Mental Health Problems


Scroll through the list below to find frequently asked question about the listed disorders.

Adjustment Disorder

Adjustment disorder is a diagnosis that is related to having trouble coping with one or more stressful life events. An adjustment disorder is not quite a full psychiatric disorder like major depression or posttraumatic stress disorder, but may share many of the same symptoms as these disorders. These symptoms can be strong and disabling but typically only last for a relatively brief time.

To be diagnosed with an adjustment disorder, the stressful event must have occurred within 3 months of the person's symptoms becoming a problem. The symptoms, such as sadness or worry, must interfere with the person's social, work, or personal functioning, and be a more extreme response than typically expected. Once the stressor is removed, the symptoms should abate within 6 months.
Yes, most people with adjustment disorders get better when the stressor is removed or with treatment. A small number still have persistent problems like Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD), or Alcohol Abuse Disorder.
The symptoms that accompany an adjustment disorder can affect a person's occupational or academic performance and can interfere with socializing and close relationships. In those with an illness, it can also negatively impact their health. For example, a person with an adjustment disorder with depressive symptoms may lack the motivation to be compliant with taking medications as directed. Most sobering, adjustment disorders are associated with an increased risk of suicidality.
Adjustment disorders are usually treated with individual or group therapy. The two commonly used types of therapy for adjustment disorder are cognitive behavioural therapy (CBT) and problem-solving therapy (PST). Treatment can often be relatively brief. Therapy for adjustment disorders includes reducing or removing the stressor, enhancing ability to cope if the stressor cannot be removed, and establishing support systems that help a person adapt. The goals of treatment are to return to normal functioning and to improve a person's coping skills.

Cognitive Behavioural Therapy

In CBT, the therapist educates the client about adjustment disorders and stress reactions. The client would monitors symptoms of stress to learn to identify triggers. The therapist helps uncover negative thoughts related to stress, and replace them with healthier thoughts and behaviours. CBT for adjustment disorders may also include relaxation training to help a person better cope with stress.

Problem-Solving Therapy

In PST, the therapist and client focus on identifying problems related to the stressor. The therapist helps the client create solutions and form an action plan around these solutions. The client implements the plan and then together, they evaluating how effective these new solutions are in addressing the problems.
The symptoms of adjustment disorder can vary greatly and may include:
  • Sadness or crying more than usual
  • Feeling hopeless
  • Being anxious, nervous, or tense
  • Isolating from other people
  • Acting impulsively or defiantly
  • Trembling or twitching
  • Physical complaints, such as palpitations
  • Sleep problems
  • Trouble concentrating
  • Loss of self-esteem
Adjustment disorders can be caused by a single stressor or by a combination of difficult life situations. The stressor can be a one-time event, appear episodically, or can be an ongoing issue.

Some common stressors for adjustment disorders include:
  • The breakup of a romantic relationship or marriage
  • Marital problems
  • Business troubles
  • Death of a loved one
  • Illness or health problems in yourself or in a loved one
  • Financial concerns
  • Problems at school
  • Losing a job
  • Sexual issues
  • Developmental events like getting married, becoming a parent, or retiring
  • Natural disasters
To develop an adjustment disorder, a person must be exposed to a life stressor. However, individuals reaction to stress varies greatly and most people do not experience adjustment disorders following a difficult event. A person's response to a stressor may vary depending on age, gender, health, other psychological disorders, social support, and economic status. Additionally, individuals living in poverty or other disadvantaged circumstances experience an elevated number of life stressors and, therefore, may be at greater risk of developing an adjustment disorder. It's also possible that people who develop adjustment disorders are exposed to more severe life stressors.

Alcohol and/or Substance Abuse Disorder

A substance use disorder is when an individual continues to use drugs or alcohol despite significant problems caused by using the substance. Someone with a substance use disorder has trouble controlling the amount of the substance or takes it for longer than originally intended and can experience cravings for the drug. Often, a person with a substance use disorder wants to quit using a drug but has great difficulty doing so. The substance or substances involved may be illegal drugs such as cocaine, a legal substance like alcohol, or prescription medication such as painkillers.

Ongoing substance use can interfere with work, school, and social relationships and a great deal of time may be dedicated to obtaining, using, and recovering from the drug. In severe cases, an individual's entire life can revolve around the substance. A person with a substance use disorder may continue to use a drug even when it has deleterious effects on one's physical and mental health. Substance use disorders also have physical effects. Someone with a substance use disorder may develop tolerance to the drug so that more and more is needed to obtain the same effect. A person might also experience withdrawal symptoms when the drug isn't being used.
Many mental health professionals believe addictions cannot be cured; however, like many chronic conditions, they can be managed successfully. Treatment helps people counteract the powerful effects of drug use on the brain and allows them to regain control over their lives. About half of people with substance use disorders relapse after treatment. This doesn't mean treatment has failed but that they may need to re-enter treatment or somehow adjust the level or type of support they are receiving.
Alcohol and drug use disorders typically require a comprehensive approach. The aims of treatment are to motivate the individual to change and to help the person learn and internalize new attitudes and behaviours to reduce the chance of relapse. Typically, abstinence is the goal but some may be unwilling or unable to abstain from the substance and so may aim for controlled use. While controlled use may help some, abstinence is associated with the best long-term outcomes. Therapists also help individuals develop social and work skills, and improve relationships that may have been disrupted by the drug use.

The appropriate treatment varies depending on the severity of the problem, the type of substance used, and the individual's available support and motivation. Individuals who are at risk of severe withdrawal symptoms may need to be hospitalized to detoxify from the substance before treatment can begin. People are typically treated as outpatients in the community but more severe or chronic cases may require a higher level of care, such as a day program or a residential program.

Psychosocial treatment is an essential component of treatment for substance use disorders. Some commonly used evidenced-based treatments include:

Cognitive Behavioural Therapy

The goals of Cognitive Behavioural Therapy (CBT) are to change dysfunctional thoughts that lead to negative feelings and unhealthy behaviours, including using drugs or alcohol. In CBT, a person learns about the chain of events that lead up to substance abuse so that they can intervene before a lapse occurs. CBT also helps individuals learn effective coping strategies and social skills. Many behavioural strategies may be employed when treating a substance problem, either alone or in combination with CBT. For example, an individual may be rewarded with a gift voucher when they remain abstinent.

Motivational Enhancement Therapy

Motivation Enhancement Therapy (MET) helps individuals increase motivation to change. An MET therapist empathically asks about a person's goals, the pros and cons of the substance use disorder, and ambivalence to change.

Marriage and Family Therapy

Problems in the family are associated with poorer outcomes in substance use disorders; therefore, marriage and family therapy can be an important component of treatment. The goals of therapy include improving family relationships and helping the client adhere to treatment.

Twelve-Step Facilitation

This form of therapy helps individuals stay abstinent by enhancing motivation and participation in 12-step programs, such as Alcoholics Anonymous and Narcotics Anonymous.

Brief Interventions

True to their name, brief interventions for substance use disorders typically take place over only a few sessions. A mental health professional, like a psychologist or a social worker, will conduct an assessment of the problem, offer objective feedback and advice about the benefits of change, and inform the client about options for further treatment. Often, brief interventions are geared to those who are at risk of developing substance use problems rather than those with substance use disorders.
Substance use disorders are a relatively common problem. Over the course of their lifetime, more than 20% of Canadians (about 6 million people) have a substance use disorder, with alcohol use disorder being the most common. Substance use disorder rates are nearly three times higher in men than they are in women. In addition, rates of problematic substance use decrease with age, from about 12% of those ages 15-24 to 1.9% of those 45 or older. Individuals with mental health disorders had three times the rate of illicit drug problems than those without other mental health problems.
Some common symptoms and consequences of substance use disorders include:
  • Feeling anxious, irritable or depressed
  • Spending money on drugs rather than food, rent, and other important items
  • Relationship problems
  • Legal troubles
  • Having a hard time thinking clearly
  • Feeling hopeless or empty
  • Getting injured while using a substance
  • Experiencing blackouts
If you continue to use alcohol or a drug even though it is causing you problems, you may have a substance use disorder. The negative effects may be mild, such as being late for work or causing fights with a partner, but even small consequences can add up over time. Another indication of a problem is if you try to stop using the substance but can't seem to quit. Other warning signs include being angry or annoyed when others comment on your drug use, feeling guilty about how much you use, or using a substance first thing in the morning.
If you are noticing that a family member or partner's substance use is impacting health, relationships, finances, or work then there is likely a substance use problem. If your family member or partner has a problem with drugs, it impacts the whole family. Often, people struggling with drugs are secretive and so it may take a while before others realize what is happening.

Family members often feel guilt, anger, and shame, and may experience denial of the severity of the problem. If the drug use escalates, family members may feel hopeless. Some people might try to control their loved ones' drug use while others may increase their own substance use. You can play an important role in your family member's recovery as support from the family helps individuals stay in treatment and be more likely to have successful outcomes.

But you need to take care of your own mental and physical health too. This includes having a support system, making time for yourself, and setting appropriate limits with your family member who is using drugs. It can be difficult to get your loved one to accept help if the individual is not ready for treatment.

