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Nutraceuticals are a special class of supplements that have been found by the FDA to be safe enough for sale over the counter in the US without a prescription. However it is an unregulated industry, where consumers are pretty unaware of what they are buying as the industry is filled with false advertisements. It is estimated that US citizens spend millions of dollars on supplements that they commonly find at local drug stores, which are commonly have addictive, fillers, etc. The bio-availability is limited for consumers may find limited or no benefits. It is important to find quality products that consumers have found beneficial. I will provide a list of various products that could be potentially beneficial based on bio-availability, quality of ingredients, source of product, and positive feedback by consumers. Remember, costs does not necessarily make it a better quality of product. SAM-E (S-adenosylmethionine) has been the first line, mainstream antidepressants mostly used in Europe over the past 20 years. SAMe is the essentially the same molecule that participates in hundreds of biochemical reactions. It donates molecules for the production of DNA, phosholipids, three key neurotransmitters (Serotonin, Norephriphrine, and Dopamine). In approximately 50 clinical trials it was found to be safe and effective. It has a very low side profile and has a rapid onset of action (compared to antidepressants which take 4-6 weeks, minimum). No adverse reactions have been reported with other medications. Bonus, it protects the liver from the toxic effects of other medications. It is a great augmenting agent, for antidepressant or when the medication seems to wear off. SAMe can be activating and can worsening underlying anxiety so should be closely monitored under the care of a licensed physician. This supplement has a low side effect profile compared to other antidepressants. One of the benefits is it causes no weight gain or sexual side effects (which are frequently caused by an SSRI or SNRI). Avoid taking this supplement without the guidance of physician as it could potentially (in rare cases) induce Bipolar Disorder (which can be caused by any antidepressant, if there is any genetic predisposition). Many physicians believe that depression and bipolar disorder lie on a spectrum and are not individual diagnosis, contrary to common belief. This symptoms should be taken on a empty stomach before breakfast. If experience anxiety or agitation, it would be transient, however mild anxiety medications used temporarily can help the transition. Like any medication, the start dose is between 200mg to 400mg, as tolerated. Based on level of depression, you should consult with your dose to see how much supplement you may need which is strongly correlated with the severity of underlying depression. You may augment this medication with a B-complex. B-vitamins tend to be deficit in patients struggling with depression, which can helpful reduce mental fatigue, improve levels of energy, and improve overall well-being as these molecules are used in a majority of metabolic process, particular to induce natural body energy. One of the fascinating aspects of SAMe, based on various double-blind studies is that it can help conditions arthritis, fibromyalgia, reduce the effect of cirrhosis (chronic liver disease), mood improvements in patients struggling with HIV/AIDS, and Parkinson's Disorder (one commonly used medication Levodopa reduces the natural SAMe produced in the body). There is ongoing research of its children (which are not responding to medication, or refuse to take medication). Given their age, they would need much smaller doses with a faster response. SAMe is minimal reactive with other medications, in fact can protect the liver, can be combined or augment typical antidepressants to reduce typical side effects issues. Source: How to Use Herbs, Nutrients, & Yoga in Mental Health

Alternative Medicine Help Depression? The signs and symptoms are well known, it is the most under-treated illnesses today. It is a general consensus that psychotherapy + medications are more effective that either treatment alone. Studies of antidepressants show that fewer than 1/3 of all patients achieve full remission after 8 weeks, which is a very long time when you have such severe symptoms. Approximately 1/3 are partial responders and 1/3 are non-responders. It is important to know the method of patient selection and definition of outcome in antidepressant studies which is why we don’t see patients being cured. The STAR*D trial from the NIMH reflected these similar outcomes amongst patients who were switched between antidepressants, which reflected that 60% to 80% of patients would not qualify for an antidepressant study. In most studies, the symptom reduction was 50%, reducing the disabiling affects of the illness, however not remission or fully functional. Complimentary Alternative Medicine (CAM) can be a great adjunct treatment to help them closer to total remission (however is not guarantee, but a helpful natural option). One factor that is a common cause of treatment failure is non-adherence, in which one study from Harvard found that 75% of patients were non-compliant with medications. A factor that influences non-adherence is not laziness but patients felt they good they were getting out of the pill was not worth putting up with the side effects. One of the challenges is testing the efficacy of CAM most rating systems and meta-analysis are not done for solo treatments Source: How to Use Herbs, Nutrients, and Yoga in Mental Health

