It’s hard not to feel depressed when we’re stuck in depression’s grasp. It’s a vicious cycle: depression feels horrible and causes us to avoid situations, people, and activities; the more we avoid these things that were once positive, though, the deeper into depression we fall; and this downward spiral causes us to feel less and less in control of life (Depression Symptoms: What Are the Symptoms of Depression?).

Take heart. There are ways out of depression's trap. Read on for information on how not to feel depressed.

How Not to Feel Depressed: Think Long-Term

The effects of depression can be downright painful, so it’s natural to concentrate on them in order to get them to go away. Unfortunately, focusing on fixing how you feel right now actually increases rather than decreases depression.

Problems like depression grow when you feed them. Because acting on the short-term goal of symptom alleviation feeds depression, instead, try looking at long-term changes. Think in terms of quality of life—not just getting rid of depression but replacing it with things that you value and bring overall life satisfaction (Coping Skills for Battling Depression: Here’s What You Need).

How not to feel depressed involves envisioning your ideal self living your ideal life. What do you value most? Then, despite the presence of depression, begin to take little steps toward that quality world. Just shifting your focus from short term depression relief to long term life satisfaction helps you not to feel depressed.

How Not to Feel Depressed: Live Intentionally and Mindfully

Living intentionally means to take charge of each day by being fully present in what is happening around you and within you. Depression puts us on autopilot so we find ourselves drifting numbly, keenly feeling depression.

How not to feel depressed and numb involves purposefully connecting with ourselves and the moments of our life. Life is a journey of moments, and it’s imperative to get out of our own head and into every moment.

The process of living intentionally in each moment is known as mindfulness. With mindfulness, we are fully present in our life. To be mindful is to become aware of our thoughts, our sensations, and what we doing in life moment by moment. When we’re present in each moment, we can experience it for what it is rather than through a lens darkened by depression.

Numerous studies have shown that living intentionally and practicing mindfulness significantly decrease depression (Strosahl, 2008). An effective answer to the question of how to feel less depressed is to live intentionally by practicing mindfulness, paying attention to what you are doing in the present moment, every day.

How Not to Feel Depressed: Know That You Have Choices

Depression is a deep, dark hole. Because it’s hard to get out of this hole, we begin to feel stuck, confined against our will with no choices. That, though, is a lie that depression wants us to believe. The truth is that regardless of how depression makes us feel, we do have choices.

When you realize that you have a say in your life, you can begin to make choices and act on them. Practicing mindfulness helps open you up to the individual moments in your life and thus pulls you out of your own head, positioning you to choose actions that will help you move toward your values.

Just a few of the choices you have include:

• Activities to do or not to do
• Who to spend time with
• How much time to spend with a given person
• What to focus on and pay attention to
• How to seek help for depression and what treatments to try
• How to think about things
• How to react to people or events

Knowing you have choices is very empowering. Realizing you can make choices, and then intentionally making choices, is a way out of feeling depressed.

How Not to Feel Depressed: Feel Hope

Hope is real. Having a vision of hope allows you to keep going despite all of the doubts. Hope doesn’t mean not having doubts or times when you feel overwhelmed and discouraged. Hope means hanging in there, being patient, and continuing working toward your values and goals despite problems (Stop Being Depressed. Use These Self-Help Tools Now). Hope won’t make depression magically disappear, but hope is how not to feel depressed.

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Many with depression don't stand up for themselves. Are you having difficulty with being assertive? Here's how to be more assertive, deal with aggressiveness and improve the communication process.

Table of Contents

• Introduction
• Non-Assertiveness
• Assertiveness
• Aggressiveness
• How To Improve the Communication Process
• Evaluate Your Assertions
• Assertive Techniques
• Method of Conflict Resolution
• Every Person's Bill of Rights

Introduction

Difficulty with being assertive has stereotypically been a challenge ascribed to women. However, research on violence and men's roles demonstrated that many physical altercations result from poor communication which then escalates into larger conflicts.

Many men feel powerless in the face of aggressive communication from men or women in their lives; conversely, passivity in some situations can arouse frustration and anger for many men. As such, assertiveness can be an effective tool for men who are seeking to proactively alleviate violence in their lives, as well as a tool for fostering healthier, more satisfying lives.

