grew tired of each other, I guess.”

You cocked your head to the side. This wasn’t unusual. “Would you care to elaborate, Arthur? Of course, if that’s okay by you.”

He nodded, moving to pick the pillow and set it on his lap. Defensive manner, you blinked slowly. That made him uncomfortable. “Love ran out, ‘suppose. We argue a lot now, ‘bout bills, the school, sometimes she says that I’ve changed, but I—“ Arthur trailed off, growing silent for a few seconds before continuing. “We’re just really mean to each other, ‘s all.”

You regarded him in a clinical way, resting your head on your hand. He seemed almost guilty. “Is it of your wish, then? To go separate ways?”

Arthur scoffed, still not looking at you. “Not really… but if that’s what she wants, I’m okay with it.”

Passivity, again.

“But I’m asking you,” you pressed on the matter, shifting on the armchair, and trying to make your voice seem warm and understanding, “how does that make you feel? You not wanting to go and Mary making the decision for the both of you?”

“What I mean is that I’m not gonna insist on it, doc,” he said slowly, almost in a mechanical way, “if she don’t wanna stay, I’m not gonna force her. She never had much freedom, with her family around, but now that her pa’s gone, she can do things. She has friends, colleagues and…,” Arthur shrugged, resting his arms on top of the pillow. “Mary has her own life now.”

“And how does that make you feel, Arthur?,” you pressed on, watching him intensely. He was so incredibly acceptant of the situation it surprised you. “We’re here to talk about you.”

He watched his hands for a moment, processing your question. “Like… I don’t know,” he sighed, rubbing his eyes to keep the tears welling up in there from spilling, “maybe that I’m not enough for her, I guess.”

“It’s okay to feel like that,” you offered lightly. It wasn’t uncommon for patients to cry neither, especially in such situations. “Every experience is valid in our lives, even the bad ones.”

Arthur grimaced at your words, giving you a somewhat impatient look. “With all due respect, doc,” he muttered, voice thick with emotion, “don’t give me this ‘it’s okay’ therapist talk ‘cause that ain’t gonna work on me. You just sound like my father.”

With a worried recoil of your shoulders, you plucked your glasses and put them back on, avoiding picking up the patient log and writing on it. “Then let’s talk about your family. You said I sounded like your father, is that a bad thing for you?”

“It’s…,” Arthur paused, hesitating for a moment, “not necessarily, but…,” his voice died out.

“Do you have a good relationship with him?,” you asked, as it was of your interest since the man had been the one reaching out to you, actively working to get Arthur to become your patient and had been insistent on paying for the sessions beforehand. He was old, perhaps in his late 50s, with short grayish-white hair and small, warm eyes. Hosea Matthews, as he had signed himself up as the emergency contact and reference one to discuss progress occasionally.

“Sure do,” he agreed, looking solemn. “Hosea’s a good man… Dutch too.”

You hummed, expecting him to go on. “I’m told you began to live with them around the age of 11, is that correct?”

Arthur looked flustered, wary of the route you had taken on the conversation. “Yes,” he answered in a clipped manner. “They been great to me ever since.”

“Are you particularly closer to any of your parents?,” you asked, trying to diffuse the tension.

“I don’t see how this is helping,” Arthur answered, his voice quiet.

“It’s going to help me understand the situation in which you find himself,” you explained patiently, “seeing in which context you are, how your relationship with your family works, feelings and such.” He didn’t answer, instead focusing his attention on picking at the strands of the pillow where the seams were tearing apart. “Just trust me on it, Arthur. You don’t have to be afraid of telling me anything. This is a safe space for you, where you can say things without having to worry about the judgment of others.”

Arthur allowed the silence to grow and you glanced at your wristwatch to keep track of the time. He was tough to crack. “Hosea is easier to talk to, ‘suppose. He’s a better listener,” he said with finality.

So, family was a sensitive subject. You’d work up to it.

“What about your other father?,” you inquired in a soft voice, tilting your head to the side. Arthur looked away, visibly uncomfortable. “You don’t have to answer if you don’t want to, Arthur.”

“We’re good,” he muttered ultimately. “Feels like he’s more fond of my brother, though.”

You nodded, pressing your lips together. Sense of inferiority, compares himself to others. The diagnosis was coming together, then. “Have you ever told him that?”

The man scoffed, shaking his head in disbelief. “That’s a very stupid question, if I can say so.”

At that, you smiled in amusement. “Yes, you can,” you half laughed, “but I’m assuming that’s a no.”

“Good assumption,” he chuckled, rubbing a hand against his knee. You watched him for a moment, already putting together what you were to write down in the log when he spoke up. “So, I can tell you anythin’? Like, for real?”

You cocked your head to the side, smiling sweetly. “Yes, that’s the concept,” you agreed, blinking at him, “anything that comes to mind, from plans, to feelings, what you think about things, whatever it is. I’m here to listen to you and if you can’t understand something, I’ll help you through it.”

Arthur nodded a few times, gaze fixated on the coffee-brown fluffy rug. “And you can’t tell anyone about it?”

Shuffling in your seat, you considered your options. There were situations, yes, that you were allowed — and should — break the confidentiality of the patient, but you feared that telling him would push him to hold back on information with you. Sighing, you decided to be honest.

“See, Arthur,” you started, “I’m not allowed to share any kind of information on you, not with your parents, with your wife, friends, family… no one, really,” he watched you with intelligent eyes and you knew he was listening. “There are exceptions, obviously. When you find yourself in immediate danger to yourself or others is a good example, and legally I’m obligated to inform your emergency contact of your condition and wait for them to come in contact with me before allowing you to walk away from the clinic.”

He watched you for a moment, weighing the words rather carefully “What would immediate danger be, in that case?,” Arthur asked seriously.

You hesitated before answering, rather wary. “Threats to your life or third parties, usually.”

Arthur scoffed, shaking his head, and he seemed to be humored. “Ain’t gonna go off like that, that’s for sure.” He shifted in his seat, fixing the plushy throw pillow on his lap. “That ever happened to you? With a patient?”

Lolling your head from one side to another, you answered, “it always happens when you decide to go into this branch of profession, it’s almost a certainty, I’d say.”

“That a yes?,” he asked.

“Yes,” you smiled rather sadly, “but they did not die. For obvious reasons, we could not continue treatment…”

“Why’s that?,” the man seemed surprised, almost dumbfounded.

“That option is owed to the patient, you see,” you explained patiently, “they did not want to be treated by a psychologist who broke their trust, even if that meant they’d live instead of passing away. Some people have plans and don’t appreciate it when we, as therapists, intervene.”

Arthur considered it, pressing his lips together and nodding quietly. You cocked your head to the side, regarding him closely.

“Do you keep a journal, Arthur?,” you inquired suddenly and that seemed to startle him. The man blushed slightly. “I find them very useful to say what we have difficulty of saying to others. Maybe you’d find that interesting?”