Data suggests that substitution of Omega-6- Fatty Acids (O6FA) for Omega-3-Fatty Acids (O3FA) is associated with unipolar and bipolar depression. This due to loss of membrane fluidity and lack of flexibility. In one study, Omega-3FA deficiencies have been associated with increase risk of suicide. Post-morteum studies found that less O3FA content in the orbitofrontal cortex from patients with Major Depressive Disorder and age-matched normal controls. DHA, is the only fatty acid found to be different from controls, was 32% lower in the OFC of female patients with MDD and 16% lower in males with depression. Overall, there is sufficient evidence of the efficacy to support O3FA as adjunct for depression and bipolar disorders. Omega 3 fatty - EPA/DHA- reduction of pro-inflammatory eicosanoids and release of pro inflammatory cytokines; our diets tend to have more saturated fat from domestic animals and more omega 6 FA. Also Omega 6 from cultivated vegetables (corn, sunflower, and soy bean) - used common as cooking oil. Fish used to be a prime source of OM-3 until farmer started feeding then vegetable oils from 6-FA. Once a rich source of Omega-3FA, now most farm-bred fish contain higher levels of O6FA versus O3FA. Also, fish such as fatty fish such a salmon (wild) still contain an important source of O3FA. Farm raised salmon now a day contain excess amounts of PCB (polychlorinated biphenyls) or mercury that contain the fish oil in liquid or capsule form. Quality brands contains no PCBs or fishy aftertaste. - reduction of pro-inflammatory eicosanoids and release of pro inflammatory cytokines; our diets tend to have more saturated fat from domestic animals and more omega 6 FA. Also Omega 6 from cultivated vegetables (corn, sunflower, and soy bean) - used common as cooking oil. Fish used to be a prime source of OM-3 until farmer feed with then vegetable oils from 6-FA. Once a rich source of Omega-3FA, now most farm-bred fish contain higher levels of O6FA versus O3FA. This is a great product that I have researched: Omega-3-Fatty Oil gel capsule that eliminates all of this toxins. Flax seeds contain Alpha-Linolenic Acid(ALA) but they must be ground to enable the ALA to be absorbed. ALA will be converted into Omega-3, EPA and DHA, but the conversion is inefficient and varies amongst individuals. Additional sources of ALA are nuts, seeds, however avoid canola or sunflower seeds (as they have high Omega 6 FA) Source: How to Use Herbs, Nutrients, & Yoga in Mental Health

Complementary and Alternative Medicine The quality and quantity of scientific information of CAM treatment varies greatly. The lack of research often has little to do with potential benefits of an herb and more to do with whether a company would profit enough from sales to oftset the costs of doing a double-blind placebo controlled study (approximately $500,000 to $2,000,000). Many companies obtain patents on “proprietary blends” which are herbal combinations. CAM treatments have been used by large groups of people all ages and stages of health for hundreds if not thousands of years, therefore clinically we have more information about the safety and efficacy than we do synthetic drugs (which some have been pulled due to adverse side effects). Introduction Complementary Alternative Medicine. It is important to understand the pros and cons of standard and alternative treatments pertinent to side effect profile. In synthetic medication trials, the patient only responds 50-75% improvement or if there are troublesome side effects, this may be a good time to consider CAM. Help improve the level of understanding of benefits of CAM are solo treatment or adjunct treatment. Stress is the focal point that exacerbates a lot of underlying symptoms of mental illness. The main components of stress is the Sympathetic Nervous System and the Hypothalamus-Pituatary Adrenal axis (HPA). The Parasympathetic Nervous System is support to counteract these affect, however suppose it fails. This imbalance is the critical in the pathology development of anxiety, depression, and other stress related conditions. Extreme cases can lead to Panic, PTSD, Chronic fatigue syndrome, Irritable Bowel, weight gain, etc. Anxiolytics and antidepressants dampen the SNS, however underactivity of PNS can lead to umbrella of anxiety disorders. Medications have no been shown to boost the activity of PNS. Based on our research; this is a quality product: Adaptogenic herbs (Rhiodola rosea) boost the PNS, which is unique. Optimal Mental Health The goal of treatment is remission, complete relief of symptoms, and resumption of a full functional life. Source: How to Use Herbs, Nutrients, and Yoga in Mental Health

Study findings reveal parallel results for alcohol consumption and depression screenings completed in primary care Background The Alcohol Use Disorders Identification Test-Consumption version (AUDIT-C) has been robustly validated as a point-in-time screen for unhealthy alcohol use, but less is known about the significance of changes in AUDIT-C scores from routine screenings over time. Unhealthy alcohol use and depression commonly co-occur, and changes in drinking often co-occur with changes in depression symptoms. We assess the associations between changes in AUDIT-C scores and changes in depression symptoms reported on brief screens completed in routine care. Methods The study sample included 198,335 primary care patients who completed two AUDIT-C screens 11 to 24 months apart and the Patient Health Questionnaire-2 (PHQ-2) depression screen on the same day as each AUDIT-C. Both screening measures were completed as part of routine care within a large health system in Washington state. AUDIT-C scores were categorized to reflect five drinking levels at both time points, resulting in 25 subgroups with different change patterns. For each of the 25 subgroups, within-group changes in the prevalence of positive PHQ-2 depression screens were characterized using risk ratios (RRs) and McNemar's tests. Results Patient subgroups with increases in AUDIT-C risk categories generally experienced increases in the prevalence of positive depression screens (RRs ranging from 0.95 to 2.00). Patient subgroups with decreases in AUDIT-C risk categories generally experienced decreases in the prevalence of positive depression screens (RRs ranging from 0.52 to 1.01). Patient subgroups that did not have changes in AUDIT-C risk categories experienced little or no change in the prevalence of positive depression screens (RRs ranging from 0.98 to 1.15). Alcohol Consumption Conclusions As hypothesized, changes in alcohol consumption reported on AUDIT-C screens completed in routine care were associated with changes in depression screening results. Results support the validity and clinical utility of monitoring changes in AUDIT-C scores over time as a meaningful measure of changes in drinking. Source: Kevin A. Hallgren, Ph.D. Wiley Online, https://doi.org/10.1111/acer.15075 Veterans Affairs, https://www.hepatitis.va.gov/alcohol/treatment/audit-c.asp#S2X

