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Past WOE Cares Need to Know Topics
E-Cigarettes From July 3. 2019
Overview
What are electronic cigarettes?
Electronic cigarettes, also known as e-cigarettes, e-vaporizers, or electronic nicotine delivery systems, are battery-operated devices that people use to inhale an aerosol, which typically contains nicotine (though not always), flavorings, and other chemicals. They can resemble traditional tobacco cigarettes (cig-a-likes), cigars, or pipes, or even everyday items like pens or USB memory sticks. Other devices, such as those with fillable tanks, may look different. Regardless of their design and appearance, these devices generally operate in a similar manner and are made of similar components. More than 460 different e-cigarette brands are currently on the market.1 Some common nicknames for e-cigarettes are:
How do e-cigarettes work?
Most e-cigarettes consist of four different components, including:
In many e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The person then inhales the resulting aerosol or vapor (called vaping).
E-cigarette Use in Teens
E-cigarettes are popular among teens and are now the most commonly used form of tobacco among youth in the United States. Their easy availability, alluring advertisements, various e-liquid flavors, and the belief that they're safer than cigarettes have helped make them appealing to this age group. Further, a study of high school students found that one in four teens reported using e-cigarettes for dripping, a practice in which people produce and inhale vapors by placing e-liquid drops directly onto heated atomizer coils. Teens reported the following reasons for dripping: to create thicker vapor (63.5 percent), to improve flavors (38.7 percent), and to produce a stronger throat hit—a pleasurable feeling that the vapor creates when it causes the throat to contract (27.7 percent).2 More research is needed on the risks of this practice.
In addition to the unknown health effects, early evidence suggests that e-cigarette use may serve as an introductory product for preteens and teens who then go on to use other tobacco products, including cigarettes, which are known to cause disease and premature death. A study showed that students who had used e-cigarettes by the time they started 9th grade were more likely than others to start smoking cigarettes and other smokable tobacco products within the next year.3 Another study supports these findings, showing that high school students who used e-cigarettes in the last month were about 7 times more likely to report that they smoked cigarettes when asked approximately 6 months later, as compared to students who said they didn't use e-cigarettes. Notably, the reverse was not true—students who said they smoked cigarettes were no more likely to report use of e-cigarettes when asked approximately 6 months later. Like the previous study, these results suggest that teens using e-cigarettes are at a greater risk for smoking cigarettes in the future.4 Another study has shown an association between e-cigarette smoking and progression to smoking actual cigarettes.5 This study suggests that e-cigarettes may actually encourage cigarette smoking in adolescents.
Additionally, a study of adult smokers in Europe found those who used e-cigarettes were less like to have stopped smoking than those that didn’t use e-cigarettes. Those that used e-cigarettes also smoked more cigarettes than those who didn’t.6 In another study of more than 800 people who said they were using e-cigarettes to help them quit traditional cigarette smoking, only nine percent reported having quit when asked a year later.7 However, more research is still needed to understand if experimenting with e-cigarettes leads to regular use of smokable tobacco.
Under U.S. Food and Drug Administration (FDA) regulations designed to protect the health of young Americans, minors can no longer buy e-cigarettes in stores or online (see "Government Regulation of E-cigarettes"). The FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes. This includes components and parts of e-cigarettes but excludes accessories.8
How do e-cigarettes affect the brain?
The nicotine in e-liquids is readily absorbed from the lungs into the bloodstream when a person uses an e-cigarette. Upon entering the blood, nicotine stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, breathing, and heart rate. As with most addictive substances, nicotine activates the brain’s reward circuits and also increases levels of a chemical messenger in the brain called dopamine, which reinforces rewarding behaviors. Pleasure caused by nicotine’s interaction with the reward circuit motivates some people to use nicotine again and again, despite risks to their health and well-being.
What are the health effects of e-cigarettes?
Are they safer than tobacco cigarettes?
Some research suggests that e-cigarettes might be less harmful than cigarettes when people who regularly smoke switch to them as a complete replacement. But nicotine in any form is a highly addictive drug. Research suggests it can even prime the brain’s reward system, putting vapers at risk for addiction to other drugs.9
Also, e-cigarette use exposes the lungs to a variety of chemicals, including those added to e-liquids, and other chemicals produced during the heating/vaporizing process.10 A study of some e-cigarette products found the vapor contains known carcinogens and toxic chemicals, as well as potentially toxic metal nanoparticles from the device itself. The study showed that the e-liquids of certain cig-a-like brands contain high levels of nickel and chromium, which may come from the nichrome heating coils of the vaporizing device. Cig-a-likes may also contain low levels of cadmium, a toxic metal also found in cigarette smoke that can cause breathing problems and disease.11 More research is needed on the health consequences of repeated exposure to these chemicals.
Health Effects for Teens
The teen years are critical for brain development, which continues into young adulthood. Young people who use nicotine products in any form, including e-cigarettes, are uniquely at risk for long-lasting effects. Because nicotine affects the development of the brain's reward system, continued e-cigarette use can not only lead to nicotine addiction, but it also can make other drugs such as cocaine and methamphetamine more pleasurable to a teen's developing brain.12
Nicotine also affects the development of brain circuits that control attention and learning. Other risks include mood disorders and permanent problems with impulse control—failure to fight an urge or impulse that may harm oneself or others.12
Can e-cigarettes help a person quit smoking?
Some people believe e-cigarettes may help lower nicotine cravings in those who are trying to quit smoking. However, e-cigarettes are not an FDA-approved quit aid, and there is no conclusive scientific evidence on the effectiveness of e-cigarettes for long-term smoking cessation. It should be noted that there are seven FDA-approved quit aids that are proven safe and can be effective when used as directed.
E-cigarettes haven't been thoroughly evaluated in scientific studies. For now, not enough data exists on the safety of e-cigarettes, how the health effects compare to traditional cigarettes, and if they are helpful for people trying to quit smoking.
Points to Remember
In 2016, the FDA established a rule for e-cigarettes and their liquid solutions. Because e-cigarettes contain nicotine derived from tobacco, they are now subject to government regulation as tobacco products, including the requirement that both in-store and online purchasers be at least 18 years of age (see "E-cigarette Use in Teens"). For more information about this ruling, visit the FDA's webpage, The Facts on the FDA's New Tobacco Rule.
Immediate switch to low levels of nicotine in cigarettes more effective than a gradual reduction
Science Highlight
September 04, 2018
The FDA is considering a regulatory policy to reduce the levels of nicotine in combustible cigarettes to minimally addictive levels. A recently published study in the Journal of the American Medical Association tested how cigarette smokers would react to switching to cigarettes with low levels of nicotine. NIDA scientists worked with 1,250 randomized participants at 10 U.S. sites, which were separated into immediate vs. gradual reduction groups. Participants were asked to record their cigarette use, backed up by urine testing to confirm use. Those in the immediate reduction group showed a greater reduction in smoke exposure, greater reduction in dependence, and more cigarette-free days. These data suggest that regulations requiring an immediate nicotine reduction in cigarettes may result in greater health benefits than a policy of stepped reduction. NIDA and the Food and Drug Administration’s Center for Tobacco Products funded this study. Further support came from the National Cancer Institute and the National Center for Advancing Translational Science, both part of the National Institutes of Health.
E-Cigs linked to heart attacks
Science Highlighs
tAugust 27, 2018
An analysis of health data concludes that e-cigarette use, adjusted for smoking conventional cigarettes and other risk factors, is associated with increased risk of myocardial infarction, which is commonly known as a heart attack caused by blockage of the arteries. Scientists noted that dual use of e-cigarettes and conventional cigarettes—the most common use pattern among e-cigarette users—is more dangerous than using either product alone. The study was funded by the National Institute on Drug Abuse, the National Cancer Institute and the U.S. Food and Drug Administration.
Learn More
For more information about e-cigarettes, visit:
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
Souce: National Institue of Drug Abuse website on 7.02.19 at https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes
What are electronic cigarettes?
Electronic cigarettes, also known as e-cigarettes, e-vaporizers, or electronic nicotine delivery systems, are battery-operated devices that people use to inhale an aerosol, which typically contains nicotine (though not always), flavorings, and other chemicals. They can resemble traditional tobacco cigarettes (cig-a-likes), cigars, or pipes, or even everyday items like pens or USB memory sticks. Other devices, such as those with fillable tanks, may look different. Regardless of their design and appearance, these devices generally operate in a similar manner and are made of similar components. More than 460 different e-cigarette brands are currently on the market.1 Some common nicknames for e-cigarettes are:
- e-cigs
- e-hookahs
- hookah pens
- vapes
- vape pens
- mods (customizable, more powerful vaporizers)
How do e-cigarettes work?
Most e-cigarettes consist of four different components, including:
- a cartridge or reservoir, which holds a liquid solution (e-liquid or e-juice) containing varying amounts of nicotine, flavorings, and other chemicals
- a heating element (atomizer)
- a power source (usually a battery)
- a mouthpiece that the person uses to inhale
In many e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The person then inhales the resulting aerosol or vapor (called vaping).
E-cigarette Use in Teens
E-cigarettes are popular among teens and are now the most commonly used form of tobacco among youth in the United States. Their easy availability, alluring advertisements, various e-liquid flavors, and the belief that they're safer than cigarettes have helped make them appealing to this age group. Further, a study of high school students found that one in four teens reported using e-cigarettes for dripping, a practice in which people produce and inhale vapors by placing e-liquid drops directly onto heated atomizer coils. Teens reported the following reasons for dripping: to create thicker vapor (63.5 percent), to improve flavors (38.7 percent), and to produce a stronger throat hit—a pleasurable feeling that the vapor creates when it causes the throat to contract (27.7 percent).2 More research is needed on the risks of this practice.
In addition to the unknown health effects, early evidence suggests that e-cigarette use may serve as an introductory product for preteens and teens who then go on to use other tobacco products, including cigarettes, which are known to cause disease and premature death. A study showed that students who had used e-cigarettes by the time they started 9th grade were more likely than others to start smoking cigarettes and other smokable tobacco products within the next year.3 Another study supports these findings, showing that high school students who used e-cigarettes in the last month were about 7 times more likely to report that they smoked cigarettes when asked approximately 6 months later, as compared to students who said they didn't use e-cigarettes. Notably, the reverse was not true—students who said they smoked cigarettes were no more likely to report use of e-cigarettes when asked approximately 6 months later. Like the previous study, these results suggest that teens using e-cigarettes are at a greater risk for smoking cigarettes in the future.4 Another study has shown an association between e-cigarette smoking and progression to smoking actual cigarettes.5 This study suggests that e-cigarettes may actually encourage cigarette smoking in adolescents.
Additionally, a study of adult smokers in Europe found those who used e-cigarettes were less like to have stopped smoking than those that didn’t use e-cigarettes. Those that used e-cigarettes also smoked more cigarettes than those who didn’t.6 In another study of more than 800 people who said they were using e-cigarettes to help them quit traditional cigarette smoking, only nine percent reported having quit when asked a year later.7 However, more research is still needed to understand if experimenting with e-cigarettes leads to regular use of smokable tobacco.
Under U.S. Food and Drug Administration (FDA) regulations designed to protect the health of young Americans, minors can no longer buy e-cigarettes in stores or online (see "Government Regulation of E-cigarettes"). The FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes. This includes components and parts of e-cigarettes but excludes accessories.8
How do e-cigarettes affect the brain?
The nicotine in e-liquids is readily absorbed from the lungs into the bloodstream when a person uses an e-cigarette. Upon entering the blood, nicotine stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, breathing, and heart rate. As with most addictive substances, nicotine activates the brain’s reward circuits and also increases levels of a chemical messenger in the brain called dopamine, which reinforces rewarding behaviors. Pleasure caused by nicotine’s interaction with the reward circuit motivates some people to use nicotine again and again, despite risks to their health and well-being.
What are the health effects of e-cigarettes?
Are they safer than tobacco cigarettes?