Sociologists and mental health professionals are finding that assertiveness is usually displayed in certain circumstances. That is, assertiveness is not a personality trait which persists consistently across all situations. Different individuals exhibit varying degrees of assertive behavior depending on whether they are in a work, social, academic, recreational or relationship context. Therefore, a goal for assertiveness training is to maximize the number of context in which an individual is able to communicate assertively.

Non-Assertiveness

A non-assertive person is one who is often taken advantage of, feels helpless, takes on everyone's problems, says yes to inappropriate demands and thoughtless requests, and allows others to choose for him or her. The basic message he/she sends is "I'm not OK."

The non-assertive person is emotionally dishonest, indirect, self-denying, and inhibited. He/she feels hurt, anxious, and possibly angry about his/her actions.

Non-Assertive Body Language:

• Lack of eye contact; looking down or away.
• Swaying and shifting of weight from one foot to the other.
• Whining and hesitancy when speaking.

Assertiveness

An assertive person is one who acts in his/her own best interests, stands up for self, expresses feelings honestly, is in charge of self in interpersonal relations, and chooses for self. The basic message sent from an assertive person is "I'm OK and you're OK."

An assertive person is emotionally honest, direct, self-enhancing, and expressive. He/she feels confident, self-respecting at the time of his/her actions as well as later.

Assertive Body Language:

• Stand straight, steady, and directly face the people to whom you are speaking while maintaining eye contact.
• Speak in a clear, steady voice - loud enough for the people to whom you are speaking to hear you.
• Speak fluently, without hesitation, and with assurance and confidence.

Aggressiveness

An aggressive person is one who wins by using power, hurts others, is intimidating, controls the environment to suit his/her needs, and chooses for others. An aggressive says, "You're not OK."

He/she is inappropriately expressive, emotionally honest, direct, and self-enhancing at the expense of another. An aggressive person feels righteous, superior, deprecatory at the time of action and possibly guilty later.

Aggressive Body Language:

• Leaning forward with glaring eyes.
• Pointing a finger at the person to whom you are speaking.
• Shouting.
• Clenching the fists.
• Putting hands on hips and wagging the head.

Remember: ASSERTIVENESS IS NOT ONLY A MATTER OF WHAT YOU SAY, BUT ALSO A FUNCTION OF HOW YOU SAY IT!

How To Improve the Communication Process

• Active listening: reflecting back (paraphrasing) to the other person both words and feelings expressed by that person.
• Identifying your position: stating your thoughts and feelings about the situation.
• Exploring alternative solution: brainstorming other possibilities; rating the pros and cons; ranking the possible solutions.

Making Simple Requests:

• You have a right to make your wants known to others.
• You deny your own importance when you do not ask for what you want.
• The best way to get exactly what you want is to ask for it directly.
• Indirect ways of asking for what you want may not be understood.
• Your request is more likely to be understood when you use assertive body language.
• Asking for what you want is a skill that can be learned.
• Directly asking for what you want can become a habit with many pleasant rewards.

Refusing requests:

• You have a right to say NO!
• You deny your own importance when you say yes and you really mean no.
• Saying no does not imply that you reject another person; you are simply refusing a request.
• When saying no, it is important to be direct, concise, and to the point.
• If you really mean to say no, do not be swayed by pleading, begging, cajoling, compliments, or other forms of manipulation.
• You may offer reasons for your refusal, but don't get carried away with numerous excuses.
• A simple apology is adequate; excessive apologies can be offensive.
• Demonstrate assertive body language.
• Saying no is a skill that can be learned.
• Saying no and not feeling guilty about it can become a habit that can be very growth enhancing.

Assertive Ways of Saying "No":

• Basic principles to follow in answers: brevity, clarity, firmness, and honesty.
• Begin your answer with the word "NO" so it is not ambiguous.
• Make your answer short and to the point.
• Don't give a long explanation.
• Be honest, direct and firm.
• Don't say, "I'm sorry, but..."

Steps in Learning to Say 'No'

• Ask yourself, "Is the request reasonable?" Hedging, hesitating, feeling cornered, and nervousness or tightness in your body are all clues that you want to say NO or that you need more information before deciding to answer.
• Assert your right to ask for more information and for clarification before you answer.
• Once you understand the request and decide you do not want to do it, say NO firmly and calmly.
• Learn to say NO without saying, "I'm sorry, but..."