In a recent Morbidity and Mortality Weekly Report the Centers for Disease Control Published information regarding Adverse childhood experiences (ACEs) data from all 50 states and the District of Columbia by surveying adults from 2011-2020. Surveys found that ACEs, which are associated with negative health outcomes, are highest among women, persons aged 25–34 years, non-Hispanic American Indian or Alaska Native adults, non-Hispanic multiracial adults, adults with less than a high school education, and adults who were unemployed or unable to work. Prevalence of individual and total number of ACEs varied across jurisdictions. Adverse childhood experiences (ACEs) are defined as preventable, potentially traumatic events that occur among persons aged <18 years and are associated with numerous negative outcomes; data from 25 states indicate that ACEs are common among U.S. adults (1). Disparities in ACEs are often attributable to social and economic environments in which some families live (2,3). Understanding the prevalence of ACEs, stratified by sociodemographic characteristics, is essential to addressing and preventing ACEs and eliminating disparities, but population-level ACEs data collection has been sporadic (1). Using 2011–2020 Behavioral Risk Factor Surveillance System (BRFSS) data, CDC provides estimates of ACEs prevalence among U.S. adults in all 50 states and the District of Columbia, and by key sociodemographic characteristics. Overall, 63.9% of U.S. adults reported at least one ACE; 17.3% reported four or more ACEs. Experiencing four or more ACEs was most common among females (19.2%), adults aged 25–34 years (25.2%), non-Hispanic American Indian or Alaska Native (AI/AN) adults (32.4%), non-Hispanic multiracial adults (31.5%), adults with less than a high school education (20.5%), and those who were unemployed (25.8%) or unable to work (28.8%). Prevalence of experiencing four or more ACEs varied substantially across jurisdictions, from 11.9% (New Jersey) to 22.7% (Oregon). Patterns in prevalence of individual and total number of ACEs varied by jurisdiction and sociodemographic characteristics, reinforcing the importance of jurisdiction and local collection of ACEs data to guide targeted prevention and decrease inequities. CDC has released prevention resources, including Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence, to help provide jurisdictions and communities with the best available strategies to prevent violence and other ACEs, including guidance on how to implement those strategies for maximum impact (4–6). BRFSS is an annual survey of health-related risk behaviors and chronic health conditions representative of noninstitutionalized adults collected from all 50 states, the District of Columbia, and three U.S. territories (7). In addition to core questions administered annually to all participants, jurisdictions and territories can include jurisdiction-approved optional modules, as well as jurisdiction-added questions.* From 2011 to 2020, ACEs questions were included in the BRFSS questionnaire at least once by all 50 states and the District of Columbia as either an optional module (2011–2012 and 2019–2020) or jurisdiction-added questions (2013–2018). For jurisdictions that included ACEs questions in more than 1 year, the most recent year was included. The optional ACEs module includes 11 questions to determine exposure to eight types of ACEs: physical abuse, emotional abuse, sexual abuse, witnessing intimate partner violence, household substance abuse, household mental illness, parental separation or divorce, and incarcerated household member† (1). The Arkansas and New Hampshire questionnaires differed from the optional ACEs module. Arkansas collapsed three sexual abuse questions into a single question, and New Hampshire omitted two of the three sexual abuse questions.§ The Arkansas questionnaire also combined household drug abuse and alcohol abuse questions into a single household substance abuse question. Responses to all ACE types were dichotomized**; ACE scores were calculated for participants by summing affirmative responses to all eight ACE types and then categorized into zero, one, two to three, or four or more ACEs. Four or more ACEs were selected as the upper cut-off given the volume of research linking exposure to four or more ACEs with negative health and life outcomes (1,2,8,9). The New Hampshire questionnaire did not include divorce or emotional abuse questions; therefore, the maximum ACE score in New Hampshire was six. Participants with missing data for any type of ACE were excluded (79,797), leaving 264,882 participants (72.5% of total). Weighted prevalence estimates and 95% CIs were calculated for individual ACEs and total ACE score, by jurisdiction and by sociodemographic characteristics (sex, age group, race and ethnicity, annual household income, educational attainment, and employment status). Age-stratified jurisdictional prevalence estimates for four or more ACEs were also calculated. All analyses accounted for survey design by using recommended weights and complex survey procedures in SAS software (version 9.4; SAS Institute). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.