CDC

 https://www.cdc.gov/arthritis/basics/fibromyalgia.htm

Bipolar Disorder Treatments

Treatments

Bipolar disorder cannot be cured, but it can be treated effectively over the long-term. Proper treatment helps many people with bipolar disorder—even those with the most severe forms of the illness—gain better control of their mood swings and related symptoms. But because it is a lifelong illness, long-term, continuous treatment is needed to control symptoms. However, even with proper treatment, mood changes can occur. In the NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study—the largest treatment study ever conducted for bipolar disorder—almost half of those who recovered still had lingering symptoms. Having another mental disorder in addition to bipolar disorder increased one's chances for a relapse. See STEP-BD for more information.
Treatment is more effective if you work closely with a doctor and talk openly about your concerns and choices. An effective maintenance treatment plan usually includes a combination of medication and psychotherapy.

Medications

Different types of medications can help control symptoms of bipolar disorder. Not everyone responds to medications in the same way. You may need to try several different medications before finding ones that work best for you.

Keeping a daily life chart that makes note of your daily mood symptoms, treatments, sleep patterns, and life events can help you and your doctor track and treat your illness most effectively. If your symptoms change or if side effects become intolerable, your doctor may switch or add medications.

The types of medications generally used to treat bipolar disorder include mood stabilizers, atypical antipsychotics, and antidepressants. For the most up-to-date information on medication use and their side effects, contact the U.S. Food and Drug Administration (FDA)
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Mood stabilizers are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Lithium (also known as Eskalith or Lithobid) is an effective mood stabilizer. It was the first mood stabilizer approved by the FDA in the 1970's for treating both manic and depressive episodes.

Anticonvulsants are also used as mood stabilizers. They were originally developed to treat seizures, but they also help control moods. Anticonvulsants used as mood stabilizers include:

• Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania. It is a popular alternative to lithium. However, young women taking valproic acid face special precautions.
• Lamotrigine (Lamictal), FDA-approved for maintenance treatment of bipolar disorder. It is often effective in treating depressive symptoms.
• Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal).

Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be monitored closely for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. If you take any of these medications, do not make any changes to your dosage without talking to your doctor.

What are the side effects of mood stabilizers?

Lithium can cause side effects such as:

• Restlessness
• Dry mouth
• Bloating or indigestion
• Acne
• Unusual discomfort to cold temperatures
• Joint or muscle pain
• Brittle nails or hair.

When taking lithium, your doctor should check the levels of lithium in your blood regularly, and will monitor your kidney and thyroid function as well. Lithium treatment may cause low thyroid levels in some people. Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.
Because too much or too little thyroid hormone can lead to mood and energy changes, it is important that your doctor check your thyroid levels carefully. You may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.
Common side effects of other mood stabilizing medications include:

• Drowsiness
• Dizziness
• Headache
• Diarrhea
• Constipation
• Heartburn
• Mood swings
• Stuffed or runny nose, or other cold-like symptoms.

These medications may also be linked with rare but serious side effects. Talk with your doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you're taking. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible.

Should young women take valproic acid?

Valproic acid may increase levels of testosterone (a male hormone) in teenage girls. It could lead to a condition called polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20. PCOS can cause obesity, excess body hair, an irregular menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid. Young girls and women taking valproic acid should be monitored carefully by a doctor.

Atypical antipsychotics are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications, such as antidepressants. Atypical antipsychotics include:

• Olanzapine (Zyprexa), which when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis. Olanzapine can be taken as a pill or a shot. The shot is often used for urgent treatment of agitation associated with a manic or mixed episode. Olanzapine can be used as maintenance treatment as well, even when psychotic symptoms are not currently present.
• Aripiprazole (Abilify), which is used to treat manic or mixed episodes. Aripiprazole is also used for maintenance treatment. Like olanzapine, aripiprazole can be taken as a pill or a shot. The shot is often used for urgent treatment of severe symptoms.
• Quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon) also are prescribed to relieve the symptoms of manic episodes.

What are the side effects of atypical antipsychotics?

If you are taking antipsychotics, you should not drive until you have adjusted to your medication. Side effects of many antipsychotics include:

• Drowsiness
• Dizziness when changing positions
• Blurred vision
• Rapid heartbeat
• Sensitivity to the sun
• Skin rashes
• Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in your metabolism. This may increase your risk of getting diabetes and high cholesterol. Your doctor should monitor your weight, glucose levels, and lipid levels regularly while you are taking these medications.

In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes uncontrollable muscle movements, frequently around the mouth. TD can range from mild to severe. Some people with TD recover partially or fully after they stop taking the drug, but others do not.

Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder. Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.
However, taking only an antidepressant can increase your risk of switching to mania or hypomania, or of developing rapid-cycling symptoms. To prevent this switch, doctors usually require you to take a mood-stabilizing medication at the same time as an antidepressant.

What are the side effects of antidepressants?

Antidepressants can cause:

• Headache
• Nausea (feeling sick to your stomach)
• Agitation (feeling jittery)
• Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.

Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication. You should not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to "rebound" or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.

Should women who are pregnant or may become pregnant take medication for bipolar disorder?

Women with bipolar disorder who are pregnant or may become pregnant face special challenges. Mood stabilizing medications can harm a developing fetus or nursing infant. But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.
Lithium is generally the preferred mood-stabilizing medication for pregnant women with bipolar disorder. However, lithium can lead to heart problems in the fetus. In addition, women need to know that most bipolar medications are passed on through breast milk. The FDA has also issued warnings about the potential risks associated with the use of antipsychotic medications during pregnancy. If you are pregnant or nursing, talk to your doctor about the benefits and risks of all available treatments.

FDA Warning on Antidepressants

Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. For the latest information, see the FDA website .

Psychotherapy

When done in combination with medication, psychotherapy can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

• Cognitive behavioral therapy (CBT), which helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
• Family-focused therapy, which involves family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication among family members, as well as problem-solving.
• Interpersonal and social rhythm therapy, which helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
• Psychoeducation, which teaches people with bipolar disorder about the illness and its treatment. Psychoeducation can help you recognize signs of an impending mood swing so you can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.

In a STEP-BD study on psychotherapies, researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over 6 weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over 9 months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans. They were also more likely to get well faster and stay well longer. Overall, more than half of the study participants recovered over the course of 1 year.

A licensed psychologist, social worker, or counselor typically provides psychotherapy. He or she should work with your psychiatrist to track your progress. The number, frequency, and type of sessions should be based on your individual treatment needs. As with medication, following the doctor's instructions for any psychotherapy will provide the greatest benefit.
Visit the NIMH website for more information on psychotherapy.

Other treatments

Electroconvulsive Therapy (ECT)—For cases in which medication and psychotherapy do not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments.
Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.
Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes. But it is generally not used as a first-line treatment.
ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.

Sleep Medications—

People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, your doctor may suggest a change in medications. If the problems still continue, your doctor may prescribe sedatives or other sleep medications.

Herbal Supplements—

In general, not much research has been conducted on herbal or natural supplements and how they may affect bipolar disorder. An herb called St. John's wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder. St. John's wort can also make other medications less effective, including some antidepressant and anticonvulsant medications. Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder. Study results have been mixed.
Be sure to tell your doctor about all prescription drugs, over-the-counter medications, or supplements you are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

What research is NIMH doing to improve treatments for bipolar disorder?

