5 Things To Know About Passive Suicidal Ideation

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If you’ve ever wanted to go to sleep and never wake up, or have some accident/incident/illness take you with no action on your part, or a loved one has ever expressed such thoughts/feelings to you… Then this video is for you. Dr. Scott Eilers explains:

Tired of living

We’ll not keep them a mystery; here are the five things that Dr. Eilers wants us to know about passive suicidal ideation:

  • What it is: a desire for something to end your life without taking active steps. While it may seem all too common, it’s not necessarily inevitable or unchangeable.
  • What it means in terms of severity: it isn’t a clear indicator of how severe someone’s depression is. It doesn’t necessarily mean that the person’s depression is mild; it can be severe even without active suicidal thoughts, or indeed, suicidality at all.
  • What it threatens: although passive suicidal ideation doesn’t usually involve active planning, it can still be dangerous. Over time, it can evolve into active suicidal ideation or lead to risky behaviors.
  • What it isn’t: passive suicidal ideation is different from intrusive thoughts, which are unwanted, distressing thoughts about death. The former involves a desire for death, while the latter does not.
  • What it doesn’t have to be: passive suicidal ideation is often a symptom of underlying depression or a mood disorder, which can be treated through therapy, medication, or a combination of both. Seeking treatment is crucial and can be life-changing.

For more on all of the above, here’s Dr. Eilers with his own words:

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  • When You Know What You “Should” Do (But Knowing Isn’t The Problem)

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    When knowing what to do isn’t the problem

    Often, we know what we need to do. Sometimes, knowing isn’t the problem!

    The topic today is going to be a technique used by therapeutic service providers to help people to enact positive changes in their lives.

    While this is a necessarily dialectic practice (i.e., it involves a back-and-forth dialogue), it’s still perfectly possible to do it alone, and that’s what we’ll be focussing on in this main feature.

    What is Motivational Interviewing?

    ❝Motivational interviewing (MI) is a technique that has been specifically developed to help motivate ambivalent patients to change their behavior.❞

    Read in full: Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice

    It’s mostly used for such things as helping people reduce or eliminate substance abuse, or manage their weight, or exercise more, things like that.

    However, it can be employed for any endeavour that requires motivation and sustained willpower to carry it through.

    Three Phases

    Motivational Interviewing traditionally has three phases:

    1. Exploring and understanding the issue at hand
    2. Guiding and deciding importance and goals
    3. Choosing and setting an action plan

    In self-practice, maybe you can already know and understand what it is that you want/need to change.

    If not, consider asking yourself such questions as:

    • What does a good day look like? What does a bad day look like?
    • If things are not good now, when were they good? What changed?
    • If everything were perfect now, what would that look like? How would you know?

    Once you have a clear idea of where you want to be, the next thing to know is: how much do you want it? And how confident are you in attaining it?

    This is a critical process:

    • Give your answers numerically on a scale from 0 to 10
    • Whatever your score, ask yourself why it’s not lower. For example, if you scored your motivation 4 and your confidence 2, what factors made your motivation not a lower number? What factors made your confidence not a lower number?
    • In the unlikely event that you gave yourself a 0, ask whether you can really afford to scrap the goal. If you can’t, find something, anything, to bring it to at least a 1.
    • After you’ve done that, then you can ask yourself the more obvious question of why your numbers aren’t higher. This will help you identify barriers to overcome.

    Now you’re ready to choose what to focus on and how to do it. Don’t bite off more than you can chew; it’s fine to start low and work up. You should revisit this regularly, just like you would if you had a counsellor helping you.

    Some things to ask yourself at this stage of the motivational self-interviewing:

    • What’s a good SMART goal to get you started?
    • What could stop you from achieving your goal?
      • How could you overcome that challenge?
      • What is your backup plan, if you have to scale back your goal for some reason?

    A conceptual example: if your goal is to stick to a whole foods Mediterranean diet, but you are attending a wedding next week, then now is the time to decide in advance 1) what personal lines-in-the-sand you will or will not draw 2) what secondary, backup plan you will make to not go too far off track.

    The same example in practice: wedding menus often offer meat/fish/vegetarian options, so you might choose the fish or vegetarian, and as for sugar and alcohol, you might limit yourself to “a small slice of wedding cake only; coffee/cheese option instead of dessert”, and “alcohol only for toasts”.