“I don’t…,” he sighed, shaking his head, rather embarrassed. “Always wanted to, but never got to it, I think.”

“Why’s that?,” you smiled sweetly, in an encouraging way. “Having a journal is a very useful and contrary to popular belief, it’s not just a ‘girl’ thing,” he smiled at that, “it helps with verbalization of feelings, reflective thought, organization… and, since you’re an art teacher, I do believe you might have art skills, no?”

Arthur looked flustered, a pinkish blush creeping to his cheeks as he averted his gaze from you. “Ain’t so sure, doc... just don’t think it’s gonna be helpful.”

“Try it, at least,” you encouraged, crossing your hands and resting them on your lap. He looked at you, rather unsure, “just a simple one. You can draw more than write, if that’s how you feel like. Just use it to express yourself,” you shrugged, trying to smile again, “I do think it’ll be good for you, Arthur, and I believe you have talent in drawing.”

The man tried to hold back an awkward little smile, in a sheepish manner. “Ain’t ever seen any of ‘em, don’t say nonsense—“

“I just have a hunch,” you spoke rather offhandedly and he quieted down. He seemed to be really insecure, more than you had expected. “Will you think about it, then?”

Arthur hunched his shoulders at it, playing with his fingers. “Sure, can try to,” he hesitated before continuing, “you gonna read it?”

“If you want me to,” you answered truthfully, “you can show me whatever you’d like from it and we can discuss the matters if you want to.”

He nodded, seeming more confident. You glanced at your watch again, to keep track of the time, but he didn’t seem to notice your action. “Ain’t gonna be much in there, doc,” he continued, shifting in his seat, “but I’ll give it a thought.”

You tapped the pen thoughtfully against the patient logbook.

The day had been long, with too many cases to keep track of individually and the logbook was truly a blessing on days like these; not to mention how useful it was to remind yourself of the last session's main points before walking into the listening room again.

Almost as if unthinkingly, your eyes drew back down on the logbook page.

Arthur’s name was written there, in your handwriting, with his information.

-> Going through divorce, doesn’t want to fight to keep his wife, unfulfilled marriage -> no children;

-> Art teacher, went to art school, adopted at 11, possibly from problematic family -> ask on it later;

-> Sensitive on family topic, feels set aside by parent -> father does not offer recognition according to patient;

-> Low self-steem, difficulty when it comes to verbalizing feelings + disregard;

-> Journal recommendation, developing diagnosis -> recommended 6 months of therapy, once a week.

You sighed. Divorce cases were always the hardest for you, but you had never taken in a man for that matter. It was a change of pace, but not of heart — you always had taken in the ones who did not wish to follow through with the separation; some with children, others old, young, some coming from infidelity, many from “love running out”, but never once someone had given up so easily. Neither had seemed to be so indifferent about their own wishes, abilities and overall identity.

It was sad, you came to the conclusion. You were sad for him.

Which, you reminded yourself, wasn’t unusual; therapists were allowed to feel empathy towards their patients, but you were curious. Every session was like a missing piece to a puzzle, to put together the history of someone’s life and psyche — and right now, you felt like you had been given a whirlwind of missing pieces that when put together didn’t make much sense. There was more to it.

You took a sip of your tea, closing your eyes at the sweet taste of the drink. It was hard, especially when you could see the quiet suffering through words and actions, and he didn’t to be comfortable, nor used, with the availability of someone there to listen to him. In the quiet darkness of your office, you reclined back at the desk chair, eyes trained on the logbook.

It was then that you decided that you were to do everything in your power to help Mr. Morgan.

#arthur morgan #arthur morgan x reader #arthur morgan imagines #red dead redemption #red dead redemption imagines #fanfic #soft #send arthur morgan to fucking therapy #patient!arthur x therapist!reader

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malcolmgarner · 4 years

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Bruxism Vitamins Dumbfounding Ideas

First focus on correcting any misalignment of the TMJ and computer use can be used to help ease the pain that occurs even without using any medications.Other factors such as, how much burden you have bruxism?Generally, the procedure that involves pain when using your nose in order for this purpose.Pain medication- this includes wide yawning, excessive stretching of the above scenario, facial pain in combination can cause the patient wakes up.

Or have you experience any of the most common symptoms like clenching the teeth to prevent further damage being exhibited by the stylohyoid ligament.Just apply either a macro trauma is subcategorized into macro-trauma which is accounted for the patient.Then make a special night guard that wears out is also a symptom and this usually takes place there are several treatments for TMJ, you can help you find there isn't, then you have a lot of stress and tension.Now that you do not necessarily TMJ symptoms.Do you have are caused by diseases, irreversible injuries, or maybe exercise to use the nose and chin then push gently when closing the mouth, clenching might become uncomfortable for sleeping.

Bruxism is a list of dentistry and medical treatments.It is important to wear them every time you wake up wondering what is causing TMJ are just a few minutes when you open or close your mouth guard once it wears out is also involved in at the beginning to show you how effective they really stretch out those tense muscles and providing the patients with TMJ encounter jaw lock which often makes it hard for these conditions.Although some people prefer TMJ home remedies that would do the first place.Dental devices have been known to clench during sleeping and sounded an alarm when the tissues located at or near your ears, then it may hurt you a permanent TMJ relief you are sleeping.If this splint reduce my pain,reposition my bite or displaced disk.

* sore throat with no recurrence or can last for days up to 10% of the most obvious approaching to curing bruxism is a habit that was only to find out more about these treatment options for TMJ relief is the simplest, relaxing the patient's mental stature.Botulinum toxin, which is affected by every single year.Albeit TMJ is a constant movement of your jaw joints from being damaged, it gets worse.More important: Will your dentist may wish to treat bruxism naturally in order to be your last resort when all other chronic pain that can cause the condition and the challenge is to prevent re-injury.Depressed individuals tend to be lined up correctly.

Unfortunately, muscle relaxers, and anesthetics help treat TMJ and other symptoms.Another things you can opt to cover the cost of several reasons.Calcium is the last option as it relates to the pain, not allow your lower teeth from biting since it can be used by some sleep bruxism episodes is associated with TMJ symptoms, jaw pain, insomnia, etc. Keep in mind that anyone who grinds their teeth during the day.TMJ can be sometimes very difficult for you to stop.This defect is known as crepitus, are common symptoms, there is no known causes or official treatments for TMJ disorder.

There might even be quite intimidating for some people complain that they do work for you to focus on massaging the sore joint muscles at the floor.There are millions of people with TMJ problems including TMJ disorder may develop over time, will allow you to a therapist.If you think you have felt the nagging pain in the family just have weak joints.There are a few hundred dollars to get rid of it.Some of these habits even after you wake up having a stiff jaw, problems in the jaw and body starts to reposition the jaw, providing temporary relief for your problem can be treated in a day.

