Thursday, December 23, 2010

A Year of Healthy Living

As this may be my last post for a while, I thought I would make it a big one. What follows is a list of ways to change thoughts, behaviours, and attitudes. It also nicely coincides with the new year.

Suggestions and explanations:

• The idea behind this list is to provide a variety of ways of changing your state of being in simple ways. Some things are specific, while some are more general and open to interpretation and contemplation. Even though you may already do many of this things, it is also beneficial to do them on purpose and with awareness.
• Print out the list and choose an activity at random each day, being fully committed to completing it. If the activity is weather or seasonally dependent, complete it at the earliest opportunity.
• There are two big things on this list. The first is yoga, which I included because of it’s many benefits. A good yoga instructor can be a great therapist providing positive comments as while as guiding you through relaxation, meditation, and exercise. If you aren’t comfortable going to a gym, get yourself a dvd or find tutorials online. If you don’t have a lot of money, many studios offer karma classes where you can pay by donation and Lululemon offers free classes at their stores. Don’t be concerned about your fitness level; I’ve gone to yoga classes where all I’ve been able to do is sit through half of it. The other big thing is to create a new, healthy habit which takes a bit of time.
• Whenever your senses are involved in an activity, be especially mindful about what you are feeling.
• Whenever repetitions or time suggestions are given, feel free to do more.
• You may want to keep a journal to record how you responded to each activity. Notice the things you find helpful and try to do them more often.
• Some things on this list may seem silly and trite, but not only does doing something outside your comfort zone and regular behaviour help change emotions, it can also give you an excuse to have fun. It’s ok, nobody’s watching.
• If you like, print the list onto pretty paper and put the items in a decorated jar.

1. Say something nice about someone you don’t like (bonus if you say it to them).
2. Give up your seat on the bus or let someone in if you drive.
3. Pay attention to objects in your favourite colour.
4. Do one thing that you’ve been putting off.
5. Call someone just to say ‘hi.’
6. Say something nice about yourself (even if you don’t think you believe it).
7. Give change/food to a homeless person (and say ‘hello’ to them).
8. Back up your important data.
9. Make a playlist of music that makes you happy.
10. Eat something delicious.
11. Watch a funny video on you-tube.
12. Tell someone who is important to you that they are important.
13. Create something (art, craft, food…).
14. Wear your favourite outfit (even if the weather is bad and even if you’re not going out).
15. Pet an animal.
16. Find or make a card and mail it to yourself.
17. Find or make a card and mail it to someone else.
18. Look at the stars.
19. Look at the moon.
20. Eat something green.
21. Eat a vegetable.
22. Start reading a book (bonus if you finish it).

23. Don’t assume the worst.
24. Smile often. Remember to create a half-smile as often as possible.
25. For 1min, examine an object nearby in detail.
26. Smell a flower.
27. Feed some birds.
28. Put up a new picture on your fridge or wall.
29. Eat some nuts.
30. Look at art (online is ok).
31. Wear nice underwear.
32. Read a comic.
33. Watch something funny.
34. Throw a rock.
35. Wear something in your favourite colour.
36. Light a candle.
37. Tell someone a joke.
38. Give a stranger a compliment.
39. Eat blueberries.
40. Sit in your favourite spot for 5 min.
41. Walk barefoot over 3 different surfaces (and compare how they feel).
42. Learn a new word.
43. Wash the dishes.
44. Play with bubbles (the bubbles in your dishes sink count).
45. Water or plant a plant.
46. Warm a towel before bathing so it is warm when you dry yourself.
47. Go for a 10min walk (take notice of your surroundings).
48. See how many different leaves you can find.
49. Take photos of at least 5 things that catch your eye.
50. Make a list of all the species (try to get to 100) in your backyard.
51. Write a positive message on a piece of paper and leave it somewhere public for someone else to find.
52. Sing.
53. Laugh often.
54. Notice people’s umbrellas (or bags, jewellery…).
55. Notice the different types of dogs/cats you see.
56. Be grateful.
57. Plan a meal (and make it).
58. Plan an activity for this week (and do it).
59. Stretch often.
60. For 1min, pay attention to your breath without changing it. Notice how deep the breath is, whether you breathe into your stomach or chest, the rate of your breaths…
61. Eat something red.
62. Buy a flower for your house.
63. Give yourself a foot massage.
64. Dance.
65. Do as many sit-ups as you can.
66. Do as many push-ups as you can.
67. Do as many jumping-jacks as you can.
68. Do your hair differently.
69. Give someone on the internet a positive comment on their blog/video.
70. Watch a cute animal video.