    Giving yourself the permission well in advance for small (clearly defined and boundaried!) diversions from the plan, will stop you from falling into the trap of “well, since today’s a cheat-day now…”

    Secret fourth stage

    The secret here is to keep going back and reassessing at regular intervals. Set your own calendar; you might want to start out weekly and then move to monthly when you’re more strongly on-track.

    For this reason, it’s good to keep a journal with your notes from your self-interview sessions, the scores you gave yourself, the goals and plans you set, etc.

    When conducting your regular review, be sure to examine what worked for you, and what didn’t (and why). That way, you can practice trial-and-improvement as you go.

    Want to learn more?

    We only have so much room here, but there are lots of resources out there.

    Here’s a high-quality page that:

    • explains motivational interviewing in more depth than we have room for here
    • offers a lot of free downloadable resource packs and the like

    Check it out: Motivational Interviewing Theory & Resources

    Enjoy!

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  • Stop Cancer 20 Years Ago

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    Get Abreast And Keep Abreast

    This is Dr. Jenn Simmons. Her specialization is integrative oncology, as she—then a breast cancer surgeon—got breast cancer, decided the system wasn’t nearly as good from the patients’ side of things as from the doctors’ side, and took to educate herself, and now others, on how things can be better.

    What does she want us to know?

    Start now

    If you have breast cancer, the best time to start adjusting your lifestyle might be 20 years ago, but the second-best time is now. We realize our readers with breast cancer (or a history thereof) probably have indeed started already—all strength to you.

    What this means for those of us without breast cancer (or a history therof) is: start now

    Even if you don’t have a genetic risk factor, even if there’s no history of it in your family, there’s just no reason not to start now.

    Start what, you ask? Taking away its roots. And how?

    Inflammation as the root of cancer

    To oversimplify: cancer occurs because an accidentally immortal cell replicates and replicates and replicates and takes any nearby resources to keep on going. While science doesn’t know all the details of how this happens, it is a factor of genetic mutation (itself a normal process, without which evolution would be impossible), something which in turn is accelerated by damage to the DNA. The damage to the DNA? That occurs (often as not) as a result of cellular oxidation. Cellular oxidation is far from the only genotoxic thing out there, and a lot of non-food “this thing causes cancer” warnings are usually about other kinds of genotoxicity. But cellular oxidation is a big one, and it’s one that we can fight vigorously with our lifestyle.

    Because cellular oxidation and inflammation go hand-in-hand, reducing one tends to reduce the other. That’s why so often you’ll see in our Research Review Monday features, a line that goes something like:

    “and now for those things that usually come together: antioxidant, anti-inflammatory, anticancer, and anti-aging”

    So, fight inflammation now, and have a reduced risk of a lot of other woes later.

    See: How to Prevent (or Reduce) Inflammation

    Don’t settle for “normal”

    People are told, correctly but not always helpfully, such things as:

    • It’s normal to have less energy at your age
    • It’s normal to have a weaker immune system at your age
    • It’s normal to be at a higher risk of diabetes, heart disease, etc

    …and many more. And these things are true! But that doesn’t mean we have to settle for them.

    We can be all the way over on the healthy end of the distribution curve. We can do that!

    (so can everyone else, given sufficient opportunity and resources, because health is not a zero-sum game)

    If we’re going to get a cancer diagnosis, then our 60s are the decade where we’re most likely to get it. Earlier than that and the risk is extant but lower; later than that and technically the risk increases, but we probably got it already in our 60s.

    So, if we be younger than 60, then now’s a good time to prepare to hit the ground running when we get there. And if we missed that chance, then again, the second-best time is now:

    See: Focusing On Health In Our Sixties

    Fast to live

    Of course, anything can happen to anyone at any age (alas), but this is about the benefits of living a fasting lifestyle—that is to say, not just fasting for a 4-week health kick or something, but making it one’s “new normal” and just continuing it for life.

    This doesn’t mean “never eat”, of course, but it does mean “practice intermittent fasting, if you can”—something that Dr. Simmons strongly advocates.

    See: Intermittent Fasting: We Sort The Science From The Hype

    While this calls back to the previous “fight inflammation”, it deserves its own mention here as a very specific way of fighting it.

    It’s never too late

    All of the advices that go before a cancer diagnosis, continue to stand afterwards too. There is no point of “well, I already have cancer, so what’s the harm in…?”