Here are some things you can do:
  • Educate yourself about the causes, signs, and symptoms of substance use disorders
  • Communicate clearly, directly, and positively and try to avoid criticism
  • Ask your loved one how you can be supportive
  • If your loved one does not want treatment, find out what aspect of the problem evokes the least resistance to changing and talk to them about treatment for that specific area
  • Learn about addiction assessment services in your community and offer to accompany your loved one to an appointment
  • Sometimes, contacting a mental health professional to stage a brief intervention may be necessary
  • Examine your own substance use and see if it may be contributing to the problem
  • Get support for yourself from an organization such as Al-Anon
For alcohol, the usual limits of "safe" alcohol use are as follows: Amounts are based on a "standard drink", which is defined as 12 grams of ethanol, 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof spirits. For men under 65: Up to 14 drinks per week, or up to 4 drinks on any day. For women under 65 and people over 65: Up to 7 drinks per week or up to 3 drinks on any one day. There are no "safe" limits for most other substances; a single use of cocaine could cause heart problems, while a single use of an intravenous drug could cause an infection like hepatitis or HIV. Therefore, the goal for drug misuse treatment is usually abstinence.
If you continue to use alcohol or a drug even though it is causing you problems, you may have a substance use disorder. The negative effects may be mild, such as being late for work or causing fights with a partner, but even small consequences can add up over time. Another indication of a problem is if you try to stop using the substance but can't seem to quit. Other warning signs include being angry or annoyed when others comment on your drug use, feeling guilty about how much you use, or using a substance first thing in the morning.
It can be very difficult to stop using a substance. One reason is drugs usually have immediate positive effects such as increasing a person's confidence or sense of well-being. Substances can also provide relief from difficult feelings and an individual may feel unable to cope with daily life without using drugs. When a person uses a substance on an ongoing basis, it causes physiological changes to the body and brain. If someone develops physical dependence on a drug, then the withdrawal experienced when discontinuing the drug can be very uncomfortable. In some people, the changes to the brain may be permanent, and contribute to cravings even when long abstinent. Many people say that when they stop using drugs, it feels as though they are leaving an important relationship. Although it is difficult, many people have successfully stop using drugs with treatment and support.
Many factors influence a person's risk for developing a substance abuse disorder including biology, environment, and age or developmental stage. An individual's biology, particularly genes, but also gender and ethnicity, contributes to substance abuse risk. So does a person's social environment, such as friends and family, as well as other environmental factors, like quality of life, stress, and experiencing abuse. Age and developmental stage play a role too. The earlier one begins to use drugs, the more likely it is to progress to a serious problem. Finally, having another mental health problem increasing a person's vulnerability to developing an alcohol use disorder.

Anger Problems

Intermittent explosive disorder (IED) is defined by occasional, sudden, and extreme outbursts and is considered an impulse-control disorder. These outbursts can be verbal, physical, or both. The outbursts are out of proportion to the provocation, and the person has limited ability to control himself. The anger episodes are not premeditated, and cause the individual significant distress or interfere with his ability to function. Since anger or impulse control problems can occur due to many illnesses, intermittent explosive disorder is only diagnosed if the outburst are not better explained by another disorder.
Intermittent explosive disorder can affect every area of a person's life. The angry outbursts can be extremely detrimental to relationships with one's spouse, family members, or friends. Individuals with intermittent explosive disorder often feel shame, guilt, or regret after episodes and may isolate themselves to avoid situations than can trigger aggression. If the symptoms are present in the workplace, the individual may be demoted or even fired. This can result in financial repercussions, as can the damage of property that may accompany outbursts. The aggressive behaviour associated with intermittent explosive disorder can result in legal problems, including civil lawsuits and criminal charges. Finally, individuals with intermittent explosive disorder are also more likely to suffer from other mental health problems, including mood disorders, anxiety disorders, and substance use disorders.
About 2.7% of adults meet criteria for intermittent explosive disorder. It is more common among individuals under 40 and those with a high school education or less. It also seems to be more prevalent in men than in women.
Intermittent explosive disorder is typically treated with what is broadly referred to as anger management. This usually includes some type of cognitive behavioural therapy (CBT), which may be most effective when it includes relaxation training. Dialectical behaviour therapy (DBT) is another promising treatment for problems with anger and aggression. These treatments may be delivered in an individual or group therapy setting. Medications can also help individuals control their impulses.

Cognitive Behavioural Therapy (CBT)

CBT for anger problems typically focuses on helping you replace negative thoughts with healthier ones, specific anger management techniques, and relaxation training. Clients are given homework so they can practice the skills in real life situations.

Relaxation Training

Relaxation training, also known as progressive muscle relaxation, teaches you how to relax your body by systematically tensing and releasing various muscle groups. Other relaxation techniques may also be used, such as mindfulness, meditation, or deep breathing. Relaxation training helps you recognize when you begin to become tense and allows you to use the techniques to calm yourself before the anger escalates.

Dialectical Behaviour Therapy (DBT)

DBT combines CBT with principles of mindfulness, or being aware of the present moment in a non-judgemental way. It focuses on helping you regulate your emotions, such as anger, as well as behavioural problems, like aggression.
The primary symptom of intermittent explosive disorder is explosive eruptions of anger. These typically come on suddenly and last less than 30 minutes. These episodes can include verbal assaults and physical aggression toward animals, objects, or other people. Often, people with intermittent explosive disorder only rarely have anger episodes that result in actual damage or destruction but have more frequent milder anger episodes of verbal or non-damaging physical assaults. People with intermittent explosive disorder may experience anger and irritability between episodes.

During the anger episodes the person may experience:
  • Irritability
  • Rage
  • More energy
  • Racing thoughts
  • Feeling pressure in the head
  • Tightness in the chest
  • Palpitations
  • Tremors
  • Tingling

Following the episodes, the person may feel relief, depression, fatigue, or regret.
If a person close to you has a problem with anger, you may feel like you always have to walk on eggshells. Remember that their anger is not your fault. There is no excuse for verbal or physical abuse. No one deserves abuse. You have the right to be treated with dignity and respect. If you are in a relationship with someone with intermittent explosive disorder, take steps to protect yourself and your children. If the situation seems to be getting worse, remove yourself from the situation.

Tips for Dealing with a Family Member's Anger:
  • Establish clear boundaries for what you will and won't tolerate
  • Talk about the anger problem when you are both calm
  • Leave the situation if they don't calm down
  • Ask your family member to go to marriage or family therapy with you
  • Considering seeking therapy and support for yourself
  • Always put your own safety first
  • Create a safety plan in case the episodes escalate – keep an emergency bag with a friend or neighbour and have a specific place to go if you feel threatened
  • Call the Assaulted Women's Helpline 24/7 for more advice: 1-866-863-0511 or your local distress centre
  • In an emergency, call 911
Anger is a normal emotion; however, if you are experiencing frequent or extreme outbursts it can be very detrimental to your relationships and wellbeing. If you try these tips and still have trouble controlling your anger, seek professional help.

Self-Help Tips for Anger:
  • Educate yourself about anger – although you can't necessarily control your feelings or the situation you are in, you can control how you respond
  • Pay attention to how anger feels in your body so you can learn to recognize the early warning signs and stop it from escalating
  • Try to identify the negative thought patterns that lead to anger, such as blaming others for your problems
  • If possible, limit exposure to situations that cause extreme anger, such as bad traffic
  • Exercise – a brisk walk or jog can let off a lot of steam
  • Practice relaxation or deep breathing techniques and use them when you start to tense up
  • Before speaking, count to 10; if you still feel out of control count to 10 again to allow your rational mind to catch up with your emotions
  • Develop an action plan for what you will do when you begin to feel anger
  • Avoid alcohol and other substances that can trigger anger
Both environmental and physiological factors contribute to the development of intermittent explosive disorder. People who have experienced emotional or physical trauma before aged 20 are at increased risk. Those with a close family member with intermittent explosive disorder are also more likely to develop the disorder themselves. There are two reasons for this. Children who grow up in a home where violence and anger are frequently expressed are more likely to have these same aggressive traits as adults. Additionally, genes likely also play a role. Research has also found some differences in the brains of people with intermittent explosive disorder. Age is another factor. Most people develop intermittent explosive disorder in late childhood or adolescence, and it rarely begins after age 40.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common childhood brain neurodevelopmental disorders, and can continue through adulthood. It shows up as a persistent pattern of inattention, hyperactivity, or impulsive behaviour. Symptoms of inattention include difficulty focusing on or completing a task. Hyperactivity describes behaviours such as difficulty sitting still and excessive talkativeness, and impulsivity refers to difficulty delaying gratification. ADHD always begins in childhood, but may not recognized or diagnosed until adulthood. To be diagnosed with ADHD, the person must have a number of ongoing symptoms that directly interfere with work, school, or social activities. Additionally, the symptoms must have started before age 12 and occur in multiple settings.

Predominantly Inattentive

People with this subtype of ADHD typically have trouble paying attention to detail and make careless mistakes at school or work. They may be absentminded and easily distracted and often have difficulty with organization or completing tasks.

Predominantly Hyperactive/Impulsive

Those with this subtype of ADHD are often fidgety and have a hard time sitting still. They can be very talkative and sometimes have a hard time waiting their turn; during conversations they will frequently interrupt others.

Combined Inattentive and Hyperactive/Impulsive

This subtype describes people who have both inattentive symptoms and hyperactive/impulsive symptoms.
ADHD is quite common. Globally, The global prevalence of ADHD is estimated to be about 5% of children have ADHD, and about 2.5% to 4.4% of adults. The discrepancy between the rates of children and adults is at least partly due to the fact that about 1/3 of children seem to grow out of their ADHD, or at least no longer have disabling symptoms as adults.
Treatment for adult ADHD should be comprehensive and include psychological, occupational, and behavioural advice and interventions. Often medication is the first line of treatment. Most other treatments for ADHD focus on behavioural changes to manage the symptoms better and improve functioning. Research shows there may be some advantage to using both medication and a psychological treatment in adults with ADHD. People with ADHD often feel inadequate and incompetent and this poor self-concept can persist even when symptoms have improved. Therapy can help people address low-self esteem and other issues caused by trying to cope with ADHD. In addition, while medication can be very effective in reducing symptoms, therapy can teach valuable life skills. Therapy for ADHD should be skill-based, where clients are taught adaptive strategies that they can practice in real situations. One evidence-based therapy used for ADHD is cognitive behavioural therapy (CBT).