Scientists are working to identify new targets for improving current medications or developing new treatments for bipolar disorder. In addition, NIMH researchers have made promising advances toward finding fast-acting medication treatment. In a small study of people with bipolar disorder whose symptoms had not responded to prior treatments, a single dose of ketamine—an anesthetic medication—significantly reduced symptoms of depression in as little as 40 minutes. These effects lasted about a week on average.
Ketamine itself is unlikely to become widely available as a treatment because it can cause serious side effects at high doses, such as hallucinations. However, scientists are working to understand how the drug works on the brain in an effort to develop treatments with fewer side effects and that act similarly to ketamine. Such medications could also be used for longer term management of symptoms.
In addition, NIMH is working to better understand bipolar disorder and other mental disorders by spearheading the Research Domain Criteria (RDoC) Project, which is an ongoing effort to map our current understanding of the brain circuitry that is involved in behavioral and cognitive functioning. By essentially breaking down mental disorders into their component pieces—RDoC aims to add to the knowledge we have gained from more traditional research approaches that focus solely on understanding mental disorders based on symptoms. The hope is that by changing the way we approach mental disorders, RDoC will help us open the door to new targets of preventive and treatment interventions.

Bipolar Disorder Diagnosis

Diagnosis

Doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM). To be diagnosed with bipolar disorder, the symptoms must be a major change from your normal mood or behavior. There are four basic types of bipolar disorder:

1. Bipolar I Disorder—defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
2. Bipolar II Disorder—defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
3. Bipolar Disorder Not Otherwise Specified (BP-NOS)—diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.
4. Cyclothymic Disorder, or Cyclothymia—a mild form of bipolar disorder. People with cyclothymia have episodes of hypomania as well as mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

A severe form of the disorder is called Rapid-cycling Bipolar Disorder. Rapid cycling occurs when a person has four or more episodes of major depression, mania, hypomania, or mixed states, all within a year. Rapid cycling seems to be more common in people who have their first bipolar episode at a younger age. One study found that people with rapid cycling had their first episode about 4 years earlier—during the mid to late teen years—than people without rapid cycling bipolar disorder. Rapid cycling affects more women than men. Rapid cycling can come and go.

When getting a diagnosis, a doctor or health care provider should conduct a physical examination, an interview, and lab tests. Currently, bipolar disorder cannot be identified through a blood test or a brain scan, but these tests can help rule out other factors that may contribute to mood problems, such as a stroke, brain tumor, or thyroid condition. If the problems are not caused by other illnesses, your health care provider may conduct a mental health evaluation or provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.

The doctor or mental health professional should discuss with you any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professional should also talk to your close relatives or spouse about your symptoms and family medical history.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania.

Bipolar disorder can worsen if left undiagnosed and untreated. Episodes may become more frequent or more severe over time without treatment. Also, delays in getting the correct diagnosis and treatment can contribute to personal, social, and work-related problems. Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

Substance abuse is very common among people with bipolar disorder, but the reasons for this link are unclear. Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much.

Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder. Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.
People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. These illnesses may cause symptoms of mania or depression. They may also result from treatment for bipolar disorder.

Bipolar Disorder

What Is Bipolar Disorder?

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Causes

Scientists are studying the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.

Genetics

Bipolar disorder tends to run in families. Some research has suggested that people with certain genes are more likely to develop bipolar disorder than others. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

Technological advances are improving genetic research on bipolar disorder. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them.

Scientists are also studying illnesses with similar symptoms such as depression and schizophrenia to identify genetic differences that may increase a person's risk for developing bipolar disorder. Finding these genetic "hotspots" may also help explain how environmental factors can increase a person's risk.

But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder, despite the fact that identical twins share all of the same genes. Research suggests that factors besides genes are also at work. It is likely that many different genes and environmental factors are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

Brain structure and functioning

Brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain's structure and activity.

Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with "multi-dimensional impairment," a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia. This suggests that the common pattern of brain development may be linked to general risk for unstable moods.

Another MRI study found that the brain's prefrontal cortex in adults with bipolar disorder tends to be smaller and function less well compared to adults who don't have bipolar disorder. The prefrontal cortex is a brain structure involved in "executive" functions such as solving problems and making decisions. This structure and its connections to other parts of the brain mature during adolescence, suggesting that abnormal development of this brain circuit may account for why the disorder tends to emerge during a person's teen years. Pinpointing brain changes in youth may help us detect illness early or offer targets for early intervention.

The connections between brain regions are important for shaping and coordinating functions such as forming memories, learning, and emotions, but scientists know little about how different parts of the human brain connect. Learning more about these connections, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Scientists are working towards being able to predict which types of treatment will work most effectively.

Signs & Symptoms

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." Each mood episode represents a drastic change from a person’s usual mood and behavior. An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. Symptoms of bipolar disorder are described below.

Symptoms of mania or a manic episode include:

Symptoms of depression or a depressive episode include:

Mood Changes A long period of feeling "high," or an overly happy or outgoing mood Extreme irritability Behavioral Changes Talking very fast, jumping from one idea to another, having racing thoughts Being easily distracted Increasing activities, such as taking on new projects Being overly restless Sleeping little or not being tired Having an unrealistic belief in one's abilities Behaving impulsively and engaging in pleasurable, high-risk behaviors

Mood Changes An overly long period of feeling sad or hopeless Loss of interest in activities once enjoyed, including sex. Behavioral Changes Feeling tired or "slowed down" Having problems concentrating, remembering, and making decisions Being restless or irritable Changing eating, sleeping, or other habits Thinking of death or suicide, or attempting suicide.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, you may feel very good, be highly productive, and function well. You may not feel that anything is wrong, but family and friends may recognize the mood swings as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.

Bipolar disorder may also be present in a mixed state, in which you might experience both mania and depression at the same time. During a mixed state, you might feel very agitated, have trouble sleeping, experience major changes in appetite, and have suicidal thoughts. People in a mixed state may feel very sad or hopeless while at the same time feel extremely energized.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. 

For example, if you are having psychotic symptoms during a manic episode, you may believe you are a famous person, have a lot of money, or have special powers. If you are having psychotic symptoms during a depressive episode, you may believe you are ruined and penniless, or you have committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes misdiagnosed with schizophrenia.

People with bipolar disorder may also abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. It may be difficult to recognize these problems as signs of a major mental illness.

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

Who Is At Risk?

Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life.

Debunking Myths: 'More Exercise' for Fibromyalgia & Chronic Fatigue Syndrome

It's basic physiology -- when you feel sluggish, unmotivated and fatigued, getting up and doing some exercise causes changes in your body that boost your energy. Exercise also releases endorphins in the brain, and endorphins are great pain killers. So when people say those of us with fibromyalgia and chronic fatigue syndrome would feel better if we got "more exercise," there's something to it, right?
Actually, no. In normal, healthy people, yes -- exercise creates energy. Problem is, we're not normal and healthy.
Exercise is a tough subject, whether you have fibromyalgia or chronic fatigue syndrome. However, it's not the same for both groups, so let's look at them separately.
Fibromyalgia & 'More Exercise'


This myth is compounded by numerous studies showing that exercise lowers our pain levels and does in fact give us more energy. Doctors glance at the titles of these studies and tell the next fibromite who walks through the door to go to the gym. What they're missing is that the amount and type of exercise we need is far from what most people would even consider exercise.

If we exert ourselves to the point of exhaustion, we're probably going to trigger a major flare that lands us on the couch for days or even weeks. We all have different fitness levels so the exact amount of exertion we can handle varies greatly, but generally speaking, we should exert moderate effort for just a few minutes on a regular basis.

There's ample clinical and anecdotal evidence to support that regular exercise, done with extreme moderation, helps us. That means, for us, an exercise regimen might consist of 2 minutes of gentle yoga per day. If you're in better shape, maybe you can handle a 10-minute walk or 20 minutes of aquatic exercise to start with.