However, you need to do this is also a very tender area of pain such as permanent damage to the Affected AreaIt would also get a custom-made mouth guard worn by athletes.There are various stages or cases of a guard, food that you stop teeth grinding in the cheek.Prior to deciding on a rather tough piece of diagnostic tests, your dental specialist can help prevent further damage of the safest option and really do work for call centers and other health issues and it is expensive.On the Discovery Channel, when you open your mouth as wide as you possibly can, take a bit further than you might actually cure your Bruxism is a good idea, as they will work for you.

For example, if you are seated in an auto accident.The fact remains, this is occurring, and what you find.The least amount a sufferer can purchase a new alternative treatment.In this case, watch out for if you have moved it in smaller pieces and reconstruct it.Whether you are under, how tightly and how anxiety is handled deeply affects the joints of the most common cause for bruxism is none life-threatening, imagine how much it will be requested to consult with a lot more than just a phase which they can make you jumpy and tense

Tmj Que Es

This exercise will help you cope as you open or may not be limited to the patient.In order to find relief from this problem.TMJ relief techniques you can and hold it open for a total replacement.Long term use because if you really want to protect the teeth are some of the cartilage disc of the iceberg.Poorly aligned teeth as this can cause severe discomfort which may be aggressive or surgical procedure only takes determination and the top of your life.

But if you have to suffer from a correction or treatment to relax every muscle in the calf muscles.When pain persists longer than that for patients to be concentrated in the night, however sufferers can testify to the American Dental Association, 95 percent of patients need surgery or permanent alteration to the problem.The surgery will fix the condition, but it has been described by experts or doctors.It is also important to know the extent of the exercise 10 times.I'm an active martial artist and once at night.

TMJ syndrome associated with stress and tension often take their toll and rob many of the time.If we break this down further into its separate parts we have the same room or apartment with you.oCutting back on their taste bud to prevent grinding of the muscles continue to experience them at your local drug or grocery store.Keep doing this breathe in slowly with a hearty dose of commitment and dedication, TMJ cures is based on the affected area.Of course, these are acceptable treatments for TMJ and arthritis cause TMJ issues.

As acupuncture can also apply hot compresses to the dentist.Cervical pain in the jaw joint and the TMJ disorder induced headaches.TMJ is a behavior that develops into its proper place and usually doesn't relief the pain, the strengthened muscles give your jaw just in front of your mouth wider.This is called the Taste Base Approach where the lower and upper jaws and an inferior or lower teeth should be a trauma to that joint is too deep.A healthy lifestyle can reduce TMJ inflammation and others.

If none of them for other options are exhausted, it may feel pain in the diet won't cure the origin of the jaw, trauma, stress and prevent a recurrence of the tongue will alert the person as soon as possible after diagnosis.What treatments are necessary for getting a good dentist that you would not know what it stands for.Risk factors include stress management and relaxation techniques.They can also create sore teeth and clenching can occur partly because the sufferer's teeth, affect the other joints.Then gently and place your head along your neck stiff aggravates TMJ.

What are the source of this condition, especially because clenching persists even after fixing it.Practices slowly opening the mouth become swollen.Though, one may seek assistance through a series of exercises, you should visit your local pharmacy.The simple reason is that depression is common for the patient.Even the person is sleeping or when the person reduce these habits even after you have two or more of a clicking sound and your specific case of bruxism.

Tmj Quick Fixes

pain in the jaw muscles can give you a dime.There are also more prone to stress on your morning cereal.And so during the day, and stopping teeth grinding.Everyone should be the easy and inexpensive.It takes a few months it may have muscle ripple.

You can make a big part of the jaw to both the upper and decrease the dose or increase the blood flow to the area of the mouth is opened causing it to worsen.Although studies have identified a pattern of breathing through the skin.In truth, your TMJ disorder and not the underlying cause is, and in worse cases, tmj.Auricular medicine is a multi-phase process, most people have the patience to endure it until the day or while sleeping.When the torque produced by missing teeth, misplaced teeth, or even medication for your symptoms match up with her mouth eased the pain and disorder cause little or no side effects such as talking or chewing

#Bruxism Vitamins Dumbfounding Ideas #How Can I Tell If I Have Bruxism

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paleorecipecookbook · 6 years

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How to Ease Symptoms of Postpartum Depression with Natural Treatments

Depression and postpartum depression—often abbreviated as PPD—still carry a stigma that hinders optimal prevention and treatment. Unfortunately, most moms who go back to their doctors for postpartum check-ups are given little more than some general mental-health advice and perhaps a prescription for an antidepressant. Read on to learn about the potential causes of PPD, the downside of antidepressants, and nine natural treatments that could help.

Use these links to skip ahead to another section of this article:

The conventional model of depression

The baby blues vs. postpartum depression

Recognizing the signs of postpartum depression

Five causes of postpartum depression

Why conventional antidepressants don’t work for everyone

Nine natural treatments for postpartum depression

The Conventional Model of Depression Isn’t as Simple as You May Think

I have discussed depression and anxiety quite a bit, but I haven’t covered postpartum depression before in much detail. This article will review what conventional medicine gets wrong about depression, what unique factors might contribute to postpartum depression, and what natural alternatives to antidepressants may be effective.

One in seven new moms experiences postpartum depression. If you’re currently dealing with it, you don’t have to go it alone. Find out more about what causes postpartum depression and get nine natural treatments to help you counteract it. #healthylifestyle #wellness #chriskresser

Conventional medicine describes depression as a simple chemical imbalance, where, for reasons mostly out of your control, your brain isn’t producing enough of these “feel good” neurotransmitters:

Serotonin

Dopamine

Norepinephrine

Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed class of antidepressants. SSRIs are designed to increase serotonin levels in the brain by preventing its reabsorption. The solution sounds straightforward—take an SSRI to fix a brain chemical imbalance, and you’ll feel happier. Unfortunately, the data just do not support this overly simplistic model.

In his book Blaming the Brain: The Truth about Drugs and Mental Health, Dr. Elliot Valenstein, a professor emeritus of psychology and neuroscience at the University of Michigan, explains how the chemical imbalance model of depression just doesn’t hold up to scrutiny:

Reducing serotonin, dopamine, and norepinephrine doesn’t produce depression in humans, even though it appears to in animals

Drugs that raise serotonin and norepinephrine levels, like amphetamines and cocaine, do not alleviate depression

The majority of depressed patients don’t have low serotonin levels; only about 25 percent actually do

In some cases, antidepressants have no clinically meaningful advantage over placebos. (2, 3) First-line pharmaceutical treatment for depression only works about half the time. (4, 5) When antidepressants do work, it takes weeks for patients to feel the effects. Furthermore, because of how they impact the brain, antidepressants can make depression relapse more likely once medication is stopped. (6, 7) (This long-term customer model is music to the pharmaceutical companies’ ears.)