Cognitive Behavioural Therapy (CBT)

CBT for ADHD is structured, relatively brief, and problem focused. Specific issues that are common in ADHD, such as emotional regulation and anger problems, are addressed. In general, CBT focused on challenged distorted thoughts and replacing them with healthier beliefs and behaviours. CBT has also been specifically adapted for ADHD to include education about prioritizing, learning to reward oneself, methods for avoiding distraction, among other things. The client practices these new strategies between sessions and discusses the results with the therapist.
When ADHD is untreated, it can profoundly affect a person's ability to function in multiple domains. People with ADHD are more likely to have problems with academic or occupational performance and be unemployed. Others may view them as lazy or irresponsible causing interpersonal conflict. The impulsive and hyperactive symptoms can alienate people with ADHD from their peers leading them to experience social rejection.

ADHD is also associated with other psychiatric disorders, including depression, bipolar disorder, anxiety disorders, and obsessive compulsive disorder, as well as learning disabilities, like dyslexia.

When people with ADHD have been trying to cope with their symptoms alone, they often feel frustrated and demoralized. Many blame themselves for being disorganized or unmotivated. Even if they have found some effective coping skills, they may have to work harder to achieve the same result than others.
The symptoms of ADHD can be divided in four categories that are further explored below. Additionally, other ADHD signs that do not neatly fit into those categories include marital conflict, trouble parenting consistently, and having a child who is diagnosed with ADHD.

Inattention:

  • Being easily distracted or frequently switching from one activity to another
  • Overlooking details
  • Trouble focusing on one thing
  • Getting bored with a task quickly unless it is very enjoyable
  • Difficulty completing school or work assignments on time
  • Frequently losing items
  • Poor organizational skills
  • Missing appointments or meetings
  • Daydreaming
  • Having a hard time processing information as quickly as others
  • Seeming like they are not listening when being spoken to

Hyperactivity:

  • Fidgeting
  • Being very talkative
  • Speaking too loudly
  • Moving constantly
  • Difficulty remaining quiet

Impulsivity:

  • Impatience or having a hard time waiting in lines
  • Acting without thinking about the consequences
  • Frequently interrupting others
  • Speeding or getting into car accidents
  • Overeating
  • Substance use or abuse
  • Problems with other addictions like shopping or gambling

Emotional Problems:

  • Trouble controlling anger
  • Feeling unmotivated
  • Sense of underachievement
  • Feeling frustrated and irritable
  • Mood swings
If you think you may have ADHD, you are probably feeling frustrating and overwhelmed. Luckily, there are many strategies that work well to help people with ADHD stay organized, a sample of which are listed below. If your symptoms continue to interfere with your life, seek professional support. Ideally, you should see a mental health professional that is experienced in diagnosing and treating ADHD. An experienced practitioner can clarify can assess you, provide education, help you with strategies to manage your ADHD, and treat other problems you me be experiencing. You can also find a support group near you by visiting: http://www.caddac.ca/cms/page.php?85.

ADHD Strategies:

  • Develop a daily routine, e.g. when specific household chores will be done
  • Choose specific spots for things that you lose often, like your keys or phone
  • Use technology to your advantage by using apps, such as a calendar and a to-do list, to help you stay organized
  • Lists are your friend – make lists to keep track of what you need to do each day; you can also use a daily planner or app
  • Avoid procrastinating – if a task can be completed in just a few minutes, do it immediately
  • Deal with your mail daily so it doesn't build up
  • Wear a watch so you can keep track of the time and time activities
  • Give yourself more time then you need and plan to be early
  • Prioritize tasks by doing the most important one first
  • Use colour-coding
  • Exercise vigorously every day, eat a balanced diet, and make sure you get enough sleep
Most people develop ADHD by age seven. Although some people are not diagnosed until they are adults, if they reflect back, they can usually trace the symptoms to childhood. Boys are twice as likely to be diagnosed with ADHD as girls, although the gender gap diminishes with age; about three men are diagnosed with ADHD for every two women.

Having a close family member with ADHD increases the chance that you have the disorder.

Finally, injury to the brain in utero or in an infant can increase a person's risk of developing ADHD. These include fetal alcohol syndrome and hypoxia, or lack of oxygen, at birth.

Bipolar Disorder

Bipolar disorder, also known as manic-depressive disorder, is a medical condition in which people have extreme mood swings. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are more distinct and enduring, and often are severe. Such moods may have nothing to do with life events or bad news. These mood swings affect thoughts, feelings, physical health, behaviour, and functioning. Bipolar disorder is no one's fault. It does not come from a weak or unstable personality. It is a medical disorder that can be treated.

Mood instability

Bipolar disorder typically consists of three states: a high state, called "mania"; a low state, called "depression"; and a well state, during which many people feel normal and balanced, and function well. The periods of high and low are called episodes of mania and depression. Symptoms of mania and depression may occur together in what is called a mixed episode. Between episodes, most people are free of symptoms. People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain a normal and balanced mood.

Manic Episode

In a manic episode, the person has an elated or irritable mood and at least three of the following symptoms every day for a week, to the point where the person has trouble functioning in a normal way: 1) less need for sleep, 2) rapid talking, 3) racing thoughts, 4) easily distracted, 5) inflated feeling of power and self-esteem, and 6) reckless activities without concern about bad consequences. In severe cases, the person may experience psychotic symptoms, like hallucinations (hearing or seeing things that are not there) or delusions (firmly held beliefs that are not based in reality). A hypomanic episode is a milder and less severe form of a manic episode, but may still be disruptive. People may feel happy and have lots of energy, but do not usually get into serious trouble. Hypomania may progress to a full-blown manic episode or a major depression, and therefore needs treatment.

Depressive Episode

In a full-blown major depressive episode, the person must have a depressed mood or inability to experience pleasure, and at least four of the following symptoms for at least two weeks: 1) trouble sleeping or sleeping too much, 2) loss of appetite or eating too much, 3) problems concentrating or making decisions, 4) feeling slowed down or feeling too agitated to sit still, 5) feeling worthless or guilty or having very low self-esteem, 6) loss of energy or feeling tired all the time, 7) thoughts of suicide or death. These symptoms must be present almost daily, for most of the day, over a two week period. Severe depression may also include hallucinations and delusions.

Types of Bipolar Disorder

Some people experience manic or mixed, depressed and well states during their illness. Such people are said to have "Bipolar-I" disorder. People who have hypomania, depression, and intervals without symptoms, but no full-blown manic episode, are said to have "Bipolar-II" disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have "Rapid Cycling" bipolar disorder.
Bipolar disorder is characterized by manic periods that can last weeks and depressive periods that can last months. When someone is manic, heavy drug or alcohol use is common. Consequently, a person may be diagnosed as only having a substance abuse problem, when in fact they also have a mood disorder. It is also common for people experiencing a depression to not realize they had a manic episode earlier.

Manic Episode

In a manic episode, the person has an elated or irritable mood and at least three of the following symptoms every day for a week, to the point where the person has trouble functioning in a normal way: 1) less need for sleep, 2) rapid talking, 3) racing thoughts, 4) easily distracted, 5) inflated feeling of power and self-esteem, and 6) reckless activities without concern about bad consequences. In severe cases, the person may experience psychotic symptoms, like hallucinations (hearing or seeing things that are not there) or delusions (firmly held beliefs that are not based in reality). A hypomanic episode is a milder and less severe form of a manic episode, but may still be disruptive. People may feel happy and have lots of energy, but do not usually get into serious trouble. Hypomania may progress to a full-blown manic episode or a major depression, and therefore needs treatment.

Depressive Episode

In a full-blown major depressive episode, the person must have a depressed mood or inability to experience pleasure, and at least four of the following symptoms for at least two weeks: 1) trouble sleeping or sleeping too much, 2) loss of appetite or eating too much, 3) problems concentrating or making decisions, 4) feeling slowed down or feeling too agitated to sit still, 5) feeling worthless or guilty or having very low self-esteem, 6) loss of energy or feeling tired all the time, 7) thoughts of suicide or death. These symptoms must be present almost daily, for most of the day, over a two week period. Severe depression may also include hallucinations and delusions.

People who have hypomania, depression, and intervals without symptoms, but no full-blown manic episode, are said to have "Bipolar-II" disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have "Rapid Cycling" bipolar disorder.
Unfortunately, at this time there is no cure for bipolar disorder. Like chronic medical disorders, such as hypertension or diabetes, bipolar disorder can be effectively managed and controlled by combining a healthy lifestyle and treatments.

With proper treatment, most people with bipolar disorder can substantially stabilize their mood swings and related symptoms. Early treatment and careful management can eliminate episodes or significantly reduce the frequency, duration, and intensity of episodes.
There is no single proven cause of bipolar disorder. However, research suggests that various biological and genetic factors play an important role. This does not mean that a person has to inherit the genes, as the genes involved may be changed when a person is conceived. Biological differences are observed in patients with bipolar disorder. These differences include changes in neurotransmitters (brain communication chemicals), brain anatomy, and in the function of brain cells. Since none of these changes occur consistently in all individuals with bipolar disorder, no reliable lab or imaging test exists for bipolar disorder. However, the research findings do convincingly show that there are various biological problems with brain functioning during episodes of bipolar disorder.
There is no single proven cause of bipolar disorder and no hard evidence that it can be inherited. See previous question: What causes bipolar disorder?
About 1-2% of adults worldwide have bipolar disorder. Men and women are affected equally.

Bipolar disorder usually begins in adolescence or early adulthood, although it can sometimes begin as late as the 40s or 50s. The younger the person is, the less typical the symptoms may be. The symptoms may be mistaken for teenage distress or rebellion. Bipolar disorder is often not diagnosed until adulthood.
Many other mental disorders can resemble bipolar disorder, or co-exist with bipolar disorder. For instance, when someone is manic, heavy drug or alcohol use is common. Consequently, a person may be diagnosed as only having a substance abuse problem, when in fact they have a mood disorder too. It is also very common for people to experience a depression and not be asked (or not know) if they ever have had a hypomanic episode. Then they are diagnosed and treated as if they only had regular clinical depression, where the treatment with anti-depressants alone (without a mood stabilizer) may provoke an episode of mania.
Medications fall into three categories – mood stabilizers, anti-depressant medications, and anti-psychotic medications. Mood stabilizers provide relief from episodes of mania or depression or help prevent them from occurring.