Evaluate Your Assertions

• Active listening: reflecting back (paraphrasing) to the other person both words and feelings expressed by that person.
• Identifying your position: stating your thoughts and feelings about the situation.
• Exploring alternative solution: brainstorming other possibilities; rating the pros and cons; ranking the possible solutions.

Assertive Techniques

1. Broken Record - Be persistent and keep saying what you want over and over again without getting angry, irritated, or loud. Stick to your point.
2. Free Information - Learn to listen to the other person and follow-up on free information people offer about themselves. This free information gives you something to talk about.
3. Self-Disclosure - Assertively disclose information about yourself - how you think, feel, and react to the other person's information. This gives the other person information about you.
4. Fogging - An assertive coping skill is dealing with criticism. Do not deny any criticism and do not counter-attack with criticism of your own.

• Agree with the truth - Find a statement in the criticism that is truthful and agree with that statement.
• Agree with the odds - Agree with any possible truth in the critical statement.
• Agree in principle - Agree with the general truth in a logical statement such as, "That makes sense."

• Negative Assertion - Assertively accepting those things that are negative about yourself. Coping with your errors.
• Workable Compromise - When your self-respect is not in question offer a workable compromise.

Method of Conflict Resolution

• Both parties describe the facts of the situation.
• Both parties express their feelings about the situation and show empathy for the other person.
• Both parties specify what behavior change they would like or can live with.
• Consider the consequences. What will happen as a result of the behavior change? Compromise may be necessary, but compromise may not be possible.
• Follow up with counseling if you need further assistance.

Every Person's Bill of Rights

1. The right to be treated with respect.
2. The right to have and express your own feelings and opinions.
3. The right to be listened to and taken seriously.
4. The right to set your own priorities.
5. The right to say NO without feeling guilty.
6. The right to get what you pay for.
7. The right to make mistakes.
8. The right to choose not to assert yourself.

Source: This page compliments of Louisiana State University Student Health Center

People who suffer from posttraumatic stress disorder (PTSD) may also experience PTSD flashback symptoms. Flashback symptoms can be both emotional (psychological) and/or physical. Flashback symptoms tend to be individual and related to a person’s specific trauma experience.

What Are PTSD Flashbacks?

Flashbacks in PTSD are a form of vivid trauma re-experiencing. In other words, to people having a PTSD flashback, it can feel like they are experiencing the trauma all over again.

Because everyone’s trauma is different and everyone’s experience of trauma is different, there is no set list of flashback symptoms that are universally experienced. Nevertheless, flashbacks are very real and can be a huge problem for those who have them.

PTSD flashbacks may seem like watching a movie of what happened or they can be more immersive. If you know someone living with PTSD, you can ask what the PTSD flashback feels like for them.

Emotional flashback symptoms vary. The key to understanding emotional PTSD flashback symptoms is knowing that they are typically the emotions felt during the initial trauma. This could be fear, disgust, confusion, anxiety or rage, among others.

You might find that PTSD flashback symptoms are so immersive they make it hard to connect with reality, with your own body or what is going on in the present. This is known as dissociation. When dissociation symptoms are recurrent or persistent, one is diagnosed with PTSD with the additional specifier of “with dissociative symptoms,” according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Physical PTSD Flashback Symptoms

You can re-experience any sense associated with the trauma. So that means you could feel the cold you felt on your skin or smell the soup that was cooking when the trauma happened. Often only some of the senses you felt during the trauma are relived. For example, a PTSD flashback symptom for one person might be visions of the trauma, while it might be sounds of the trauma for another and for a third it might be all the senses together.

Physical PTSD flashback symptoms can also include the physical reactions to the trauma such as a racing heart or rapid, loud breathing.

Managing PTSD Flashback Symptoms

Current experiences are the common trigger of PTSD flashback symptoms. For example, walking by a specific place or hearing a specific sound may set off a flashback. It is recommended that you begin to identify what triggers your individual flashback symptoms in order to further deal with them or avoid them altogether.

It’s important to know that while PTSD flashback symptoms can be terrifying, you can treat your PTSD and lessen, or even get rid of, the flashbacks.

For more, see Treatment of PTSD Flashbacks: Can Anything Help?

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You want things to help depression, but maybe because of depression you’re thinking nothing will help (Coping Skills for Battling Depression: Here’s What You Need). No matter how bad depression gets, there is hope. Hope exists, and it is real because there are things to help with depression. The below list contains 10 things that have been proven to help depression.