Some research suggests that e-cigarettes might be less harmful than cigarettes when people who regularly smoke switch to them as a complete replacement. But nicotine in any form is a highly addictive drug. Research suggests it can even prime the brain’s reward system, putting vapers at risk for addiction to other drugs.9
Also, e-cigarette use exposes the lungs to a variety of chemicals, including those added to e-liquids, and other chemicals produced during the heating/vaporizing process.10 A study of some e-cigarette products found the vapor contains known carcinogens and toxic chemicals, as well as potentially toxic metal nanoparticles from the device itself. The study showed that the e-liquids of certain cig-a-like brands contain high levels of nickel and chromium, which may come from the nichrome heating coils of the vaporizing device. Cig-a-likes may also contain low levels of cadmium, a toxic metal also found in cigarette smoke that can cause breathing problems and disease.11 More research is needed on the health consequences of repeated exposure to these chemicals.
Health Effects for Teens
The teen years are critical for brain development, which continues into young adulthood. Young people who use nicotine products in any form, including e-cigarettes, are uniquely at risk for long-lasting effects. Because nicotine affects the development of the brain's reward system, continued e-cigarette use can not only lead to nicotine addiction, but it also can make other drugs such as cocaine and methamphetamine more pleasurable to a teen's developing brain.12
Nicotine also affects the development of brain circuits that control attention and learning. Other risks include mood disorders and permanent problems with impulse control—failure to fight an urge or impulse that may harm oneself or others.12
Can e-cigarettes help a person quit smoking?
Some people believe e-cigarettes may help lower nicotine cravings in those who are trying to quit smoking. However, e-cigarettes are not an FDA-approved quit aid, and there is no conclusive scientific evidence on the effectiveness of e-cigarettes for long-term smoking cessation. It should be noted that there are seven FDA-approved quit aids that are proven safe and can be effective when used as directed.
E-cigarettes haven't been thoroughly evaluated in scientific studies. For now, not enough data exists on the safety of e-cigarettes, how the health effects compare to traditional cigarettes, and if they are helpful for people trying to quit smoking.
Points to Remember
- Electronic cigarettes are battery-operated devices that people use to inhale an aerosol, which typically contains nicotine (though not always), flavorings, and other chemicals. In many e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge or reservoir. The person then inhales the resulting aerosol or vapor (called vaping).
- E-cigarettes are popular among teens. Under U.S. Food and Drug Administration (FDA) regulations designed to protect the health of young Americans, minors can no longer buy e-cigarettes in stores or online.
- Nicotine stimulates the adrenal glands to release the hormone epinephrine (adrenaline) and increases the levels of a chemical messenger in the brain called dopamine. Pleasure caused by nicotine’s interaction with the brain’s reward system motivates some people to use nicotine again and again, despite possible risks to their health and well-being.
- Research so far suggests that e-cigarettes are less harmful than cigarettes when people who regularly smoke switch to them as a complete replacement. But e-cigarettes can still damage a person's health.
- E-cigarettes can lead to nicotine addiction and increased risk for addiction to other drugs.
- E-cigarette use also exposes the lungs to a variety of chemicals, including those added to e-liquids, and other chemicals produced during the heating/vaporizing process.
- More research is needed to determine if e-cigarettes may be as effective as smoking cessation aids already approved by the FDA.
In 2016, the FDA established a rule for e-cigarettes and their liquid solutions. Because e-cigarettes contain nicotine derived from tobacco, they are now subject to government regulation as tobacco products, including the requirement that both in-store and online purchasers be at least 18 years of age (see "E-cigarette Use in Teens"). For more information about this ruling, visit the FDA's webpage, The Facts on the FDA's New Tobacco Rule.
Immediate switch to low levels of nicotine in cigarettes more effective than a gradual reduction
Science Highlight
September 04, 2018
The FDA is considering a regulatory policy to reduce the levels of nicotine in combustible cigarettes to minimally addictive levels. A recently published study in the Journal of the American Medical Association tested how cigarette smokers would react to switching to cigarettes with low levels of nicotine. NIDA scientists worked with 1,250 randomized participants at 10 U.S. sites, which were separated into immediate vs. gradual reduction groups. Participants were asked to record their cigarette use, backed up by urine testing to confirm use. Those in the immediate reduction group showed a greater reduction in smoke exposure, greater reduction in dependence, and more cigarette-free days. These data suggest that regulations requiring an immediate nicotine reduction in cigarettes may result in greater health benefits than a policy of stepped reduction. NIDA and the Food and Drug Administration’s Center for Tobacco Products funded this study. Further support came from the National Cancer Institute and the National Center for Advancing Translational Science, both part of the National Institutes of Health.
E-Cigs linked to heart attacks
Science Highlighs
tAugust 27, 2018
An analysis of health data concludes that e-cigarette use, adjusted for smoking conventional cigarettes and other risk factors, is associated with increased risk of myocardial infarction, which is commonly known as a heart attack caused by blockage of the arteries. Scientists noted that dual use of e-cigarettes and conventional cigarettes—the most common use pattern among e-cigarette users—is more dangerous than using either product alone. The study was funded by the National Institute on Drug Abuse, the National Cancer Institute and the U.S. Food and Drug Administration.
Learn More
For more information about e-cigarettes, visit:
- the NIDA TV Spotlight on Electronic Cigarettes
- A NIDA Science Spotlight on the association between e-cigarette use and future tobacco cigarette use
- the FDA's webpage, Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS)
- the website, Know the Risks: E-cigarettes & Young People, based on the U.S. Surgeon General's Report on e-cigarette use among youth and young adults; includes various resources such as a parent tip sheet, healthcare provider conversation card, and FAQs
- Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018 (MMRW) (CDC, November 2018)
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
Souce: National Institue of Drug Abuse website on 7.02.19 at https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes
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Teens Using E-cigarettes More Likely to Start Smoking Tobacco
Video: Dr. Nora Volkow discusses study findings
Video: Dr. Nora Volkow discusses study findings
Schizophrenia From June 25, 2019
Overview
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
Signs and Symptoms
Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too.
The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.
Positive symptoms: “Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include:
Negative symptoms: “Negative” symptoms are associated with disruptions to normal emotions and behaviors. Symptoms include:
Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include:
It is common for people with schizophrenia to have problems with illicit drugs and alcohol. A treatment program that includes treatment for both illnesses is critical for recovery because misuse of drugs and alcohol can interfere with treatment for schizophrenia.
Drug abuse can increase the risk of suicide, trauma, and homelessness in people with schizophrenia as well as increase the risk of developing other mental illnesses. To learn more about substance use and mental health, visit www.nimh.nih.gov (search: substance use).
Risk Factors
There are several factors that contribute to the risk of developing schizophrenia.
Genes and environment: Scientists have long known that schizophrenia sometimes runs in families. However, there are many people who have schizophrenia who don’t have a family member with the disorder and conversely, many people with one or more family members with the disorder who do not develop it themselves.
Scientists believe that many different genes may increase the risk of schizophrenia, but that no single gene causes the disorder by itself. It is not yet possible to use genetic information to predict who will develop schizophrenia.
Scientists also think that interactions between genes and aspects of the individual’s environment are necessary for schizophrenia to develop. Environmental factors may involve:
Different brain chemistry and structure: Scientists think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters (substances that brain cells use to communicate with each other) dopamine and glutamate, and possibly others, plays a role in schizophrenia.
Some experts also think problems during brain development before birth may lead to faulty connections. The brain also undergoes major changes during puberty, and these changes could trigger psychotic symptoms in people who are vulnerable due to genetics or brain differences.
Treatments and Therapies
Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the disease. Treatments include:
Antipsychotics
Antipsychotic medications are usually taken daily in pill or liquid form. Some antipsychotics are injections that are given once or twice a month. Some people have side effects when they start taking medications, but most side effects go away after a few days. Doctors and patients can work together to find the best medication or medication combination, and the right dose. Check the U.S. Food and Drug Administration (FDA) website: (http://www.fda.gov/), for the latest information on warnings, patient medication guides, or newly approved medications.
A patient should not stop taking a medication without first talking to a doctor. Suddenly stopping medication can be dangerous, and it can make schizophrenia symptoms worse.
Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and based on an individual’s needs and medical situation . Only an expert clinician can help a patient decide whether the medication’s ability to help is worth the risk of a side effect.
Psychosocial Treatments
Psychosocial treatments help patients deal with everyday challenges of schizophrenia. These treatments are often most helpful after patients find a medication that works. Examples of treatment include:
This treatment model integrates medication, psychosocial therapies, case management, family involvement, and supported education and employment services, all aimed at reducing symptoms and improving quality of life. The NIMH Recovery After an Initial Schizophrenia Episode (RAISE) research project seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated specialty care treatment in the earliest stages of the disorder. RAISE is designed to reduce the likelihood of long-term disability that people with schizophrenia often experience and help them lead productive, independent lives.
How can I help someone I know with schizophrenia?
Caring for and supporting a loved one with schizophrenia can be hard. It can be difficult to know how to respond to someone who makes strange or clearly false statements. It is important to understand that schizophrenia is a biological illness.
Here are some things you can do to help your loved one:
Schizophrenia: A brief brochure on schizophrenia that offers basic information on signs and symptoms, treatment, and finding help.
Research and Statistics
Souce: National Institue of Mental Health website on 6.26.19 at https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
Signs and Symptoms
Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too.
The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.
Positive symptoms: “Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include:
- Hallucinations: When a person sees, hears, smells, tastes, or feels things that are not real. Hearing voices is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem.
- Delusions: When a person believes things that are not true. For example, a person may believe that people on the radio and television are talking directly to him or her. Sometimes people who have delusions may believe that they are in danger or that others are trying to hurt them.
- Thought disorders: When a person has ways of thinking that are odd or illogical. People with thought disorders may have trouble organizing their thoughts. Sometimes a person will stop talking in the middle of a thought or make up words that have no meaning.
- Movement disorders: When a person exhibits abnormal body movements. A person may repeat certain motions over and over—this is called stereotypies. At the other extreme, a person may stop moving or talking for a while, which is a rare condition called catatonia.
Negative symptoms: “Negative” symptoms are associated with disruptions to normal emotions and behaviors. Symptoms include:
- “Flat affect” (reduced expression of emotions via facial expression or voice tone)
- Reduced feelings of pleasure in everyday life
- Difficulty beginning and sustaining activities
- Reduced speaking
Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include:
- Poor “executive functioning” (the ability to understand information and use it to make decisions)
- Trouble focusing or paying attention
- Problems with “working memory” (the ability to use information immediately after learning it)
It is common for people with schizophrenia to have problems with illicit drugs and alcohol. A treatment program that includes treatment for both illnesses is critical for recovery because misuse of drugs and alcohol can interfere with treatment for schizophrenia.
Drug abuse can increase the risk of suicide, trauma, and homelessness in people with schizophrenia as well as increase the risk of developing other mental illnesses. To learn more about substance use and mental health, visit www.nimh.nih.gov (search: substance use).
Risk Factors
There are several factors that contribute to the risk of developing schizophrenia.
Genes and environment: Scientists have long known that schizophrenia sometimes runs in families. However, there are many people who have schizophrenia who don’t have a family member with the disorder and conversely, many people with one or more family members with the disorder who do not develop it themselves.
Scientists believe that many different genes may increase the risk of schizophrenia, but that no single gene causes the disorder by itself. It is not yet possible to use genetic information to predict who will develop schizophrenia.
Scientists also think that interactions between genes and aspects of the individual’s environment are necessary for schizophrenia to develop. Environmental factors may involve:
- Exposure to viruses
- Malnutrition before birth
- Problems during birth
- Psychosocial factors
Different brain chemistry and structure: Scientists think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters (substances that brain cells use to communicate with each other) dopamine and glutamate, and possibly others, plays a role in schizophrenia.
Some experts also think problems during brain development before birth may lead to faulty connections. The brain also undergoes major changes during puberty, and these changes could trigger psychotic symptoms in people who are vulnerable due to genetics or brain differences.