One medication, Lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes. Mood stabilizing anti-convulsants, such as Carbamazepine and Valproate, are also useful especially in bipolar episodes that are difficult to treat.

Anti-depressant medications specifically treat the depressive episode. However, if given alone, anti-depressants can sometimes cause a major problem in bipolar disorder by pushing the mood up too high, causing hypomania or mania. Therefore, in bipolar disorder, anti-depressants are given together with a mood stabilizer.

Finally, anti-psychotic medications are used to treat psychotic symptoms. The newer anti-psychotic agents ("atypical anti-psychotics") are also being used to treat all phases of the illness, like mood stabilizers, even if no psychotic symptoms are present.

Manic Episode Treatment

The best way to initially treat a manic episode, especially an acute manic episode, is to combine a mood stabilizer with an anti-psychotic medication. The first line mood stabilizers are Lithium and Valproate, with Carbamazepine as a good back-up, are particularly effective in times of rapid emotional cycling. The first line anti-psychotics commonly used include Olanzapine, Risperidone, and Quetiapine. It is also common to prescribe other medications to help with poor sleep, anxiety, and restlessness. Such medications include benzodiazepines such as Clonazepam or Lorazepam, which are used on a short term basis only.

Depressive Episode Treatment

For severe depression, a mood stabilizer medication may need to be combined with an anti-depressant medication. Currently, there are over 40 anti-depressants available. Anti-depressants usually take several weeks to show effects. While waiting for the anti-depressant to work, it may be helpful to take a sedating medication to help relieve insomnia, anxiety, or agitation. If depression persists despite use of anti-depressants with a mood stabilizer, adding Lithium (if not already used) or changing the mood stabilizer might help. After a person recovers from the depression, the doctor will help decide whether to taper off the anti-depressant. Combinations of mood stabilizers can also be used for treating depression. Newer treatments for bipolar disorder include using Lamotrigine or atypical anti-psychotics such as Olanzapine and Quetiapine.

Recovery Treatment

Bipolar disorder is a highly recurrent illness. People are much more likely to stay well if they remain on medications rather than stop them. People with bipolar disorder are often tempted to stop taking their medication because the person feels fine or are bothered by the medication side-effects. Stopping the medication almost always results in relapse within weeks.

Treatment over the long-term depends on the severity of the illness. People with a mild single episode usually stay on medications for one to two years. For most people, longer-term treatments are recommended and in many cases treatment may be needed indefinitely.

Hospitalization

During severe episodes of depression or mania, a person may exhibit aggressive risk taking behaviours, fail to look after his/her basic needs, or become suicidal and homicidal. Hospitalization is needed if the person is a safety risk to self or others.
Psychotherapy helps relieve stress through discussion and expression of feelings. It also helps change negative attitudes, behaviours, and habits into more helpful patterns and healthier ways of living.

Psychotherapy is much more likely to be helpful for depression than mania, since patients in a manic phase often have trouble retaining what they learn. Psychotherapy can be individual, group, or family. The person who provides therapy may be the doctor or another clinician who works in partnership with the doctor.
Tell family members of the causes and treatments of bipolar disorder. If possible, family members can meet with the doctor to talk about the illness. Family members should be informed of the warning signs for how that person acts when he or she is getting manic or depressed. While the person is well, plan for how family members should respond when they see symptoms. Provide family members with educational pamphlets about bipolar disorder.
Depending on personal level of comfort, the person should try and discuss with friends the nature of the illness, its causes and treatments. It can be helpful for friends to recognize typical bipolar symptoms, as they can assist the person in seeking treatment if necessary.

Eating Disorders

An eating disorder is characterized by an abnormal pattern of eating behaviours that interferes with a person's health, relationships, or daily activities. Eating disorders generally involve two types of symptoms, not eating enough, and loss of control over eating. In addition to being preoccupied with food, people with eating disorders often obsess over their body weight or shape. There are three primary eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Anorexia Nervosa

People with anorexia nervosa restrict their food intake causing them to be significantly underweight. They also have either an intense fear of gaining weight or becoming fat, or will persistently avoid weight gain despite its necessity. Finally, those with anorexia nervosa will see themselves as larger than they are, deny the danger of low body weight, or place undue importance on their body weight or shape. Some people with anorexia maintain their low weight by primarily reducing their caloric intake while others engage in binge-eating or purging behaviors. They may purge through vomiting, laxatives, diuretics, or enemas.

Bulimia Nervosa

Individuals with bulimia nervosa experience recurrent episodes of binge-eating. Binge-eating is eating abnormally large amounts of food within a certain period, along with the feeling of being out of control over eating during the episode. People with bulimia nervosa also engage in unhealthy compensatory behaviours to try to counteract the binges and prevent weight gain. These may include vomiting, laxative use, fasting, or excessive exercise. Like individuals with anorexia nervosa, those with bulimia nervosa overemphasize the importance of weight or shape. However, people suffering from bulimia nervosa are not underweight; they are typically normal weight or overweight.

Binge-Eating Disorder

Like bulimia nervosa, binge-eating disorder is characterized by episodes of binge-eating. However, those with binge-eating disorder do have inappropriate compensatory purging behaviours. People with binge-eating disorder often eat more rapidly than is normal, eat until they are uncomfortably full, eat large amounts even when not hungry, eat alone out of shame for the amount they are eating, and feel disgusted, guilty, or depressed about how much they eat. Individuals with binge-eating disorder can be normal weight, overweight, or obese.
Yes, research shows that people can fully recover from eating disorders, and in fact, most people do recover partially or completely. For example, most people with anorexia nervosa recover within 5 years of initiating treatment. However, recovery can take years and often involves relapses. Early treatment improves one's likelihood of recovery, as does treatment by eating disorder specialists.

The primary component of eating disorder recovery is being rid of eating disorder thoughts and behaviours. Although vital, recovery is much more than just giving up eating disorder symptoms. Being recovered from an eating disorder includes maintaining a healthy weight, regular menstrual periods, eating a variety of foods, eliminating irrational fears about food, awareness of unrealistic cultural expectations of thinness, having satisfying and healthy reciprocal relationships with others, strong coping skills, and a strengthened sense of self.
Eating disorders are among the most dangerous of all psychiatric disorders; anorexia nervosa has the highest mortality rate of any mental illness. All eating disorders take a toll on the body. Anorexia nervosa can cause severe medical problems that lead to death, self-induced vomiting causes electrolyte imbalances that can result in heart problems and sudden death, and binge-eating disorder can have severe medical consequences related to being overweight. These are just some of the consequences of eating disorders.

Psychological:

  • Depression or intense mood swings
  • Slowed thinking
  • Trouble with memory and concentration
  • Weakness and fatigue
  • Insomnia
  • Anxiety

Physical:

  • Weakness and fatigue
  • Hair loss
  • Tooth decay, mouth sores, and gum disease
  • Bloating and constipation
  • Dizziness and fainting
  • Heart problems
  • Low or high blood pressure
  • Loss of or irregular menstrual periods
  • Osteoporosis or low bone density
  • Kidney problems
  • Swollen salivary glands
  • Elevated cholesterol
  • Ruptured stomach or esophagus
  • Acid reflux
  • Gallbladder disease
The most important first step in treating eating disorders is ensuring the individual is medically stable. The medical status of those with anorexia nervosa or bulimia nervosa must be regularly monitored by an experienced physician. Eating disorder treatment aims to normalize eating patterns and reduce eating disorder behaviours, as well as address the underlying issues. These are the problems that made someone susceptible to developing an eating disorder or perpetuate it. In individuals with anorexia nervosa, weight restoration is a major component of treatment. Most people with eating disorders can be treated as an outpatient or in a day treatment program; however, some individuals with severe anorexia nervosa or bulimia nervosa may require inpatient treatment. No matter the level of care, eating disorders typically respond best to a comprehensive treatment team, for example, a therapist, dietician, and physician. Ideally, all members of a treatment team should have experience with eating disorders and should be frequently communicating with one another. Some commonly used treatments for eating disorders are described below.

Individual and Group Therapy

Cognitive behavioural therapy, dialectical behaviour therapy, psychodynamic therapy, and interpersonal therapy are the best-researched types of therapy for eating disorders. These therapies can take place in an individual or group setting, and often eating disorder treatment includes both. Due to the complex and enduring nature of eating disorders, typically a minimum of one year of individual therapy is required.

Marriage & Family Therapy

This type of therapy can be useful when family problems are contributing to the eating disorder. It can also help the family or a partner better support the individual in recovery.

Nutritional Counselling

As eating disorder behaviours can be very dangerous, and reducing these behaviours central to recovery, nutritional counselling is an important component of treatment. A dietician can help you with normalizing weight, constructing a meal plan, specific strategies to target symptoms, and to develop a healthier relationship with your body and food.
Eating disorders are relatively rare. In their lifetime, 0.9% of women and 0.3% of men will suffer from anorexia nervosa. The lifetime prevalence of bulimia nervosa is 1.5% for women and 0.5% for men. Binge-eating disorder is the most common eating disorder; 3.5% of women and 2.0% of men will suffer from it at some point in their lives.
The signs of an eating disorder vary depending on what eating disorder a person is experiencing. These are some common warning signs.