1. Take responsibility for your own wellness. Take charge of yourself and your depression rather than waiting for something or someone to save you. You’re strong; use books, therapy, support groups, and the other items on this list to rise up out of depression.
2. Get active. Regular movement and mild exercise positively affect the brain and your own sense of well-being. Also, gradually begin to do things you used to enjoy, and you’ll find real enjoyment returning.
3. Sleep well. Adequate sleep is crucial in depression recovery. Create a calming nighttime routine that involves avoiding television and other screens will help induce restorative sleep.
4. Eat and drink well. Nutrition plays a key role in depression. Food can increase or decrease neurotransmitters like dopamine, noradrenaline, and serotonin affect moods and impact energy levels.
5. Breathe. Deep breathing releases endorphins and other mood-enhancing biochemicals in the brain. Slow, deep breaths steady the body and mind and impact energy levels.
6. See the light. The brain needs full-spectrum light in order to regulate moods and improve outlook. Every day, spend about half an hour outside or use full-spectrum bulbs or a lightbox inside.
7. Make self-care routine. Self-care, attending to your physical health, mental health, and personal hygiene, is a vital part of depression care; however, depression makes self-care difficult. Make self-care routine by creating and writing down a daily self-care routine.
8. Be touchy. Skin-to-skin contact is a powerful component of human connection, and it reduces the effects of depression. Get a massage or partner with someone for informal massages.
9. Expand your perspective. Depression narrows your attention and makes you focus on the negative. Shift your perspective and your interpretation of the people and events in your life; open yourself up to the possibility of different ways of thinking and feeling.
10. Visualize your depression free self. The power of visualization is real. Create an image of yourself living without depression, and think about it often throughout each day to provide a steady stream of inspiration and motivation.

Give these 10 things to help with depression a try. They’re all effective components of a plan to overcome depression.

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Depression, low self-esteem keep some from taking AIDS medication

Thirty-nine-year-old Rick Otterbein owes his life to the ever-changing regimen of drugs he has taken in the 17 years since he learned he was HIV-positive. He watched a lover and several close friends die of AIDS, and is grateful to be alive. But he has also struggled with treatment and, at times, has even abandoned his HIV medications because taking them was just too difficult.

"At one point I was taking 24 pills a day, and I just couldn't do it," he says. "Psychologically, taking so many pills was making me sicker than I already was. It was a constant reminder that I had this illness that could kill me. You can't forget because your life revolves around taking medication."

More than 800,000 people in the United States are living with HIV, and many of them are on the new therapies that have transformed AIDS from a sure killer to a disease that can be managed. But there is growing evidence that adherence to these AIDS treatments is often compromised by treatment-related depression and other psychological issues.

In an effort to identify predictors of psychological well-being among HIV patients taking highly active antiretroviral therapy (HAART), researcher Steven Safren, PhD, and colleagues at Massachusetts General Hospital surveyed 84 such patients participating in a 12-week study of treatment adherence. Their findings are reported in the latest issue of the journal Psychosomatics.

The researchers first assessed levels of depression, quality of life, and self-esteem, using standardized questionnaires. They then asked the patients to complete surveys assessing particular life events, perceived social support and coping styles.

Patients with adequate social support and good coping skills were least likely to report depression, poor quality of life, and low self-esteem. But patients who perceived their HIV status as punishment were more likely to report low self-esteem and depression.

According to Safren, the idea that HIV is a punishment is a common clinical response that is independently predictive of depression. Although the study did not specifically look at treatment adherence, he said other studies have shown that poor adherence is associated with depression and low self-esteem.

"There are several types of issues related to well-being in people living with HIV who are on these medications," says Safren. "Many people struggle with negative beliefs about their own infection and their medication."

Like Otterbein, many patients on HAART also struggle with the life-altering restrictions and side effects of treatment. Adherence needs to be in the range of 95% for a patient to have the best chance of suppressing HIV. That means failure to take medications just once a week can compromise therapy.

"You feel like you can't do anything or go anywhere because you have to plan your life around taking pills," says Otterbein, who now works with an AIDS task force in his home state of Michigan. "I hear from people all the time who are depressed because their treatment keeps them from doing what they want to do or there are too many side effects."

Otterbein now takes just two pills a day, but he says most patients still take far more. He is frustrated by the perception that living with AIDS is now little different from living with chronic diseases like diabetes.

"This is not an easy life," he says. "There is no forgetting that you have this disease."