Treatments and Therapies
Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the disease. Treatments include:
Antipsychotics
Antipsychotic medications are usually taken daily in pill or liquid form. Some antipsychotics are injections that are given once or twice a month. Some people have side effects when they start taking medications, but most side effects go away after a few days. Doctors and patients can work together to find the best medication or medication combination, and the right dose. Check the U.S. Food and Drug Administration (FDA) website: (http://www.fda.gov/), for the latest information on warnings, patient medication guides, or newly approved medications.
A patient should not stop taking a medication without first talking to a doctor. Suddenly stopping medication can be dangerous, and it can make schizophrenia symptoms worse.
Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and based on an individual’s needs and medical situation . Only an expert clinician can help a patient decide whether the medication’s ability to help is worth the risk of a side effect.
Psychosocial Treatments
Psychosocial treatments help patients deal with everyday challenges of schizophrenia. These treatments are often most helpful after patients find a medication that works. Examples of treatment include:
- Family education: Teaches the whole family how to cope with the illness and help their loved one.
- Illness management skills: Helps the patient learn about schizophrenia and manage it from day to day.
- Cognitive behavioral therapy (CBT): Helps the patient identify current problems and how to solve them. A CBT therapist focuses on changing unhelpful patterns of thinking and behavior.
- Rehabilitation: Helps with getting and keeping a job or going to school and everyday living skills.
- Peer counseling: Encourages individuals to receive help from other people who are further along in their recovery from schizophrenia.
- Self-help groups: Provides support from other people with the illness and their families.
- Treatment for drug and alcohol misuse: Is often combined with other treatments for schizophrenia.
This treatment model integrates medication, psychosocial therapies, case management, family involvement, and supported education and employment services, all aimed at reducing symptoms and improving quality of life. The NIMH Recovery After an Initial Schizophrenia Episode (RAISE) research project seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated specialty care treatment in the earliest stages of the disorder. RAISE is designed to reduce the likelihood of long-term disability that people with schizophrenia often experience and help them lead productive, independent lives.
How can I help someone I know with schizophrenia?
Caring for and supporting a loved one with schizophrenia can be hard. It can be difficult to know how to respond to someone who makes strange or clearly false statements. It is important to understand that schizophrenia is a biological illness.
Here are some things you can do to help your loved one:
- Get them treatment and encourage them to stay in treatment
- Remember that their beliefs or hallucinations seem very real to them
- Tell them that you acknowledge that everyone has the right to see things their own way
- Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior
- Check to see if there are any support groups in your area
Schizophrenia: A brief brochure on schizophrenia that offers basic information on signs and symptoms, treatment, and finding help.
Research and Statistics
- Recovery After an Initial Schizophrenia Episode (RAISE): The NIMH-launched RAISE is a large-scale research initiative that began with two studies examining different aspects of coordinated specialty care (CSC) treatments for people who were experiencing first episode psychosis.
- Psychotic Disorders Research Program: This program supports research into the origins, onset, course, and outcome of schizophrenia spectrum disorders and other psychotic psychopathology.
- Schizophrenia Statistics: This webpage provides information on the best statistics currently available on the prevalence and treatment of schizophrenia in the U.S.
- Schizophrenia Clinical Trials at NIMH: Adults: This webpage lists NIMH clinical trials that are currently recruiting adults with schizophrenia.
Souce: National Institue of Mental Health website on 6.26.19 at https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
Cocaine From June 20, 2019
Overview
Also known as: Blow, Bump, C, Candy, Charlie, Coke, Crack, Flake, Rock, Snow, and Toot
Cocaine is an addictive stimulant drug made from the leaves of the coca plant native to South America. Cocaine comes in two forms:
How Cocaine Is Used
There are a few different ways that cocaine can enter the body: through the nose by snorting, and directly into the blood stream by injecting or rubbing it into gums above the teeth. The crystal of crack cocaine is heated in a glass pipe to produce vapors that are absorbed into the blood through the lungs.
What happens to your brain when you use cocaine?
All drugs change the way the brain works by changing the way nerve cells communicate. Nerve cells, called neurons, send messages to each other by releasing chemicals called neurotransmitters. These neurotransmitters attach to molecules on neurons called receptors. (Learn more about how neurotransmitters work.) Drugs affect this signaling process.
There are many neurotransmitters, but dopamine is the main one that makes people feel good when they do something they enjoy, like eating a piece of chocolate cake or playing a video game. Normally, dopamine gets recycled back into the cell that released it, thus shutting off the signal. Stimulants like cocaine prevent the dopamine from being recycled, causing a buildup of the neurotransmitter in the brain. It is this flood of dopamine that reinforces taking cocaine, “training” the brain to repeat the behavior. The drug can cause a feeling of intense pleasure and increased energy.
With repeated use, stimulants like cocaine can disrupt how the brain’s dopamine system works, reducing a person’s ability to feel pleasure from normal, everyday activities. People will often develop tolerance, which means they must take more of the drug to get the desired effect. If a person becomes addicted, they might take the drug just to feel “normal.”
After the "high" of the cocaine wears off, many people experience a "crash" and feel tired or sad for days. They also experience a strong craving to take cocaine again to try to feel better.
Learn more about how the brain works and what happens when a person uses drugs. And, check out how the brain responds to natural rewards and to drugs.
What happens to your body when you use cocaine?
Short-Term Effects
Cocaine is a stimulant so it gives the body a feeling of stimulation and alertness, which can be both pleasurable and harmful. Cocaine’s short-term effects appear quickly and disappear within a few minutes to an hour. How long and intense the effects are depends on the method of use. Here are some of the ways cocaine affects the body:
Long-Term Effects
The long-term effects of cocaine depend, in part, on the method of use and include the following:
Yes. In, 2017, nearly 14,000 people died from a cocaine overdose. That's more than twice as many people who died in 2015 from a cocaine overdose. Males are much more likely to die in this way than are females.1
Cocaine can be deadly when taken in large doses or when mixed with other drugs or alcohol. Cocaine-related deaths often happen because the heart stops (cardiac arrest), then breathing stops. Using cocaine and drinking alcohol or using other drugs increases these dangers, including the risk of overdose. For example, combining cocaine and heroin (known as a “speedball”) puts a person at higher risk of death from an overdose. In rare instances, sudden death can occur on the first use of cocaine or soon after. Among the deaths that occurred from cocaine use, most also included misuse of an opioid of some form, either a prescription pain reliever, heroin, or man-made opioids like fentanyl. Learn more about drug overdoses in youth.
Is cocaine addictive?
Yes, repeated cocaine use can lead to addiction. Addiction is a devastating brain disease in which people can’t stop using drugs even when they really want to and even after it causes terrible consequences to their health and other parts of their lives.
Because a cocaine high usually doesn't last very long, people take this drug again and again to try to keep feeling good. Once addicted, people who are trying to quit taking cocaine might experience withdrawal symptoms, including:
The right treatment, however, can help a person who is addicted control cravings and stop using cocaine.
How many teens use cocaine?
It is mostly adults who use cocaine, but there are a few teens who report that they have tried it. Repeated cocaine use can produce addiction and other adverse health consequences. According to results from the 2016 National Survey on Drug Use and Health, about 865,000 Americans met the criteria for dependence or abuse of cocaine (in any form) during the past 12 months.2
What should I do if someone I know needs help?
If you, or a friend, are in crisis and need to speak with someone now:
If you want to help a friend, you can:
If a friend is using drugs, you might have to step away from the friendship for a while. It is important to protect your own mental health and not put yourself in situations where drugs are being used.
For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.
Where can I get more information?
NIDA Resources:
Other Government Resources:
Souce: National Institue of Mental Health website on 6.10.19 at https://teens.drugabuse.gov/drug-facts/cocaine
Also known as: Blow, Bump, C, Candy, Charlie, Coke, Crack, Flake, Rock, Snow, and Toot
Cocaine is an addictive stimulant drug made from the leaves of the coca plant native to South America. Cocaine comes in two forms:
- Powder cocaine is a white powder (which scientists call a hydrochloride salt). Street dealers often mix cocaine with other substances like cornstarch, talcum powder, or sugar. They also mix cocaine with stimulant drugs like amphetamines, or synthetic opioids, including fentanyl, which has caused deaths.
- Crack is a form of cocaine that has been processed to make a rock crystal that people smoke. The term “crack” refers to the cracking sound the rocks make when they are heated.
How Cocaine Is Used
There are a few different ways that cocaine can enter the body: through the nose by snorting, and directly into the blood stream by injecting or rubbing it into gums above the teeth. The crystal of crack cocaine is heated in a glass pipe to produce vapors that are absorbed into the blood through the lungs.
What happens to your brain when you use cocaine?
All drugs change the way the brain works by changing the way nerve cells communicate. Nerve cells, called neurons, send messages to each other by releasing chemicals called neurotransmitters. These neurotransmitters attach to molecules on neurons called receptors. (Learn more about how neurotransmitters work.) Drugs affect this signaling process.
There are many neurotransmitters, but dopamine is the main one that makes people feel good when they do something they enjoy, like eating a piece of chocolate cake or playing a video game. Normally, dopamine gets recycled back into the cell that released it, thus shutting off the signal. Stimulants like cocaine prevent the dopamine from being recycled, causing a buildup of the neurotransmitter in the brain. It is this flood of dopamine that reinforces taking cocaine, “training” the brain to repeat the behavior. The drug can cause a feeling of intense pleasure and increased energy.
With repeated use, stimulants like cocaine can disrupt how the brain’s dopamine system works, reducing a person’s ability to feel pleasure from normal, everyday activities. People will often develop tolerance, which means they must take more of the drug to get the desired effect. If a person becomes addicted, they might take the drug just to feel “normal.”
After the "high" of the cocaine wears off, many people experience a "crash" and feel tired or sad for days. They also experience a strong craving to take cocaine again to try to feel better.
Learn more about how the brain works and what happens when a person uses drugs. And, check out how the brain responds to natural rewards and to drugs.
What happens to your body when you use cocaine?
Short-Term Effects
Cocaine is a stimulant so it gives the body a feeling of stimulation and alertness, which can be both pleasurable and harmful. Cocaine’s short-term effects appear quickly and disappear within a few minutes to an hour. How long and intense the effects are depends on the method of use. Here are some of the ways cocaine affects the body:
- extreme happiness and energy
- mental alertness
- sensitivity to sight, sound, and touch
- irritability
- paranoia (feeling that people are out to get you)
- constricted blood vessels and dilated pupils
- higher body temperature
- higher blood pressure and faster heartbeat, leading to higher risk of heart attack or stroke
- feeling sick to the stomach
- restlessness
- decreased appetite and, over time, a loss of weight
- inability to sleep
Long-Term Effects
The long-term effects of cocaine depend, in part, on the method of use and include the following:
- snorting: loss of sense of smell, nosebleeds, nasal damage, and trouble swallowing
- smoking: cough, asthma, and lung damage
- consuming by mouth: damage to intestines (between the stomach and anus) caused by reduced blood flow
- needle injection: higher risk for HIV and hepatitis (a liver disease) through shared needles (read more about the link between viral infections and drug use)
- all methods: poor nutrition and weight loss
Yes. In, 2017, nearly 14,000 people died from a cocaine overdose. That's more than twice as many people who died in 2015 from a cocaine overdose. Males are much more likely to die in this way than are females.1
Cocaine can be deadly when taken in large doses or when mixed with other drugs or alcohol. Cocaine-related deaths often happen because the heart stops (cardiac arrest), then breathing stops. Using cocaine and drinking alcohol or using other drugs increases these dangers, including the risk of overdose. For example, combining cocaine and heroin (known as a “speedball”) puts a person at higher risk of death from an overdose. In rare instances, sudden death can occur on the first use of cocaine or soon after. Among the deaths that occurred from cocaine use, most also included misuse of an opioid of some form, either a prescription pain reliever, heroin, or man-made opioids like fentanyl. Learn more about drug overdoses in youth.
Is cocaine addictive?