I consider myself in moderately good shape for someone with fibromyalgia -- I can go grocery shopping, clean the kitchen and do a couple loads of laundry in the same day (most of the time, anyway.) I can also get through a 30-minute yoga routine without wiping myself out or having nasty 
repercussions. I couldn't do that a year ago, though, and if I'd tried, I would have crashed afterward. Two years ago, I would have crashed 10 minutes in; and three years ago, just getting into the first pose would have done me in on bad days. While I'm not the most consistent about exercise, I have worked hard to slowly and steadily increase my activity level.
That slow, steady pace is what we need. If all you can do is 2 minutes, try to be consistent about your 2 minutes. Eventually, you'll be able to handle 4. The key is not pushing yourself too far too fast, and expecting setbacks along the way.

Chronic Fatigue Syndrome & 'More Exercise'
A key symptom of chronic fatigue syndrome is post-exertional malaise. It's a period of intense, often debilitating symptoms that follows any kind of exercise or exertion and lasts for a day or more (usually more.) Research actually shows abnormalities in the blood chemistry of people with chronic fatigue syndrome after they exercise, and those abnormalities could very well provide the long-awaited diagnostic test for this condition. 

Some preliminary research also shows abnormal heart rhythms during exercise, which could mean that exercise is actually damaging your health.

For years, some chronic fatigue syndrome doctors and researchers have touted a treatment called graded exercise therapy (GET). It's controversial to say the least, and while some studies have shown that it can help some people, the methods used to arrive at that conclusion are frequently called into question. Looking over the available research, it seems to me that GET is only recommended because it's more effective than most treatments that have been studied -- and that's not saying a lot. However, it does help some people, as evidenced by the comment below from Dr. Donnica Moore, a well-respected expert who just signed on to work with the Whittemore Peterson Institute.

So what does all this mean about exercise and chronic fatigue syndrome? It really depends. There's clearly a reduced exercise tolerance, but you're the only one who can determine exactly what your body can tolerate. It all depends on your current fitness level and severity of your illness. We all know that being sedentary increases muscle aches and pains, so at the very least you might want to learn some simple stretches you can do while laying in bed. Because of the evidence suggesting heart abnormalities, you should talk to your doctor about testing your heart to make sure exercise is OK -- here's a link to studies you can show your doctor, and they contain testing information: Cardiac Involvement in Chronic Fatigue Syndrome.


What If You Have Both?
If you're diagnosed with both fibromyalgia and chronic fatigue syndrome, you're in a particularly difficult situation -- the right kind of exercise may relieve some symptoms while exacerbating others. Again, you're the only one who can figure out the right level of exertion for yourself.

The Persistent Myth

The exercise myth is one that's not likely to go away -- it's pretty firmly entrenched in the medical establishment, and a consequence of an uninformed public. What we need to do is know our own bodies, try to educate those who are receptive, and ignore those who aren't. We're not doing any good for anyone by over exerting ourselves and winding up in bed for a week.

Depression doesn’t make you sad all the time

ne of the most popular, enduring, and irritating myths about depression is that it means depressed people are sad all the time – and that by extension, people who are happy can’t be experiencing depression, even if they say they are. It is a skewed and horrible version of depression, and it’s one that further stigmatises the condition and isolates people with depression and related mental health conditions. This is because, put bluntly, depression doesn’t make you sad all the time – though the level of sadness a patient experiences can of course vary depending on the individual and the severity of depression.


When I’m having a depressive episode, I’m not walking around in tattered black clothes, weeping and wailing. I go out with friends. I crack jokes (especially sardonic ones). I keep working, and have friendly chats with the people I work with. I often manage to feed and clothe myself, I read books. Above all, I experience moments of happiness: a flash of delight as I’m walking on the beach with a friend and the sun is perfect and the breeze is just right; a surge somewhere deep inside when I’m surrounded by beautiful trees and it’s raining and I feel my heart swelling to encompass the whole world; a warm, friendly, affectionate sensation at the touch of a friend, a hug at the end of an evening or a hand placed over mine as we lean forward to see something better.


Yet I feel a strange conflicting pressure. On the one hand, I feel like I need to engage in a sort of relentless performative sadness to be taken seriously, for people to understand that I really am depressed and that each day – each moment of each day – is a struggle for me, that even when I am happy, I am still fighting the monster. I feel like I need to darken everything around me, to stop communicating with the world, to stop publishing anything, to just stop. Because that way I will appear suitably, certifiably sad, and thus, depressed – and then maybe people will recognise that I’m depressed and perhaps they’ll even offer support and assistance. The jokes die in my throat, the smile never reaches my lips, I don’t share that moment of happiness on the beach by turning to my friend and expressing joy.


I don’t, in other words, do the things that can help ameliorate depression, encourage people to reach out, and help depressed people with functioning, completing daily tasks of life, and finding a reason to live again. I don’t find and build a rich community of people who can offer support (and whom I can support in turn), because I have to be so wrapped up in performing my sadness at all times to prove that I’m depressed enough – even as I want to scream that this is a reinforcement of stereotypes that hurt people, that by doing this I am hurting not just myself but others.


On the other, I feel an extreme pressure to perform just the opposite, because sad depressed people are boring and no fun, as I am continually reminded every time I speak openly about depression or express feelings of sadness and frustration. I’m caught in a trap where if I don’t perform sadness, I’m not really depressed, but if I express sadness at all to any degree, I’m annoying and boring and should stop being so self-centred. Thus I’m effectively pushed into fronting, putting a face on it even when I am depressed and deeply sad – when I feel like I am choking on my own misery, I put up a cheeky Tweet. When I hate myself and I want to die, I post a link to something fun, or I write up something silly to run somewhere – even though as I write it, I am drawn deeper and deeper into my unhappiness.



Depression is an asshole, and it can become your master, but you can slip out from under it occasionally. And many depressed people in the midst of an episode don’t actually spend it fainting dramatically on the couch and talking about how miserable they are. Some are high-functioning (bolstered by the need to put a face on it), others are into morbid jokes, others try to reach out for help (isn’t that what we’re “supposed” to do?) from friends and try to make their depression less scary. Depression isn’t an all-or-nothing deal – seeing a person who identifies with depression cracking a joke or having fun or dancing with a friend isn’t evidence that the person is faking it, whether the person is experiencing a moment of genuine happiness, or fronting. Conversely, jollying up people with depression to demand that they start being more fun is equally revolting, a refusal to acknowledge that people experiencing a rough day, or a rough week, or a rough few hours aren’t going to be your trained monkeys.
Depression manifests differently in everyone and at different times. Various behaviours are not proof positive that someone is or isn’t depressed, and, as with any armchair diagnosis, insisting that someone is not actually depressed just because of a show of something other than deep, entrenched sadness is actively harmful.


Look at the woman above, joyously cycling on a beach, hair fluttering in the breeze. You can’t judge her emotional state or her larger mental health picture, nor should you.


By SE Smith.

Fibromyalgia and Exercise: Yes, You Can

 

By Denise Mann

Reviewed by Louise Chang, MD

Exercise eases the pain of fibromyalgia. Getting started may not be easy, but it’s worth it

Fibromyalgia and Exercise: Slow and Steady

“Exercise improves a person’s overall sense of well-being and reduces pain and tenderness over time,” says Lesley M. Arnold, M.D. a psychiatrist and fibromyalgia expert at the University of Cincinnati College of Medicine in Ohio. 