“Education is a process that must accompany you on this journey.” (Copeland, 2001).

Books about depression can be an important part of depression self-care. The process of reading books and other material about depression (or other mental health disorders) in order to learn and grow is called bibliotherapy. Bibliotherapy allows us to arm ourselves with knowledge rather than relying exclusively on others to feed it to us. Books on depression can be very useful self-help tools.

There are numerous approaches to overcoming depression. Some attend primarily to people’s thoughts. Others emphasize changes in behavior. Approaches can also focus on emotions or one’s background. Still others stress outlook and perspective. Each person is unique, and each person’s experience with depression is also unique; therefore, treating depression without medication isn’t a one-size-fits-all approach. The more you know about depression and the myriad ways of treating it, the better equipped you’ll be to beat it. That’s where books about depression come in handy.

Many good self-help and depression books exist (Self-Help for Depression: What Helps?). The following five books on depression were selected for inclusion in this article because they offer sound, research-based information about depression itself as well as treatment approaches that are practical and whose effectiveness is supported by research.

5 Best Books About Depression You Need to Read

1. The Depression Workbook by Mary Ellen Copeland. In this self-help book, Copeland presents a wealth of depression information in a very readable fashion. Depression can make concentration-heavy tasks like reading a chore. Copeland’s book with its user-friendly writing style and organization makes learning about depression easier. Further, this book is interactive, filled with activities to help you make the information personal.
2. The Happiness Trap by Russ Harris. This book offers a frank and supportive conversation about what contributes to depression: society’s happiness trap. Harris emphasizes how by starting from where we are, we can create and live a valued life. The principles of the acclaimed acceptance-and-commitment therapy (ACT) are clearly explained, and readers are taught techniques for how to apply the principles of ACT and live a quality life.
3. The Feeling Good Handbook by David Burns. This is a classic self-help book, designed to help readers overcome things like depression and anxiety. Burns explains cognitive-behavioral therapy (CBT) and includes numerous opportunities for readers to interact with the information to help change their faulty thought patterns. This book, while very long and thus to be read over time, provides very helpful information about overcoming depression by changing our thoughts.
4. A Primer in Positive Psychology by Christopher Peterson. While not exclusively a depression book, Peterson does address depression. This book reads a bit like a textbook; therefore, it is one that is best read when someone is beyond the throes of depression but is still working toward mental health and well-being. The focus here is on how to create a meaningful, quality, life worth living.
5. Breaking Free from Depression by Jesse Wright and Laura McCray. This highly interactive book about depression is a great addition to a personal library of depression books. The workbook format helps the reader apply all of the presented information about depression to make the book personally helpful.

These five books about depression are different from each other but have one very important thing in common: they provide great bibliotherapy for people taking charge of depression.

See Also:

• Depression Books that Help Others Understand Your Depression 

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People who suffer from posttraumatic stress disorder (PTSD) quite understandably want to know why PTSD flashbacks happen. This is because PTSD flashback symptoms can create a completely immersive experience wherein it feels like you’re living through the trauma that caused the PTSD. These flashbacks can be very frightening.

As to what causes a PTSD flashbacks, read on.

What Is a Traumatic Event that May Cause PTSD Flashbacks?

Most people will experience trauma at some point in their lives. Approximately 50% of women and 60% of men experience trauma. However, the vast majority of these people will not develop PTSD. Posttraumatic stress disorder has a lifetime prevalence of 8% (higher in women than in men).

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the causation of PTSD includes trauma that is caused when:

“The victim was exposed to actual or threatened death, serious injury or sexual violence in one of four ways:

• Directly experiencing the traumatic event(s)
• Witnessing, in person, the event(s) as it occurred to others
• Learning that the traumatic event(s) occurred to a close family member or friend
• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s); this does not apply to exposure through media such as television, movies, or pictures”

Note that in order to be considered PTSD, the flashback must not be caused by the physiological events of substance use or other medical condition.

People can experience repeated traumas and be at greater risk for more severe PTSD symptoms. Long-term, severe abuse or multiple traumas can cause an illness known as complex PTSD (C-PTSD), also known as disorder of extreme stress not otherwise specified (DESNOS).

Triggers that Cause PTSD Flashbacks

Once a person has PTSD, flashbacks can happen. Flashbacks are a type of re-experiencing of the trauma. When a flashback happens, it is typically triggered by some kind of experience. While, initially, it may seem like flashbacks are random, once you start to look more closely at them, you can start to see that they are, in fact, triggered by something.