    The harm in it after a diagnosis will be the same as the harm before. When it comes to lifestyle, preventing a cancer and preventing it from spreading are very much the same thing, which is also the same as shrinking it. Basically, if it’s anticancer, it’s anticancer, no matter whether it’s before, during, or after.

    Dr. Simmons has seen too many patients get a diagnosis, and place their lives squarely in the hands of doctors, when doctors can only do so much.

    Instead, Dr. Simmons recommends taking charge of your health as best you are able, today and onwards, no matter what. And that means two things:

    1. Knowing stuff
    2. Doing stuff

    So it becomes our responsibility (and our lifeline) to educate ourselves, and take action accordingly.

    Want to know more?

    We recently reviewed her book, and heartily recommend it:

    The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons

    Enjoy!

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  • Coffee, From A Blood Sugar Management Perspective

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    Our favorite French biochemist (Jessie Inchauspé) is back, and this time, she’s tackling a topic near and dear to this writer’s heart: coffee ☕💕

    What to consider

    Depending on how you like your coffee, some or all of these may apply to you:

    • Is coffee healthy? Coffee is generally healthy, reducing the risk of type 2 diabetes by improving fat burning in the liver and protecting beta cells in the pancreas.
    • Does it spike blood sugars? Usually not so long as it’s black and unsweetened. Black coffee can cause small glucose spikes in some people due to stress-induced glucose release, but only if it contains caffeine.
    • When is it best to drink it? Drinking coffee after breakfast, especially after a poor night’s sleep, can actually reduce glucose and insulin spikes.
    • What about milk? All milks cause some glucose and insulin spikes. While oat milk is generally healthy, for blood sugar purposes unsweetened nut milks or even whole cow’s milk (but not skimmed; it needs the fat) are better options as they cause smaller spikes.
    • What about sweetening? Adding sugar to coffee, especially on an empty stomach, obviously leads to large glucose spikes. Alternative sweeteners like stevia or sweet cinnamon are fine substitutes.

    For more details on all of those things, plus why Kenyan coffee specifically may be the best for blood sugars, enjoy:

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    Want to learn more?

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    Take care!

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  • Little Treatments, Big Effects – by Dr. Jessica Schleider

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The author, a clinical psychologist, discusses how mental healthcare has come a very long way, yet still has a long way to go. While advocating for top-down reforms, she does have a stopgap solution:

    Find ways to significantly improve people’s mental health in a single-session intervention.

    This seems like a tall order, but her method is based on good science, and also, most people will agree from experience that big changes can happen to someone in the space of moments, at pivotal turning points in life—they just have to be the right moments.

    Dr. Schleider recommends that therapists train in (and then offer) this method, but she does also give comprehensive advice for self-therapy of this kind too.

    These self-therapy directions, ways to induce those life-pivoting moments for the better, are perhaps the greatest value that the book gives us.

    Bottom line: if you’d like a lot of the benefits of therapy without getting therapy, this book can definitely point you in the right direction, in a manner that won’t be a drain on your time or your wallet.

    Click here to check out Little Treatments, Big Effects, and see what a difference you can make for yourself!

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  • How light can shift your mood and mental health

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    This is the next article in our ‘Light and health’ series, where we look at how light affects our physical and mental health in sometimes surprising ways. Read other articles in the series.

    It’s spring and you’ve probably noticed a change in when the Sun rises and sets. But have you also noticed a change in your mood?

    We’ve known for a while that light plays a role in our wellbeing. Many of us tend to feel more positive when spring returns.

    But for others, big changes in light, such as at the start of spring, can be tough. And for many, bright light at night can be a problem. Here’s what’s going on.

    llaszlo/Shutterstock

    An ancient rhythm of light and mood

    In an earlier article in our series, we learned that light shining on the back of the eye sends “timing signals” to the brain and the master clock of the circadian system. This clock coordinates our daily (circadian) rhythms.

    “Clock genes” also regulate circadian rhythms. These genes control the timing of when many other genes turn on and off during the 24-hour, light-dark cycle.

    But how is this all linked with our mood and mental health?

    Circadian rhythms can be disrupted. This can happen if there are problems with how the body clock develops or functions, or if someone is routinely exposed to bright light at night.