Yes, repeated cocaine use can lead to addiction. Addiction is a devastating brain disease in which people can’t stop using drugs even when they really want to and even after it causes terrible consequences to their health and other parts of their lives.
Because a cocaine high usually doesn't last very long, people take this drug again and again to try to keep feeling good. Once addicted, people who are trying to quit taking cocaine might experience withdrawal symptoms, including:
- depression
- feeling very tired
- increased appetite
- bad dreams and trouble sleeping
- slowed thinking
- restlessness
The right treatment, however, can help a person who is addicted control cravings and stop using cocaine.
How many teens use cocaine?
It is mostly adults who use cocaine, but there are a few teens who report that they have tried it. Repeated cocaine use can produce addiction and other adverse health consequences. According to results from the 2016 National Survey on Drug Use and Health, about 865,000 Americans met the criteria for dependence or abuse of cocaine (in any form) during the past 12 months.2
What should I do if someone I know needs help?
If you, or a friend, are in crisis and need to speak with someone now:
- Call the National Suicide Prevention Lifeline at 1-800-273-TALK (they don't just talk about suicide—they cover a lot of issues and will help put you in touch with someone close by)
If you want to help a friend, you can:
- Share resources from this site, including this page.
- Point your friend to NIDA's Step by Step Guide for Teens and Young Adults.
- Encourage your friend to speak with a trusted adult.
If a friend is using drugs, you might have to step away from the friendship for a while. It is important to protect your own mental health and not put yourself in situations where drugs are being used.
For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.
Where can I get more information?
NIDA Resources:
- Commonly Abused Drugs Chart
- Drugs + Your Body (Scholastic)
- DrugFacts: Cocaine
- Mind Over Matter Teaching Guide and Series: Cocaine
- DrugFacts: High School and Youth Trends
Other Government Resources:
- Pick Your Poison. Intoxicating Pleasures & Medical Prescriptions: Cocaine [National Library of Medicine]
- Slang Terms and Code Words: A Reference for Law Enforcement Personnel (PDF, 1MB) [Drug Enforcement Agency]
Souce: National Institue of Mental Health website on 6.10.19 at https://teens.drugabuse.gov/drug-facts/cocaine
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Victim of Cocaine Overdose
One of the most famous victims of cocaine overdose is Len Bias, a senior at the University of Maryland, who had been drafted as the No. 2 pick by the Boston Celtics on June 17, 1986. Just 2 days later, he died from a cocaine overdose.
Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released 2018. Available at http://wonder.cdc.gov.
Prescription stimulants (amphetamines)? From June 5, 2019
Overview
What are prescription stimulants (amphetamines)?
Also known as: Bennies, Black Beauties, Crosses, Hearts, JIF, LA Turnaround, MPH, R-ball, Skippy, Speed, Study Drugs, The Smart Drug, Truck Drivers, Uppers, and Vitamin R
Prescription stimulants increase—or "stimulate"—activities and processes in the body. When prescribed by a doctor for a specific health condition, like ADHD, they can be relatively safe and effective. However, it is considered misuse when they are taken not as prescribed, to get "high," or when you take some prescribed for someone else. This can lead to dependence and addiction.
Dependence means you will get uncomfortable withdrawal symptoms when you try to quit. Addiction means you continue to seek out and take these drugs despite negative consequences.
There are three commonly misused types of stimulants: dextroamphetamines (e.g., Dexedrine®), dextromethylphenidate (e.g., Ritaln®), and stimulants that are a combination dextroamphetamines and amphetamines (e.g., Adderall®). Medical uses for these stimulant drugs are listed below:
- dextroamphetamines (Dexedrine®) for ADHD
- dextromethylphenidate/amphetamine combination (Adderall®) for Narcolepsy (Sleep Disorder)
- dextromethylphenidate (Ritalin® and Concerta®) for Despression
Read more about prescription drugs and what happens to the brain and body when someone misuses them.
How Stimulants Are Misused
Prescription stimulants are normally taken in pill form, but some people who misuse them to get "high" crush the tablets and snort or inject them. This can be dangerous because ingredients in the tablets can block small blood vessels, damaging the heart and other organs.
Some teens are prescribed stimulants to manage their ADHD. But if they share their medication with friends, it is considered misuse. People misuse stimulants by taking them in a way that is not intended, such as:
- Taking someone else’s prescription stimulant medication, even if it is for a medical reason, like ADHD.
- Taking stimulant medication thinking it will improve your grades even though you do not have ADHD.
- Taking more than the prescribed dose.
- Taking a prescription stimulant medication in a way other than prescribed—for instance, crushing pills, adding them to water, and injecting the liquid.
- Taking the prescription stimulant to get "high."
- Mixing the prescription stimulant with alcohol and certain other drugs. A pharmacist can tell you which drugs are not safe to mix with stimulants.
Stimulants have been misused as an "academic performance enhancer," (for example, to stay awake all night to cram for an exam). That's why people sometimes refer to them as "study drugs." However, there is no evidence that stimulants increase your grades if you do not have ADHD; although there might be several other reasons those students struggle in school.
What happens to your brain when you use prescription stimulants?
The brain is made up of nerve cells that send messages to each other by releasing chemicals called neurotransmitters. Common stimulants, such as amphetamines and methylphenidate, have chemical structures that are similar to certain key brain neurotransmitters including dopamine and norepinephrine. Stimulants boost the effects of these chemicals in the brain and body.
When doctors prescribe stimulants for a medical condition, they start with low doses and increase them slowly until they find the dose that works best. However, when taken in amounts or ways other than prescribed, like snorting or injecting, stimulants can increase the dopamine in the brain very quickly. This changes the normal communication between brain cells, producing a ‘high’ while also increasing the risk for dangerous side effects. Over time, this can lead to addiction, which is when you continue to use the drug despite negative consequences.
Learn more about how the brain works and what happens when a person miuses drugs.
What can happen to your body when you use prescription stimulants?
Short-Term Effects
Stimulant use can have side effects, even when prescribed by a doctor. Misusing them can be especially dangerous. Taking high doses of a stimulant can cause:
- increased blood pressure
- irregular heartbeat
- dangerously high body temperatures
- decreased sleep
- lack of interest in eating, which can lead to poor nutrition
- risk for seizures and stroke at high doses
- if drugs are injected, there is an increased risk of HIV, hepatitis, and other infectious diseases from shared needles.
Over time, prescription stimulant medications can cause:
- heart problems
- psychosis (having false thoughts or seeing or hearing things that aren’t there)
- intense anger
- paranoia (feeling like someone is going to harm you even though they aren’t)
Yes, it is possible to die from stimulant misuse. Taking high doses of a stimulant can raise a person’s body temperature and blood pressure to dangerous levels and make the heart beat irregularly. This can lead to seizures, heart failure, and death. Stimulants should not be mixed with medicines used to treat depression or over-the-counter medicines that contain decongestants. This is why it is important to discuss with your doctor all the drugs you take.
Deaths from an overdose of prescription drugs have been on the rise since the early 1990s. Learn more about drug overdoses in youth.
Are prescription stimulants addictive?
Yes, misusing stimulants can lead to addiction. Addiction is when you continue to seek out and take the drug even though you know it is damaging your health and life, even ruining your relationships and causing you problems in school or at work.
When a person who regularly misuses stimulants stops taking them, they may experience withdrawal symptoms. Stimulant withdrawal can cause:
- an inability to feel pleasure
- thoughts of suicide
- anxiety and irritability
- feeling very tired, lack of energy, and changes in sleep patterns
- intense drug cravings
People who have these symptoms should seek medical help. People should ask their doctor for advice on how to safely stop using stimulants.
How many teens misuse prescription stimulants?
Misuse of prescription stimulant medications among teens has been dropping steadily since 2014.
What should I do if someone I know needs help?
If you, or a friend, are in crisis and need to speak with someone now:
- Call the National Suicide Prevention Lifeline at 1-800-273-TALK (they don't just talk about suicide—they cover a lot of issues and will help put you in touch with someone close by)
- Share resources from this site, including this page.
- Point your friend to NIDA's Step by Step Guide for Teens and Young Adults.
- Encourage your friend to speak with a trusted adult.
For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.
Where can I get more information?
NIDA Resources:
- Commonly Abused Prescription Drugs Chart
- DrugFacts: Prescription and Over-the-Counter Medications
- DrugFacts: Stimulant ADHD Medications – Methylphenidate and Amphetamines
- DrugFacts: High School and Youth Trends
- Slang Terms and Code Words: A Reference for Law Enforcement Personnel (PDF, 1MB) [Drug Enforcement Agency]
- Monitoring the Future
- National Survey on Drug Use and Health [Substance Abuse and Mental Health Services Administration]
Souce: National Institue of Mental Health website on 6.05.19 at https://teens.drugabuse.gov/drug-facts/prescription-stimulant-medications-amphetamines
Boarderline Personality Disorder From 29, 2019
Overview
Borderline personality disorder is a mental illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.
Signs and Symptoms
People with borderline personality disorder may experience mood swings and display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly.
People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships.
Other signs or symptoms may include:
- Efforts to avoid real or imagined abandonment, such as rapidly initiating intimate (physical or emotional) relationships or cutting off communication with someone in anticipation of being abandoned
- A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
- Distorted and unstable self-image or sense of self
- Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating. Please note: If these behaviors occur primarily during a period of elevated mood or energy, they may be signs of a mood disorder—not borderline personality disorder
- Self-harming behavior, such as cutting
- Recurring thoughts of suicidal behaviors or threats
- Intense and highly changeable moods, with each episode lasting from a few hours to a few days
- Chronic feelings of emptiness
- Inappropriate, intense anger or problems controlling anger
- Difficulty trusting, which is sometimes accompanied by irrational fear of other people’s intentions
- Feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality.
Risk Factors
The cause of borderline personality disorder is not yet clear, but research suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing borderline personality disorder.
- Family History. People who have a close family member, such as a parent or sibling with the disorder may be at higher risk of developing borderline personality disorder.
- Brain Factors. Studies show that people with borderline personality disorder can have structural and functional changes in the brain especially in the areas that control impulses and emotional regulation. But is it not clear whether these changes are risk factors for the disorder, or caused by the disorder.
- Environmental, Cultural, and Social Factors. Many people with borderline personality disorder report experiencing traumatic life events, such as abuse, abandonment, or adversity during childhood. Others may have been exposed to unstable, invalidating relationships, and hostile conflicts.
Treatments and Therapies
Borderline personality disorder has historically been viewed as difficult to treat. But, with newer, evidence-based treatment, many people with the disorder experience fewer or less severe symptoms, and an improved quality of life. It is important that people with borderline personality disorder receive evidence-based, specialized treatment from an appropriately trained provider. Other types of treatment, or treatment provided by a doctor or therapist who is not appropriately trained, may not benefit the person.
Many factors affect the length of time it takes for symptoms to improve once treatment begins, so it is important for people with borderline personality disorder and their loved ones to be patient and to receive appropriate support during treatment.
Tests and Diagnosis
licensed mental health professional—such as a psychiatrist, psychologist, or clinical social worker—experienced in diagnosing and treating mental disorders can diagnose borderline personality disorder by:
- Completing a thorough interview, including a discussion about symptoms
- Performing a careful and thorough medical exam, which can help rule out other possible causes of symptoms
- Asking about family medical histories, including any history of mental illness
Borderline personality disorder often occurs with other mental illnesses. Co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with the symptoms of borderline personality disorder. For example, a person with borderline personality disorder may be more likely to also experience symptoms of depression, bipolar disorder, anxiety disorders, substance use disorders, or eating disorders.
Seek and Stick with Treatment
NIMH-funded studies show that people with borderline personality disorder who don’t receive adequate treatment are:
- More likely to develop other chronic medical or mental illnesses
- Less likely to make healthy lifestyle choices
Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than the general public.
People with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away.
If you or someone you know is in crisis, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are free and confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Read more on NIMH’s Suicide Prevention health topic page.