The cause of a PTSD flashback can be a trigger from any of the senses. Even a smell or sound can cause a flashback. Examples of triggers that could cause flashbacks for someone with PTSD include:

• If traumatized by a car accident, traffic or being in a car may be triggering.
• If traumatized by a burglary, the sound of breaking glass may be triggering.
• If traumatized by combat, a loud noise (such as a car backfire) may be triggering.
• It traumatized by an assault, the smell of the cologne of the perpetrator may be triggering.
• If traumatized by a tornado, seeing a news report with a tornado prediction may be triggering.

In other words, the triggers that can cause a PTSD flashback can be anything that the person finds relevant to the trauma he or she experienced.

Identifying Triggers that Cause PTSD Flashbacks

It’s important to become aware of your PTSD triggers in order to start preventing future PTSD flashbacks. Once you know what they are, you can learn how to deal with them or avoid them.

For more on preventing PTSD flashbacks, see here: How to Stop PTSD Flashbacks?

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Neuroleptics or antipsychotics are prescribed for bipolar disorder and schizophrenia. They are used to treat a variety of psychiatric problems, such as preoccupation with troublesome and recurring thoughts, overactivity, and unpleasant and unusual experiences such as hearing and seeing things not normally seen or heard.

Some of the benefits of these antipsychotics may occur in the first few days, but it is not unusual for it to take several weeks or months to see the full benefits. In contrast, many of the side effects are worse when you first start taking it.

Antipsychotics, Prolactin and Sexual Side Effects

Antipsychotics can cause a raising of the body's level of a hormone called prolactin. In women, this can lead to an increase in breast size and irregular periods. In men, it can lead to impotence and the development of breasts. Most of the typical antipsychotic drugs, risperidone (Risperidal) and amisulpride have the worst effect.

The best-known function of prolactin is the stimulation and maintenance of lactation, but it has also been found to be involved in over 300 separate functions including involvement in water and electrolyte balance, growth and development, endocrinology and metabolism, brain and behavior, reproduction and immunoregulation.

In humans, prolactin is also thought to play a role in the regulation of sexual activity and behavior. It has been observed that orgasms cause a large and sustained (60 min) increase in plasma prolactin in both men and women, which is associated with decreased sexual arousal and function. Furthermore, increased prolactin is thought to promote behaviors that encourage long-term partnership.

Studies of patients who are treatment-naive or who have been withdrawn from treatment for a period of time indicate that schizophrenia per se does not affect prolactin concentrations.

Sexual Problems Among Worst Side Effects

Patients with Schizophrenia and Bipolar Disorder consider sexual dysfunction to be among the most important side effects. Sexual dysfunction includes low sexual desire, difficulty maintaining an erection (for men), difficulty achieving orgasm.

(If you have any of these symptoms and they are causing you concern, contact your doctor. He/she may be able to reduce your dose or change your medication.)

These adverse antipsychotic sexual side effects can have a serious negative impact on the patient in terms of causing distress, impairing quality of life, contributing to stigma, and on acceptance of treatment. In fact, many discontinue treatment because of the sexual side effects.

Effects of Antipsychotics on Prolactin and Sexual Health

The effects of conventional antipsychotics on prolactin are well known. Over 25 years ago, the sustained elevation of serum prolactin to pathological levels by conventional antipsychotics was demonstrated by Meltzer and Fang. The most important factor regulating prolactin is the inhibitory control exerted by dopamine. Any agent that blocks dopamine receptors in a non-selective manner can cause elevation of serum prolactin. Most studies have shown that conventional antipsychotics are associated with a two-to ten-fold increase in prolactin levels.

Prolactin is a hormone in the blood that helps to produce milk and is involved in breast development. However, increased prolactin can lead to a decrease in libido when it is not needed.

The increase in prolactin that occurs through the use of conventional antipsychotics develops over the first week of treatment and remains elevated throughout the period of use. Once treatment stops, prolactin levels return to normal within 2-3 weeks.

In general, second-generation atypical antipsychotics produce lower increases in prolactin than conventional agents. Some agents, including olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon) and clozapine (Clozaril) have been shown to produce no significant or sustained increase in prolactin in adult patients. However, in adolescents (age 9-19 years) treated for childhood-onset schizophrenia or psychotic disorder, it has been shown that after 6 weeks of olanzapine treatment prolactin levels were increased beyond the upper limit of the normal range in 70% of patients.