†† Survey response rate ranged by jurisdiction from 30.6% (Illinois, 2017) to 67.2% (Mississippi, 2020) (Table 1). Nearly two thirds of U.S. adults (63.9%) experienced one or more ACE: 23.1% reported one; 23.5% reported two to three; and 17.3% reported four or more ACEs (Table 2). The prevalence of four or more ACEs was highest among females (19.2%), persons aged 25–34 years (25.2%), AI/AN adults (32.4%), and multiracial adults (31.5%). The prevalence of four or more ACEs was also higher among adults with household incomes <$15,000 (24.1%), those with less than a high school education (20.5%), and those who were unable to work (28.8%). Prevalence of four or more ACEs was lowest among persons aged ≥65 years (7.7%). Emotional abuse was the most reported type of ACE (34.0%), followed by parental separation or divorce (28.4%), and household substance abuse (26.5%) (Table 3). Patterns in prevalence of individual types of ACEs differed by sociodemographic characteristics. Prevalence of individual ACEs (Table 3), total number of ACEs (Table 1), and four or more ACEs varied by jurisdiction (figure 1-suppliments table 1) For example, Alaska had one of the highest prevalences of reported emotional abuse (42.2%) but one of the lower prevalences of physical abuse (19.4%). Among jurisdictions that asked all eight types of ACE questions, the prevalence of adults reporting four or more ACEs ranged from 11.9% (New Jersey) to 22.7% (Oregon). Geographic patterns of reporting four or more ACEs also differed by age group (Supplementary Figure 2), with some consistent regional differences observed across age groups (e.g., increased prevalence of reporting 4 or more ACEs among jurisdictions in the Pacific Northwest). https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a2.htm?s_cid=mm7226a2_w#T1_down Discussion This study provides the first estimates of ACEs among U.S. adults for all 50 states and the District of Columbia using BRFSS data. During 2011–2020, nearly two thirds of U.S. adults reported at least one ACE, and approximately one in six U.S. adults reported four or more ACEs. Among certain sociodemographic groups, for example, AI/AN or multiracial adults, these numbers are even higher, reflecting inequities in socioeconomic conditions that increase risk for ACEs. These numbers also highlight the potential intergenerational impact of ACEs through lost opportunities and lasting impacts on behavior and health (8). The prevalence of ACEs is strikingly lower among adults aged ≥65 years than among younger age groups; although this might be due to recall bias or differing trends over time, it might also reflect the risk of premature mortality accompanying exposure to a high number of ACEs (9). Patterns in individual and total number of ACEs varied widely by jurisdiction and among sociodemographic groups, reinforcing the importance of population-level and local collection of ACE data to inform targeted prevention and intervention strategies. Variations in ACEs can result from several factors: differing demographic patterns, jurisdiction-level policies related to domestic violence, economic supports for families, historical and ongoing trauma because of discrimination, and social conditions (4). Better understanding of the relative contributions of these factors to ACEs in individual jurisdictions can help policymakers identify the most promising areas for intervention and the populations with the greatest need for services (4). Jurisdictions could consider further contextualizing their ACEs data with other BRFSS questions, such as those examining social determinants of health. CDC has released prevention resources to help provide jurisdictions and communities with the best available strategies to prevent violence and other ACEs, including guidance on how to implement those strategies for maximum impact (4–6). Clinicians and others who work directly with families play an important role in mitigating and preventing ACEs, from primary prevention opportunities (e.g., home visitation programs), to secondary and tertiary prevention strategies that reduce harms associated with ACEs (e.g., trauma-informed care, ensuring required linkage to services, and supports for identified issues) (10). The findings in this report are subject to at least four limitations. First, data were collected over a 10-year period; prevalence might have changed in jurisdictions without recent data. In addition, jurisdiction-specific prevalences reflect the experiences of adults living in that jurisdiction, but do not necessarily represent the jurisdiction in which the ACE occurred. Second, although most jurisdictions used identical measures, two states (Arkansas and New Hampshire) collapsed or omitted sexual abuse questions, and one state (New Hampshire) omitted two types of ACEs. As a result, estimates for emotional abuse and parental separation or divorce are unavailable for New Hampshire. The reported prevalences of ACEs might be underestimated because respondents with missing ACEs data (79,797) were excluded from the analysis; these respondents reported higher prevalence of individual ACEs on the questions they did answer than those who answered all of the ACEs questions. Third, recall and social desirability biases might reduce the accuracy of self-reported ACEs, leading to underestimation, because participants might no longer remember or be willing to disclose potentially traumatic events from their childhood. Finally, BRFSS questions measure a limited set of ACEs and do not reflect the full range, severity, or frequency of ACEs. It is possible that ACEs included in BRFSS are experienced differently by certain groups, thereby shaping some of the demographic and geographic differences observed. In addition, certain limitations need to be considered when interpreting jurisdiction-specific estimates. First, BRFSS records a small subset of potential ACEs; there might be ACEs that are particularly relevant in certain parts of the country that are not included on BRFSS (e.g., experiences of racism or discrimination and community violence) and are thereby not reflected in estimates. Second, adults with six or more ACEs die approximately 20 years earlier on average than do those without ACEs (9); survivorship bias might undercount ACE prevalence in regions affected by premature