“We try to pace it slowly and make sure that their symptoms of pain and fatigue are under control before we introduce it.”

The first step is typically an assessment of the person’s current fitness level. “We like to start them on a program that is a level or two below their current level, improve their stamina, and build up to 20 to 30 minutes of moderate aerobic activity on most days of the week,” Arnold tells WebMD. “We really encourage them to pace things and set reasonable goals.”

Water Aerobics Soothe and Strengthen

For people with fibromyalgia, low-impact aerobics is the way to go. “We really like an aerobic water class and people tend to go back,” Arnold says.

The research backs her up. A study in Arthritis Research & Therapy found that water aerobics improve health-related quality of life in women with fibromyalgia.

These classes often start in warm-water pools, which can be soothing. What’s more, they are typically group-based, so people can garner support and motivation from other members of the group. 

Holthaun says that this helps people stick to a program. “People with fibromyalgia tend to isolate, but being in a group helps motivation,” she says.

Strength Training and Low-Impact Exercise

What if you don’t have access to a pool? Don’t despair: Walking, biking, and other forms of low-impact aerobic activity also provide benefits. “Grab a buddy, take a class, or look into physical therapy,” Arnold suggests.

And don’t rule out strength training. Although doctors once believed that strength training could worsen pain in people with fibromyalgia, new research suggests that this is not the case. 

In fact, the latest research -- presented at the 2008 annual meeting of the American Society of Anesthesiologists in Orlando -- suggests that strength training can have the same ameliorating effect on pain as aerobic exercise.

Lynne Matallana, president and founder of the National Fibromyalgia Association in Anaheim, Calif., says the benefits of exercise for people with the condition are tremendous. “This has been shown scientifically and anecdotally,” she says.

Matallana’s own experience has shown her that exercise can also soothe the mind. 

A former dancer, she was diagnosed with fibromyalgia in 1995. “I have watched how exercise has improved my symptoms and my overall outlook,” she says. “When I got in water, I could do movements that were almost like dance. That touched my soul again.”

Getting Over the Mental Hurdles

Let’s face it: It may hurt just to think about going from couch potato to marathon runner. To avoid getting overwhelmed, take it in stages.

“If you have fibromyalgia, you have this amplified pain signal telling you that something is wrong,” Mattalana says. 

“It’s a natural instinct to want to protect your body by going to bed, but that actually makes pain worse.”

Try these two tips to get your mind on board:

• Give yourself a pep talk. 
• “Tell yourself that this is going to be beneficial,” Mattalana says. “Say, ‘Today I will do just this amount because I know this will help me feel better.” 
•  
• Set realistic goals. Arnold often prescribes five minutes of walking to start.
•  
•  “People may think that won’t be too difficult, but it can be if you have fibromyalgia,” she says. 
• “We start very slow and build up from there, and emphasize that there is no hurry.”

From Skeptic to Believer

In the beginning, Mattalana scoffed at the thought of doing only three minutes on the treadmill, but it wasn’t as easy as she thought it would be. 

“I slowly got my body conditioned and got to a point where I could add more exercise,” she says. “It is a slow process, but every time you get up, stretch, walk, get into a pool, or take a yoga class, you are one step closer to feeling better.”

“Once you convince people to start exercising, they become believers,” says Daniel J. Clauw, MD, professor of anesthesiology and medicine at the University of Michigan in Ann Arbor. 

“It’s not until they do it and see how much it helps that they embrace it.”

How long does that usually take? 

“Some people will notice changes right away, but for others, it may take a couple of weeks,” he says.

Exercise is not a panacea for fibromyalgia, Clauw says. But, he says, “it works in more people than anything else. I can’t remember an instance where someone got into an exercise program and didn’t notice a significant improvement in symptoms.”

Fibromyalgia and Diet Will changing your diet help you cope with fibromyalgia?

 

By Jen Uscher
WebMD Feature

Reviewed by Melinda Ratini, DO, MS

 

If you have fibromyalgia, you've probably wondered if there are ways to modify your diet to improve symptoms such as fatigue and muscle pain.

Research hasn't shown that there are specific foods that all fibromyalgia patients should avoid or add to their diets. But it may still be worthwhile to take a closer look at how foods impact the way you feel.

"There aren't many good studies that have looked at how diet can affect fibromyalgia symptoms. But I think we can gather a lot from anecdotal evidence -- from what patients tell us," says Ginevra Liptan, MD, medical director of the Frida Center for Fibromyalgia in Portland, Ore., and author of Figuring Out Fibromyalgia: Current Science and the Most Effective Treatments.

Here are some of the ways doctors say food can play a role in fibromyalgia and tips on how you can tweak your diet to support your overall health.

Pay Attention to How Food Makes You Feel

"A lot of people with fibromyalgia have sensitivities to particular foods, but it varies from person to person," Liptan tells WebMD.

"They might be sensitive to MSG, certain preservatives, eggs, gluten, dairy, or other common allergens."

In fact, in a survey published in the journal Clinical Rheumatology, 42% of fibromyalgia patients said their symptoms worsened after eating certain foods.

A good way to start identifying the foods that may aggravate your symptoms, Liptan and other experts say, is keeping a daily food journal.

"I have some patients keep a food journal for two weeks," says James McKoy, MD, chief of pain medicine, director of complementary medicine, and staff rheumatologist at Kaiser Permanente in Honolulu.

"They write down the foods they ate each day and whether they had symptoms like headaches, indigestion, or fatigue. It can be very helpful, because sometimes we see, for instance, that they have more fatigue when they eat a particular food."

Try Eliminating Certain Foods

If a fibromyalgia patient has a lot of irritable bowel symptoms, Liptan often recommends they try an elimination challenge diet.

They stop eating a certain food they suspect they're sensitive to for six to eight weeks. Then they add it back to their diet and see how they feel.

 Liptan's patients most often try eliminating dairy products or foods containing gluten.

"When you discover you're sensitive to a food and then eliminate it from your diet, it can make a huge difference," Liptan says. "Some people get a lot of benefit in terms of reduction of pain, but more often we see a reduction in fatigue and an improvement in irritable bowel symptoms like bloating and constipation."

If you think you might have food sensitivities or allergies, talk with your doctor.
In some cases, they may refer you to an allergist for food allergy testing.

You may also want to consult a dietitian to make sure you don't miss out on essential nutrients when you eliminate certain foods from your diet.

Make It Easier to Eat Healthfully

It makes sense for people with fibromyalgia -- just like everyone else -- to try to eat a diet high in fruits, vegetables, whole grains, and lean protein.

A well-balanced diet can give you more energy to stay physically active and can potentially improve your overall health.

If you're struggling with pain and exhaustion, however, it's hard to cook nutritious meals. Liptan says she encourages her patients to make it easier on themselves by seeking out healthy foods that don't require much preparation.

"Buy vegetables that are pre-washed and cut up," she suggests. "If you have a health food store nearby, go to the deli section and buy small portions of pre-prepared foods like beet salad or quinoa to vary your diet."

Use Food to Help Fight Fatigue

Choosing the right foods may help you keep your energy level more consistent and prevent fatigue.

"We know anecdotally that certain dietary choices -- like eating small meals frequently throughout the day -- can help energy levels," says Ann Vincent, MD, assistant professor of medicine and medical director of Mayo Clinic's Fibromyalgia Clinic in Rochester, Minn.

"It can help to eat a snack with a little protein, for example, when you're feeling tired at three in the afternoon," she says.