    When circadian disruption happens, it increases the risk of certain mental disorders. These include bipolar disorder and atypical depression (a type of depression when someone is extra sleepy and has problems with their energy and metabolism).

    Light on the brain

    Light may also affect circuits in the brain that control mood, as animal studies show.

    There’s evidence this happens in humans. A brain-imaging study showed exposure to bright light in the daytime while inside the scanner changed the activity of a brain region involved in mood and alertness.

    Another brain-imaging study found a link between daily exposure to sunlight and how the neurotransmitter (or chemical messenger) serotonin binds to receptors in the brain. We see alterations in serotonin binding in several mental disorders, including depression.

    Man in hammock, strung between two trees, arms outstretched
    Our mood can lift in sunlight for a number of reasons, related to our genes, brain and hormones. New Africa/Shutterstock

    What happens when the seasons change?

    Light can also affect mood and mental health as the seasons change. During autumn and winter, symptoms such as low mood and fatigue can develop. But often, once spring and summer come round, these symptoms go away. This is called “seasonality” or, when severe, “seasonal affective disorder”.

    What is less well known is that for other people, the change to spring and summer (when there is more light) can also come with a change in mood and mental health. Some people experience increases in energy and the drive to be active. This is positive for some but can be seriously destabilising for others. This too is an example of seasonality.

    Most people aren’t very seasonal. But for those who are, seasonality has a genetic component. Relatives of people with seasonal affective disorder are more likely to also experience seasonality.

    Seasonality is also more common in conditions such as bipolar disorder. For many people with such conditions, the shift into shorter day-lengths during winter can trigger a depressive episode.

    Counterintuitively, the longer day-lengths in spring and summer can also destabilise people with bipolar disorder into an “activated” state where energy and activity are in overdrive, and symptoms are harder to manage. So, seasonality can be serious.

    Alexis Hutcheon, who experiences seasonality and helped write this article, told us:

    […] the season change is like preparing for battle – I never know what’s coming, and I rarely come out unscathed. I’ve experienced both hypomanic and depressive episodes triggered by the season change, but regardless of whether I’m on the ‘up’ or the ‘down’, the one constant is that I can’t sleep. To manage, I try to stick to a strict routine, tweak medication, maximise my exposure to light, and always stay tuned in to those subtle shifts in mood. It’s a time of heightened awareness and trying to stay one step ahead.

    So what’s going on in the brain?

    One explanation for what’s going on in the brain when mental health fluctuates with the change in seasons relates to the neurotransmitters serotonin and dopamine.

    Serotonin helps regulate mood and is the target of many antidepressants. There is some evidence of seasonal changes in serotonin levels, potentially being lower in winter.

    Dopamine is a neurotransmitter involved in reward, motivation and movement, and is also a target of some antidepressants. Levels of dopamine may also change with the seasons.

    But the neuroscience of seasonality is a developing area and more research is needed to know what’s going on in the brain.

    How about bright light at night?

    We know exposure to bright light at night (for instance, if someone is up all night) can disturb someone’s circadian rhythms.

    This type of circadian rhythm disturbance is associated with higher rates of symptoms including self-harm, depressive and anxiety symptoms, and lower wellbeing. It is also associated with higher rates of mental disorders, such as major depression, bipolar disorder, psychotic disorders and post-traumatic stress disorder (or PTSD).

    Why is this? Bright light at night confuses and destabilises the body clock. It disrupts the rhythmic regulation of mood, cognition, appetite, metabolism and many other mental processes.

    But people differ hugely in their sensitivity to light. While still a hypothesis, people who are most sensitive to light may be the most vulnerable to body clock disturbances caused by bright light at night, which then leads to a higher risk of mental health problems.

    Man studying at computer late at night
    Bright light at night disrupts your body clock, putting you at greater risk of mental health issues. Ollyy/Shutterstock

    Where to from here?

    Learning about light will help people better manage their mental health conditions.

    By encouraging people to better align their lives to the light-dark cycle (to stabilise their body clock) we may also help prevent conditions such as depression and bipolar disorder emerging in the first place.

    Healthy light behaviours – avoiding light at night and seeking light during the day – are good for everyone. But they might be especially helpful for people at risk of mental health problems. These include people with a family history of mental health problems or people who are night owls (late sleepers and late risers), who are more at risk of body clock disturbances.

