What should I do if I can’t see a psychiatrist?

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People presenting at emergency with mental health concerns are experiencing the longest wait times in Australia for admission to a ward, according to a new report from the Australasian College of Emergency Medicine.

But with half of New South Wales’ public psychiatrists set to resign next week after ongoing pay disputes – and amid national shortages in the mental health workforce – Australians who rely on psychiatry support may be wondering where else to go.

If you can’t get in to see a psychiatrist and you need help, there are some other options. However in an emergency, you should call 000.

Why do people see a psychiatrist?

Psychiatrists are doctors who specialise in mental health and can prescribe medication.

People seek or require psychiatry support for many reasons. These may include:

  • severe depression, including suicidal thoughts or behaviours
  • severe anxiety, panic attacks or phobias
  • post-traumatic stress disorder (PTSD)
  • eating disorders, such as anorexia or bulimia
  • attention deficit hyperactivity disorder (ADHD).

Psychiatrists complement other mental health clinicians by prescribing certain medications and making decisions about hospital admission. But when psychiatry support is not available a range of team members can contribute to a person’s mental health care.

Can my GP help?

Depending on your mental health concerns, your GP may be able to offer alternatives while you await formal psychiatry care.

GPs provide support for a range of mental health concerns, regardless of formal diagnosis. They can help address the causes and impact of issues including mental distress, changes in sleep, thinking, mood or behaviour.

The GP Psychiatry Support Line also provides doctors advice on care, prescription medication and how support can work.

It’s a good idea to book a long consult and consider taking a trusted person. Be explicit about how you’ve been feeling and what previous supports or medication you’ve accessed.

What about psychologists, counsellors or community services?

Your GP should also be aware of supports available locally and online.

For example, Head to Health is a government initiative, including information, a nationwide phone line, and in-person clinics in Victoria. It aims to improve mental health advice, assessment and access to treatment.

Medicare Mental Health Centres provide in-person care and are expanding across Australia.

There are also virtual care services in some areas. This includes advice on individualised assessment including whether to go to hospital.

Some community groups are led by peers rather than clinicians, such as Alternatives to Suicide.

How about if I’m rural or regional?

Accessing support in rural or regional areas is particularly tough.

Beyond helplines and formal supports, other options include local Suicide Prevention Networks and community initiatives such as ifarmwell and Men’s sheds.

Should I go to emergency?

As the new report shows, people who present at hospital emergency departments for mental health should expect long wait times before being admitted to a ward.

But going to a hospital emergency department will be essential for some who are experiencing a physical or mental health crisis.

Managing suicide-related distress

With the mass resignation of NSW psychiatrists looming, and amid shortages and blown-out emergency waiting times, people in suicide-related distress must receive the best available care and support.

Roughly nine Australians die by suicide each day. One in six have had thoughts of suicide at some point in their lives.

Suicidal thoughts can pass. There are evidence-based strategies people can immediately turn to when distressed and in need of ongoing care.

Safety planning is a popular suicide prevention strategy to help you stay safe.

What is a safety plan?

This is a personalised, step-by-step plan to remain safe during the onset or worsening of suicidal urges.

You can develop a safety plan collaboratively with a clinician and/or peer worker, or with loved ones. You can also make one on your own – many people like to use the Beyond Now app.

Safety plans usually include:

  1. recognising personal warning signs of a crisis (for example, feeling like a burden)
  2. identifying and using internal coping strategies (such as distracting yourself by listening to favourite music)
  3. seeking social supports for distraction (for example, visiting your local library)
  4. letting trusted family or friends know how you’re feeling – ideally, they should know they’re in your safety plan
  5. knowing contact details of specific mental health services (your GP, mental health supports, local hospital)
  6. making the environment safer by removing or limiting access to lethal means
  7. identifying specific and personalised reasons for living.

Our research shows safety planning is linked to reduced suicidal thoughts and behaviour, as well as feelings of depression and hopelessness, among adults.

Evidence from people with lived experience shows safety planning helps people to understand their warning signs and practice coping strategies.

A serious-looking woman touches a man's shoulder as they sit on a couch.
Sharing your safety plan with loved ones may help understand warning signs of a crisis. Dragana Gordic/Shutterstock

Are there helplines I can call?

There are people ready to listen, by phone or online chat, Australia-wide. You can try any of the following (most are available 24 hours a day, seven days a week):

Suicide helplines:

There is also specialised support:

Additionally, each state and territory will have its own list of mental health resources.

With uncertain access to services, it’s helpful to remember that there are people who care. You don’t have to go it alone.

Monika Ferguson, Senior Lecturer in Mental Health, University of South Australia and Nicholas Procter, Professor and Chair: Mental Health Nursing, University of South Australia

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

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  • Fast Burn – by Dr. Ian K. Smith

    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.