mortality related to ACEs. Despite these limitations, the findings from this study update the baseline for ACEs measurement from previous estimates from 25 states (1), providing actionable data for all 50 states and the District of Columbia. ACEs are common, but not equally distributed within the population. Differing patterns by jurisdiction and sociodemographic characteristics demonstrate the importance of collecting ACEs data at the jurisdiction level to understand the scope of the problem, identify populations more affected by ACEs, and ACEs-related outcomes; to help guide prevention and mitigation interventions and policies (6). CDC has released prevention resources to help provide jurisdictions and communities with the best available strategies to prevent violence and other ACEs, and with guidance on how to implement those strategies for maximum impact (4–6). Clinicians and others who work directly with families play an important role in mitigating and preventing ACEs, from primary prevention opportunities (e.g., home visitation programs) to secondary and tertiary prevention strategies that reduce harms associated with ACEs (e.g., trauma-informed care, ensuring appropriate linkage to services, and supports for identified issues) (10). Source: Morbidity and Mortality Weekly Report

Power of Perseverance "It is in your hands, to make a better world for all who live in it.” Nelson Mandela I heard this amazing story about Nelson Mandela who was imprisoned for 27 years during the apartheid. He never turned bitter during his injustice he just used it as fuel to gain inner strength and wisdom. It's something that I admire when some can rise above their situation as life can be unfair but what it is the point of suffering let get of resistance. Suffering is pain x resistance. Concept of mindfulness which I need to practice more often. Overcoming Adversity Nelson Mandela influenced great change in South Africa that resonated around the world. He was a pioneer in ending white minority rule and fostering post-apartheid reconciliation in the early 1990s. In 1994, he became South Africa’s first democratically-elected president and its first black leader. Unlike his predecessors, Mandela stepped down at the conclusion of his term. Overcoming Adversity. Before becoming president, Mandela was imprisoned for 27 years. He was jailed for standing up to the human rights abuses committed by the apartheid government against black South Africans. When he was released from prison in 1990, Mandela addressed the crowds from Cape Town’s City Hall, saying: “I greet you all in the name of peace, democracy and freedom for all. I stand here before you not as a prophet, but as a humble servant of you, the people. Your tireless and heroic sacrifices have made it possible for me to be here today. I therefore place the remaining years of my life in your hands.” As a sign of gratitude for his selflessness, many South Africans refer to Mandela as Madiba, the African name of his tribe. When Mandela was a child, it was customary for a South African student to be assigned an English name. In school, he came to be known as Nelson. Many South Africans still refer to Mandela as Madiba as a sign of respect and endearment, paying tribute to his African roots. After his presidency, Mandela became a philanthropist with a special focus on education. Through the Nelson Mandela Foundation in 1999, he pursued noble work such as rural development, school construction, and combating HIV/AIDS. Nelson Mandela’s legacy of humility and service lives on not only in South Africa, but also around the world.

Natural and herbal remedies, also known as “alternative” or “complementary” medicines. This industry has grown tremendously in popularity over the past two decades, becoming a major component of health care and general wellness in the United States and worldwide. The ready availability of these remedies over the counter and their generally good tolerability and safety contribute to this popularity, and many people have benefited from them, often in cases when conventional treatments have failed or caused intolerable side effects. Despite many Food and Drug Administration (FDA) –approved psychotropic medications on the market, efficacy has been inconsistent for some, and many treatment responders will eventually relapse. Continued research on the efficacy and safety of these alternative therapies is, therefore, important. This article reviews six of the most commonly used natural remedies for psychiatric conditions, including the antidepressants St. John’s wort, omega-3 fatty acids, and S-adenosyl methionine (SAMe); the sedative-hypnotics valerian and melatonin; and the nootropic ginkgo biloba. Natural and herbal remedies, also known as “complementary” or “alternative” medicines (CAMs), have grown tremendously in popularity over the past two decades, becoming a major component of health care and general wellness in the United States and worldwide. Many people certainly benefit from them, often in cases when conventional treatments have failed or caused side effects. A 2007 National Health Interview Survey found that 38% of adults and 12% of children had used CAM practices and products in the past year, representing about $33.9 billion in out-of-pocket costs (1). Although there is growing evidence of efficacy and safety to support the use of these remedies, it is important for clinicians to be aware of the limitations of the evidence base and to take that into account with all the other factors that contribute to clinical decision making (2). In psychiatry, we have about 40 FDA-approved antidepressants on the market, yet their efficacy has been inconsistent (3), and many treatment responders will eventually relapse (4). Continued research on natural therapies is called for, partly because they are readily available over the counter and widely used, and also because of their generally good tolerability and safety. Source: Popular Herbal and Natural Remedies Used in Psychiatry; David Mischoulon, M.D., Ph.D.