Behavioural Signs:

  • Constant dieting
  • Rituals around food preparation and eating
  • Evidence of binge-eating or vomiting
  • Hiding or stockpiling food
  • Eating very slowly or rapidly
  • Avoiding eating around others
  • Compulsive body checking behaviours
  • Isolating from friends, particularly in situations with food
  • Wearing baggy clothes
  • Excessive exercising

Psychological Signs:

  • Fear of weight gain
  • Preoccupation with food, body shape, or weight
  • Poor body image
  • Increased sensitivity to comments around food intake, weight, or body
  • Anxiety around eating
  • Feeling out of control around food
  • Low mood, irritability, and low self-esteem

Physical Signs:

  • Rapid weight loss or frequent weight fluctuations
  • Loss of or changes in menstruation
  • Fainting, dizziness, or fatigue
  • Increased sensitivity to the cold
  • Puffy cheeks caused by vomiting
There is no single cause for eating disorders; rather, they are caused by a combination of biological, psychological, and cultural factors. There is some evidence to suggest that a person can have a genetic vulnerability to developing an eating disorder. Individuals with a family member with an eating disorder are 7-12 times more likely to develop one themselves. It does not appear to be a single gene but rather a complex interaction between many genes. Some of the genes that seem to be linked to eating disorders are specific personality traits such as perfectionism, obsessive thinking and impulsivity. Additionally, the eating disorder symptoms themselves cause changes in the brain that perpetuate the eating disorder. Research has demonstrated that even in healthy people, a semi-starvation diet causes anxiety, depression, and obsessive thinking and behaviour around food that promote further starvation. These symptoms only abate after a period of weight restoration and normalized eating.

Psychological factors such as depression, low self-esteem, feeling ineffective, being unaware of one's emotional state, and having a difficult time tolerating negative feelings also contribute to the development of eating disorders. The eating disorder symptoms are often used as a method for coping with difficult feelings.

Social and cultural factors, such as idealized pictures of thinness in magazines and movies, contribute to the preoccupation with body image and weight that characterize eating disorders. Those that internalize the messages than a thin body is ideal are more likely to be dissatisfied with their bodies and to develop an eating disorder. Most eating disorders begin with a diet. In North America, there is a strong pressure, particularly on women, to diet and maintain a thin body. Research shows that the vast majority of diets are ineffective and may sometimes be dangerous. Even being exposed to a friend's diet may be linked to developing an eating disorder. Being overly concerned with one's weight also increases eating disorder risk.
If someone you love has an eating disorder, it can be very frightening and frustrating, particularly because the solution seems so simple. But eating disorders are about much more than food and weight. The eating disorder symptoms help people cope with difficult emotions and these underlying issues need to be addressed alongside the behaviours. If you suspect your friend or family member has an eating disorder, approach them in a loving, supportive, and non-confrontational manner. He or she may deny it or become defensive; it can take time before the person admits to having a problem. If the person is an adult, you cannot usually force them into treatment. If you think your child has an eating disorder, seek professional help right away. As for an adult with an eating disorder, make it clear that you are there for them when they are ready to seek help. Be supportive and encourage them to seek treatment and to see a medical doctor. You should educate yourself on eating disorders so you can better understand the signs and how to be supportive. Caring for someone with an eating disorder is extremely stressful. Make sure you take care of yourself too; don't neglect your own needs out of concern for a loved one. You may want to try to find a support groups for friends and family members of people with eating disorders in your area. For more information on how to support someone, look at our Resources page.

How to Approach People with Eating Disorders:

  • Share your feelings and concern for them rather than focusing on food
  • Talk about how it impacts your relationship
  • Tell them you are worried about their health and well-being
  • Don't comment on their appearance as people with eating disorders are overly aware of their bodies
  • Avoid power struggles over food
  • Do not shame, blame or guilt them
  • Offer to support them in ways that will be useful to their recover, e.g. having meals together
It can be hard to admit that you may have a problem. If you think you may have anorexia nervosa or bulimia nervosa, seek help immediately. You may be medically compromised and need to be examined by a physician who is experienced in eating disorders. Find a friend or family member than you trust and tell them about your eating disorder. This person can help you find appropriate treatment and support you through the recovery process. It is important to get treatment for your eating disorder, as early intervention increases the likelihood of a good outcome. You can find an eating disorder specialist your area by asking your family doctor for a referral or by using the National Eating Disorder Collaboration's service provider search. An eating disorder professional can assess you and guide you toward appropriate treatment options. Treatment for eating disorders usually requires support from a few different health professionals that work together as a team, like a psychiatrist, therapist, and dietician. Most people with eating disorders can get help as an outpatient or day patient. If you are very underweight or have severe bulimic symptoms, you may initially require inpatient treatment. Even if your symptoms are mild, if they are causing you distress you would likely benefit from individual therapy. Some people find eating disorder supports groups a useful adjunct to treatment, but they do not replace therapy.

Some techniques you can do on you own to help your recovery include not weighing yourself, getting rid of clothes that are too small and only wearing clothing you feel comfortable in, stop any dieting, stick to a meal plan, challenge your eating rules, and try to replace your negative thoughts about yourself with some healthier, more realistic ones.
Although anyone can develop an eating disorder, some are at greater risk than others. Women are more likely to have an eating disorder than men. Age also plays a role. Eating disorders typically begin in adolescence or early adulthood so this age group is most at risk. Both male and female elite athletes face an increased eating disorder risk. The same is true for athletes competing within a weight class and for female athletes that compete in a sport where aesthetics are important, such as gymnastics or figure skating. Another risk factor for eating disorders is extreme diets. About 20-30% of extreme dieters develop full-blown eating disorders. Dieting causes physiological changes in the body that may trigger eating disorders. Those with a close family member with an eating disorder are also more vulnerable to developing one themselves.

Generalized Anxiety Disorder (GAD)

Among the variety of symptoms of General Anxiety Disorder, the most prevalent one is excessive worry and anxiety about events or activities, such as concerns at work or performance at school. If the worrying develops into anxiety attacks that occur more days than not over a period of more than six months, then a General Anxiety Disorder has developed that requires treatment.

In addition to the worry and anxiety, a person suffering from GAD will typically experience at least three of the following six symptoms:
  • Restlessness or feeling "keyed up" or "on edge"
  • Fatigue and feeling easily run down
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep or unsatisfying sleep).

It is very common for those with GAD to also experience feelings of sadness and depression. Fortunately, many treatments that are effective for GAD also work to alleviate depression.
Worry is a normal occurrence when there is uncertainty about how to cope with a possible event. Recent popular self-help books suggest some stress and anxiety helps us meet our goals. Most people that are worried or anxious, work on a solution to the problem and the anxiety subsides. Normal worry may be uncontrollable, but it is manageable if the problem that causes the worry is talked about or thought over and solved. Even if the solution is unsatisfactory, reduction in uncertainty of what to do if the event occurs, usually reduces the level of anxiety and worry.

GAD worry is uncontrollable, excessive, and may not be linked to specific events or occurrences. It may be about many aspects of life such as health, money and the safety of family members. The worry continues even though there is no evidence of any threat. Some people with GAD worry that they will lose their jobs and become destitute even though all the feedback they get is that they are doing a good job. In effect, the person exaggerates the fear and refuses to accept possible solutions. GAD worry is intense; it lasts for hours each day and cannot be turned off. It interferes in normal pleasurable activity and causes sufferers to be very distracted.
The physical treatment of GAD is usually a two-step process, starting with anti-anxiety medication for short term relief from anxiety attacks, followed by anti-depressant medication over the long term.

Anti-anxiety medications tend to be fast acting but have a short term effect. Benzodiazepine tranquillizers like Alprazolam (Xanax), Diazepam (Valium), and Lorazepam (Ativan) can relieve anxiety within minutes, but last for only a few hours. These drugs can also produce a dependency if taken for more than two or three weeks.

Anti-depressant medication has longer term benefits in reducing or eliminating the symptoms of anxiety, but typically take two or three weeks to make a noticeable effect. Anti-depressants like Venlafaxine extended-release (Effexor XR), Paroxetine (Paxil), Imipramine (Tofranil) or Citalopram (Celexa) can relieve the symptoms of anxiety, and should be taken for months after the symptoms subside to prevent a relapse while the person gradually learns to cope with the causes of the anxiety.
The most effective psychological therapies are Cognitive Behavioral Therapy and Interpersonal Therapy.

Interpersonal Psychotherapy investigates the ways in which problems with relationships (role disputes, role transitions, unresolved grief and social deficits) can have a profound impact on mood and functioning.

Cognitive Behavioural Therapy relies on evidence that depressed and anxious people think differently than well-adjusted people.

Cognitive Behavioural Therapy is based on the scientific fact that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. By changing the way we think, we can feel and act better even if the situation does not change. Learning new, more rational ways of reacting to situations leads to long term positive results.

Major Depressive Disorder (Depression)

Sometimes, the word depression is used to describe the normal lows that are common experiences. However, clinical depression, such as major depressive disorder (MDD), is a serious mental illness that can affect every aspect of a person's life. The main symptom of MDD is either persistent low mood or loss of interest or pleasure in most activities. Additionally, someone with MDD also experiences other symptoms such as appetite changes, changes in amount of sleep, fatigue, and trouble concentrating.
Depression usually refers to major depressive disorder (MDD), which is described above. There are different types of MDD, including: postpartum depression, depression with a seasonal pattern (usually fall or winter), and depression with psychotic features. Some people have a less severe but long-term type of depression called persistent depressive disorder or dysthymia. Depression can also be part of bipolar disorder, where in addition to experiencing periods of low mood, the person also has times where they feel high or euphoric.
Depression is a common mental illness. In any given year, about 5% of Canadians meet criteria for major depressive disorder. Furthermore, about 1 in 9 Canadians will experience depression at some point in their lives. Women have higher rates of depression; about twice as many women suffer from depression than men.
Depression is a treatable illness. Many forms of therapy have been shown to be effective in treating depression. These include cognitive behavioural therapy (CBT), interpersonal therapy (IPT), mindfulness-based cognitive therapy (MBCT), psychodynamic therapy, and problem-solving therapy.