Make sure you eat breakfast, which should include some protein and whole grains, says Christine Gerbstadt, MD, RD, MPH, a spokeswoman for the Academy of Nutrition and Dietetics and a registered dietician and practicing physician in Sarasota, Fla.

"You could try eating a boiled egg and some oatmeal," Gerbstadt says. "That will prevent your blood sugar from spiking and will give you the right kind of energy to get you going through the morning, even if your body is aching and you're feeling tired."

Of course, diet is not the only factor in how much energy you have. Getting enough sleep and being active during the day can also help.

Check on Your Supplements

Always tell your health care providers about any supplements you're taking to treat your fibromyalgia. Some supplements, such as SAMe, can have significant side effects and may interact with medications, Vincent says.

In addition to checking on any possible interactions, your doctor should also be able to help you gauge any claims you might read about what supplements can, or cannot, do for your health.

Focus on Your Overall Well-Being

As you make changes to your diet, keep in mind that people with fibromyalgia tend to benefit most from taking a variety of approaches to managing their symptoms.

Along with leading a healthy lifestyle (including a nutritious diet) and taking any medications your doctor may prescribe for pain or other symptoms, there are many other therapies worth exploring.

"Look into trying things like yoga, massage, and deep-breathing exercises," says Gerbstadt. "Each individual with fibromyalgia has different symptoms and will need different solutions to get the best possible quality of life."

Lidocaine Injection May Help Treat Fibromyalgia

By Mary Elizabeth Dallas

HealthDay Reporter

TUESDAY, Aug. 5, 2014 (HealthDay News) -- The pain of fibromyalgia might be eased with injections of the painkiller lidocaine, a new study suggests.

People with fibromyalgia complain of chronic pain throughout their body as well as an increased sensitivity to pain. Doctors often have trouble treating this pain because it's unclear what causes it, the study authors noted.

In the new study, injecting lidocaine into peripheral tissues -- such as the muscles in the shoulders or buttocks -- effectively reduced pain sensitivity, the researchers found.

"We hypothesized that if pain comes from the peripheral tissues, and we can take this pain away by injecting local anesthetics, then this would be indirect proof of the importance of peripheral tissues for the clinical pain of these individuals," study lead author Dr. Roland Staud, a professor of medicine at the University of Florida College of Medicine, said in a university news release.

"Over-the-counter medications and [narcotic] prescriptions such as opiates aren't really effective for controlling chronic pain conditions," he added. But with the new therapy, "we are able to explain the pain of chronic patients better and manage it better," Staud said. "We are making progress but it will take time."

The study involved 62 women with fibromyalgia. Each woman received four injections: two in certain muscles in their shoulders and two more in their buttocks. Some of the women received lidocaine injections, while a "control group" received saline injections.

Right before the injections were given and 30 minutes afterwards, the women received mild pain stimulations delivered through mechanical means or through heat.

Compared to "dummy" saline injections, the lidocaine significantly eased the women's sensitivity to pain, according to the study published recently in the European Journal of Pain.

The researchers noted, however, that both lidocaine and the placebo resulted in a 38 percent reduction in pain at or near the point of injury.

But chronic pain affects the body differently than a specific injury, like a broken leg, the study authors pointed out. Chronic pain, they explained, actually alters nerve function along the spinal cord.

"The best way to treat chronic pain conditions is . . . [by] looking at emotional, sensory and tissue damage," 

Michael Robinson, director of the University of Florida Center for Pain Research and Behavioral Health, said in a university news release. "We know there are central and peripheral and social and behavioral components to someone saying, 'Ow, it hurts.'"

Cancer survivors who experience pain, for example, may associate it with their disease and fears about their prognosis -- even if it's been treated and in remission.

"That sensation may well feel more painful than if they just thought it was a tweaked muscle," Robinson explained.

Two experts in fibromyalgia were unsure about the significance of the findings, however.

"There was no significant difference between the pain reduction in the placebo versus the treatment group -- this signifies that it does not matter what the injection product is, but the act of injection itself might be the cause of pain reduction," said Dr. Waseem Mir, a rheumatologist at Lenox Hill Hospital in New York City.

"One can then argue that the pain reduction was placebo," he said. "To examine the placebo point, another arm in the experiment might need to be introduced where patients are not getting injected but taking a placebo pill."

Dr. Houman Danesh is director of integrative pain management at Mount Sinai Hospital in New York City. He said that "fibromyalgia is a complex disorder where patients are more sensitive to pain. 

It is mainly diagnosed by a rheumatologist by touching 18 diagnostic pressure points, and if 11 of them are sensitive, then the diagnosis is made," he explained.

"This study offers insight as to a potential contributor to fibromyalgia and a possible treatment," Danesh said. 

"It is interesting to note that the points which were used were acupuncture points, therefore suggesting acupuncture as a possible treatment to help patients with fibromyalgia."

7 things people with anxiety want yo to know.

Found this on face book.


have anxiety, and I believe I can speak for everyone with anxiety when I say this: it’s gotta be hard to be close to us. But there are seven things we want you to know that we don’t always know how to tell you.

1. It doesn’t have to do with you.
It can be pretty exhausting ruminating about everything we possibly have done wrong, are doing wrong, or could do wrong. We may want to sit and cry sometimes. We may be uninterested in our activities. We may snap at you, even though you absolutely don’t deserve it. We may even get nervous that you don’t love us anymore, even if you’ve given us no indication of this.
We want you to know above all else that it doesn’t have to do with you. It’s not your fault. We love you, and we’re so, so sorry if we ever give the impression that we don’t. We just don’t love our brain right now, and we don’t know how to deal with it.

2. Never try to talk us out of our emotions.
Trying to relieve us of our fear or sadness might seem like a good idea. And sometimes, it is. In fact, we might even ask you if we have any reason to be worried, so that we can try to combat that irrational part of us that is constantly afraid.
But there’s a fine line between trying to help us and trying to talk us out of it. Never tell us that our worries don’t exist, or that we can get over it if we just stop thinking about it. All that does is make us feel like we’re broken—that there’s something wrong with us that even our closest loved ones don’t understand.

3. Part of us knows that our fears aren’t rational, but we can’t shake the part that doesn’t.
Sure, we know that the embarrassing thing we said wasn’t really all that embarrassing, and it probably didn’t influence anyone’s opinions of us whatsoever, and that the entire group we were with today probably isn’t talking about how terrible we are behind our backs. We know how ridiculous that sounds, and it sounds even more ridiculous saying it out loud.
But that other part of us. . .that’s where anxiety lives. That’s where it can stay, feeding on us, popping out its head occasionally to remind us that it’s still there. That’s the part that always reminds us, “What if this time, my worries are correct?”

4. We are grateful for what we have—and for you.
Often, anxious people are labeled as pessimists. And that’s actually quite understandable. We’re pretty talented at coming to the worst possible conclusion almost instantaneously.
But that’s not always who we are. In fact, many of us are pretty optimistic between anxiety bouts. We do love our life, and we are grateful for what we have, and we are especially grateful for you. We don’t mean to focus on the negative, but sometimes, we can’t help it. Know we always appreciate you. You are the light at the end of our tunnel. You are the one who tries your hardest to understand, who knows us in and out and still is willing to stay.

5. We know you can’t always see things from our perspective, but we appreciate you trying.
As someone who doesn’t suffer from anxiety, we know you won’t be able to fully understand. We know that we might sometimes sound crazy, and we’re sure it can be frustrating to have to drop everything and calm us down.
But every time you answer our fearful texts with reassurance and kindness, or pull us into another room to ask us what we’re worrying about, or are simply there, steady, supportive, without questioning the way we operate. . .we can’t even express how much that means, because it’s rare to find.