The treatments described on this page are just some of the options that may be available to a person with borderline personality disorder.
Psychotherapy
Psychotherapy is the first-line treatment for people with borderline personality disorder. A therapist can provide one-on-one treatment between the therapist and patient, or treatment in a group setting. Therapist-led group sessions may help teach people with borderline personality disorder how to interact with others and how to effectively express themselves.
It is important that people in therapy get along with, and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with the disorder to maintain a comfortable and trusting bond with their therapist.
Two examples of psychotherapies used to treat borderline personality disorder include:
- Dialectical Behavior Therapy (DBT): This type of therapy was developed for individuals with borderline personality disorder. DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help:
- Control intense emotions
- Reduce self-destructive behaviors
- Improve relationships
- Cognitive Behavioral Therapy (CBT): This type of therapy can help people with borderline personality disorder identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others, and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
Read more on NIMH’s Psychotherapies health topic page.
Medications
Because the benefits are unclear, medications are not typically used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms such as:
- mood swings
- depression
- other co-occurring mental disorders
Treatment with medications may require care from more than one medical professional. Certain medications can cause different side effects in different people. Talk to your doctor about what to expect from a particular medication. Read more in NIMH’s Mental Health Medications health topic.
Other Elements of Care
Some people with borderline personality disorder experience severe symptoms and need intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care.
Therapy for Caregivers and Family Members
Families and caregivers of people with borderline personality disorder may also benefit from therapy. Having a relative or loved one with the disorder can be stressful, and family members or caregivers may unintentionally act in ways that can worsen their loved one’s symptoms.
Some borderline personality disorder therapies include family members, caregivers, or loved ones in treatment sessions. This type of therapy helps by:
- Allowing the relative or loved one develop skills to better understand and support a person with borderline personality disorder
- Focusing on the needs of family members to help them understand the obstacles and strategies for caring for someone with borderline personality disorder. Although more research is needed to determine the effectiveness of family therapy in borderline personality disorder, studies on other mental disorders suggest that including family members can help in a person's treatment.
More information about finding a health care provider or treatment for mental disorders in general is available on our Help for Mental Illness webpage. You may also find additional information through the NIMH Outreach Partners or the NIMH National Partners.
Tips for Family and Caregivers
To help a friend or relative with the disorder:
- Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with borderline personality disorder, but it is possible for them to get better over time
- Learn about mental disorders, including borderline personality disorder, so you can understand what the person with the disorder is experiencing
- Encourage your loved one who is in treatment for borderline personality disorder to ask about family therapy
- Seek counseling for yourself from a therapist. It should not be the same therapist that your loved one with borderline personality disorder is seeing.
Research on borderline personality disorder is focusing on biological and environmental risk factors, with special attention on symptoms that may emerge at a young age. Researchers are conducting studies focused on adolescents at risk for borderline personality disorder to develop methods that help identify the disorder early. Borderline personality disorder research is also focused on the development and evaluation of psychotherapy and pharmacological interventions to prevent self-harming and suicidal behaviors, which occur at a high rate among people with borderline personality disorder.
How can I take part in clinical research?
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including borderline personality disorder. During clinical trials, treatments might be new drugs, new types of psychotherapy, new combinations of drugs, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe.
Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future. Decisions about participating in a clinical trial are best made in collaboration with a licensed health professional.
To learn more about clinical trials, please visit NIH Clinical Trials and You (www.nih.gov/health/clinicaltrials/index.htm). To find a clinical trial, visit www.ClinicalTrials.gov.
For More Information
To learn more information about borderline personality disorder, visit:
Medline Plus (National Library of Medicine)
http://medlineplus.gov
(En espanol: http://medlineplus.gov/spanish)
For information on clinical trials, visit:
ClinicalTrials.gov: http://www.clinicaltrials.gov
(En espanol: http://salud.nih.gov/investigacion-clinica/)
For more information on conditions that affect mental health, resources, and research, visit the NIMH website (http://www.nimh.nih.gov).
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301–443–4513 or 1–866–615–NIMH (6464) toll-free
TTY: 301–443–8431 or 1–866–415–8051 toll-free
FAX: 301–443–4279
E-mail: [email protected]
Website: www.nimh.nih.gov
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
National Institutes of Health
National Institute of Mental Health
NIH Publication No. QF 17-4928
Souce: National Institue of Mental Health website on 5.28.19 at https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
Learn more about mental health by
going to the NIH Website.
going to the NIH Website.
Autism Spectrum Disorder From May 22, 2019
Overview
Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior. Although autism can be diagnosed at any age, it is said to be a “developmental disorder” because symptoms generally appear in the first two years of life.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association used to diagnose mental disorders, people with ASD have:
- Difficulty with communication and interaction with other people
- Restricted interests and repetitive behaviors
- Symptoms that hurt the person’s ability to function properly in school, work, and other areas of life
Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience. ASD occurs in all ethnic, racial, and economic groups. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and ability to function. The American Academy of Pediatrics recommends that all children be screened for autism. All caregivers should talk to their doctor about ASD screening or evaluation.
Signs and Symptoms of ASD
People with ASD have difficulty with social communication and interaction, restricted interests, and repetitive behaviors. The list below gives some examples of the types of behaviors that are seen in people diagnosed with ASD. Not all people with ASD will show all behaviors, but most will show several.
Social communication / interaction behaviors may include:
- Making little or inconsistent eye contact
- Tending not to look at or listen to people
- Rarely sharing enjoyment of objects or activities by pointing or showing things to others
- Failing to, or being slow to, respond to someone calling their name or to other verbal attempts to gain attention
- Having difficulties with the back and forth of conversation
- Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
- Having facial expressions, movements, and gestures that do not match what is being said
- Having an unusual tone of voice that may sound sing-song or flat and robot-like
- Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions
Restrictive / repetitive behaviors may include:
- Repeating certain behaviors or having unusual behaviors. For example, repeating words or phrases, a behavior called echolalia
- Having a lasting intense interest in certain topics, such as numbers, details, or facts
- Having overly focused interests, such as with moving objects or parts of objects
- Getting upset by slight changes in a routine
- Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature
People with ASD may also experience sleep problems and irritability. Although people with ASD experience many challenges, they may also have many strengths, including:
- Being able to learn things in detail and remember information for long periods of time
- Being strong visual and auditory learners
- Excelling in math, science, music, or art
Causes and Risk Factors
While scientists don’t know the exact causes of ASD, research suggests that genes can act together with influences from the environment to affect development in ways that lead to ASD. Although scientists are still trying to understand why some people develop ASD and others don’t, some risk factors include:
- Having a sibling with ASD
- Having older parents
- Having certain genetic conditions—people with conditions such as Down syndrome, fragile X syndrome, and Rett syndrome are more likely than others to have ASD
- Very low birth weight
Doctors diagnose ASD by looking at a person’s behavior and development. ASD can usually be reliably diagnosed by the age of two. It is important for those with concerns to seek out assessment as soon as possible so that a diagnosis can be made, and treatment can begin.
Diagnosis in Young Children
Diagnosis in young children is often a two-stage process.
Stage 1: General Developmental Screening During Well-Child Checkups
Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children be screened for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits and specifically for autism at their 18- and 24-month well-child visits. Additional screening might be needed if a child is at high risk for ASD or developmental problems. Those at high risk include children who have a family member with ASD, have some ASD behaviors, have older parents, have certain genetic conditions, or who were born at a very low birth weight.
Parents’ experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the child’s behaviors and combine those answers with information from ASD screening tools, and with his or her observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention (CDC) website.
Children who show developmental problems during this screening process will be referred for a second stage of evaluation.
Stage 2: Additional Evaluation
This second evaluation is with a team of doctors and other health professionals who are experienced in diagnosing ASD.
This team may include:
- A developmental pediatrician—a doctor who has special training in child development
- A child psychologist and/or child psychiatrist—a doctor who has specialized training in brain development and behavior
- A neuropsychologist—a doctor who focuses on evaluating, diagnosing, and treating neurological, medical, and neurodevelopmental disorders
- A speech-language pathologist—a health professional who has special training in communication difficulties
- Cognitive level or thinking skills
- Language abilities
- Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting
- Blood tests
- Hearing test
Diagnosis in older children and adolescents
ASD symptoms in older children and adolescents who attend school are often first recognized by parents and teachers and then evaluated by the school’s special education team. The school’s team may perform an initial evaluation and then recommend these children visit their primary health care doctor or doctors who specialize in ASD for additional testing.
Parents may talk with these specialists about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language.
Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers.
Diagnosis in adults
Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental-health disorders, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).
Adults who notice the signs and symptoms of ASD should talk with a doctor and ask for a referral for an ASD evaluation. While testing for ASD in adults is still being refined, adults can be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about concerns, such as:
- Social interaction and communication challenges
- Sensory issues
- Repetitive behaviors
- Restricted interests
Getting a correct diagnosis of ASD as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help. Studies are now underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of transition-age youth and adults with ASD.
Changes to the diagnosis of ASDIn 2013, a revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released. This revision changed the way autism is classified and diagnosed. Using the previous version of the DSM, people could be diagnosed with one of several separate conditions:
- Autistic disorder
- Asperger’s’ syndrome
- Pervasive developmental disorder not otherwise specified (PDD-NOS)
In the current revised version of the DSM (the DSM-5), these separate conditions have been combined into one diagnosis called “autism spectrum disorder.” Using the DSM-5, for example, people who were previously diagnosed as having Asperger’s syndrome would now be diagnosed as having autism spectrum disorder. Although the “official” diagnosis of ASD has changed, there is nothing wrong with continuing to use terms such as Asperger’s syndrome to describe oneself or to identify with a peer group.
Treatments and Therapies
Treatment for ASD should begin as soon as possible after diagnosis. Early treatment for ASD is important as proper care can reduce individuals’ difficulties while helping them learn new skills and make the most of their strengths.
The wide range of issues facing people with ASD means that there is no single best treatment for ASD. Working closely with a doctor or health care professional is an important part of finding the right treatment program.
Medication
A doctor may use medication to treat some symptoms that are common with ASD. With medication, a person with ASD may have fewer problems with:
- Irritability
- Aggression
- Repetitive behavior
- Hyperactivity
- Attention problems
- Anxiety and depression
Behavioral, psychological, and educational therapy
People with ASD may be referred to doctors who specialize in providing behavioral, psychological, educational, or skill-building interventions. These programs are typically highly structured and intensive and may involve parents, siblings, and other family members. Programs may help people with ASD:
- Learn life-skills necessary to live independently
- Reduce challenging behaviors
- Increase or build upon strengths
- Learn social, communication, and language skills
There are many social services programs and other resources that can help people with ASD. Here are some tips for finding these additional services:
- Contact your doctor, local health department, school, or autism advocacy group to learn about special programs or local resources.
- Find an autism support group. Sharing information and experiences can help individuals with ASD and/or their caregivers learn about treatment options and ASD-related programs.
- Record conversations and meetings with health care providers and teachers. This information helps when it’s time to make decisions about which programs might best meet an individual’s needs.
- Keep copies of doctors' reports and evaluations. This information may help an individual qualify for special programs.
Souce: National Institue of Mental Health website on 5.21.19 at https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
Attention-Deficit/Hyperactivity Disorder From May 15, 2019
Attention-Deficit/Hyperactivity Disorder From May 15, 2019
Overview
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
- Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
- Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
- Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Signs and Symptoms
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
In preschool, the most common ADHD symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:
- are more severe
- occur more often
- interfere with or reduce the quality of how they functions socially, at school, or in a job
Inattention
People with symptoms of inattention may often:
- Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
- Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
- Not seem to listen when spoken to directly
- Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
- Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
- Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers
- Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
- Be easily distracted by unrelated thoughts or stimuli
- Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
Hyperactivity-Impulsivity
People with symptoms of hyperactivity-impulsivity may often:
- Fidget and squirm in their seats
- Leave their seats in situations when staying seated is expected, such as in the classroom or in the office
- Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
- Be unable to play or engage in hobbies quietly
- Be constantly in motion or “on the go,” or act as if “driven by a motor”
- Talk nonstop
- Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation
- Have trouble waiting his or her turn
- Interrupt or intrude on others, for example in conversations, games, or activities
Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.
ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.
ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.
Risk Factors
Scientists are not sure what causes ADHD. Like many other illnesses, a number of factors can contribute to ADHD, such as:
- Genes
- Cigarette smoking, alcohol use, or drug use during pregnancy
- Exposure to environmental toxins during pregnancy
- Exposure to environmental toxins, such as high levels of lead, at a young age
- Low birth weight
- Brain injuries
Treatment and Therapies
While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.
Medication
For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.
Stimulants. The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it works because it increases the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention. Under medical supervision, stimulant medications are considered safe. However, there are risks and side effects, especially when misused or taken in excess of the prescribed dose. For example, stimulants can raise blood pressure and heart rate and increase anxiety. Therefore, a person with other health problems, including high blood pressure, seizures, heart disease, glaucoma, liver or kidney disease, or an anxiety disorder should tell their doctor before taking a stimulant.
Talk with a doctor if you see any of these side effects while taking stimulants:
- decreased appetite
- sleep problems
- tics (sudden, repetitive movements or sounds);
- personality changes
- increased anxiety and irritability
- stomachaches
- headaches
Although not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, some antidepressants are sometimes used alone or in combination with a stimulant to treat ADHD. Antidepressants may help all of the symptoms of ADHD and can be prescribed if a patient has bothersome side effects from stimulants. Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder.
Doctors and patients can work together to find the best medication, dose, or medication combination. Learn the basics about stimulants and other mental health medications on the NIMH Mental Health Medications webpage and check the FDAwebsite (http://www.fda.gov/), for the latest information on warnings, patient medication guides, or newly approved medications.
Psychotherapy
Adding psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.
Behavioral therapy is a type of psychotherapy that aims to help a person change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:
- monitor his or her own behavior
- give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting.
Parents, teachers, and family members also can give positive or negative feedback for certain behaviors and help establish clear rules, chore lists, and other structured routines to help a person control his or her behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.
Cognitive behavioral therapy can also teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
Family and marital therapy can help family members and spouses find better ways to handle disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.
For more information on psychotherapy, see the Psychotherapies webpage on the NIMH website.
Education and Training
Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. For school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. Parents and children may need special help to overcome negative feelings. Mental health professionals can educate parents about ADHD and how it affects a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.
Parenting skills training (behavioral parent management training) teaches parents the skills they need to encourage and reward positive behaviors in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors that they want to discourage. They may also learn to structure situations in ways that support desired behavior.
Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.
Support groups can help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
Tips to Help Kids and Adults with ADHD Stay Organized
For Kids: Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:
- Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
- Organizing everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
- Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
- Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
- Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
For Adults: A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:
- Keeping routines
- Making lists for different tasks and activities
- Using a calendar for scheduling events
- Using reminder notes
- Assigning a special place for keys, bills, and paperwork
- Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.
Souce: National Institue of Mental Health website on 5.15.19 at https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
Anxiety Disorders From May 8, 2019
Overview
Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.
There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.
Signs and Symptoms
Generalized Anxiety Disorder
People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.
Generalized anxiety disorder symptoms include:
People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.
During a panic attack, people may experience:
Phobia-related disorders
A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.
People with a phobia:
Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:
Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.
Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:
Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.
Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders.
Risk Factors
Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although the risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include:
Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety and people should work with their doctor to choose the treatment that is best for them.
Psychotherapy
Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.
CBT can be conducted individually or with a group of people who have similar difficulties. Often “homework” is assigned for participants to complete between sessions.
Medication
Medication does not cure anxiety disorders but can help relieve symptoms. Medication for anxiety is prescribed by doctors, such as a psychiatrist or primary care provider. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are anti-anxiety drugs (such as benzodiazepines), antidepressants, and beta-blockers.
Anti-Anxiety Medications
Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.
Some benefits of benzodiazepines are that they are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. Some drawbacks of benzodiazepines are that people can build up a tolerance to them if they are taken over a long period of time and they may need higher and higher doses to get the same effect. Some people may even become dependent on them.
To avoid these problems, doctors usually prescribe benzodiazepines for short periods of time, a practice that is especially helpful for older adults, people who have substance abuse problems, and people who become dependent on medication easily.
If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose.
For long-term use, benzodiazepines are often considered a second-line treatment for anxiety (with antidepressants being considered a first-line treatment) as well as an “as-needed” treatment for any distressing flare-ups of symptoms.
A different type of anti-anxiety medication is buspirone. Buspirone is a non-benzodiazepine medication specifically indicated for the treatment of chronic anxiety, although it does not help everyone.
Antidepressants
Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
Antidepressants can take time to work, so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
Beta-Blockers
Although beta-blockers are most often used to treat high blood pressure, they can also be used to help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications, when taken for a short period of time, can help people keep physical symptoms under control. They can also be used “as needed” to reduce acute anxiety, including as a preventive intervention for some predictable forms of performance anxieties.
Choosing the Right Medication
Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with their doctor to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. Patients should talk with their doctor, so they can learn which substances are safe and which to avoid.
Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and should be based on a person’s needs and their medical situation. Your doctor may try several medicines before finding the right one.
You and your doctor should discuss:
Support Groups
Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful, but any advice received over the internet should be used with caution, as Internet acquaintances have usually never seen each other and what has helped one person is not necessarily what is best for another. You should always check with your doctor before following any treatment advice found on the internet. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from a doctor or other health professional.
Stress Management Techniques
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. Research suggests that aerobic exercise can help some people manage their anxiety; however, exercise should not take the place of standard care and more research is needed.
Souce: National Institue of Mental Health website on 5.8.19 at https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.
There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.
Signs and Symptoms
Generalized Anxiety Disorder
People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.
Generalized anxiety disorder symptoms include:
- Feeling restless, wound-up, or on-edge
- Being easily fatigued
- Having difficulty concentrating; mind going blank
- Being irritable
- Having muscle tension
- Difficulty controlling feelings of worry
- Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep.
People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.
During a panic attack, people may experience:
- Heart palpitations, a pounding heartbeat, or an accelerated heartrate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath, smothering, or choking
- Feelings of impending doom
- Feelings of being out of control
Phobia-related disorders
A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.
People with a phobia:
- May have an irrational or excessive worry about encountering the feared object or situation
- Take active steps to avoid the feared object or situation
- Experience immediate intense anxiety upon encountering the feared object or situation
- Endure unavoidable objects and situations with intense anxiety
Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:
- Flying
- Heights
- Specific animals, such as spiders, dogs, or snakes
- Receiving injections
- Blood
Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.
Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd
- Being outside of the home alone
Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.
Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders.
Risk Factors
Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although the risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include:
- Temperamental traits of shyness or behavioral inhibition in childhood
- Exposure to stressful and negative life or environmental events in early childhood or adulthood
- A history of anxiety or other mental illnesses in biological relatives
- Some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder.
Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety and people should work with their doctor to choose the treatment that is best for them.
Psychotherapy
Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.
CBT can be conducted individually or with a group of people who have similar difficulties. Often “homework” is assigned for participants to complete between sessions.
Medication
Medication does not cure anxiety disorders but can help relieve symptoms. Medication for anxiety is prescribed by doctors, such as a psychiatrist or primary care provider. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are anti-anxiety drugs (such as benzodiazepines), antidepressants, and beta-blockers.
Anti-Anxiety Medications
Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.
Some benefits of benzodiazepines are that they are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. Some drawbacks of benzodiazepines are that people can build up a tolerance to them if they are taken over a long period of time and they may need higher and higher doses to get the same effect. Some people may even become dependent on them.
To avoid these problems, doctors usually prescribe benzodiazepines for short periods of time, a practice that is especially helpful for older adults, people who have substance abuse problems, and people who become dependent on medication easily.
If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose.
For long-term use, benzodiazepines are often considered a second-line treatment for anxiety (with antidepressants being considered a first-line treatment) as well as an “as-needed” treatment for any distressing flare-ups of symptoms.
A different type of anti-anxiety medication is buspirone. Buspirone is a non-benzodiazepine medication specifically indicated for the treatment of chronic anxiety, although it does not help everyone.
Antidepressants
Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
Antidepressants can take time to work, so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
Beta-Blockers
Although beta-blockers are most often used to treat high blood pressure, they can also be used to help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications, when taken for a short period of time, can help people keep physical symptoms under control. They can also be used “as needed” to reduce acute anxiety, including as a preventive intervention for some predictable forms of performance anxieties.
Choosing the Right Medication
Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with their doctor to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. Patients should talk with their doctor, so they can learn which substances are safe and which to avoid.
Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and should be based on a person’s needs and their medical situation. Your doctor may try several medicines before finding the right one.
You and your doctor should discuss:
- How well medications are working or might work to improve your symptoms
- Benefits and side effects of each medication
- Risk for serious side effects based on your medical history
- The likelihood of the medications requiring lifestyle changes
- Costs of each medication
- Other alternative therapies, medications, vitamins, and supplements you are taking and how these may affect your treatment; a combination of medication and psychotherapy is the best approach for many people with anxiety disorders
- How the medication should be stopped (Some drugs can’t be stopped abruptly and must be tapered off slowly under a doctor’s supervision).
Support Groups
Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful, but any advice received over the internet should be used with caution, as Internet acquaintances have usually never seen each other and what has helped one person is not necessarily what is best for another. You should always check with your doctor before following any treatment advice found on the internet. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from a doctor or other health professional.
Stress Management Techniques
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. Research suggests that aerobic exercise can help some people manage their anxiety; however, exercise should not take the place of standard care and more research is needed.
Souce: National Institue of Mental Health website on 5.8.19 at https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
Suicide Prevention From May 1, 2019
This free support is
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If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. Nacional de Prevención del Suicidio 1-888-628-9454 |
Introduction
Suicide is a major public health concern. Over 40,000 people die by suicide each year in the United States; it is the 10th leading cause of death overall. Suicide is complicated and tragic but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.
Signs and Symptoms
The behaviors listed below may be signs that someone is thinking about suicide.
Risk FactorsSuicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex and there is no single cause. In fact, many different factors contribute to someone making a suicide attempt. But people most at risk tend to share certain characteristics.
The main risk factors for suicide are:
Do gender and age affect suicide risk?
Men are more likely to die by suicide than women, but women are more likely to attempt suicide. Men are more likely to use deadlier methods, such as firearms or suffocation. Women are more likely than men to attempt suicide by poisoning. The most recent figures released by the CDC show that the highest rate of suicide deaths among women is found between ages 45 and 64, while the highest rate for men occurs at ages 75+. Children and young adults also are at risk for suicide. Suicide is the second leading cause of death for young people ages 15 to 34.
What about different racial/ethnic groups?
The CDC reports that among racial and ethnic groups, American Indians and Alaska Natives tend to have the highest rate of suicides, followed by non-Hispanic Whites. African Americans tend to have the lowest suicide rate, while Hispanics tend to have the second lowest rate.
Treatments and Therapies
Research has shown that there are multiple risk factors for suicide and that these factors may vary with age, gender, physical and mental well-being, and with individual experiences. Treatments and therapies for people with suicidal thoughts or actions will vary as well. NIMH has focused research on strategies that have worked well for mental health conditions related to suicide such as depression and anxiety.
Psychotherapies
Multiple types of psychosocial interventions have been found to be beneficial for individuals who have attempted suicide. These types of interventions may prevent someone from making another attempt. Psychotherapy, or "talk therapy," is one type of psychosocial intervention and can effectively reduce suicide risk.
One type of psychotherapy is called cognitive behavioral therapy (CBT). CBT can help people learn new ways of dealing with stressful experiences through training. CBT helps individuals recognize their own thought patterns and consider alternative actions when thoughts of suicide arise.
Another type of psychotherapy, called dialectical behavior therapy (DBT), has been shown to reduce the rate of suicide among people with borderline personality disorder, a serious mental illness characterized by unstable moods, relationships, self-image, and behavior. A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.