"Dietary supplements", aka herbal remedies are not stringently regulated as medicines. Despite the regulation by the FDA, various medications have strong side effect profile so it is always important to advocate for yourself when seeing a physician (such as primary care or psychiatrist) about how your body is reacting to the medication, as various mood stabilizers and anti-psychotic medications have horrible side effects. It was very surprising that the FDA approved Abilify and Risperdal for the treatment of irritability for children with Autism Spectrum Disorder. Both of these medications having side effects such as weight gain, blunting the dopamine receptor (the happy neurotransmittor) - one potential cause of overeating as you receive dopamine responses with food. Risperdal was originally developed to treat patients with schizophrenia, which is odd how it would reduce the irritability of patients with ASD. Personally, I think there are many agents that can help control the symptoms of irritability if you understand the root cause of where it is coming from. Sorry that was a tangent, as I tend to be very cautious about use of mood stabilizers/anti-psychotics, as it seems that everyone is on it these days. I have added a link below so you can read and identify that you are not having severe or moderate side effects to your medications, as I could imagine it would be a frustrating experience. You are trying to get rid of one problem, while adding on one or more. Regardless, consumers are left in an unregulated industry, unprotected by watchdogs like the FDA there is very hard to predict which manufacturer, products, and forms would we good for our consumption. Also, there is a lot of misinformation and erroneous information on the internet so it is important to know the source of information. It is always important to use these supplements under the guidance of a clinician, as sometimes herbal remedies are not potent enough for the underlying condition or may need to be augment with a medication and/or therapy. Self-diagnosis is always frowned upon as we innately have our own biases and lack objectivity. Also, it is important to understand and recognize that there is no such thing as a "fully safe treatment", even herbal remedies. It is important to recognize that the source of herb is just as important, as there are many ways of mass producing products that are not high grade with fillers/preventatives/contaminants. A majority of the content that I use is from Herbs of the Mind, which I feel is a well written book that helps a person understand and integrate mental health from a holistic model, is from two experienced psychiatrist from Duke University Medical Center, Johnathan Davidson, MD and Kathryn Connor, MD. There is various studies that reflect simple herbs, which should be taken under the care of a physician, such as St. John's Wort (which can induce mania in patients) or 5-HTP can reduce symptoms of depression, Kava can alleviate stress and anxiety, valerian root can help with sleep issues, or ginkgo can help slow the rate of declining memory. Now, each response in on a case by case basis, again as mentioned is not full safe, therefore I would not recommend purchase these products without a physician's supervision. Did you know that Gingko Biloba can reverse the sexual side effects of SSRIs? St. John's Wort can long been used to help reduce the symptoms of depression (with caution based on concerns of inducing mania). Kava bars exist around the world, particularly in the Polynesia, but more recently into the US. The advantage of kava is can potential improve cognitive acuity unlike other anxiolytics that have a dulling effect. Valerian root is an alternative for people suffering with insomnia or mild anxiety (particular at night), compared to sleep aid (which cause sedation, which typically disrupt REM sleep). Most of data for herbal remedies comes from Europe, however there is limited long term data present in the US, as it is not typically studied as it is seen a non-lucrative, that is open to a lot of competition as it is hard to patient natural remedies, as they are hundreds, if not thousands of years old. One herb Ashwaganda has been used for thousands of years in India for anxiety, with minimal side effects. Source: Herbs of the Mind

Gambling disorder involves repeated, problem gambling behavior. The behavior leads to problems for the individual, families, and society. Adults and adolescents with gambling disorder have trouble controlling their gambling. They will continue even when it causes significant problems. Diagnosis A diagnosis of gambling disorder requires at least four of the following during the past year: Need to gamble with increasing amounts to achieve the desired excitement. Restless or irritable when trying to cut down or stop gambling. Repeated unsuccessful efforts to control, cut back on or stop gambling. Frequent thoughts about gambling (such as reliving past gambling or planning future gambling). Often gambling when feeling distressed. After losing money gambling, often returning to get even. (This is referred to as "chasing" one's losses.) Lying to hide gambling activity. Risking or losing a close relationship, a job, or a school or job opportunity because of gambling. Relying on others to help with money problems caused by gambling People with gambling disorder can have periods where symptoms subside. The gambling may not seem a problem in between periods of more severe symptoms. Gambling disorder tends to run in families. Factors such as trauma and social inequality, particularly in women, can be risk factors. Symptoms can begin as early as adolescence or as late as older adulthood. Men are more likely to start at a younger age. Women are more likely to start later in life. Gambling Disorder Treatment Some people can stop gambling on their own. But many people need help to address their gambling problems. Only