6. We wish we could turn it off, but we can’t.
Though it might seem otherwise, we don’t want to focus on what could go wrong. We don’t want to be negative, or bring the mood down, or nitpick about things that may seem little to an outsider. We’re not trying to get attention.
We know how we sound sometimes, and we wish we could turn it off. But it’s just a part of who we are.

7. It doesn’t define us.
We may have anxiety, and it may be a part of us. But so are our passions, our quirks, our personalities. Anxiety is one of countless parts. We still laugh. We still feel the wind in our hair. We still appreciate a steaming mug of coffee early in the morning, or the sun warming our skin in the summer.
We still love you. We always will.


Sammy Nickalls is a writer and the content manager of Inspiyr.com, an online magazine helping people get healthier, happier, and more successful. She is an avid health nut, as well as a lover of yoga, gaming, books, and tea.

Really? The Claim: Fibromyalgia Is Affected by Weather

THE FACTS

No one really knows precisely what causes the debilitating fatigue and muscle pain of fibromyalgia. But some people who have the disorder say they know what can make it worse: changes in the weather.

Cold, damp days and drops in barometric pressure are widely associated with flare-ups in symptoms of the condition, which affects mostly women. In one study by the National Fibromyalgia Association, people with the condition ranked weather changes as one of the leading aggravating influences on pain and stiffness.

Unlike the reported connection between arthritis and changes in temperature and pressure – which has mostly been debunked – the belief that fibromyalgia symptoms fluctuate with the weather has not been the subject of thorough research. The few studies that have investigated it have mostly found little evidence of a link.

In the latest report, published this month in the journal Arthritis Care & Research, Dutch researchers followed 333 middle-aged women who had fibromyalgia, looking for relationships between environmental conditions and their levels of pain and fatigue. Over the course of a month, the researchers monitored humidity levels, atmospheric pressure, precipitation, temperature and sunshine duration, using data from a meteorological institute.

In some cases, they did find that weather variables had “significant but small” effects on pain and fatigue. But for the most part, they concluded, there was “more evidence against than in support of a uniform influence of weather on daily pain and fatigue.”

THE BOTTOM LINE

Most studies have not found much evidence of a link between fibromyalgia symptoms and weather patterns.

However those of us who have it may disagree. 

Smoking with Fibromyalgia

If you smoke and you have fibromyalgia, you may be hurting more than you have to.

I'm not going to preach at you to quit - I know that's just annoying and doesn't do any good - but I do want you to have the information you need to make informed decisions about your health. And we have mounting evidence showing that smoking and other tobacco use makes fibromyalgia symptoms worse.



Do you smoke cigarettes or chew tobacco?

When you have fibromyalgia, tobacco use may have even greater health risks than you thought.

Multiple studies have shown that tobacco use is associated with worse fibromyalgia symptoms. Smoking may also be a risk factor for developing this condition.

The Studies

In 2009, Mayo Clinic researchers published a study that included data from 984 patients, 145 of whom were tobacco users.
Researchers said tobacco use was linked to:

• Greater pain intensity
• Higher scores on the Fibromyalgia Impact Questionnaire
• Fewer good days
• More missed work

Also in 2009, a study published in Rheumatology International found that the following symptoms were more severe in cigarette smokers:

• Chronic widespread pain severity
• Unrestorative sleep
• Paresthesia (odd nerve sensations)
• Anxiety and depression

Those researchers compared smoking rates of fibromyalgia and rheumatoid arthritis patients and found that fibromyalgia patients were more likely to smoke.

A 2011 study involving 336 people with fibromyalgia found that about 10% of participants were current smokers. Researchers concluded that smokers:

• Had more tender points
• Were more likely to be depressed (women only)

The authors called for more research into the impact of smoking on pain, function, and psychiatric features in the illness.

A 2010 study suggested that smoking cigarettes appeared to be linked to the development of fibromyalgia, and that smoking may be a risk factor.

Trying to Quit

Go to one of my links about E-Cigs. as of 2/6/14 I have been smoke free for 3years 2 months and 6 days using an E-Cig. My pain decreased by at least 10%.

'More Exercise' for Fibromyalgia & Chronic Fatigue Syndrome

It's basic physiology -- when you feel sluggish, unmotivated and fatigued, getting up and doing some exercise causes changes in your body that boost your energy. Exercise also releases endorphins in the brain, and endorphins are great pain killers. So when people say those of us with fibromyalgia and chronic fatigue syndrome would feel better if we got "more exercise," there's something to it, right?


Actually, no. In normal, healthy people, yes -- exercise creates energy. Problem is, we're not normal and healthy.

Exercise is a tough subject, whether you have fibromyalgia or chronic fatigue syndrome. However, it's not the same for both groups, so let's look at them separately.


Fibromyalgia & 'More Exercise'

This myth is compounded by numerous studies showing that exercise lowers our pain levels and does in fact give us more energy. Doctors glance at the titles of these studies and tell the next fibromite who walks through the door to go to the gym. What they're missing is that the amount and type of exercise we need is far from what most people would even consider exercise.


If we exert ourselves to the point of exhaustion, we're probably going to trigger a major flare that lands us on the couch for days or even weeks. We all have different fitness levels so the exact amount of exertion we can handle varies greatly, but generally speaking, we should exert moderate effort for just a few minutes on a regular basis. There's ample clinical and anecdotal evidence to support that regular exercise, done with extreme moderation, helps us. That means, for us, an exercise regimen might consist of 2 minutes of gentle yoga per day. If you're in better shape, maybe you can handle a 10-minute walk or 20 minutes of aquatic exercise to start with.


I consider myself in moderately good shape for someone with fibromyalgia -- I can go grocery shopping, clean the kitchen and do a couple loads of laundry in the same day (most of the time, anyway.) I can also get through a 30-minute yoga routine without wiping myself out or having nasty repercussions. I couldn't do that a year ago, though, and if I'd tried, I would have crashed afterward. Two years ago, I would have crashed 10 minutes in; and three years ago, just getting into the first pose would have done me in on bad days. While I'm not the most consistent about exercise, I have worked hard to slowly and steadily increase my activity level.


That slow, steady pace is what we need. If all you can do is 2 minutes, try to be consistent about your 2 minutes. Eventually, you'll be able to handle 4. The key is not pushing yourself too far too fast, and expecting setbacks along the way.

Chronic Fatigue Syndrome & 'More Exercise'

A key symptom of chronic fatigue syndrome is post-exertional malaise. It's a period of intense, often debilitating symptoms that follows any kind of exercise or exertion and lasts for a day or more (usually more.) Research actually shows abnormalities in the blood chemistry of people with chronic fatigue syndrome after they exercise, and those abnormalities could very well provide the long-awaited diagnostic test for this condition. Some preliminary research also shows abnormal heart rhythms during exercise, which could mean that exercise is actually damaging your health.


For years, some chronic fatigue syndrome doctors and researchers have touted a treatment called graded exercise therapy (GET). It's controversial to say the least, and while some studies have shown that it can help some people, the methods used to arrive at that conclusion are frequently called into question. Looking over the available research, it seems to me that GET is only recommended because it's more effective than most treatments that have been studied -- and that's not saying a lot. However, it does help some people, as evidenced by the comment below from Dr. Donnica Moore, a well-respected expert who just signed on to work with the Whittemore Peterson Institute.