    Intermittent fasting seems simple enough: how complicated can “stop eating for a bit” be? Well, there are nuances and tweaks and hacks and “if you do this bit wrong it will sabotage your benefits” things to know about, too.

    Dr. Smith takes us through the basic essentials first, and covers each of the main kinds of intermittent fasting, for example:

    • Time-restricted eating; 12:12, 16:8, etc, with those being hours fasting vs hours eating
    • Caloric restriction models; for example 5:2, where one eats “normally” for 5 days a week, and on two non-consecutive days, eats only 500 calories
    • Day off models and more; for example, “no eating on Sundays” that can, depending on your schedule, be anything from a 24-hour fast to 36 hours or more.

    …and, most notably, what they each do metabolically.

    Then, the real meat of the book is his program. Taking into account the benefits of each form of fasting, he weaves together a 9-week program to first ease us gently into intermittent fasting, and then enjoy the maximum benefits with minimum self-sabotage.

    Which is the biggest stumbling-block for many trying intermittent fasting for the first time, so it’s a huge help that he takes care of this here.

    He also includes meal plans and recipes; readers can use those or not; the fasting plan stands on its own two feet without them too.

    Bottom line: if you’ve been thinking of trying intermittent fasting but have been put off by all the kinds or have had trouble sticking to it, this book may be just what you need.

    Click here to check out Fast Burn on Amazon and see what you can achieve!

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  • Macadamias vs Hazelnuts – Which is Healthier?

    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.

    Our Verdict

    When comparing macadamias to hazelnuts, we picked the hazelnuts.

    Why?

    In terms of macros first, hazelnuts have 2x the protein, and slightly more carbs and fiber. We call this a win for hazelnuts.

    When it comes to vitamins, macadamias have more of vitamins B1, B2, and B3, while hazelnuts have more of vitamins A, B5, B6, B7, B9, C, and E. Notably, 28x more vitamin E, so that’s not inconsiderable. Also 10x the vitamin B9, and 5x the vitamin C, and the rest, more modest wins. In any case, clearly a strong win for hazelnuts here.

    In the category of minerals, macadamias have more selenium, while hazelnuts have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. Another clear win for hazelnuts.

    In short, hazelnuts win in all categories. However, by all means enjoy either or both (unless you have a nut allergy, in which case, obviously don’t).

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts

    Take care!

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  • What’s So Special About Alpha-Lipoic Acid?

    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 Access-All-Areas Antioxidant

    Alpha-Lipoic Acid (ALA) is one of the most bioavailable antioxidants in existence. A bold claim, but most antioxidants are only water-soluble or fat-soluble, whereas ALA is both. This has far-reaching implications—and we mean that literally, because its “go everywhere” status means that it can access (and operate in) all living cells of the human body.

    We make it inside our body, and we can also get it in our diet, or take it as a supplement.

    What foods contain it?

    The richest food sources are:

    • For the meat-eaters: organ meats
    • For everyone: broccoli, tomatoes, & spinach

    However, supplements are more efficient at delivering it, by several orders of magnitude:

    Read more: Lipoic acid – biological activity and therapeutic potential

    What are its benefits?

    Most of its benefits are the usual benefits you would expect from any antioxidant, just, more of it. In particular, reduced inflammation and slowed skin aging are common reasons that people take ALA as a supplement.

    Does it really reduce inflammation?

    Yes, it does. This one’s not at all controversial, as this systematic review of studies shows:

    Effects of alpha-lipoic acid supplementation on C-reactive protein level: A systematic review and meta-analysis of randomized controlled clinical trials

    (C-reactive protein is a marker of inflammation)

    Does it really reduce skin aging?

    Again yes—which again is not surprising for such a potent antioxidant; remember that oxidative stress is one of the main agonists of cellular aging:

    The clinical efficacy of cosmeceutical application of liquid crystalline nanostructured dispersions of alpha lipoic acid as anti-wrinkle

    As a special feature, ALA shows particular strength against sun-related skin aging, because of how it protects against UV radiation and increases levels of gluthianone, which also helps:

    Where can I get some?

    We don’t sell it, but here for your convenience is an example product on Amazon

    Enjoy!

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  • Broccoli vs Cauliflower – Which is Healthier?

    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.

    Our Verdict

    When comparing broccoli to cauliflower, we picked the broccoli.

    Why?

    This one is quite straightforward. Superficially, they’re very similar:

    Both are great cruciferous vegetables with many health benefits to offer. Even for those keen to avoid oxalates, which cruciferous vegetables in general can be high in, these ones are quite low.

    However, if you have IBS, you might want to avoid both, for their raffinose content that may cause problems for you.

    For pretty much everyone else, unless you have a special reason why it’s not the case for you, both are a good source of abundant vitamins and minerals, and yet…

    Anything cauliflower can do, broccoli can do better!