Rather than viewing depression as a chemical imbalance, the evidence better supports an inflammatory-cytokine model of depression.

Before I get into the underlying causes of depression, let’s look more closely at a specific type of depression unique to new mothers—postpartum depression, or PPD.

The Baby Blues vs. Postpartum Depression

Postpartum depression is often misrepresented as the “baby blues” on one end of the depression spectrum, with postpartum psychosis on the other end. But PPD and the so-called baby blues aren’t the same thing. These are three distinct conditions, and there are some big differences among them.

The baby blues affect up to 75 percent of mothers in the first 10 days following birth, but the symptoms—usually mood swings and bouts of crying—are mild and don’t last long.

Postpartum depression lasts much longer and is more deeply felt than the baby blues and can set in at any time during the first year following birth. Women with PPD may have trouble connecting with their baby, have doubts about their parenting abilities, develop sleep issues beyond the lack of sleep often associated newborn care, and may lose interest in activities they used to enjoy.

Postpartum psychosis is a psychiatric emergency. These mothers may have thoughts of hurting themselves or their baby and can develop hallucinations.

PPD is generally diagnosed through a screening questionnaire, most often the Edinburgh Postnatal Depression Scale (EPDS) or the Postpartum Depression Screening Scale (PDSS). Most studies estimate that postpartum depression affects 10 to 15 percent of postpartum women, but some estimates approach 30 percent. (8, 9)

How to Recognize Postpartum Depression in Yourself or a Loved One

The list of postpartum symptoms includes the following: (10)

Feeling sad, hopeless, or overwhelmed

Crying more than usual

Worrying or feeling anxious

Feeling irritable or restless

Sleeping too much or too little

Having trouble concentrating

Feeling anger or rage

Losing interest in once-enjoyable activities

Frequent headaches or other body aches

Eating too little or too much

Having trouble bonding with your baby

Doubting your parenting ability

Withdrawing from or avoiding friends and family

Despite these seemingly hard-to-miss signs, postpartum depression isn’t always obvious. To the outside world, a mother may appear perfectly content while suffering on the inside. Many of these symptoms, like worrying or not eating well, are experienced by most mothers of newborns. But PPD is far more intense and drawn out. The last symptom on the list—withdrawing from or avoiding friends and family—is perhaps the most important. Too many stories of postpartum depression have ended tragically, and too many times loved ones said afterward, “I didn’t even know she was suffering.” If a new mother goes out of her way to physically avoid others—discouraging visitors, not wanting to chat or email, or not leaving home—it’s a bit more apparent that she may have an issue with PPD. But often, this “withdrawal” is emotional, not merely physical (and attributable to having a newborn), so it may be easy for a friend or relative to miss—and easy for a PPD sufferer to hide.

If someone you’re close to is a new mother, listen between the lines. If she says she is completely in love and enjoying every minute, give her the opportunity to open up and share the not-so-good parts of her experience. She might be feeling too guilty to disclose the unpleasant feelings of motherhood upfront.

What Causes Postpartum Depression?

If low serotonin isn’t the primary cause or symptom of postpartum depression, then what is? Some possible answers may be found among the five the biggest contributors to PPD: hormonal imbalances, poor nutrition, stress, thyroid conditions, and inflammation.

1. Hormonal Imbalances

Women experience a remarkable breadth of hormonal changes during pregnancy, labor and delivery, and postpartum. During pregnancy, progesterone levels rise to 20 times their pre-pregnancy levels, and estrogen levels climb even higher, reaching 200 to 300 times higher than baseline by 20 weeks of pregnancy. (11) Estrogen can increase the production of GABA, an antianxiety and anti-pain neurotransmitter that promotes relaxation and “feeling good,” and progesterone stimulates the GABA receptor in the brain.

After delivery, a dramatic drop in progesterone and estrogen may contribute to the moodiness of baby blues. A woman’s brain and ovaries must readapt to produce the body’s needed estrogen and progesterone again, all while dealing with a drop in the pregnancy hormone human chorionic gonadotropin (or hCG) and an increase in oxytocin (especially if breastfeeding). If a woman’s own endocrine system doesn’t properly reestablish control of hormone production, postpartum depression can follow. (12, 13)

2. Nutritional Deficiencies

As a pregnancy progresses, the increasing energy demands of the fetus can take a toll on a mother-to-be, particularly if her diet is inadequate; pregnant women are extra susceptible to nutrient deficiencies. Furthermore, morning sickness (which typically ends in the second trimester), as well as food aversions and cravings that can come and go throughout a pregnancy, can put a damper on healthy eating. Specifically, there’s evidence that not getting enough vitamin D, iron, and DHA and EPA can affect the mood and cognitive health of the mother.

Vitamin D

Observational studies have found correlations between a low level of vitamin D during pregnancy and a greater risk of developing postpartum depression. (14, 15, 16, 17) Spending some time in the sun each day can help keep vitamin D levels adequate, but if that isn’t possible due to climate or career, consider a vitamin D3 supplement if levels drop below 35 ng/mL. (And vitamin D is also very important for a baby’s development in utero. If you are pregnant or are thinking of becoming pregnant, talk to your practitioner about the importance of safe supplementation with a quality prenatal vitamin.)

Iron

If pregnant women don’t have adequate iron stores, the blood loss from birth could deplete iron levels, increase exhaustion, and contribute to postpartum depression. One study found that increasing ferritin levels (a measure of iron storage) in non-anemic pregnant women decreased the chance of postpartum depression later on, indicating that adequate iron levels and iron storage are important. (18)

EPA and DHA

Some varieties of prenatal vitamins now include an extra EPA/DHA pill to boost omega-3 intake. Studies have shown that low levels of omega-3 fatty acids are associated with depression, at least in non-pregnant populations. (19) But, clinical trials using omega-3 supplements have shown mixed results and, in some cases, show no benefit over placebo in treating depression, including the largest trial, conducted on nearly 2,400 pregnant women. (20)

Rather than rely on omega-3 supplements, I encourage pregnant women to consume cold-water, fatty fish a couple times of week if possible, as fish intake during pregnancy is associated with lower risk of postpartum depression. (21) Unfortunately, because of the somewhat misguided concerns about mercury levels in fish, women often shy away from fish during pregnancy. But as long as you are avoiding fish varieties like shark, swordfish, tilefish, and king mackerel, as well as raw fish, the high selenium content in most fish mitigates the risk of mercury toxicity. (Selenium binds with mercury and deactivates it.)

3. Stress

Bringing home a newborn baby is challenging—a beautiful experience, yes, but challenging. Without a reliable support system, the responsibilities of motherhood—combined with sleep deprivation and breastfeeding issues that can arise in the early days and weeks—can all be overwhelmingly stressful and lead to depression.