NIMH’s Find Help for Mental Illnesses page can help you locate a mental health provider in your area.
Medication
Some individuals at risk for suicide might benefit from medication. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose.
Clozapine, is an antipsychotic medication used primarily to treat individuals with schizophrenia. However, it is the only medication with a specific U.S. Food and Drug Administration (FDA) indication for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are at risk for ongoing suicidal behavior. Because many individuals at risk for suicide often have psychiatric and substance use problems, individuals might benefit from medication along with psychosocial intervention.
If you are prescribed a medication, be sure you:
Ongoing Research
In order to know who is most at risk and to prevent suicide, scientists need to understand the role of long-term factors (such as childhood experiences) as well as more immediate factors like mental health and recent life events. Researchers also are looking at how genes can either increase risk or make someone more resilient to loss and hardships.
Recent findings from NIMH funded research are listed in the Research and Statistics section below but NIMH also is funding a number of ongoing studies related to suicide.
Learn MoreFree eBooks and Brochures
Suicide is a major public health concern. Over 40,000 people die by suicide each year in the United States; it is the 10th leading cause of death overall. Suicide is complicated and tragic but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.
Signs and Symptoms
The behaviors listed below may be signs that someone is thinking about suicide.
- Talking about wanting to die or wanting to kill themselves
- Talking about feeling empty, hopeless, or having no reason to live
- Making a plan or looking for a way to kill themselves, such as searching online, stockpiling pills, or buying a gun
- Talking about great guilt or shame
- Talking about feeling trapped or feeling that there are no solutions
- Feeling unbearable pain (emotional pain or physical pain)
- Talking about being a burden to others
- Using alcohol or drugs more often
- Acting anxious or agitated
- Withdrawing from family and friends
- Changing eating and/or sleeping habits
- Showing rage or talking about seeking revenge
- Taking great risks that could lead to death, such as driving extremely fast
- Talking or thinking about death often
- Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
- Giving away important possessions
- Saying goodbye to friends and family
- Putting affairs in order, making a will
Risk FactorsSuicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex and there is no single cause. In fact, many different factors contribute to someone making a suicide attempt. But people most at risk tend to share certain characteristics.
The main risk factors for suicide are:
- Depression, other mental disorders, or substance abuse disorder
- Certain medical conditions
- Chronic pain
- A prior suicide attempt
- Family history of a mental disorder or substance abuse
- Family history of suicide
- Family violence, including physical or sexual abuse
- Having guns or other firearms in the home
- Having recently been released from prison or jail
- Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities
- Many people have some of these risk factors but do not attempt suicide. It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention, and should not be ignored.
Do gender and age affect suicide risk?
Men are more likely to die by suicide than women, but women are more likely to attempt suicide. Men are more likely to use deadlier methods, such as firearms or suffocation. Women are more likely than men to attempt suicide by poisoning. The most recent figures released by the CDC show that the highest rate of suicide deaths among women is found between ages 45 and 64, while the highest rate for men occurs at ages 75+. Children and young adults also are at risk for suicide. Suicide is the second leading cause of death for young people ages 15 to 34.
What about different racial/ethnic groups?
The CDC reports that among racial and ethnic groups, American Indians and Alaska Natives tend to have the highest rate of suicides, followed by non-Hispanic Whites. African Americans tend to have the lowest suicide rate, while Hispanics tend to have the second lowest rate.
Treatments and Therapies
Research has shown that there are multiple risk factors for suicide and that these factors may vary with age, gender, physical and mental well-being, and with individual experiences. Treatments and therapies for people with suicidal thoughts or actions will vary as well. NIMH has focused research on strategies that have worked well for mental health conditions related to suicide such as depression and anxiety.
Psychotherapies
Multiple types of psychosocial interventions have been found to be beneficial for individuals who have attempted suicide. These types of interventions may prevent someone from making another attempt. Psychotherapy, or "talk therapy," is one type of psychosocial intervention and can effectively reduce suicide risk.
One type of psychotherapy is called cognitive behavioral therapy (CBT). CBT can help people learn new ways of dealing with stressful experiences through training. CBT helps individuals recognize their own thought patterns and consider alternative actions when thoughts of suicide arise.
Another type of psychotherapy, called dialectical behavior therapy (DBT), has been shown to reduce the rate of suicide among people with borderline personality disorder, a serious mental illness characterized by unstable moods, relationships, self-image, and behavior. A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.
NIMH’s Find Help for Mental Illnesses page can help you locate a mental health provider in your area.
Medication
Some individuals at risk for suicide might benefit from medication. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose.
Clozapine, is an antipsychotic medication used primarily to treat individuals with schizophrenia. However, it is the only medication with a specific U.S. Food and Drug Administration (FDA) indication for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are at risk for ongoing suicidal behavior. Because many individuals at risk for suicide often have psychiatric and substance use problems, individuals might benefit from medication along with psychosocial intervention.
If you are prescribed a medication, be sure you:
- Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you're taking.
- Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to "rebound" or worsening of symptoms. Other uncomfortable or potentially dangerous withdrawal effects also are possible.
- Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication.
- Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your doctor may send a report.
Ongoing Research
In order to know who is most at risk and to prevent suicide, scientists need to understand the role of long-term factors (such as childhood experiences) as well as more immediate factors like mental health and recent life events. Researchers also are looking at how genes can either increase risk or make someone more resilient to loss and hardships.
Recent findings from NIMH funded research are listed in the Research and Statistics section below but NIMH also is funding a number of ongoing studies related to suicide.
Learn MoreFree eBooks and Brochures
- Suicide: A Major, Preventable Mental Health Problem, this fact sheet answers some common questions about suicide and suicide prevention among teens and young adults.
- Suicide in America: Frequently Asked Questions, this brochure covers suicide risk in people of all genders and age groups.
- Understanding Suicide, a fact sheet from the Centers for Disease Control and Prevention
Beverly, Pam, and Sally have developed WOE Care Cards to try and help teenagers in time of need and before real danger arises.
They could help save a life!
You can read why they decided to
create these WOE Care Cards
by reading their story; Drugs can Kill.
Learn more about drugs by visiting The National Institute for Drug Abuse for Teens at https://teens.drugabuse.gov/drug-facts
What is Alcohol? From April 24
What is alcohol use disorder?
Also known as: Booze, Brew, Liquor, and Sauce
Alcohol use disorder (AUD) is a medical condition that doctors diagnose when someone’s drinking causes them distress or harm. AUD ranges from mild to severe.
What is a standard drink?
Many people are surprised to learn what counts as a drink. The amount of liquid in one’s glass, can, or bottle is not necessarily equal to how much alcohol is in their beverage. In the United States, one "standard" drink (or one alcoholic drink-equivalent) contains roughly 14 grams of pure alcohol, which is the amount of alcohol found in:
How does alcohol affect the teenage brain?
When teens drink, alcohol affects their brains in the short-term– but repeated drinking can also impact it down the road, especially as their brains grow and develop.
Short-Term Consequences of Intoxication (being “drunk”):
People who drink are affected even before they show signs of being drunk, especially when it comes to decision-making abilities.
At first, alcohol causes people to feel upbeat and excited. But this is temporary and they shouldn’t be fooled.
If drinking continues, the effects on the body—and the potential risks—multiply. Here’s what can happen:
What are the negative consequences of underage drinking?
There are increased risks and a range of negative consequences related to underage drinking. It is dangerous because it:
Alcohol poisoning (also called alcohol overdose) occurs when there is so much alcohol in a person’s bloodstream that areas of the brain controlling basic life-support systems—such as breathing, heart rate, and temperature control—begin to shut down.
Symptoms of alcohol poisoning include:
What is an alcohol blackout?
An alcohol blackout is a gap in a person’s memory for events that took place while he or she was drinking. When a blackout happens, a person’s brain does not create memories for these events as they are happening. For people who have had a blackout, it can be frightening to wake up the next day and not remember what they did the night before.
Is underage drinking a serious health problem?
Underage drinking is drinking alcohol before a person turns age 21, which is the minimum legal drinking age in the United States. Underage drinking is a serious problem, as you may have seen from your friends’ or your own experiences. Alcohol is the most commonly used substance of abuse among young people in America, and drinking when you’re underage puts your health and safety at risk.
Why do teens drink alcohol?
Teens drink for a variety of reasons. Some teens want to experience new things. Others feel pressured into drinking by peers. And some are looking for a way to cope with stress or other problems. Unfortunately, drinking will only make any problems a person has already worse, not better.
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
The National Institute on Drug Abuse Blog Team. (). Alcohol. Retrieved from https://teens.drugabuse.gov/drug-facts/alcohol on April 24, 2019.
What is alcohol use disorder?
Also known as: Booze, Brew, Liquor, and Sauce
Alcohol use disorder (AUD) is a medical condition that doctors diagnose when someone’s drinking causes them distress or harm. AUD ranges from mild to severe.
What is a standard drink?
Many people are surprised to learn what counts as a drink. The amount of liquid in one’s glass, can, or bottle is not necessarily equal to how much alcohol is in their beverage. In the United States, one "standard" drink (or one alcoholic drink-equivalent) contains roughly 14 grams of pure alcohol, which is the amount of alcohol found in:
- 12 ounces of beer (about 5% alcohol)
- 8 ounces of malt liquor – beer with a high alcohol content (about 7% alcohol)
- 5 ounces of table wine (about 12% alcohol)
- 1.5 ounces (a “shot”) of liquor, like gin, rum, vodka, tequila, or whiskey (about 40% alcohol)
- No level of drinking is safe or legal for anyone under age 21, but unfortunately many teens drink—and they often drink multiple drinks, which is very dangerous.
How does alcohol affect the teenage brain?
When teens drink, alcohol affects their brains in the short-term– but repeated drinking can also impact it down the road, especially as their brains grow and develop.
Short-Term Consequences of Intoxication (being “drunk”):
- An intoxicated person has a harder time making good decisions.
- A person is less aware that his/her behavior may be inappropriate or risky.
- A person may be more likely to engage in risky behavior, including drinking and driving, sexual activity (like unprotected sex) and aggressive or violent behavior.
- A person is less likely to recognize potential danger.
- How does alcohol affect your body?
People who drink are affected even before they show signs of being drunk, especially when it comes to decision-making abilities.
At first, alcohol causes people to feel upbeat and excited. But this is temporary and they shouldn’t be fooled.
If drinking continues, the effects on the body—and the potential risks—multiply. Here’s what can happen:
- Inhibitions and memory: People may say and do things that they will regret later, or possibly not remember at all. Inhibitions are lost - leading to poor decision making.
- Decision-making skills: When they drink, individuals are more likely to be impulsive. They may be at greater risk for having an alcohol-related traffic crash, getting into fights, or making unwise decisions about sex.
- Coordination and physical control: When drinking leads to loss of balance, slurred speech, and blurred vision, even normal activities can become more dangerous.
- Death: Drinking too much alcohol can also lead to death. If people drink too much, they will eventually get sleepy and pass out. Reflexes like gagging and breathing can be suppressed. That means they could vomit and choke, or stop breathing completely.
- And finally, it’s easy to misjudge how long alcohol’s effects last. Alcohol continues to affect the brain and body long after the last drink has been finished. Even after someone stops drinking, alcohol in the stomach and intestine continues to enter the bloodstream, impairing judgment and coordination for hours.
What are the negative consequences of underage drinking?
There are increased risks and a range of negative consequences related to underage drinking. It is dangerous because it:
- Causes many deaths.
On average, alcohol plays a role in the deaths of 4,358 young people under age 21 every year. These deaths include:- 1,580 deaths from car crashes
- 1,269 from murders
- 245 from alcohol poisoning, falls, burns, and drowning
- 492 from suicides
-
- Causes many injuries.
- Drinking alcohol can cause young people to have accidents and get hurt. In 2011 alone, about 188,000 people under age 21 visited an emergency room for injuries related to drinking alcohol.