    Broccoli contains more of the vitamins they both contain, and more of the minerals they both contain.

    Broccoli also beats cauliflower on amino acids (except lysine), and contains a lot more lutein and zeaxanthin, carotenoids important for healthy eyes and brain.

    So by all means enjoy both, but if you’re going to pick one, pick broccoli!

    Want to know more?

    Check out: Brain Food? The Eyes Have It!

    Enjoy!

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  • New research suggests intermittent fasting increases the risk of dying from heart disease. But the evidence is mixed

    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.

    Kaitlin Day, RMIT University and Sharayah Carter, RMIT University

    Intermittent fasting has gained popularity in recent years as a dietary approach with potential health benefits. So you might have been surprised to see headlines last week suggesting the practice could increase a person’s risk of death from heart disease.

    The news stories were based on recent research which found a link between time-restricted eating, a form of intermittent fasting, and an increased risk of death from cardiovascular disease, or heart disease.

    So what can we make of these findings? And how do they measure up with what else we know about intermittent fasting and heart disease?

    The study in question

    The research was presented as a scientific poster at an American Heart Association conference last week. The full study hasn’t yet been published in a peer-reviewed journal.

    The researchers used data from the National Health and Nutrition Examination Survey (NHANES), a long-running survey that collects information from a large number of people in the United States.

    This type of research, known as observational research, involves analysing large groups of people to identify relationships between lifestyle factors and disease. The study covered a 15-year period.

    It showed people who ate their meals within an eight-hour window faced a 91% increased risk of dying from heart disease compared to those spreading their meals over 12 to 16 hours. When we look more closely at the data, it suggests 7.5% of those who ate within eight hours died from heart disease during the study, compared to 3.6% of those who ate across 12 to 16 hours.

    We don’t know if the authors controlled for other factors that can influence health, such as body weight, medication use or diet quality. It’s likely some of these questions will be answered once the full details of the study are published.

    It’s also worth noting that participants may have eaten during a shorter window for a range of reasons – not necessarily because they were intentionally following a time-restricted diet. For example, they may have had a poor appetite due to illness, which could have also influenced the results.

    Other research

    Although this research may have a number of limitations, its findings aren’t entirely unique. They align with several other published studies using the NHANES data set.

    For example, one study showed eating over a longer period of time reduced the risk of death from heart disease by 64% in people with heart failure.

    Another study in people with diabetes showed those who ate more frequently had a lower risk of death from heart disease.

    A recent study found an overnight fast shorter than ten hours and longer than 14 hours increased the risk dying from of heart disease. This suggests too short a fast could also be a problem.

    But I thought intermittent fasting was healthy?

    There are conflicting results about intermittent fasting in the scientific literature, partly due to the different types of intermittent fasting.

    There’s time restricted eating, which limits eating to a period of time each day, and which the current study looks at. There are also different patterns of fast and feed days, such as the well-known 5:2 diet, where on fast days people generally consume about 25% of their energy needs, while on feed days there is no restriction on food intake.

    Despite these different fasting patterns, systematic reviews of randomised controlled trials (RCTs) consistently demonstrate benefits for intermittent fasting in terms of weight loss and heart disease risk factors (for example, blood pressure and cholesterol levels).

    RCTs indicate intermittent fasting yields comparable improvements in these areas to other dietary interventions, such as daily moderate energy restriction.

    A group of people eating around a table.
    There are a variety of intermittent fasting diets. Fauxels/Pexels

    So why do we see such different results?

    RCTs directly compare two conditions, such as intermittent fasting versus daily energy restriction, and control for a range of factors that could affect outcomes. So they offer insights into causal relationships we can’t get through observational studies alone.

    However, they often focus on specific groups and short-term outcomes. On average, these studies follow participants for around 12 months, leaving long-term effects unknown.

    While observational research provides valuable insights into population-level trends over longer periods, it relies on self-reporting and cannot demonstrate cause and effect.

    Relying on people to accurately report their own eating habits is tricky, as they may have difficulty remembering what and when they ate. This is a long-standing issue in observational studies and makes relying only on these types of studies to help us understand the relationship between diet and disease challenging.

    It’s likely the relationship between eating timing and health is more complex than simply eating more or less regularly. Our bodies are controlled by a group of internal clocks (our circadian rhythm), and when our behaviour doesn’t align with these clocks, such as when we eat at unusual times, our bodies can have trouble managing this.

    So, is intermittent fasting safe?

    There’s no simple answer to this question. RCTs have shown it appears a safe option for weight loss in the short term.

    However, people in the NHANES dataset who eat within a limited period of the day appear to be at higher risk of dying from heart disease. Of course, many other factors could be causing them to eat in this way, and influence the results.