one in ten people with gambling disorder seek treatment. Gambling affects people in different ways. Different approaches may work better for different people. Several types of therapy are used to treat gambling disorders, including cognitive behavioral therapy (CBT), psychodynamic therapy, group therapy, and family therapy. Counseling can help people understand gambling and think about how gambling affects them and their family. It can also help people consider options and solve problems. There are no FDA-approved medications to treat gambling disorders. Some medications may help treat co-occurring conditions like depression or anxiety. Support from family and friends can be critical to a person's recovery from gambling. However, only the individual can decide to stop the behaviors. Counseling can help: Gain control over your gambling. Heal family relationships. Deal with your urge to gamble. Handle stress and other problems. Find other things to do with your time. Put your finances in order. Maintain recovery and avoid triggers. Support Groups and Self-Help Support groups, such as Gamblers Anonymous and Alcoholics Anonymous, use peer support to help others stop gambling. Some research has shown physical activity can help those with gambling disorder. Many states have gambling helplines and other assistance. A National Helpline is available at 1-800-662-HELP (4357). Strategies to Deal with Cravings Reach out for support. Call a trusted friend or family member. Go to a Gamblers Anonymous meeting. Distract yourself with other activities. Postpone gambling. Giving yourself time may allow the urge to pass or weaken. Stop for a moment and consider what will happen when you gamble. Avoid isolation. "Dos" and "Don'ts" for Partners, Friends, or Family Members Do Seek the support of others with similar problems; attend a self-help group for families such as Gam-Anon. Recognize your partner's good qualities. Remain calm when speaking to the person with a gambling disorder. Let them know that you are seeking help for yourself; the gambling is affecting you (and possibly children). Explain problem gambling to children. Understand the need for treatment of problem gambling and that it may take time. Set boundaries in managing money; take control of family finances; review bank and credit card statements. Don't Preach, lecture, or allow yourself to lose control of your anger Exclude the gambler from family life and activities Expect immediate recovery, or that all problems will be resolved when the gambling stops Bailout the gambler Preventing Suicide Problem gamblers are at increased risk of suicide. It’s very important to take any thoughts or talk of suicide seriously. For immediate attention, call 988, text 988, or chat at 988lifeline.org. Source: Yale Medicine - Gambling Disorder

Body Dysphoric Disorder Individuals with body dysmorphic disorder are preoccupied with what they perceive as flaws in their physical appearance. The perceived flaws are not noticeable or appear only slight to others but are seen as ugly or abnormal to the person with body dysmorphic disorder. It is not the same as the typical concerns many people have about their appearance. Body dysmorphic disorder also involves repetitive behaviors (such as checking a mirror or seeking reassurance) or repetitive thinking (such as comparing one’s appearance with others). The preoccupations can focus on one or many body areas, most commonly the skin, hair or nose. The preoccupations and behaviors are intrusive, unwanted, and time-consuming (occurring, on average, three to eight hours per day). The individual feels driven to perform them and usually has difficulty resisting or controlling them. The preoccupation causes significant distress or problems in daily activities such as work or social interactions. This can range from avoiding some social situations to being completely isolated and housebound. Body dysmorphic disorder is associated with high levels of anxiety, social anxiety, social avoidance, depressed mood and low self-esteem. Many individuals seek and too often receive cosmetic treatment, such as skin treatments or surgery, to try to fix their perceived defects. People with body dysmorphic disorder may or may not understand that their concerns about their appearance are distorted. Many individuals with body dysmorphic disorder believe that other people take special notice of them or mock them because of how they look. It affects an estimated 2% of people. It typically begins before age 18 and affects both men and women. Body dysmorphic disorder is usually treated with a combination of cognitive behavior therapy and medication, such as selective serotonin reuptake inhibitors (SSRIs). Muscle Dysphoria - subcategory of Body Dysphoria Muscle dysmorphia, a form of body dysmorphic disorder, more common in males, consists of preoccupation with the idea that one’s body is too small or too heavy, or not muscular enough. Individuals with this form of the disorder actually have a normal-looking body or are even very muscular. A majority (but not all) diet, exercise, and/or lift weights excessively. Source: Mayo Clinic - Body Dysphoric Disorder