Cognitive Behavioural Therapy

CBT is one of the most common and well-researched treatments for depression. The guiding philosophy of CBT for depression is that a person's negative thoughts are directly related to their low mood. Treatment focuses on challenging these unhealthy thoughts, evaluating how valid they are, and replacing them with healthier, more positive thoughts. CBT treatment also targets specific behaviours to help a person overcome depression.

Interpersonal Therapy

IPT is a short-term therapy that addresses interpersonal issues, such as marital conflict or grief, which contribute to depression. In IPT, the client learns how to address these issues in a healthier way and improve relationships.

Mindfulness-Based Cognitive Therapy

MBCT seems to be particularly helpful in people who have had repeated episodes of depression. This treatment combines traditional cognitive therapy, which focuses on thoughts, with principles of mindfulness, such as being present in the moment in a non-judgemental way.
Depression is caused by a combination of biological and environmental factors. Biological factors include hormonal changes, such as giving birth or menopause, which can cause depression in women. There is a genetic component to depression, with close family members of individuals with major depressive disorder having 2 to 4 times the risk of developing it themselves. Some of the genes involved with depression are related to neuroticism, which is the tendency to be in a negative mood state such as depression or anxiety. Having this personality trait is a major risk factor for depression. Although a person can be genetically prone to depression, certain external factors can trigger it. Experiencing trauma as a childhood is a significant risk factor, as are upsetting life events, such as the loss of a family member, marital problems, or financial difficulties.
The symptoms of depression can be categorized as follows:

Emotional

  • Feeling sad or down
  • Feeling empty or hopeless
  • Loss of interest in hobbies or previously pleasurable activities
  • Being tearful
  • Feeling guilt, worthlessness or helplessness
  • Anger or irritability
  • Thoughts of death or suicide

Physical

  • Sleeping a lot more or less than usual
  • Fatigue or loss of energy
  • Weight gain or loss
  • Body aches and pains
  • Slowed speech or body movements

Behavioural

  • Physical agitation or trouble sitting still
  • Isolating from family or friends
  • Eating much less or much more than usual

Cognitive

  • Difficulty concentrating
  • Indecisiveness
  • Memory problems
  • Negative thinking
The evidence is clear that when a person is depressed, support by others can make a huge difference. For more information, visit our page on Helping Others.

If someone close to you is depressed, it is likely impacting you. You may feel frustrated, angry, guilty, or helpless. Although it is not up to you to cure this person's depression, you can take steps to help your friend or family member. First, educate yourself on the signs, symptoms, and treatment of depression. Approach the person with your concerns in a loving and non-judgemental manner and try to listen rather than give advice. Encourage your friend or family member to seek treatment and offer to help him or her take this important step. You can also support your friend to get out more or by exercising together. If you are concerned for your loved one's life immediate safety, connect your friend to the resources available to them, be it a 24/7 hotline or counseling, so that they have an option for immediate help from a professional. Caring for someone with depression can be very difficult, make sure you get support too and don't neglect your own needs. Consider joining a support group for family members of people with depression.
If you are suffering with depression, you need to take action to help yourself but this can be especially difficult as depression causes low motivation and fatigue. Even though the behaviours that will help you the most will be hard to do, they are not impossible. If your depression is significantly interfering with your life or you are having thoughts of death or suicide, seek professional help. Your family doctor can be a good place to start.

Reach Out: Even if you seek professional help, there are things you can do to help yourself. Start with small achievable goals, like calling one friend. The first step is often to reach out to a close friend or family member about your depression. Just having someone listen can be helpful and it's important to have someone to support you. Depression often causes individuals to isolate from family and friends and social support is a vital component of recovery. Try to be social even if you don't feel like it. Being alone all the time will only contribute to your depression. Joining a local depression support group can help you feel less isolated.

Exercise alone can significantly help people with depression. Aim to exercise at least 30 minutes a day but start with small manageable goals, like a short walk around the block. Pair up with an exercise buddy to get both the benefits of social support and physical activity. Yoga, walking, swimming, or dancing are all good choices.

Some other tips:
  • Try to get about 8 hours of sleep, both too much and too little sleep can contribute to depression
  • Eat a balanced diet
  • Avoid drugs or alcohol
  • Practice relaxation techniques
  • Push yourself to do things you used to enjoy
  • Try to get a little sunlight every day
  • Educate yourself on depression
  • Know when to seek professional help – if your depression doesn't improve, get help

If you feel you are in immediate danger of harming yourself, call 911, 1-800-SUICIDE (1-800-784-2433), or go to your local emergency room.
There are many risk factors for depression, including:
  • Having family members with depression or who committed suicide
  • Stressful life events
  • Childhood trauma or abuse
  • Lack of social support
  • Having a serious illness
  • Abusing drugs or alcohol
  • Certain medications
  • Having recently given birth
  • Having another mental health problem, such as an anxiety disorder

Obsessive Compulsive Disorder (OCD)

As the name Obsessive Compulsive Disorder suggests, there are two important symptoms that constitute the disorder: an obsession over unwanted thoughts and a compulsion to repeat actions or words. The obsessive (i.e. excessive, intrusive and unwanted) thoughts or images cause a great deal of anxiety. The thoughts or images may focus on harm coming to a loved one, or the possibility of getting a serious illness or of doing something socially inappropriate such as shouting blasphemy in public.

The compulsive (i.e. virtually uncontrollable urges) actions usually consist of repeated physical activities, such as frequent washing, repeated counting of items or checking the work of others. The compulsions are a reaction that helps control the anxiety caused by the obsessive thoughts.

People with OCD often avoid feared situations that trigger unwanted thoughts and actions. This can limit their activities a great deal. The symptoms usually cause significant distress and impairment and can make it very difficult for people to complete school or develop a career.

Often, people with OCD experience bouts of sadness and depression. Fortunately, many treatments that are effective for OCD also alleviate depression.
Obsessive Compulsive Disorder affects over 4% of the population at different points in their lives. One third of afflicted adults had their first symptoms in childhood, and more boys are afflicted in childhood than girls. Females are more likely to have their first symptoms in adolescence and early adulthood.
At times we all get a tune or a phrase stuck in our thoughts. This can be irritating but eventually the thought goes away. In OCD the thoughts and images can persist for hours each day, may be quite repugnant, and can cause significant anxiety. The thoughts may involve violence to others or distasteful sexual images or frightening images. Some evidence suggests that becoming frightened by unwanted thoughts can lead to them recurring.
Obsessive Compulsive Disorder is typically treated with anti-depressant medication. Studies indicate that selective serotonin reuptake inhibitor (SSRI) drugs are the most effective anti-depressants for treating OCD. SSRI drugs include Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), Fluvoxamine (Luvox) and Fluoxetine (Prozac). SSRIs are often combined with Venlafaxine (Effexor) as the first line of medication treatment. These medications have to be taken consistently for at least six to eight weeks to produce a noticeable reduction of symptoms.

Alternatively, chronic case treatment may begin with Benzodiazepines (BZs) such as Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan) or Clonazepam (Rivotril) to quickly reduce the effects of anxiety attacks. Benzodiazepines are fast-acting but are also addictive and should not be taken daily for longer than 2-3 weeks. The SSRIs are much longer lasting, have a more moderate effect in reducing the anxiety associated with OCD, and by relieving depression provide a better frame of mind for the person to overcome the feelings of OCD.
Obsessive Compulsive Disorder can be effectively treated with psychotherapy. Studies indicate Cognitive Behavioral Therapy (CBT) is the most effective psychotherapy. CBT assesses the person's specific fears, and discusses coping mechanisms and beliefs so that the person can do the things they fear without the anxiety that triggers their compulsive actions. CBT is also referred to as Exposure and Response Prevention Therapy (ERP). CBT / ERP typically involves 16 to 20 weekly sessions, either in an individual or group setting.

Panic Disorder

There are a number of symptoms that are commonly found in Panic Disorder. The most important symptom is the onset of unexpected panic attacks. Some of the attacks come completely out of the blue and may even occur during sleep. Attacks may repeat when a person is in a similar situation or in specific places.

The attacks can be quite severe with rapid heart pounding, breathlessness, dizziness, fear of having a bowel movement, clammy hands and fear of loss of control. People may fear that they are about to collapse and die.

Panic Disorder can lead to agoraphobia – the fear of public places – in order to avoid the circumstances or places that can lead to panic attacks. In very severe cases the avoidance may lead to the person becoming housebound and unable to go anywhere unaccompanied.

Panic Disorder is also associated with at least four of the following symptoms:
  • Restlessness or feeling "keyed up" or "on edge"
  • Fatigue and being easily rundown
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep, or unsatisfying sleep).

Panic Disorder is so debilitating that it often leads to depression. Fortunately, many of the treatments that are effective for Panic Disorder also work to alleviate depression as well.
Panic Disorder affects 1.7% of the population and is often connected with major life transitions such as changing jobs, divorce, etc. It is usually accompanied by major depression.
For most people who experience a panic attack the experience can be quite frightening but it is often understood as being due to stress or tiredness. For most panic attacks, there is no expectation that another attack might occur without cause.

To be diagnosed with Panic Disorder, the attacks must come out of the blue on at least one occasion, and must be accompanied by at least four physical anxiety symptoms, followed by either continuing attacks or the intense fear that they might come back. The use of avoidance of feared situations to control anxiety can limit activity a great deal. The anxiety must cause significant distress and impairment in the usual roles at home, work or school.
Occasional panic attacks do not usually need to be treated with medication. Sometimes the attacks are very infrequent but can be predicted to occur in stressful situations such as flying. Medications can be used for this type of panic on an "as needed" basis. Usually a single dose of a tranquillizer such as Lorazepam or Clonazepam can be taken 30 minutes before the event that is feared. Care has to be taken not to allow the infrequent use to develop into unintended regular use.