    When faced with conflicting data, it’s generally agreed among scientists that RCTs provide a higher level of evidence. There are too many unknowns to accept the conclusions of an epidemiological study like this one without asking questions. Unsurprisingly, it has been subject to criticism.

    That said, to gain a better understanding of the long-term safety of intermittent fasting, we need to be able follow up individuals in these RCTs over five or ten years.

    In the meantime, if you’re interested in trying intermittent fasting, you should speak to a health professional first.

    Kaitlin Day, Lecturer in Human Nutrition, RMIT University and Sharayah Carter, Lecturer Nutrition and Dietetics, RMIT University

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

    The Conversation

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  • Antihistamines’ Generation Gap

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    Are You Ready For Allergy Season?

    For those of us in the Northern Hemisphere, fall will be upon us soon, and we have a few weeks to be ready for it. A common seasonal ailment is of course seasonal allergies—it’s not serious for most of us, but it can be very annoying, and can disrupt a lot of our normal activities.

    Suddenly, a thing that notionally does us no real harm, is making driving dangerous, cooking take three times as long, sex laughable if not off-the-table (so to speak), and the lightest tasks exhausting.

    So, what to do about it?

    Antihistamines: first generation

    Ye olde antihistamines such as diphenhydramine and chlorpheniramine are probably not what to do about it.

    They are small molecules that cross the blood-brain barrier and affect histamine receptors in the central nervous system. This will generally get the job done, but there’s a fair bit of neurological friendly-fire going on, and while they will produce drowsiness, the sleep will usually be of poor quality. They also tax the liver rather.

    If you are using them and not experiencing unwanted side effects, then don’t let us stop you, but do be aware of the risks.

    See also: Long-term use of diphenhydramine ← this is the active ingredient in Benadryl in the US and Canada, but safety regulations in many other countries mean that Benadryl has different, safer active ingredients elsewhere.

    Antihistamines: later generations

    We’re going to aggregate 2nd gen, 3rd gen, and 4th gen antihistamines here, because otherwise we’ll be writing a history article and we don’t have room for that. But suffice it to say, later generations of antihistamines do not come with the same problems.

    Instead of going in all-guns-blazing to the CNS like first-gens, they are more specific in their receptor-targetting, resulting in negligible collateral damage:

    CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

    Special shout-out to cetirizine and loratadine, which are the drugs behind half the brand names you’ll see on pharmacy shelves around most of the world these days (including many in the US and Canada).

    Note that these two are very often discussed in the same sentence, sit next to each other on the shelf, and often have identical price and near-identical packaging. Their effectiveness (usually: moderate) and side effects (usually: low) are similar and comparable, but they are genuinely different drugs that just happen to do more or less the same thing.

    This is relevant because if one of them isn’t working for you (and/or is creating an unwanted side effect), you might want to try the other one.

    Another honorable mention goes to fexofenadine, for which pretty much all the same as the above goes, though it gets talked about less (and when it does get mentioned, it’s usually by its most popular brand name, Allegra).

    Finally, one that’s a little different and also deserving of a special mention is azelastine. It was recently (ish, 2021) moved from being prescription-only to being non-prescription (OTC), and it’s a nasal spray.

    It can cause drowsiness, but it’s considered safe and effective for most people. Its main benefit is not really the difference in drug, so much as the difference in the route of administration (nasal rather than oral). Because the drug is in liquid spray form, it can be absorbed through the mucus lining of the nose and get straight to work on blocking the symptoms—in contrast, oral antihistamines usually have to go into your stomach and take their chances there (we say “usually”, because there are some sublingual antihistamines that dissolve under the tongue, but they are less common.)

    Better than antihistamines?

    Writer’s note: at this point, I was given to wonder: “wait, what was I squirting up my nose last time anyway?”—because, dear readers, at the time I got it I just bought one of every different drug on the shelf, desperate to find something that worked. What worked for me, like magic, when nothing else had, was beclometasone dipropionate, which a) smelled delightfully of flowers, which might just be the brand I got, b) needs replacing now because I got it in March 2023 and it expired July 2024, and c) is not an antihistamine at all.

    But, that brings us to the final chapter for today: systemic corticosteroids

    They’re not ok for everyone (check with your doctor if unsure), and definitely should not be taken if immunocompromised and/or currently suffering from an infection (including colds, flu, COVID, etc) unless your doctor tells you otherwise (and even then, honestly, double-check).

    But! They can work like magic when other things don’t. Unlike antihistamines, which only block the symptoms, systemic corticosteroids tackle the underlying inflammation, which can stop the whole thing in its tracks.

    Here’s how they measure up against antihistamines:

    ❝The results of this systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis.❞

    ~ Dr. Robert Puy et al.

    Read in full: Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials

    Take care!

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