Second-generation antipsychotics that have been associated with increases in prolactin levels are amisulpride, zotepine and risperidone (Risperidal).

The most common clinical effects of hyperprolactinemia (high prolactin levels) are:

In Women:

• anovulation
• infertility
• amenorrhoea (loss of period)
• decreased libido
• gynaecomastia (swollen breasts)
• galactorrhoea (abnormal breast milk production)

In Men:

• decreased libido
• erectile or ejaculatory dysfunction
• azoospermia (no sperm are present in the ejaculate)
• gynaecomastia (swollen breasts)
• galactorrhoea (occasionally) (abnormal breast milk production)

Less frequently, hirsutism (excessive hairiness) in women, and weight gain have been reported.

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Antipsychotics and Sexual Dysfunction Sometimes Tough to Link

Sexual function is a complex area that includes emotions, perception, self-esteem, complex behavior and the ability to initiate and complete sexual activity. Important aspects are the maintenance of sexual interest, the ability to achieve arousal, the ability to achieve orgasm and ejaculation, the ability to maintain a satisfying intimate relationship, and self-esteem. The impact of antipsychotics on sexual functioning is difficult to evaluate, and sexual behavior in schizophrenia is an area in which research is lacking. Data from short-term clinical trials may greatly underestimate the extent of endocrine adverse events.

One thing we do know is that drug-free patients with schizophrenia have lower sexual libido, decreased frequency of sexual thoughts, a decreased frequency of sexual intercourse and higher requirements for masturbation. Sexual activity was also found to be reduced in patients with schizophrenia compared with the general population; 27% of schizophrenia patients reported no voluntary sexual activity and 70% reported having no partner. While untreated schizophrenia patients exhibit decreased sexual desire, neuroleptic treatment is associated with restoration of sexual desire, yet it entails erectile, orgasmic and sexual satisfaction problems.

Atypical antipsychotics are also known to contribute to the development of hyperprolactinaemia. Data for Zyprexa (olanzapine), Seroquel (quetiapine) and Risperdal (risperidone) are published in the Physician's Desk Reference (PDR); a useful reference source since it reports incidence rates for most adverse effects, including EPS, weight gain, and somnolence. The PDR states that "olanzapine elevates prolactin levels, and a modest elevation persists during chronic administration." The following adverse effects are listed as "frequent": decreased libido, amenorrhoea, metrorrhagia (uterine bleeding at irregular intervals), vaginitis. For Seroquel (quetiapine), the PDR states, "an elevation of prolactin levels was not demonstrated in clinical trials", and no adverse effects relating to sexual dysfunction are listed as "frequent". The PDR states that "Risperdal (risperidone) elevates prolactin levels and the elevation persists during chronic administration." The following adverse effects are listed as "frequent": diminished sexual desire, menorrhagia, orgastic dysfunction, and dry vagina.

Management of Hyperprolactinaemia

Before initiating antipsychotic treatment, a careful examination of the patient is necessary. In routine situations, clinicians should examine patients for evidence of sexual adverse events, including menorrhagia, amenorrhoea, galactorrhoea and erectile/ejaculatory dysfunction. If evidence of any such effects are found, then the patient's prolactin level should be measured. This is an important prerequisite to differentiate between adverse effects due to the current medication, those remaining from the previous medication or symptoms of the illness. Furthermore, such checks should be repeated at regular intervals.

The current recommendation is that a rise in prolactin concentrations should not be of concern unless complications develop, and until such time no change in treatment is required. Increased prolactin may be due to the formation of macroprolactin, which does not have serious consequences for the patient. If there are doubts that hyperprolactinemia is related to antipsychotic treatment, other possible causes of the hyperprolactinemia have to be excluded; these include pregnancy, nursing, stress, tumors and other drug therapies.

When treating antipsychotic-induced hyperprolactinemia, decisions should be made on an individual basis after a full and frank discussion with the patient. These discussions should include consideration of the benefits of antipsychotic therapy, as well as the potential impact of any adverse effects. The importance of discussing symptom impact is highlighted by data showing that only a minority of patients discontinue their antipsychotic medication because of breast tenderness, galactorrhoea or menstrual irregularities. However, sexual side-effects are thought to be one of the most important causes of non-compliance. Therefore, the decision whether the current treatment with a prolactin-increasing antipsychotic should be continued or switched to an antipsychotic drug not characteristically associated with increases in prolactin levels has to be made on the basis of the patient's risk-benefit estimation.