    Alexis Hutcheon has lived experience of a mental health condition and helped write this article.

    If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

    Jacob Crouse, Research Fellow in Youth Mental Health, Brain and Mind Centre, University of Sydney; Emiliana Tonini, Postdoctoral Research Fellow, Brain and Mind Centre, University of Sydney, and Ian Hickie, Co-Director, Health and Policy, Brain and Mind Centre, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Kava vs Anxiety

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    Kava, sometimes also called “kava kava” but we’re just going to call it kava once for the sake of brevity, is a heart-shaped herb that bestows the powers of the Black Panther is popularly enjoyed for its anxiolytic (anxiety-reducing) effects. Despite the similarity of the name in many languages, it is unrelated to coffee (except insofar as they are both plants), and its botanical name is Piper methysticum.

    Does it work?

    Yes! At least in the short-term; more on that later.

    Firstly, you may be wondering how it works; it works by its potentiation of GABA receptors in the brain. GABA (or gamma-aminobutyric acid, to give it its full name), as you may recall, is a neurotransmitter that is associated with feelings of calm; we wrote about it here:

    GABA Against Stress/Anxiety

    So, what does “potentiation of GABA receptors” mean? It means… Scientists don’t for 100% sure know how it works yet, but it does make GABA receptors fire more. It’s possible that to some degree GABA fits the “molecular lock” of the receptors and causes them to say “GABA is here”; it’s also possible that they just make them more sensitive to the real GABA that is there, or there could be another explanation as yet undiscovered. Either way, it means that taking kava has a similar effect to having increased GABA levels in the brain:

    Kavain, the Major Constituent of the Anxiolytic Kava Extract, Potentiates GABAA Receptors: Functional Characteristics and Molecular Mechanism

    As for how much to use, 20–300mg appears to be an effective dose, and most sources recommend 80–250mg:

    Kava as a Clinical Nutrient: Promises and Challenges

    This review of clinical trials found that it was more effective than placebo in only 3 of 7 trials; specifically, it was beneficial in the short-term and not in the long-term. For these reasons, the researchers concluded:

    ❝Kava Kava appears to be a short-term treatment for anxiety, but not a replacement for prolonged anti-anxiety use. Although not witnessed in this review, liver toxicity is especially possible if taken longer than 8 weeks.❞

    Source: The effectiveness and safety of Kava Kava for treating anxiety symptoms: A systematic review and analysis of randomized clinical trials

    Another review of clinical trials found better results over the course of 11 clinical trials, though again, short-term treatment only was considered to be where the “safe and effective” claim can be placed:

    ❝Compared with placebo, kava extract appears to be an effective symptomatic treatment option for anxiety. The data available from the reviewed studies suggest that kava is relatively safe for short-term treatment (1 to 24 weeks), although more information is required. Further rigorous investigations, particularly into the long-term safety profile of kava are warrant❞

    Source: Kava extract for treating anxiety

    Is it safe?

    Nope! It has been associated with liver damage:

    FDA | Consumer Advisory: Kava-Containing Dietary Supplements May be Associated With Severe Liver Injury

    The likely main mechanism of toxicity is that it simply monopolizes the liver’s metabolic abilities, meaning that while it’s metabolizing the kava, it’s not metabolizing other things (such as alcohol or other medications), which will then build up, and potentially overwhelm the liver:

    Constituents in kava extracts potentially involved in hepatotoxicity: a review

    However, traditionally-prepared kava has not had the same effect as modern extracts; at first it seemed the difference was the traditional aqueous extracts vs modern acetonic/ethanolic extracts, but eventually that was found not to be the case, as toxicity occurred with industrial aqueous extracts too. The conclusion so far is that it is about the quality of the source ingredients, and the problems inherent to mass-production:

    Kava hepatotoxicity in traditional and modern use: the presumed Pacific kava paradox hypothesis revisited

    Meanwhile, short-term use doesn’t seem to have this problem, if you’re not drinking alcohol or taking medications that affect the liver:

    Mechanisms/risk factors – kava-associated hepatotoxicity ← you’ll need to scroll down to 4.2.4 to read about this

    Want to try it?

    If the potential for hepatotoxicity doesn’t put you off, here’s an example product on Amazon ← we do not recommend it, but we are not the boss of you, and maybe you’re confident about your liver and want to use it only very short-term?

    Take care!

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