- Increases the risk of physical and sexual assault.
- Young people under age 21 who drink are more likely to carry out or be the victim of a physical or sexual assault after drinking than others their age who do not drink.
- Can lead to other problems.
Drinking can cause teens to have trouble in school or with the law. Teens who drink are more likely to use other drugs than teens who don’t. - Can lead to developing alcohol use disorder.
Alcohol use disorder (AUD) is a medical condition that doctors diagnose when someone’s drinking causes them distress or harm. In 2017 about 443,000 young people ages 12-17 had AUD. Even more important, the younger the use of alcohol the more likely one is to develop AUD later in life. - Increases the risk of cancer.
Drinking alcohol increases your risk of developing various cancers, including cancers of the mouth, esophagus, pharynx, larynx, liver, and breast.
Alcohol poisoning (also called alcohol overdose) occurs when there is so much alcohol in a person’s bloodstream that areas of the brain controlling basic life-support systems—such as breathing, heart rate, and temperature control—begin to shut down.
Symptoms of alcohol poisoning include:
- Confusion
- Difficulty remaining conscious
- Vomiting
- Seizures
- Trouble with breathing
- Slow heart rate
- Clammy skin
- Dulled responses, such as no gag reflex (which prevents choking)
- Extremely low body temperature
- Death.
What is an alcohol blackout?
An alcohol blackout is a gap in a person’s memory for events that took place while he or she was drinking. When a blackout happens, a person’s brain does not create memories for these events as they are happening. For people who have had a blackout, it can be frightening to wake up the next day and not remember what they did the night before.
Is underage drinking a serious health problem?
Underage drinking is drinking alcohol before a person turns age 21, which is the minimum legal drinking age in the United States. Underage drinking is a serious problem, as you may have seen from your friends’ or your own experiences. Alcohol is the most commonly used substance of abuse among young people in America, and drinking when you’re underage puts your health and safety at risk.
Why do teens drink alcohol?
Teens drink for a variety of reasons. Some teens want to experience new things. Others feel pressured into drinking by peers. And some are looking for a way to cope with stress or other problems. Unfortunately, drinking will only make any problems a person has already worse, not better.
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
The National Institute on Drug Abuse Blog Team. (). Alcohol. Retrieved from https://teens.drugabuse.gov/drug-facts/alcohol on April 24, 2019.
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Depression From April 17, 2019
Overview
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.
Some forms of depression are slightly different, or they may develop under unique circumstances, such as:
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
Risk Factors
Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.
Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.
Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.
Risk factors include:
Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.
Quick Tip: No two people are affected the same way by depression and there is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best for you.
Medications
Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.
To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.
You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.
Psychotherapies
Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH websiteand in the NIMH publication Depression: What You Need to Know.
Brain Stimulation TherapiesIf medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:
If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.
Beyond Treatment: Things You Can DoHere are other tips that may help you or a loved one during treatment for depression:
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.
Some forms of depression are slightly different, or they may develop under unique circumstances, such as:
- Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
- Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
- Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
- Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
- Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
- Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Irritability
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.
Risk Factors
Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.
Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.
Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.
Risk factors include:
- Personal or family history of depression
- Major life changes, trauma, or stress
- Certain physical illnesses and medications
Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.
Quick Tip: No two people are affected the same way by depression and there is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best for you.
Medications
Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.
To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.
You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.
Psychotherapies
Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH websiteand in the NIMH publication Depression: What You Need to Know.
Brain Stimulation TherapiesIf medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:
- ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
- Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
- Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
- ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
- ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.
If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.
Beyond Treatment: Things You Can DoHere are other tips that may help you or a loved one during treatment for depression:
- Try to be active and exercise.
- Set realistic goals for yourself.
- Try to spend time with other people and confide in a trusted friend or relative.
- Try not to isolate yourself, and let others help you.
- Expect your mood to improve gradually, not immediately.
- Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
- Continue to educate yourself about depression.
What are Opioids? From April 10
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.
All opioids are chemically related and interact with opioid receptors on nerve cells in the body and brain. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to addiction, overdose incidents, and deaths.
An opioid overdose can be reversed with the drug naloxone when given right away. Improvements have been seen in some regions of the country in the form of decreasing availability of prescription opioid pain relievers and decreasing misuse among the Nation’s teens. However, since 2007, overdose deaths related to heroin have been increasing. Fortunately, effective medications exist to treat opioid use disorders including methadone, buprenorphine, and naltrexone.
What are Opioids?
Opioids are naturally found in the opium poppy plant. Some opioid medications are made from this plant while others are made by scientists in labs. Opioids have been used for hundreds of years to treat pain, cough, and diarrhea.
What are the most commonly used opioids?
The most commonly used prescription opioids are oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine. Heroin is an opioid, but it is not a medication. Fentanyl is a powerful prescription pain reliever, but it is sometimes added to heroin by drug dealers, causing doses so strong that people are dying from overdoses.
How do opioids work?
Your brain is full of molecules called receptors that receive signals from other parts of the body. Opioids attach to receptors on nerve cells in the brain, spinal cord, and other organs. This allows them to block pain messages sent from the body to the brain, which is why they are prescribed for serious injuries or illnesses.
When the opioids attach to the receptors, they also cause a large amount of dopamine to be released in the pleasure centers of the brain. Dopamine is the chemical responsible for making us feel reward and motivates our actions. The dopamine release caused by the opioids sends a rush of extreme pleasure and well-being throughout the body.
Health effects on the brain and body
In the short term, the release of dopamine into your body can make some people feel really relaxed and happy. But it can also cause more harmful effects, like extreme sleepiness, confusion, nausea, vomiting, and constipation. Over time, opioids can lead to insomnia, muscle pain, heart infections, pneumonia, and addiction
Letter to Teens
You have probably heard a lot about the “opioid overdose crisis” in the news lately. But what are opioids? And why are they such a problem?
You might not realize this, but if you have had a sports injury, dental work, or surgery, it is possible your doctor gave you a pain reliever that was actually an opioid medication. While opioids can be very effective at treating pain, they can be very addictive and should only be used under a doctor’s careful watch.
In addition to opioids given to you by a doctor, there is another kind of opioid you have probably heard about called heroin. Heroin is a very dangerous drug that is usually used by injecting it directly into a vein with a needle. The chemical makeup of heroin is the same as that of pain relievers and both can be very addictive and cause deadly opioid overdoses. In fact, 2.14 million people ages 12 and older had an opioid use disorder in 2016, including 153,000 12- to 17-year-olds.1
Our goal is to give you the facts so you can make smart choices and be your best self. We hope that you will use this booklet to share information about opioids with your friends, parents, teachers, and others.
Nora D. Volkow, M.D.
Director, National Institute on Drug Abuse
Go to booklet; Opioid Facts for Tenns
Source NIDA. (). Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids on 2019, April 9
What is fentanyl? From April 3
Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent.1,2 It is a prescription drug that is also made and used illegally. Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery.3 It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.4 Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.4,5 Street names for illegally used fentanyl include Apache, China Girl, China White, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and Tango & Cash.
Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59.8percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.
How do people use fentanyl? When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops.6 The illegally used fentanyl most often associated with recent overdoses is made in labs. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.7
Some drug dealers are mixing fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose. To learn more about the mixture of fentanyl into other drugs, visit the Drug Enforcement Administration’s Drug Facts on fentanyl.
How does fentanyl affect the brain? Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opioid receptors, which are found in areas of the brain that control pain and emotions.8 After taking opioids many times, the brain adapts to the drug, diminishing its sensitivity, making it hard to feel pleasure from anything besides the drug. When people become addicted, drug seeking and drug use take over their lives.
Fentanyl's effects include
How can a fentanyl overdose be treated? As mentioned above, many drug dealers mix the cheaper fentanyl with other drugs like heroin, cocaine, MDMA and methamphetamine to increase their profits, making it often difficult to know which drug is causing the overdose. Naloxone is a medicine that can treat a fentanyl overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs. But fentanyl is stronger than other opioid drugs like morphine and might require multiple doses of naloxone.
Because of this, if you suspect someone has overdosed, the most important step to take is to call 911 so he or she can receive immediate medical attention. Once medical personnel arrive, they will administer naloxone if they suspect an opioid drug is involved. People who are given naloxone should be monitored for another two hours after the last dose of naloxone is given to make sure breathing does not slow or stop.
To learn more about Fentanyl, go to the National Institute of Drug Abuse website.
Source - NIDA. (2019, February 28). Fentanyl. Retrieved from https://www.drugabuse.gov/publications/drugfacts/fentanyl on 2019, April 5
Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent.1,2 It is a prescription drug that is also made and used illegally. Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery.3 It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.4 Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.4,5 Street names for illegally used fentanyl include Apache, China Girl, China White, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and Tango & Cash.
Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59.8percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.
How do people use fentanyl? When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops.6 The illegally used fentanyl most often associated with recent overdoses is made in labs. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.7
Some drug dealers are mixing fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose. To learn more about the mixture of fentanyl into other drugs, visit the Drug Enforcement Administration’s Drug Facts on fentanyl.
How does fentanyl affect the brain? Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opioid receptors, which are found in areas of the brain that control pain and emotions.8 After taking opioids many times, the brain adapts to the drug, diminishing its sensitivity, making it hard to feel pleasure from anything besides the drug. When people become addicted, drug seeking and drug use take over their lives.
Fentanyl's effects include
- extreme happiness
- drowsiness
- nausea
- confusion
- constipation
- sedation
- problems breathing
- unconsciousness
How can a fentanyl overdose be treated? As mentioned above, many drug dealers mix the cheaper fentanyl with other drugs like heroin, cocaine, MDMA and methamphetamine to increase their profits, making it often difficult to know which drug is causing the overdose. Naloxone is a medicine that can treat a fentanyl overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs. But fentanyl is stronger than other opioid drugs like morphine and might require multiple doses of naloxone.
Because of this, if you suspect someone has overdosed, the most important step to take is to call 911 so he or she can receive immediate medical attention. Once medical personnel arrive, they will administer naloxone if they suspect an opioid drug is involved. People who are given naloxone should be monitored for another two hours after the last dose of naloxone is given to make sure breathing does not slow or stop.
To learn more about Fentanyl, go to the National Institute of Drug Abuse website.
Source - NIDA. (2019, February 28). Fentanyl. Retrieved from https://www.drugabuse.gov/publications/drugfacts/fentanyl on 2019, April 5
What is marijuana? From March 27. 2019
Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant. The plant contains the mind-altering chemical THC and other similar compounds. Extracts can also be made from the cannabis plant (see "Marijuana Extracts").
Marijuana is the most commonly used illicit drug in the United States.1 Its use is widespread among young people. In 2015, more than 11 million young adults ages 18 to 25 used marijuana in the past year.1 According to the Monitoring the Future survey, rates of marijuana use among middle and high school students have dropped or leveled off in the past few years after several years of increase. However, the number of young people who believe regular marijuana use is risky is decreasing.2
Legalization of marijuana for medical use or adult recreational use in a growing number of states may affect these views. Read more about marijuana as medicine in our DrugFacts: Marijuana as Medicine.
How do people use marijuana?People smoke marijuana in hand-rolled cigarettes (joints) or in pipes or water pipes (bongs). They also smoke it in blunts—emptied cigars that have been partly or completely refilled with marijuana. To avoid inhaling smoke, some people are using vaporizers. These devices pull the active ingredients (including THC) from the marijuana and collect their vapor in a storage unit. A person then inhales the vapor, not the smoke. Some vaporizers use a liquid marijuana extract.
People can mix marijuana in food (edibles), such as brownies, cookies, or candy, or brew it as a tea. A newly popular method of use is smoking or eating different forms of THC-rich resins (see "Marijuana Extracts").
Marijuana ExtractsSmoking THC-rich resins extracted from the marijuana plant is on the rise. People call this practice dabbing. These extracts come in various forms, such as:
- hash oil or honey oil—a gooey liquid
- wax or budder&mdsh;a soft solid with a texture like lip balm
- shatter—a hard, amber-colored solid