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person’s daily activities and social interactions. Many people without OCD have distressing thoughts or repetitive behaviors. However, these do not typically disrupt daily life. For people with OCD, thoughts are persistent and intrusive, and behaviors are rigid. Not performing the behaviors commonly causes great distress, often attached to a specific fear of dire consequences (to self or loved ones) if the behaviors are not completed. Many people with OCD know or suspect their obsessional thoughts are not realistic; others may think they could be true. Even if they know their intrusive thoughts are not realistic, people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions. A diagnosis of OCD requires the presence of obsessional thoughts and/or compulsions that are time-consuming (more than one hour a day), cause significant distress, and impair work or social functioning. OCD affects 2-3% of people in the United States, and among adults, slightly more women than men are affected. OCD often begins in childhood, adolescence, or early adulthood. Some people may have some symptoms of OCD but not meet full criteria for this disorder. Obsessive-compulsive disorder Obsessions Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety, fear or disgust. Many people with OCD recognize that these are a product of their mind and that they are excessive or unreasonable. However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessional thinking, or to undo the perceived threats, by using compulsions. They may also try to ignore or suppress the obsessions or distract themselves with other activities. Examples of common content of obsessional thoughts: Fear of contamination by people or the environment Disturbing sexual thoughts or images Religious, often blasphemous, thoughts or fears Fear of perpetrating aggression or being harmed (self or loved ones) Extreme worry something is not complete Extreme concern with order, symmetry, or precision Fear of losing or discarding something important Can also be seemingly meaningless thoughts, images, sounds, words or music Compulsions Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors typically prevent or reduce a person's distress related to an obsession temporarily, and they are then more likely to do the same in the future. Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible. Examples of compulsions: Excessive or ritualized hand washing, showering, brushing teeth, or toileting Repeated cleaning of household objects Ordering or arranging things in a particular way Repeatedly checking locks, switches, appliances, doors, etc. Constantly seeking approval or reassurance Rituals related to numbers, such as counting, repeating, excessively preferencing or avoiding certain numbers People with OCD may also avoid certain people, places, or situations that cause them distress and trigger obsessions and/or compulsions. Avoiding these things may further impair their ability to function in life and may be detrimental to other areas of mental or physical health. Treatment Patients with OCD who receive appropriate treatment commonly experience increased quality of life and improved functioning. Treatment may improve an individual's ability to function at school and work, develop and enjoy relationships, and pursue leisure activities. Cognitive Behavioral Therapy One effective treatment is a type of cognitive-behavioral therapy (CBT) known as exposure and response prevention (ERP). During treatment sessions, patients are exposed to feared situations or images that focus on their obsessions. Although it is standard to start with those that only lead to mild or moderate symptoms, initially the treatment often causes increased anxiety. Patients are instructed to avoid performing their usual compulsive behaviors (known as response prevention). By staying in a feared situation without anything terrible happening, patients learn that their fearful thoughts are just thoughts. People learn that they can cope with their thoughts without relying on ritualistic behaviors, and their anxiety decreases over time. Using evidence-based guidelines, therapists and patients typically collaborate to develop an exposure plan that gradually moves from lower anxiety situations to higher anxiety situations. Exposures are performed both in treatment sessions and at home. Some people with OCD may not agree to participate in CBT because of the initial anxiety it evokes, but it is the most powerful tool available for treating many types of OCD. Medication A class of medications known as selective serotonin reuptake inhibitors (SSRIs), typically used to treat depression, can also be effective in the treatment of OCD. The SSRI dosage used to treat OCD is often higher than that used to treat depression. Patients who do not respond to one SSRI medication sometimes respond to another. The maximum benefit usually takes six to twelve weeks or longer to be fully visible. Patients with mild to moderate OCD symptoms are typically treated with either CBT or medication depending on patient preference, the patient’s cognitive abilities and level of insight, the presence or absence of associated psychiatric conditions, and treatment availability. The best treatment of OCD is a combination of CBT and SSRIs, especially if OCD symptoms are severe. Neurosurgical treatment Some newer studies show that gamma ventral capsulotomy, a surgical procedure, can be very effective for patients who do not respond to typical treatments and are very impaired, but it is underused due to historical prejudice and its invasiveness. Deep brain stimulation, which involves an implanted device in the brain, has data to support efficacy and does not permanently destroy brain tissue as done in a capsulotomy. However, it is still highly invasive and complex to manage, and there are limited providers and hospital systems trained to offer this treatment and, able to provide the long-term support needed by DBS patients. How to Support a Loved One Struggling with OCD In people with OCD who live with family, friends, or caregivers, enlisting their support to help with exposure practice at home is recommended. In fact, the participation of family and friends is a predictor of treatment success. Self-care Maintaining a healthy lifestyle can help in coping with OCD. Getting enough good quality sleep, eating healthy food, exercising, and spending time with others can help with overall mental health. Also, using basic relaxation techniques (when not doing exposure exercises) such as meditation, yoga, visualization, and massage can help ease the stress and anxiety. Source: International OCD foundation