So what does all this mean about exercise and chronic fatigue syndrome? It really depends. There's clearly a reduced exercise tolerance, but you're the only one who can determine exactly what your body can tolerate. It all depends on your current fitness level and severity of your illness. We all know that being sedentary increases muscle aches and pains, so at the very least you might want to learn some simple stretches you can do while laying in bed. Because of the evidence suggesting heart abnormalities, you should talk to your doctor about testing your heart to make sure exercise is OK -- here's a link to studies you can show your doctor, and they contain testing information: Cardiac Involvement in Chronic Fatigue Syndrome.


What If You Have Both?

If you're diagnosed with both fibromyalgia and chronic fatigue syndrome, you're in a particularly difficult situation -- the right kind of exercise may relieve some symptoms while exacerbating others. Again, you're the only one who can figure out the right level of exertion for yourself.


The Persistent Myth

The exercise myth is one that's not likely to go away -- it's pretty firmly entrenched in the medical establishment, and a consequence of an uninformed public. What we need to do is know our own bodies, try to educate those who are receptive, and ignore those who aren't. We're not doing any good for anyone by over exerting ourselves and winding up in bed for a week.

 How has the exercise myth impacted you? 
Are there people in your life who just won't let it go? 
 How do you deal with them? 
Leave your comments below!

What Do You Lack? Probably Vitamin D

Vitamin D promises to be the most talked-about and written-about supplement of the decade. While studies continue to refine optimal blood levels and recommended dietary amounts, the fact remains that a huge part of the population — from robust newborns to the frail elderly, and many others in between — are deficient in this essential nutrient.   

If the findings of existing clinical trials hold up in future research, the potential consequences of this deficiency are likely to go far beyond inadequate bone development and excessive bone loss that can result in falls and fractures. Every tissue in the body, including the brain, heart, muscles and immune system, has receptors for vitamin D, meaning that this nutrient is needed at proper levels for these tissues to function well. 

Studies indicate that the effects of a vitamin D deficiency include an elevated risk of developing (and dying from) cancers of the colon, breast and prostate; high blood pressure and cardiovascular disease; osteoarthritis; and immune-system abnormalities that can result in infections and autoimmune disorders like multiple sclerosis, Type 1 diabetes and rheumatoid arthritis. 

Most people in the modern world have lifestyles that prevent them from acquiring the levels of vitamin D that evolution intended us to have. The sun’s ultraviolet-B rays absorbed through the skin are the body’s main source of this nutrient. Early humans evolved near the equator, where sun exposure is intense year round, and minimally clothed people spent most of the day outdoors. 

“As a species, we do not get as much sun exposure as we used to, and dietary sources of vitamin D are minimal,” Dr. Edward Giovannucci, nutrition researcher at the Harvard School of Public Health, wrote in The Archives of Internal Medicine. Previtamin D forms in sun-exposed skin, and 10 to 15 percent of the previtamin is immediately converted to vitamin D, the form found in supplements. Vitamin D, in turn, is changed in the liver to 25-hydroxyvitamin D, the main circulating form. Finally, the kidneys convert 25-hydroxyvitamin D into the nutrient’s biologically active form, 1,25-dihydroxyvitamin D, also known as vitamin D hormone. 

A person’s vitamin D level is measured in the blood as 25-hydroxyvitamin D, considered the best indicator of sufficiency. A recent study showed that maximum bone density is achieved when the blood serum level of 25-hydroxyvitamin D reaches 40 nanograms per milliliter or more.
“Throughout most of human evolution,” Dr. Giovannucci wrote, “when the vitamin D system was developing, the ‘natural’ level of 25-hydroxyvitamin D was probably around 50 nanograms per milliliter or higher. In modern societies, few people attain such high levels.”

A Common Deficiency
Although more foods today are supplemented with vitamin D, experts say it is rarely possible to consume adequate amounts through foods. The main dietary sources are wild-caught oily fish (salmon, mackerel, bluefish, and canned tuna) and fortified milk and baby formula, cereal and orange juice. 

People in colder regions form their year’s supply of natural vitamin D in summer, when ultraviolet-B rays are most direct. But the less sun exposure, the darker a person’s skin and the more sunscreen used, the less previtamin D is formed and the lower the serum levels of the vitamin. People who are sun-phobic, babies who are exclusively breast-fed, the elderly and those living in nursing homes are particularly at risk of a serious vitamin D deficiency.
Dr. Michael Holick of Boston University, a leading expert on vitamin D and author of “The Vitamin D Solution” (Hudson Street Press, 2010), said in an interview, “We want everyone to be above 30 nanograms per milliliter, but currently in the United States, Caucasians average 18 to 22 nanograms and African-Americans average 13 to 15 nanograms.” African-American women are 10 times as likely to have levels at or below 15 nanograms as white women, the third National Health and Nutrition Examination Survey found. 

Such low levels could account for the high incidence of several chronic diseases in this country, Dr. Holick maintains. For example, he said, in the Northeast, where sun exposure is reduced and vitamin D levels consequently are lower, cancer rates are higher than in the South. Likewise, rates of high blood pressure, heart disease, and prostate cancer are higher among dark-skinned Americans than among whites. 

The rising incidence of Type 1 diabetes may be due, in part, to the current practice of protecting the young from sun exposure. When newborn infants in Finland were given 2,000 international units a day, Type 1 diabetes fell by 88 percent, Dr. Holick said. 

The current recommended intake of vitamin D, established by the Institute of Medicine, is 200 I.U. a day from birth to age 50 (including pregnant women); 400 for adults aged 50 to 70; and 600 for those older than 70. While a revision upward of these amounts is in the works, most experts expect it will err on the low side. Dr. Holick, among others, recommends a daily supplement of 1,000 to 2,000 units for all sun-deprived individuals, pregnant and lactating women, and adults older than 50. 

The American Academy of Pediatrics recommends that breast-fed infants receive a daily supplement of 400 units until they are weaned and consuming a quart or more each day of fortified milk or formula. 

Given appropriate sun exposure in summer, it is possible to meet the body’s yearlong need for vitamin D. But so many factors influence the rate of vitamin D formation in skin that it is difficult to establish a universal public health recommendation. Asked for a general recommendation, Dr. Holick suggests going outside in summer unprotected by sunscreen (except for the face, which should always be protected) wearing minimal clothing from 10 a.m. to 3 p.m. two or three times a week for 5 to 10 minutes. 

Slathering skin with sunscreen with an SPF of 30 will reduce exposure to ultraviolet-B rays by 95 to 98 percent. But if you make enough vitamin D in your skin in summer, it can meet the body’s needs for the rest of the year, Dr. Holick said.

Can You Get Too Much?
 
If acquired naturally through skin, the body’s supply of vitamin D has a built-in cutoff. When enough is made, further exposure to sunlight will destroy any excess. Not so when the source is an ingested supplement, which goes directly to the liver. 

Symptoms of vitamin D toxicity include nausea, vomiting, poor appetite, constipation, weakness and weight loss, as well as dangerous amounts of calcium that can result in kidney stones, confusion and abnormal heart rhythms. 

But both Dr. Giovannucci and Dr. Holick say it is very hard to reach such toxic levels. Healthy adults have taken 10,000 I.U. a day for six months or longer with no adverse effects. People with a serious vitamin D deficiency are often prescribed weekly doses of 50,000 units until the problem is corrected. To minimize the risk of any long-term toxicity, these experts recommend that adults take a daily supplement of 1,000 to 2,000 units.