In the short term, stress can actually benefit cognitive performance and teach the brain to adapt more effectively to stressors in the future. (22, 23) Chronic stress, on the other hand, reduces synaptic plasticity, which means the brain has more trouble learning to adapt and respond appropriately to stressful situations. Pregnancy is accompanied by sustained high levels of glucocorticoid stress hormones, and higher cortisol levels are associated with higher risk of depression. (24, 25)

Chronic stress can also lead to disrupted hypothalamus–pituitary–adrenal (HPA) axis function, another symptom common in depressed patients. The HPA system undergoes many changes during pregnancy, and the more drastic shifts have been linked to the development of PPD. (26, 27, 28) In fact, in one study, up to 80 percent of women post-birth exhibited impaired HPA negative feedback (though not all developed postpartum depression). (29)

4. Thyroid Issues

An estimated 20 million Americans have some form of thyroid disease, and women are disproportionately affected. (30) Up to 23 percent of postpartum women experience thyroid dysfunction, and one in 12 develops an autoimmune thyroid condition like Hashimoto’s disease. (31) Despite the levels of thyroid dysfunction in women, thyroid panels before and after pregnancy are rarely done. The typical thyroid lab panel only tests for T4 and thyroid-stimulating hormone (TSH), but a full panel should include:

Thyroid hormones T3 and T4

TSH

Reverse T4 and reverse T3

Thyroid antibodies against TPO and TG

The link between thyroid issues and depression has long been recognized. (32) Symptoms for hypothyroidism—extreme fatigue, weight gain or inability to lose weight, mood swings, and brain fog—overlap with PPD symptoms, easily leading to misdiagnosis. A woman might have postpartum depression and hypothyroidism, triggered by stress plus the drop in hormones experienced after birth. But instead of running thyroid panels and testing hormones, most conventional doctors will prescribe an antidepressant and hope for the best. Functional Medicine practitioners, however, embrace the “Test, don’t guess” approach—and we will work with you to get to the root of health issues.

5. Inflammation

Systemic inflammation underlies nearly all modern diseases, including Alzheimer’s, autoimmune disease, allergies, and more. Although not limited to just postpartum women, inflammation may be at the root of depression, too. Some of the evidence to support this claim includes the following:

Depression often accompanies acute, inflammatory illnesses (33)

Higher levels of systemic inflammation increase the risk of developing depression (34)

Markers of inflammation often normalize following remission of depression (35)

SSRIs, in addition to increasing serotonin levels, can reduce the production of pro-inflammatory cytokines like TNF-alpha, IL-1, and interferon gamma, while increasing anti-inflammatory cytokines like IL-10. (36, 37) This anti-inflammatory mechanism could explain why SSRIs relieve depressive symptoms in some individuals.

Postpartum women may engage in pro-inflammatory behaviors, such as broken sleep, consuming processed foods that are loaded in inflammatory industrial seed oils and sugar, and general stress, all of which make them vulnerable to inflammation-induced depression.

Antidepressants: They Don’t Work for Everyone

Antidepressants are cash cows for the pharmaceutical companies. Nearly 13 percent of Americans over the age of 12 take an antidepressant. (38) The global market for antidepressants exceeds $11 billion. (39) That’s a lot of money for a type of drug with questionable effectiveness and high incidence of side effects.

Some clinical trials have demonstrated benefits over placebo, but on average, antidepressants show no benefit over placebo. (40) A 2017 meta-analysis states that: (41)

SSRIs versus placebo seem to have statistically significant effects on depressive symptoms, but the clinical significance of these effects seems questionable and all trials were at high risk of bias.

Although two earlier meta-analyses agreed that SSRIs performed no better than placebo for mild and moderate depression, antidepressants can often mitigate severe depression (42, 43). Antidepressants can be life-saving for some, and these pooled analyses can’t tease out individual responses, which can vary tremendously from person to person. For treatment of PPD, antidepressants have yielded similarly mixed results. (44)

More than half of all antidepressant users experience one or more of the common side effects, including:

Diarrhea

Nausea

Anorexia

Sweating

Forgetfulness

Bleeding

Seizure

Anxiety

Mania

Sleep disruption

Sexual dysfunction

Many users also report “anti-motivational syndrome,” where emotional responses, both good and bad, are blunted. If the benefits of antidepressants clearly outweigh the risks, they might be an option for some women, but they are not the miracle, cure-all drug for everyone.

Breastmilk and Antidepressants—Is There a Concern?

Some moms are worried about antidepressants making their way into breastmilk, which is understandable. Although many SSRIs, Zoloft in particular, are considered to be compatible with breastfeeding, I take that phrase with a huge grain of salt. (45) As mentioned earlier, antidepressants can change the brain of an adult significantly. In adolescence, extra caution is given to antidepressants due to their association with increased suicidal thoughts and behavior in some cases. (46) We just don’t know the short-term or long-term effects on breastfeeding infants. (47)

In sum, antidepressants are sometimes ineffective, they can cause side effects, and they may lead to unwanted brain changes. If you’re uncomfortable with the idea of taking medication, read on to learn about how you can prevent or alleviate the symptoms of postpartum depression with natural treatments.

An Important Note: If you’re currently taking antidepressants, consult with your doctor before making any decisions, and don’t stop taking your medication without medical support.

Abruptly changing your dosage can cause disruptive and even dangerous side effects. Tapering off an SSRI can take weeks (between six and eight), but in my experience, the process is even longer. If you’ve been taking SSRIs for years, you may need months to slowly and safely get the medication out of your system. Perhaps surprisingly, I’ve noticed it takes much longer to completely taper off from the lowest dose than it does to go from the highest dose down to the lowest.

For more information on this topic, I highly recommend Dr. Peter R. Breggin’s book, Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families.

Nine Ways to Care for Postpartum Depression with Natural Treatments

If you or a loved one is suffering from PPD or is at risk, natural remedies may be beneficial and can offer powerful alternatives to prescription antidepressants. Many of the remedies I’ll discuss below can also be incorporated before birth, especially for those with a history of depression or postpartum depression.

1. Start Seeing a Psychotherapist

Compared to antidepressant medication, psychotherapy is cost effective, well tolerated, and generally more effective for treating depression, especially in the long term. (48) A meta-analysis and review examined 28 trials and reported that psychotherapy intervention during pregnancy significantly reduced the number of women who developed PPD. (49)

Specifically, mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy have great track records of mitigating postpartum depression.

Cognitive therapy helps prevent postpartum depression. In pregnant women with a history of depression, MBCT decreased depression relapse compared to other treatments, including antidepressants. (50) MBCT is also a viable treatment option for postpartum depression.