Panic disorder is most frequently treated with an anti-depressant. Selective serotonin reuptake inhibitor (SSRI) drugs such as Paroxetine (Paxil), Sertraline (Zoloft) and Citalopram (Celexa) are the most effective in treating Panic Disorder. The SSRIs together with Venlafaxine (Effexor) are the usual first line of medication treatment. These drugs have to be taken consistently for at least two to three weeks to produce a noticeable reduction of symptoms. Older anti-depressants, particularly the tricyclic agents Imipramine (Tofranil) and Clomipramine (Anafranil), are also effective anti-panic medications.

In acute cases, the panic can be immediately reduced with Benzodiazepines (BZs) such as Alprazolam (Xanax), Diazepam (Valium), and Lorazepam (Ativan). The BZs are relatively fast-acting but addictive and should not be taken for more than 2-3 weeks.
The most effective psychological therapies are Cognitive Behavioral Therapy and Interpersonal Therapy.

Interpersonal Psychotherapy investigates the ways in which problems with relationships (role disputes, role transitions, unresolved grief and social deficits) can have a profound impact on mood and functioning.

Cognitive Behavioural Therapy relies on evidence that depressed and anxious people think differently than well-adjusted people.

Cognitive Behavioural Therapy is based on the scientific fact that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. By changing the way we think, we can feel and act better even if the situation does not change. Learning new, more rational ways of reacting to situations leads to long term positive results.

Post-Traumatic Stress Disorder (PTSD)

The symptoms of PTSD usually begin within a month after a traumatic event. On rare occasions, symptoms may not appear for months or years. Three typical symptoms include: 1) re-experiencing the traumatic event, 2) avoiding places or circumstances similar to the event or becoming mentally numb to similar events, and 3) becoming persistently aroused because of thoughts of the event.

Re-experiences can take the form of intense images or thoughts or flashbacks (intense visual images) or nightmares of the traumatic event. Re-experiences can occur day or night and can be triggered by any reminder, e.g. TV or print images. Characteristically, intense emotional and physical distress accompanies a re-experience. It resembles a panic attack.

Avoidance and numbing include the urge to stay away physically and psychologically from the trauma scene and from any reminders of the event. At times the avoidance blocks out memory of significant parts of the traumatic event (but rarely blots out the entire trauma). Numbing is characterized by feelings of detachment. Often people experiencing PTSD believe they do not have long to live.

The symptoms of excessive arousal include severe anxiety, disturbed sleep, irritability, poor concentration, being on edge and jumpy.

It is also very common for people with PTSD to experience feelings of sadness and depression. Fortunately, many treatments that are effective for PTSD also work to alleviate depression.
The nature of PTSD is the symptoms can disappear and reappear for no apparent reason. Studies indicate certain rules of thumb in the likelihood of recovery from PTSD:
  • Those who remain ill beyond one year are less likely to recover completely
  • Severity of sleep disturbance
  • Chronic pain may slow recovery, complicate care and increase the risk of adverse side effects from medications.
PTSD is not inherited. By definition, a "traumatic experience" is required for PTSD to develop. However some forms of vulnerability are inherited. People with a history of prior psychiatric illness or a psychiatric family history may be more vulnerable.
The lifetime prevalence of PTSD is found in 1% of men and 2% of women. Amongst people who have experienced a traumatic event such as war, rape or child molestation, roughly 8% of men and 20% of women develop PTSD.
Most people will experience one or more traumatic events during their lives. The most common civilian traumas are assaults and frightening accidents. Military personnel may experience PTSD during combat.

Most people experience acute stress after a significant trauma. In most cases the feelings pass as the person receives support from friends and with the passage of time. People prone to anxiety and depression and those closest to the trauma, are most likely to develop PTSD.

PTSD differs from normal stress because the trauma overwhelms the victim. It also differs from normal stress in regards to the severity of symptoms. Panic anxiety is common. Stress intolerance and nightmares are the rule. PTSD is diagnosed when symptoms disrupt normal functioning.

PTSD likely has a physiological basis that goes beyond normal stress. In chronic PTSD, structural brain abnormalities may occur such as reduced hippocampal volume. Changes in brain activation have also been observed. It is not yet clear if these changes represent abnormalities characteristic for PTSD or if they suggest a physiological vulnerability to PTSD.

A majority of PTSD sufferers experience concurrent psychiatric disorders such as depression and excessive alcohol use.
Panic attacks include many symptoms that resemble PTSD, in particular hyper-arousal and excessive fear. However, the main fear during a panic attack is that of impending incapacitation by anxiety, while the main fear for people suffering from PTSD is that another traumatic event may occur.

Preoccupation with a loss, distressing dreams and moodiness are common in grief. Grief can reach abnormal proportion in cases of a pathological grief reaction and turn into depression.
The evidence is clear that when a person is depressed, support by others can make a huge difference. For more information, visit our page on Helping Others.

Three pre-disposing risk factors for PTSD are:
  • A history of prior psychiatric illness
  • A family history of psychiatric illness
  • A history of childhood trauma.
In the acute phase of PTSD the stress may be relieved initially by a brief use of anti-anxiety medication such as the Benzodiazepines (BZs) (e.g. Alprazolam (Xanax), Diazepam (Valium), or Lorazepam (Ativan). BZs are fast-acting but are also addictive and should not be taken daily for more than 2-3 weeks. BZs alone are not effective for long term treatment.

In the mid-term, PTSD is typically treated with an anti-depressant. Several studies have shown that selective serotonin reuptake inhibitor (SSRI) medication is effective in relieving PTSD. Examples include Paroxetine (Paxil), Sertraline (Zoloft) and Citalopram (Celexa) and can be augmented with non-SSRI Venflaxamine (Effexor). It usually takes 2-3 weeks for the effects of an anti-depressant to become noticeable.
Psychotherapy can be an effective treatment for PTSD, either in an individual or group setting. Amongst the various psychotherapies, Cognitive Behaviour Therapy (CBT) offers the greatest benefit. CBT involves a detailed assessment of the specific fears, coping mechanisms and beliefs about social situations. A course of CBT typically requires 16 to 20 weekly sessions.

Facing fears through imaginary and direct (in vivo) exposure is an important part of CBT. Equally important is the development of coping strategies, e.g. developing a renewed sense of security through various practical measures.

A more recent treatment, Eye Movement Desensitization and Reprocessing (EMDR) has found limited acceptance.

Routine debriefing after a traumatic event is not necessarily helpful. Recent research suggests that it may focus on the trauma and interfere with moving on.

However, for people clearly suffering from PTSD, psychotherapy is often the best first step in treatment, followed by medication if necessary. Switching medication is recommended whenever treatment response is poor or side-effects are intolerable.

Sleep Disorder (Insomnia)

Insomnia refers to trouble with the duration or quality of sleep. This may include problems falling asleep, difficulty staying asleep or waking up too early in the morning and being unable to fall back asleep. Insomnia can also include nonrestorative sleep, meaning sleep that may be long enough in duration but does not result in the individual feeling rested upon awakening.
While insomnia is difficult on its own, it can cause physical and psychological problems. Possible consequences of insomnia include daytime fatigue and low energy, problems with attention and memory, as well as low mood, anxiety, and irritability. These symptoms are often the primary reason people seek help for insomnia, and can sometimes be dangerous. For example, inattention or sleepiness caused by insomnia can lead to traffic or work accidents. Disrupted sleep can also provoke or prolong problems with mood disorders, like depression or bipolar disorder.
  • Don't eat for at least 2-3 hours before bedtime
  • Avoid caffeine, alcohol, and smoking before bedtime
  • Get regular exercise but don't exercise before bedtime
  • Establish a regular routine for when you wake up and go to bed, even on weekends
  • Create a relaxing bedtime routine that allows you to wind down, like listening to soothing music or taking a hot bath, and start this routine at least an hour before you expect to be asleep
  • Ensure your bedroom is dark, quiet, and comfortable
  • Sleep on a comfortable mattress
  • Only use your bed for sleeping and sex – definitely do not watch tv or use your computer in bed
  • Do not bring your smartphone into bed
  • Make sleep a priority
Symptoms of insomnia are very common. About one third of adults have some symptoms of insomnia and about 10% of adults meet criteria for a clinical diagnosis of insomnia. Women are about 1.5 times more likely to have insomnia than men. Having another mental health problem increases your risk for insomnia; about half of people with insomnia have another psychological disorder. Additionally, having a close family member with insomnia, like a parent or a sibling, increases your risk. Insomnia symptoms vary among age groups. Middle-aged and older adults are more likely to experience insomnia, partly due to health problems associated with aging. Younger adults are more likely to experience difficulties with falling asleep, while middle-aged and older individuals tend to have a hard time staying asleep.
The recommended treatments for insomnia are psychological and behavioural techniques. These include cognitive behavioural therapy (CBT), relaxation training, stimulus control, and sleep restriction. You can learn some of these techniques yourself, while others are better done with a sleep specialist or a therapist.

Cognitive Behavioural Therapy (CBT)

The goals of CBT for insomnia include challenging unhealthy beliefs regarding sleep, replacing these with more positive, rational thoughts, and changing behaviours to improve sleep habits. Research supports the use of CBT for insomnia.

Relaxation Training

Relaxation training, also known as progressive muscle relaxation, teaches you how to relax your body by systematically tensing and release various muscle groups. Other relaxation techniques may also be used, such as mindfulness, meditation, or deep breathing. Relaxation can help you fall asleep and return to sleep if you wake up during the night.

Stimulus Control

Many people with insomnia have poor sleep habits that contribute to prolonging or worsening the problem. These include watching the clock, spending a lot of time in bed without sleeping, and worrying about not getting enough sleep. These thoughts and behaviours cause people with insomnia to associate their beds with feelings of frustration and wakefulness. Stimulus control can help you break this association by, for example, only going to bed when you are sleepy and not staying in bed awake longer than 20 minutes.