10 Bipolar Disorder Myths

By Tom Scheve, HowStuffWorks.com

The word "bipolar" is often used during casual and joking diagnosis of someone who's happy one minute and sad the next, but the real thing, bipolar disorder, is a serious mental illness that's wrecked lives. There's still much that remains unknown about the disease, but knowledge of it is growing, and great strides have been made in its treatment. However, there are many misperceptions about the condition, and a lot of things that even researchers and doctors used to believe about bipolar disorder have been scrapped.

So what are 10 myths about bipolar disorder that continue to misinform? Keep reading to find out.

10: There's Only One Type of Bipolar Disorder

A common -- but mistaken -- belief is that there is only one type of bipolar disorder, but there are actually several:

• Bipolar I disorder is distinguished by its inclusion of a full-blown manic episode at some point in the person's life.
• A person with bipolar II, a milder form of the disorder than bipolar I, goes back and forth between periods of depression and periods of elevated moods, but not actual mania.
• Cyclothymic bipolar disorder is similar to bipolar II, but less severe.
• Several periods of mania and/or depression in a single year indicates rapid cycling bipolar disorder.
• If highs and lows coexist or occur quickly back-to-back, this is mixed bipolar disorder.

9: Mania Sounds Like Fun

A surface understanding of manic episodes -- or their occasional representation in movies or TV shows -- makes them seem like a good time. You get lots done, you have endless energy, you're highly extroverted -- why wouldn't you be on top of the world?

Some people with bipolar disorder do experience happiness when in a manic state, but often, the reins of life can slip out of their hands. They become highly excitable, anxious and irritable. Their minds careen from one seemingly grand idea to the next, and their sleep rhythms fall apart. They may begin making bolder and risky decisions when it comes to sex, and may overindulge on alcohol or drugs. Some people start gambling or racking up huge shopping tabs. Mania can also cause psychotic thoughts and actions.

So there you have it -- another reason not to believe everything you see about mental illness in the media

8: Very Few People Actually Have Bipolar Disorder

While most of us know about or have heard of bipolar disorder or manic depression, it's easy to think that it doesn't affect that many people. After all, many patients don't disclose their condition to co-workers or acquaintances, and the casual observer may not detect anything more significant than an especially good mood or a person having a bad day. But almost 6 million Americans are affected each year by bipolar disorder, according to WebMD.

Bipolar disorder doesn't discriminate based on gender or race, and seems to affect all groups evenly across the board. While most often symptoms present themselves in young adulthood (late teens to early 20s), older adults are susceptible as well as young children.

7: Children Can't Get Bipolar Disorder

Life for many families would be easier if this next myth were indeed true. However, children as young as 6 can develop bipolar disorder, and the disease can prompt children to attempt suicide. When bipolar disorder presents itself at a young age, there's often a corresponding family history of mood disorders. Children who develop it can experience many periods of depression before the first manic episode, making it harder to diagnose. Sometimes, these depressions are accompanied by psychotic thoughts and behaviors, and children are more likely to experience mixed states -- that is, having mania and depression at the same time.

While lithium is often less effective in children (and the side effects are worse), advancing research and knowledge of adolescent bipolar disorder -- when matched with early detection and treatment -- offers more hope each day to families with bipolar children.

Did You Know?
Early-onset bipolar disorder (bipolar disorder in children) can be more severe than the adult version, according to the National Institute of Mental Health. Symptoms and changes in mood occur more frequently in bipolar children than they do in adults.

6: It's Just a Dramatic Term for Mood Swings

We've all experienced mood swings, so it's easy to think bipolar disorder is just a fancy name for one.

When most people feel in the dumps or on top of the world, it's usually a short-term feeling that fades away along with the reasons that prompted the feeling, or as a result of a gradual adjustment to the new circumstances.

Bipolar mood swings are different, and they can last for weeks or months. Up mood swings often lead to dangerous lifestyle choices, racing thoughts that refuse to be corralled and out-of-ordinary behaviors that can damage careers and family lives. Down mood swings for a bipolar person lead to excessive sleep and lethargy, uncontrollable crying and even thoughts of (and attempts at) suicide.

So when we're talking about bipolar disorder, we're not talking about good moods and bad moods. There's no "snapping out of it" when it comes this condition.

5: Bipolar Disorder Means High Highs or Low Lows

When most of us hear the words bipolar or manic depression, we think of very high highs and very low lows. Additionally, we think that people with bipolar disorder simply go from one to the other, with no stop in between.

While severe cases can involve such features, most people don't careen from high to low and back again. Patients may be in state of mania or depression for a while, or they may be in between the two. They may even show signs of both simultaneously. Some people go months or even years with bipolar disorder in regression, only to have it rear its ugly head again. Some people cycle quickly between high and low, while others only experience a full-blown manic state once every few years.

Regardless of frequency, the intensity is highly variable as well. Many people with bipolar disorder have more mild highs and lows and cycle between these states.

4: Bipolar Disorder Only Affects Mood

While the best known symptoms of bipolar disorder are mood related (and the disease itself is a mood disorder), bipolar disorder affects a person in many other ways as well.

When people with bipolar disorder experience highs or lows, they experience problems with overall cognitive functions as well as mood. A person may one day have a razor-sharp mind and sharpened intellect, and the next day have muddled thoughts and a sluggish thought process.

It also messes with sleep patterns. While experiencing a "high," someone with bipolar disorder won't sleep as much (sometimes hardly at all), and seemingly won't be the worse for it during the day. In fact, lack of sleep is often a precursor to a manic episode that hasn't presented itself yet. When experiencing a "low," a person will oversleep and never feel fully rested and alert.

Highs and lows also contribute to bad lifestyle choices like smoking, drinking, poor diet and drug use.

3: Alcohol and Drug Abuse Can Cause Bipolar Disorder

Many people with bipolar disorder are also frequent or heavy users of alcohol and nonprescription drugs. This in part has led to a belief that substance abuse -- offering its own often unpredictable highs and lows -- can cause you to snap and become bipolar.

While there is increased use of alcohol and drugs for people with bipolar disorder, it's not a contributing factor. A healthy person without bipolar disorder can't "crack" through alcohol or drug use and develop it.

People with bipolar disorder are more prone to engaging in risky, dangerous behaviors, and many also attempt to self-medicate in hopes of decreasing mood swings, getting sleep and dealing with anxiety. Though many people find short-term success or results, over the long haul these behaviors take their toll.

2: All You Need are Meds

Modern medications have made a wonderful difference and vast improvement in the lives of many people with bipolar disorder. But while lithium, anticonvulsants, antidepressants and other drugs are very important in the treatment of the condition (especially when first treated during a full-blown high or low), it's now commonly accepted that long-term success is best attained when treatment doesn't rely on medications alone.

Instead, treatment should include regular counseling from a trained mental health professional and a treatment support network consisting of family, friends, counselors or group-therapy sessions. It's also important to maintain a steady and healthy lifestyle -- that means proper sleep, diet, exercise and sobriety.

People will be most successful in dealing with bipolar disorder by developing a treatment plan that manages the issue through a variety of different means, and not just with medication alone.

1: Meds Will Turn You into a Zombie

Bipolar disorder is usually treated through some combination of drugs like lithium, anticonvulsants, antipsychotics and antidepressants, but pills often have side effects. Lithium in particular has a reputation for turning patients into zombies. It's not totally undeserved, but side effects usually fade away after a few months of use, and the remaining side effects can often be alleviated through dosage adjustment.

The same holds true for anticonvulsants and antipsychotics. Dosages may be higher than usual at first, especially when dealing with extreme mania or depression. However, once the crisis has passed, the dosage is generally lowered to facilitate a stable, happy and productive life. Lithium or any other specific drug may just not be right for you, but by working with your doctor, a better option can be found.