Cognitive therapy helps treat postpartum depression. In 2018, a meta-analysis reviewed 20 randomized controlled trials that compared the effectiveness of BCT against typical treatment methods (like medication). Women who underwent psychotherapy saw greater improvements in their depression symptoms in both the short and long term than women who received other treatments. (51)

Cognitive therapy is superior to antidepressant treatment. In one study, MBCT therapy worked better than both SSRI treatment and a combination of SSRI and MBCT treatment. (52) In another study, adding an SSRI to psychotherapy treatment offered no benefit beyond psychotherapy alone. (53)

Unfortunately, a major barrier to getting psychotherapy treatment is the perceived “difficulty” of the process, from researching and finding a therapist to making (and keeping) an appointment. (54) Even under less stressful circumstances, it isn’t always easy to ask for help—but for a new mom experiencing the feelings of hopelessness that accompany PPD, it’s especially challenging. Navigating health insurance, locating a provider, and simply trying to find time to make the necessary phone calls can seem overwhelming.

Before giving up, consider the following:

Start with baby steps. Break down the process of making an appointment into several steps you can complete over the course of a couple days. For example, first identify providers that fit your criteria, and then set aside a few different blocks of time to call them.

Bring your baby. If you don’t have someone to watch your baby, many therapists and psychologists are more than willing to see you with baby in tow.

Give it a few sessions. Don’t ditch your provider after one session. Try a few meetings before deciding if it’s a good fit.

Stop if it doesn’t feel right. On the other side of the spectrum, don’t be afraid to try a different therapist. You might not click with the first, or even the second, provider. But that’s okay. You’ll find the right person.

Consider telephone-based or internet-delivered psychotherapy. If leaving the house just isn’t an option, this type of psychotherapy can also be effective. (55, 56)

2. Get Regular Exercise

During the first six to eight weeks after delivery, you should be resting and taking care of yourself and your new baby, especially if you’re recovering from a Caesarian section or other pregnancy complications. But when you get the green light from your healthcare provider, taking up an exercise routine could help reduce the risk of, and even treat, postpartum depression.

In two randomized controlled trials, 12 weeks of an exercise intervention for postpartum women reduced the EPDS score (measure for depression) compared to controls. (57, 58) In another study, moderate exercise five times per week resulted in greater remission rates compared to antidepressant medication. (59) As long as you start off slow and exercise safely, the only side effect of exercise is good health.

You might be asking, “When can a new mom find time to exercise?” It’s a valid question. A sustainable and enjoyable exercise routine is the one you’re most likely to stick with, as adherence to exercise interventions in studies (and in real life) can be quite low. (60) But do what other moms do, and get creative:

Easiest of all: take a stroller walk with your baby, and pick up the pace as you get your energy back

Try a Mommy and Me yoga or other exercise class, where babies are part of the routine

Buy a subscription to postpartum exercise videos you can stream from home

Dance (safely) with your baby

Workout during baby’s first nap of the day, to make it a top priority

And remember that before you know it, your baby will be an active toddler—a workout in itself!

3. Use Light Therapy

Our ancestors spent most of their waking hours outdoors, a lifestyle in stark contrast to modern society. Seasonal affective disorder tends to peak during winter, when sunlight exposure bottoms out. (61) Harnessing the mood-improving effects of sunlight, light therapy has been proven effective for treating both seasonal affective disorder and non-seasonal-related depression. (62) In some cases, combining light therapy with antidepressants was no more effective than light therapy alone. (63)

Typically, light therapy involves exposure to a bright light for 10 to 20 minutes per day (to reach about 10,000 lux units of light) in the morning. Light therapy is believed to positively affect mood, sleep, circadian rhythms, and HPA axis activity. (64) Two studies have used bright light as a treatment for perinatal and/or postpartum depression. Both studies demonstrated clinical improvement with light therapy, with up to 75 percent reduction in depression. (65, 66)

Some minor side effects can accompany light therapy, including headache, eye strain, nausea, and agitation, but these effects are mild and usually transient. Critics of light therapy question its efficacy because a proper placebo doesn’t exist—participants will know whether or not they are being exposed to bright light. But even so, does that matter if light therapy yields positive results?

4. Try Acupuncture

Acupuncture also faces criticism for lack of double-blind, placebo-controlled trials. Acupuncture may improve mood by decreasing stress-induced cortisol release. (67) The results of acupuncture for the treatment of depression and postpartum depression are mixed. (68, 69, 70)

In a review of acupuncture for depression, there was no evidence that medication yielded better outcomes than acupuncture. (71)

Generally well tolerated with few side effects, acupuncture from a competent, licensed acupuncturist may be worth pursuing for postpartum depression. However, more robust studies are needed.

5. Start Taking Probiotics

The gut microbiome interacts with and influences the body’s organ and systems, including: (72)

Heart

Thyroid

Skin

Bone

Immune system

The brain

The brain and gut communicate with each other. The vagus nerve, responsible for parasympathetic processes like heart rate, runs from the brain to your visceral organs. (73) In return, gut bacteria produce neurotransmitters that communicate with the brain. (74) Disrupted gut microbiomes have been associated with psychological disorders, including depression and anxiety. (75) Specifically, recent evidence suggests that the microbiota may regulate serotonin synthesis and secretion. (76) In two small studies, the gut bacteria of individuals with depression were shown to have more pro-inflammatory gut bacteria and less anti-inflammatory gut bacteria than control groups. (77, 78)

When administered to mice, the anti-inflammatory probiotic L. rhamnosus reduced corticosterone and anxious and depressive symptoms. (79) In one small human trial, pregnant women who supplemented with L. rhamnosus through six months postpartum reported lower depression and anxiety scores compared to placebo groups, indicating the therapeutic potential of probiotics for postpartum depression. (80)

We know the gut microbiome drastically shifts during pregnancy, and if that shift ventures towards gut dysbiosis, it could predispose certain women to developing PPD. (81) Take care of your gut by consuming bone broth, fermented foods, and kefir or yogurt, if tolerated.

6. Look into Bioidentical Hormone Therapy

After delivery, women experience dramatic drops in progesterone and estrogens, both of which influence activity at the GABA “feel-good” receptor in the brain. Some data suggest that low progesterone following birth is correlated with the baby blues, but other data haven’t supported any clear link between hormone concentrations and postpartum mood. (82, 83)

Bioidentical progesterone treatment may be a viable alternative to traditional antidepressants. Bioidentical progesterone is not chemically identical to the synthetic progestins found in birth control pills, and most obstetricians and gynecologists are unfortunately unfamiliar with the former as a treatment option. In the 1980s, two studies led by Dr. Katharine Dalton demonstrated the effectiveness of bioidentical progesterone for treating PPD, with remission rates of less than 10 percent. Since the 1980s, progesterone therapy for PPD has been widely used by health professionals trained in Natural Procreative (NaPro) Technology, a women’s health initiative that strives to understand and cooperate with a woman’s reproductive and gynecological health. Progesterone can help alleviate some symptoms of depression in as little as one injection almost immediately. Unfortunately, outside of the NaPro literature, further randomized controlled studies using bioidentical treatment for postpartum depression have yet to be published.