Sleep Restriction

Sleep restriction is a behavioural treatment that aims to improve the quality of your sleep by following a strict bedtime and wake time and not staying in bed while awake.
Insomnia may be situational, chronic, or episodic. Situational insomnia is short-term, typically caused by a change in sleep schedule or a stressful life event. This acute insomnia usually improves once the situation goes away. If the insomnia lasts long after the triggering event, it is considered persistent or chronic. The elements that first caused the insomnia may be very different from those that maintain it. Even those with chronic insomnia may have some nights where they sleep well. Individuals with episodic insomnia have normal sleep interspersed with recurrent episodes of sleep problems, typically following life stressors.
Research suggests that adults need about 7 to 8 hours of sleep. However, sleep needs vary greatly depending on age, health, and lifestyle. Sleep needs also differ between individuals based on the amount of sleep they normally need to feel rested and their sleep debt. Sleep debt is the difference between how much sleep you are getting and how much sleep you actually need. If you are getting less sleep then your body needs, the effects of this sleep deprivation accumulate over time. So even if you are getting your sleep needs met a few nights in a row, you may have a previously accumulated sleep debt that leaves you feeling tired during the day. Research suggests that a sleep debt can be "paid off" by getting extra sleep.

If you catch yourself falling asleep during the day, or need caffeine to stay awake, you may not be getting enough sleep. Keeping a sleep diary (such as, http://sleepfoundation.org/sleep-diary/SleepDiaryv6.pdf) can be useful in determining your sleep patterns and whether you are getting enough sleep. Another strategy you can use is to take a "sleep vacation" when you have a couple of weeks where you are not working or your time is flexible. Choose a consistent bedtime and allow yourself to wake up naturally. Initially, you will likely be paying off your sleep debt and will sleep longer than your typical need. As you continue to go to bed at the same time, you will establish a regular sleeping pattern that will likely be between 7 to 9 hours per night. This amount is how much sleep you typically need.
Insomnia may be caused by psychological disorders, medical conditions, substances, poor sleep habits, or specific biological factors. Depression, bipolar disorder, and anxiety disorders frequently cause insomnia. Some medical causes include chronic pain, hyperthyroidism, and acid reflux. Eating patterns such as consuming substances like alcohol, nicotine, or caffeine or eating a heavy meal before bedtime can lead to insomnia. Insomnia may also be caused by lifestyle factors, such as working late, using a computer before bedtime, sleeping in or napping in the afternoon, or working shifts. Sometimes, one or more of these factors will trigger acute an acute insomnia episode, causing a person to worry about being able to sleep. These fears can worsen that insomnia and cause a vicious cycle, turning a short-term insomnia episode into a chronic problem. Finally, some people may be more biologically prone to insomnia due to genetics and/or their brains' sleep-wake cycle.
Sleep problems are very common. To get a clinical diagnosis of insomnia, the symptoms must be present at least 3 nights per week and have a significant negative impact on a person's functioning during the day. Even if symptoms are not severe enough to meet criteria for insomnia, it may still be useful to treat them.

Social Anxiety Disorder (SAD)

Of the several symptoms commonly found in SAD, the most important symptom is excessive anxiety and worry about being evaluated by other people in a critical way. These fears may relate to a few situations such as public speaking, or can extend to most circumstances where the person could be observed. The latter is referred to as Generalized Social Anxiety Disorder. The two forms of the disorder are also referred to as Social Phobia.

In addition to anxiety and worry, people suffering from SAD experience at least three of the following six symptoms:
  • Restlessness or feeling "keyed up" or "on edge"
  • Fatigue or feeling rundown
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep or unsatisfying sleep)

It is very common for those with SAD to also experience feelings of sadness and depression. Fortunately, many treatments that are effective for SAD also work to alleviate depression.
Social Anxiety Disorder affects 7% of the population and studies show it is the third largest psychological disorder in the U.S. It is equally common among men and women.
SAD usually occurs infrequently and medications can be used on an "as needed" basis. Usually a single dose of a tranquillizer such as Lorazepam or Clonazepam can be taken 30 minutes before the event that is feared. The alternative choice is to use a medication from the beta-blocker group of drugs that slow down the heart rate and reduce the physical symptoms. Musicians or surgeons sometimes use these medications to reduce shaking.

The physical treatment of SAD is usually a two-step process, starting with anti-anxiety medication for short term relief from anxiety attacks, followed by anti-depressant medication over the long term.

Anti-anxiety medications tend to be fast acting but have a short term effect. Benzodiazepine tranquillizers like Alprazolam (Xanax), Diazepam (Valium), and Lorazepam (Ativan) can relieve anxiety within minutes, but last for only a few hours. These drugs can also produce a dependency if taken daily for more than two or three weeks.

Anti-depressant medication has longer term benefits in reducing or eliminating the symptoms of anxiety, but typically take two or three weeks to make a noticeable effect. Anti-depressants like Venlafaxine extended-release (Effexor XR), Paroxetine (Paxil), Imipramine (Tofranil) or Citalopram (Celexa) can relieve anxiety symptoms, and should be taken for months after the symptoms subside to prevent a relapse while the person gradually learns to cope with the causes of the anxiety.
Symptoms of insomnia are very common. About one third of adults have some symptoms of insomnia and about 10% of adults meet criteria for a clinical diagnosis of insomnia. Women are about 1.5 times more likely to have insomnia than men. Having another mental health problem increases your risk for insomnia; about half of people with insomnia have another psychological disorder. Additionally, having a close family member with insomnia, like a parent or a sibling, increases your risk. Insomnia symptoms vary among age groups. Middle-aged and older adults are more likely to experience insomnia, partly due to health problems associated with aging. Younger adults are more likely to experience difficulties with falling asleep, while middle-aged and older individuals tend to have a hard time staying asleep.
The recommended treatments for insomnia are psychological and behavioural techniques. These include cognitive behavioural therapy (CBT), relaxation training, stimulus control, and sleep restriction. You can learn some of these techniques yourself, while others are better done with a sleep specialist or a therapist.

Cognitive Behavioural Therapy (CBT)

The goals of CBT for insomnia include challenging unhealthy beliefs regarding sleep, replacing these with more positive, rational thoughts, and changing behaviours to improve sleep habits. Research supports the use of CBT for insomnia.

Relaxation Training

Relaxation training, also known as progressive muscle relaxation, teaches you how to relax your body by systematically tensing and release various muscle groups. Other relaxation techniques may also be used, such as mindfulness, meditation, or deep breathing. Relaxation can help you fall asleep and return to sleep if you wake up during the night.

Stimulus Control

Many people with insomnia have poor sleep habits that contribute to prolonging or worsening the problem. These include watching the clock, spending a lot of time in bed without sleeping, and worrying about not getting enough sleep. These thoughts and behaviours cause people with insomnia to associate their beds with feelings of frustration and wakefulness. Stimulus control can help you break this association by, for example, only going to bed when you are sleepy and not staying in bed awake longer than 20 minutes.

Sleep Restriction

Sleep restriction is a behavioural treatment that aims to improve the quality of your sleep by following a strict bedtime and wake time and not staying in bed while awake.
Insomnia may be situational, chronic, or episodic. Situational insomnia is short-term, typically caused by a change in sleep schedule or a stressful life event. This acute insomnia usually improves once the situation goes away. If the insomnia lasts long after the triggering event, it is considered persistent or chronic. The elements that first caused the insomnia may be very different from those that maintain it. Even those with chronic insomnia may have some nights where they sleep well. Individuals with episodic insomnia have normal sleep interspersed with recurrent episodes of sleep problems, typically following life stressors.
Research suggests that adults need about 7 to 8 hours of sleep. However, sleep needs vary greatly depending on age, health, and lifestyle. Sleep needs also differ between individuals based on the amount of sleep they normally need to feel rested and their sleep debt. Sleep debt is the difference between how much sleep you are getting and how much sleep you actually need. If you are getting less sleep then your body needs, the effects of this sleep deprivation accumulate over time. So even if you are getting your sleep needs met a few nights in a row, you may have a previously accumulated sleep debt that leaves you feeling tired during the day. Research suggests that a sleep debt can be "paid off" by getting extra sleep.

If you catch yourself falling asleep during the day, or need caffeine to stay awake, you may not be getting enough sleep. Keeping a sleep diary (such as, http://sleepfoundation.org/sleep-diary/SleepDiaryv6.pdf) can be useful in determining your sleep patterns and whether you are getting enough sleep. Another strategy you can use is to take a "sleep vacation" when you have a couple of weeks where you are not working or your time is flexible. Choose a consistent bedtime and allow yourself to wake up naturally. Initially, you will likely be paying off your sleep debt and will sleep longer than your typical need. As you continue to go to bed at the same time, you will establish a regular sleeping pattern that will likely be between 7 to 9 hours per night. This amount is how much sleep you typically need.
Insomnia may be caused by psychological disorders, medical conditions, substances, poor sleep habits, or specific biological factors. Depression, bipolar disorder, and anxiety disorders frequently cause insomnia. Some medical causes include chronic pain, hyperthyroidism, and acid reflux. Eating patterns such as consuming substances like alcohol, nicotine, or caffeine or eating a heavy meal before bedtime can lead to insomnia. Insomnia may also be caused by lifestyle factors, such as working late, using a computer before bedtime, sleeping in or napping in the afternoon, or working shifts. Sometimes, one or more of these factors will trigger acute an acute insomnia episode, causing a person to worry about being able to sleep. These fears can worsen that insomnia and cause a vicious cycle, turning a short-term insomnia episode into a chronic problem. Finally, some people may be more biologically prone to insomnia due to genetics and/or their brains' sleep-wake cycle.
Sleep problems are very common. To get a clinical diagnosis of insomnia, the symptoms must be present at least 3 nights per week and have a significant negative impact on a person's functioning during the day. Even if symptoms are not severe enough to meet criteria for insomnia, it may still be useful to treat them.

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