Adjunctive therapies have also been tested to reduce the symptoms of hyperprolactinemia, but these are associated with their own risks. Estrogen replacement can prevent the effects of estrogen deficiency but it carries the risk of thromboembolism. Dopamine agonists such as carmoxirole, cabergoline and bromocriptine have been suggested for the management of hyperprolactinemia in patients receiving antipsychotics, but these are associated with side-effects and may worsen psychosis.

Source: Hyperprolactinaemia and Antipsychotic Therapy in Schizophrenia, Martina Hummer and Johannes Huber. Curr Med Res Opin 20(2):189-197, 2004.

People who have posttraumatic stress disorder (PTSD) may experience flashbacks. Posttraumatic stress disorder flashbacks are a way of re-experiencing the trauma that caused the PTSD. Flashbacks look different for different people. Flashbacks in PTSD are related to other re-experiencing types like nightmares and intrusive thoughts about the traumatic event.

Definition of a PTSD Flashback

According to Dictionary.com, in psychiatry, a PTSD flashback would be defined as:

recurrent and abnormally vivid recollection of a traumatic experience, as a battle, sometimes accompanied by hallucinations.

PTSD Flashback Description

When people experience PTSD flashbacks, they typically feel they are living through the trauma again in the present moment. The feelings the person had during the traumatic event can occur again during a flashback. Flashbacks can feel so real that it may seem like the perpetrator is actually, physically in the room. Because flashbacks are so vivid, it can be difficult for sufferers to connect with what is really happening around them. Because flashbacks are so immersive, they are often considered a type of dissociation.

What Is a Traumatic Event?

Traumatic events are defined as events wherein the person is exposed to actual or threatened death, serious injury or sexual violence. People may experience traumatic events personally, they may witness them in person, they may find out about a traumatic event that occurs to a loved one or they may be exposed repeatedly or extremely to the details of a traumatic event (this does not apply to exposure through television, movies, etc.).

Examples of Traumatic Events

Traumatic events can include:

• Sexual assault
• Physical assault
• Living through a natural disaster
• Combat-related experiences

While people often think of a PTSD flashback as involving memories of combat, really, a PTSD flashback can be of any traumatic event that caused the PTSD.

The important thing is not the specific trauma but, rather, how the person experienced that trauma. The traumas themselves are innumerable.

How Long Do PTSD Flashbacks Last?

When considering how long flashbacks last, a small survey of those with PTSD indicates that flashbacks last:

• A few minutes – 61.5%
• A few hours – 40.4%
• A day or more – 28.9%

(In the above, multiple votes were allowed for those that experience flashbacks of different durations.)

Handling PTSD Flashbacks

While PTSD flashbacks can make the trauma feel current and be very frightening, there are ways to prevent PTSD flashbacks or deal with flashbacks when they occur.

For example, for help preventing flashbacks, start to learn your own flashback warning signs. Each person is different, but, typically, there are physical and/or mental signs before a flashback occurs. You also need to identify what triggers a flashback so you can learn to avoid those triggers or plan ahead of time what to do if those triggers occur.

There’s more information on treating PTSD flashbacks here.

If you’re experiencing PTSD flashbacks, make sure you work with a healthcare professional such as a psychologist or psychiatrist for help. Posttraumatic stress disorder flashbacks can be conquered.

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Prozac (Fluoxetine) and its pharmaceutical peers -- officially known as selective serotonin reuptake inhibitors, or SSRIs -- have been gaining a reputation for inhibiting sexual desire. So, in 1998, when Lisa Piazza, M.D., of Cornell University Medical College, placed a group of 25 depressed people on SSRls, the surprise was not that the sexual functioning of the men got significantly worse -- but that of the women significantly improved.

After six weeks of treatment, Piazza found that sexual desire, psychological arousal, and overall sexual functioning improved for the women, while ease of orgasm, satisfaction from orgasm, and deteriorated for the men.

Side effects from SSRI treatment may simply be less common in women, says Piazza. She also points out that the women had greater sexual impairment compared to the men at the beginning of the study, as a result of their chronic depression. Their low starting point left ample room for improvement.