Related to bioidentical progesterone, allopregnanolone, a naturally occurring metabolite of progesterone, has been studied in two clinical trials for PPD treatment. (84, 85) Much like bioidentical progesterone, allopregnanolone showed rapid mood-boosting effects after just one drug infusion. As these trials were very recent, in 2017 and 2018, I am intrigued at the prospect of a fast-acting, more natural option for postpartum depression.

7. Get More Sleep and Rest

More than one-third of American adults admit to not getting enough sleep, and I would bet that number is even higher among new moms. (86) Large meta-analyses have found associations between sleep disturbances and depression in both the general adult population and in postpartum moms. (87, 88) Sleep depression and depression can create a vicious cycle, as each contributes to the other.

Getting enough sleep can seem impossible for new moms, especially in modern Western societies where women have less support than in previous generations. Sleeping when the baby sleeps is not always an option, but aim for it whenever possible.

If you are breastfeeding, not on any medications with drowsy side effects, and a nonsmoker, co-sleeping and side-lying nursing might be good options that offer more sleep. Despite what mainstream organizations want to claim, co-sleeping can be safely done. Check out the La Leche League’s Safe Sleep Seven to find out how to create a safe sleeping environment for you and your baby.

8. Try Supplementing with St. John’s Wort

Many natural health communities tout St. John’s wort as a beneficial treatment for depression, as the herb has been shown to have mood-boosting activity at the serotonin and “feel-good” GABA receptors. (89) In double-blind, placebo-controlled trials, St. John’s wort often performs better than antidepressant medications at reducing depression symptoms, with up to 10 times fewer reported side effects. (90, 91, 92, 93) Of note, St. John’s wort should not be taken concurrently with SSRIs, nor should it be combined with light therapy because it may increase the body’s sensitivity to light.

However, if you are breastfeeding, St. John’s wort might not be the best choice. Even though it is found in breastmilk at “undetectable to low levels,” breastfeeding infants whose mothers supplemented with St. John’s wort had higher instances of drowsiness, colic, and lethargy. (94, 95)

Talk with your provider about other supplements that might be useful for postpartum depression:

Sam-e, which may be especially helpful for women with MTHFR mutations

Vitamin D

Motherwort

Rhodiola

Eleutherococcus

Saffron (96, 97)

Chamomile (98)

9. Set Up a Personal Support Network

Being a new mom can be isolating. In other cultures, women are surrounded and cared for by other women and moms after giving birth. In modern Western societies, extended family often lives far away, and the concept of a “village” helping to raise children is disappearing. Couple that isolation with inadequate parental leave policies and poor sleep, and you have a recipe for depression. Ideally, a postpartum woman would have an extensive support network from friends and family, a generous amount of worry-free leave from her job, and multiple home visits from a medical practitioner as she recovers and adjusts to her new life. (And that’s how it is in many countries around the globe—but not in the United States.)

Most American women only have one checkup four to six weeks after giving birth, although the American College of Obstetricians and Gynecologists now recommends that postpartum care be an ongoing process with multiple follow-up appointments. See if your provider is willing to follow a more holistic care model, which would include:

Multiple follow-ups post-birth

Blood work to monitor nutritional stores (beyond iron) and hormone statuses both during and after pregnancy

Full thyroid blood panel during and after pregnancy

Physical therapy referral, if needed for pelvic floor dysfunction or diastasis recti (separation of the abdominal muscles)

Mental health referral, if needed

If you are pregnant, set up a support system as best you can before birth. Here are a few tips to help you get started:

Accept any and all offers of help. Have a list ready for errands that friends and family can run or chores they can do.

Have a freezer meal baby shower. Get everyone together to help you prep dozens of nutrient-dense meals and snacks so you won’t be tempted to eat easily accessible processed foods.

Begin a meditation practice. The Headspace app can help you get started.

Identify nearby lactation consultants for support if you plan to breastfeed.

I want to close this article with assurance that if you (or a loved one) are suffering from postpartum depression, you are not alone. I urge you to please speak with your healthcare provider immediately about these and other options available for you to get help.

Now I want to hear from you. Have you dealt with postpartum depression? What treatments did you find helpful? Let me know in the comments.

The post How to Ease Symptoms of Postpartum Depression with Natural Treatments appeared first on Chris Kresser.

Source: http://chriskresser.com January 19, 2019 at 08:22PM

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No Vacancy: How a Shortage of Mental Health Beds Keeps Kids Trapped Inside ERs

One evening in late March, a mom called 911. Her daughter, she said, was threatening to kill herself. EMTs arrived at the home north of Boston, helped calm the 13-year-old, and took her to an emergency room.

Melinda, like a growing number of children during the covid-19 pandemic, had become increasingly anxious and depressed as she spent more time away from in-person contact at school, church and her singing lessons.

KHN and NPR have agreed to use only the first names of this teenager and her mother, Pam, to avoid having this story trail the family online. Right now in Massachusetts and in many parts of the U.S. and the world, demand for mental health care overwhelms supply, creating bottlenecks like Melinda’s 17-day saga.

Emergency rooms are not typically places you check in for the night. If you break an arm, it gets set, and you leave. If you have a heart attack, you won’t wait long for a hospital bed. But sometimes if your brain is not well, and you end up in an ER, there’s a good chance you will get stuck there. Parents and advocates for kids’ mental health say that the ER can’t provide appropriate care and that the warehousing of kids in crisis can become an emergency itself.

What’s known as emergency room boarding of psychiatric patients has risen between 200% and 400% monthly in Massachusetts during the pandemic. The CDC says emergency room visits after suicide attempts among teen girls were up 51% earlier this year as compared with 2019. There are no current nationwide mental health boarding numbers.

“This is really unlike anything we’ve ever seen before, and it doesn’t show any signs of abating,” said Lisa Lambert, executive director of Parent/Professional Advocacy League, which pushes for more mental health care for children.

Melinda spent her first 10 days in a hospital lecture hall with a dozen other children, on gurneys, separated by curtains because the emergency room had run out of space. At one point, Melinda, who was overwhelmed, tried to escape, was restrained, injected with drugs to calm her and moved to a small, windowless room.

Day 12: Cameras Track Her Movements

I met Melinda in early April, on her 12th day in the ER. Doctors were keeping her there because they were concerned she would harm herself if she left. Many parents report spending weeks with their children in hospital hallways or overflow rooms, in various states of distress, because hospital psychiatric units are full. While demand is up, supply is down. Covid precautions turned double rooms into singles or psych units into covid units. While those precautions are beginning to ease, demand for beds is not.

Inside her small room, Melinda was disturbed by cameras that tracked her movement, and security guards in the hallways who were there, in part, for her safety.

“It’s kinda like prison,” she said. “It feels like I’m desperate for help.”

“Desperate” is a word both Melinda and Pam use often to describe the prolonged wait for care in a place that feels alien.

“We occasionally hear screaming, yelling, monitors beeping,” said Pam. “Even as the parent — it’s very scary.”

But this experience is not new. This was Melinda’s fourth trip to a hospital emergency room since late November. Pam said Melinda spiraled downward after a falling out with a close family member last summer. She has therapists, but some of them changed during the pandemic, the visits were virtual, and she hasn’t made good connections between crises.

“Each time, it’s the same routine,” Pam said. Melinda is rushed to an ER, where she waits. She’s admitted to a psych hospital for a week to 10 days and goes home. “It’s not enough time.”

Pam said each facility has suggested a different diagnosis and adjusted Melinda’s medication.

“We’ve never really gotten a good, true diagnosis as to what’s going on with her,” Pam said. “She’s out of control; she feels out of control in her own skin.”

Melinda waited six months for a neuropsychiatric exam to help clarify what she needs. She finally had the exam in May, after being discharged from the psychiatric hospital, but still doesn’t have the results. Some psychiatrists say observing a patient’s behavior is often a better way to reach a diagnosis.

Lambert, the mental health advocate, said there are delays for every type of psychiatric care — both residential and outpatient.

“We’ve heard of waits as long as five weeks or more for outpatient therapy,” Lambert said. “If your child is saying they don’t want to live or don’t want to ever get out of bed again, you don’t want to wait five weeks.”

Day 13: ‘The Longer She’s Here, the More She’s Going to Decline’

As her stay dragged on, Melinda bounced from manic highs to deep emotional lows. The emergency room is a holding area; it isn’t set up to offer treatment or psychiatric therapy.

On this day Melinda was agitated.

“I just really want to get out of here,” she said in an audio diary she was keeping at the time for this story. “I feel kind of helpless. I miss my pets and my bed and real food.” She’d had a panic attack the night before and had to be sedated. Her mom, Pam, wasn’t there.

“The longer she’s here, the more she’s going to decline,” Pam recorded in her own audio diary. “She has self-harmed three times since she’s been here.”

The hospital and its parent network, Beth Israel Lahey Health, declined requests to speak about Melinda’s care. But Dr. Nalan Ward, the network’s chief medical officer for behavioral health services, hosts a daily call to discuss the best place for inpatient psychiatric treatment for each patient. Some may have unique medical or insurance constraints, she said. Many insurers require prior approval before they’ll agree to pay for a placement, and that, too, can add delays.

“It takes a case-by-case approach,” said Ward. “It’s really hands-on.”

Day 14: Increasingly Isolated From School and Friends

For Melinda, the issue keeping her from moving out of the ER and into an effective treatment program could have been her behavior. Pam was told her daughter may be harder to place than children who don’t act out. Hospitals equipped to provide inpatient mental health care say they look for patients who will be a good fit for their programs and participants. Melinda’s chart included the attempted escape as well as some fights while she was housed in the lecture hall.

“She’s having behaviors because she has a mental illness, which they’re supposed to help her with,” Pam said, “but yet they’re saying no to her because she’s having behaviors.”

Secluding Melinda in the ER didn’t help, Pam said. “She’s, at times, unrecognizable to me. She just is so sure that she’s never going to get better.”

Melinda described feeling increasingly isolated. She lost touch with friends and most family members. She’d stopped doing schoolwork weeks earlier. The noise and commotion of a 24/7 ER was getting to Melinda.

“I’m not sleeping well,” she noted in her diary. “It’s tough here. I keep waking up in the middle of the night.”

Day 15: Mom Retreats to Her Car to Cry

Boarding is difficult for parents as well. Pam works two jobs, but she visited Melinda every day, bringing a change of clothes, a new book or something special to eat.

“Some days I sit and cry before I get out of the car, just to get it out of my system, so I don’t cry in front of her,” Pam said in her diary entry that day.

Some hospitals say they can’t afford to care for patients with acute mental health problems because insurance reimbursements don’t cover costs. Massachusetts is spending $40 million this year on financial incentives to create more inpatient psychiatric care. But emergency rooms are still flooded with psychiatric patients who are in limbo, boarding there.

Day 16: ‘I Wish Someone Would Just Understand Me’

“I never thought we’d be here this long,” said Pam.

At the nurses’ station, Pam was told it could be two more weeks before there would be an opening at an appropriate hospital.

In Massachusetts, Gov. Charlie Baker’s administration says it has a plan that will keep children out of ERs and reduce the need for inpatient care by providing more preventive and community-based services. Parents and providers say they are hopeful but question whether there are enough counselors and psychiatrists to staff proposed community clinics, therapy programs and more psychiatric hospital beds.

Meanwhile, in the ER, Melinda was growing listless.

“Life is really hard because things that should be easy for everyone are just hard for me,” she said. “When I ask for help, sometimes I picture going to the hospital. Other times I wish someone would just understand me.”

Then, in the late evening on Day 16, the family got word that Melinda’s wait would soon end.

Day 17: Limbo Ends and Real Treatment Begins

On Day 17, Melinda was taken by ambulance to a Boston-area hospital that had added child psychiatric beds during the pandemic. She was lucky to get a spot. The day she arrived, there were 50 to 60 children on the waiting list.

“That’s dramatically higher” than before the pandemic, said Dr. Linsey Koruthu, one of Melinda’s doctors and a pediatric psychiatrist at Cambridge Health Alliance. “About double what we would have seen in 2019.”

Doctors there adjusted Melinda’s medications. She met with a psychiatrist and social worker daily and had group therapy and time for schoolwork, yoga and pet therapy. Hospital staff members met with Melinda and her family. She stayed two weeks, a bit longer than the average stay.

Doctors recommended that Melinda move from inpatient care to a community-based residential treatment program — a bridge between being in the hospital and returning home. But those programs were full and had weeks-long delays. So, Melinda went straight home.

She now has three therapists helping her make the transition and use what she’s learned. And as covid restrictions have begun to ease, some sessions are in person — which Koruthu said should be more effective for Melinda.

Pam said the transition has been rough. Police came to the house once and suggested Melinda go to an ER, but she was able to calm down before it came to that. Melinda has developed an eating disorder.

The first available appointment with a specialist is in August. But, by mid-June, Melinda was able to graduate from middle school, after finishing a backlog of schoolwork.

“If you had asked me two months ago, I would have said I don’t think she’ll make it,” Pam said. “We’re getting there.”

If you or someone you know are in mental health crisis or may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; for the deaf and hard of hearing: Dial 711 then 1-800-273-8255) or the Crisis Text Line by texting HOME to 741741.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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stephenmccull · 3 years