71. Next time you buy groceries, buy something you wouldn’t normally get.
72. Draw a picture (and maybe give it to someone).
73. Look at old photographs.
74. For 1min, work on slowing down the rate of your breath.
75. Take a deep breath and sigh out loud.
76. Rub your palms together quickly until they are warm and then gently massage your eye sockets (with your eyes closed) with the heels of your hands.
77. Clear your plans for 1 day and then fill the day with improvised activities.
78. Every time you have a negative thought, also think of something positive (even something as simple as ‘kittens are cute’).
79. Every time you think something negative about another person, also find something positive to say about them.
80. Dedicate all of your positive experiences to a person who might need some extra help/energy.
81. Say something nice about your body.
82. Practice simplicity. Cut out superfluous activities doing only what is necessary.
83. Choose an activity from an art therapy website (and do it).
84. Write down all the positive events/feelings that occurred during the day (find at least three).
85. Notice moments of quiet.
86. Whenever you feel overwhelmed, stop what you are doing and take 3 deep breaths.
87. Order free samples of stuff from the internet (
88. Find 3 scents you enjoy.
89. Write (anything you want).
90. Change your physical state (posture, facial expression…)
91. Don’t panic.
92. Spend 1 day away from the internet.
93. Look at pictures of space.
94. Learn something new.
95. Think of 5 people you have enjoyed spending time with.
96. Make plans to spend time with someone (and do it).
97. Get up to watch the sunrise (you can go back to bed afterwards).
98. Keep the beat to a song (snap your fingers, tap your foot…).
99. Jump up and down a few times.
100. Stick your tongue out.
101. Do yoga.
102. Throughout the day, check your body for areas of tension and then relax them.
103. Trust in something.
104. Eat something yellow.
105. Touch a tree.
106. Notice how your body temperature changes throughout the day and how the temperature varies in different areas of your body.
107. Eat a healthy breakfast.
108. Eat a healthy dinner.
109. Draw/write something with your opposite hand.
110. When bathing, notice what it feels like to be wet.
111. Take a chance.
112. Hug something, someone, or yourself.
113. Touch 5 different things.
114. Look up volunteer opportunities (bonus if you start volunteering).
115. Avoid drama.
116. De-clutter your home or office.
117. Forgive (yourself and others).
118. Drink a hot beverage.
119. Smile at strangers.
120. Skip.
121. Make a paper airplane or origami.
122. Be brave.
123. Participate (in conversations, the work you are doing, in your community…).
124. Whistle.
125. Learn to say ‘hello’ in 5 languages.
126. Watch the sunset.
127. See something good in every person you encounter.
128. Be patient.
129. Have 1 day without any tv.
130. Take the stairs instead of the elevator/escalator.
131. Make your bed.
132. Read a children’s book.
133. Be curious.
134. Google your name to see who else is out there.
135. Look at the clouds.
136. Take vitamins (vitamin B and omega-3 are especially good for depression).
137. Listen to the birds.
138. Do something difficult.
139. Floss.
140. Daydream.
141. Take a different route to work.
142. Take a bath with low or no lights.
143. Go through your closet and donate what you don’t need anymore.
144. Set a nice table for dinner (even if you’re only eating KD).
145. Say ‘I love you’ to someone (or yourself).
146. Remember a moment of joy and bring that feeling into whatever you do.
147. Look out the window.
148. Clean out your junk drawer.
149. Do 10min of exercise.
150. Clean your fridge.
151. Change the desktop background on your computer/phone.
152. Do a puzzle or solve a riddle.
153. Play a game.
154. Pretend your coffee/water is a magic potion and choose a superpower and pretend you have it for the rest of the day.
155. See how long you can hold your breath.
156. Make a list of the bigger goals you want to accomplish (a set an intention to complete them).
157. Write a poem/haiku.
158. Start a piggy-bank or savings account.
159. Clean out your inbox.
160. Pick a person and make a list of all the things you like about them (and give it to them).
161. Search for an interesting rock to keep.
162. Write a note by cutting words out of a magazine.
163. Memorise a poem.
164. Try not to think about dancing unicorns.
165. Send a thank-you note to someone.
166. Try to catch food in your mouth by tossing it in the air.
167. Follow a bug for 5min to see what it does.
168. Paint with your fingers/toes.
169. Find free activities to do in your city.
170. Grow an herb.

171. Explore lolcats.
172. Make yourself a survival kit. Include things that make you feel better: a soft, scented scarf, an old letter from a friend, a picture that always makes you smile...Bring out your kit when you're feeling down.
173. Pick a letter of the alphabet and notice things that begin with that letter.
174. Build a fort.
175. Be the person you want to be.
176. Give advice to yourself in the past.
177. Notice people who are holding hands.
178. Take an old book and leave it somewhere for someone to find (maybe leave your email in it to see if anyone contacts you).
179. Send a postcard to a stranger and get one back (
180. Go to bed on time.
181. Indulge in a guilty pleasure (as long as it doesn’t harm anyone).
182. Share a one sentence story at
183. Drop a dollar on the ground and see if it’s returned or just leave it for someone to find.
184. Make an animal sound.
185. Sit in 5 different positions.
186. Hold an ice cube in your hand.
187. Balance something on your nose/head.
188. Sit in a different chair/area than you usually do.
189. List as many words beginning with D as you can in 3 min.
190. Listen to music while lying on the floor in the dark.
191. Plan a holiday (even if you can’t go).
192. Think about the best sex you’ve had.
193. Look up your name at
194. Drink everything through a straw.
195. Bring cookies (or something) to work.
196. Lie in the sun.
197. Change your ring tone.
198. Believe that everything is always getting better.
199. Be accepting.
200. Really taste your food.
201. Drink your coffee or tea without sugar if you normally have sugar, or with sugar if you normally drink it without.
202. Notice 5 things you can see.
203. Notice 5 things you can hear.
204. Notice 5 things you can smell.
205. Notice 5 things you can feel.
206. Count to 10 without being interrupted by other thoughts. When you are interrupted, start the count over.
207. Measure your breath by counting how many footsteps you take per breath.
208. Notice how your arms swing when you’re walking.
209. Make a list of your favourite movies.
210. Try not to say the word ‘is.’
211. Ask someone to recommend a book (and read it).
212. Ask someone to recommend a movie (and watch it).
213. Wear nice jewellery.
214. Don’t complain.
215. Appreciate what you have.
216. Choose happiness.
217. Try to feel your heart beating in your chest.
218. Don’t procrastinate.
219. Avoid alcohol/drugs.
220. Walk backwards.
221. Blink your eyes rapidly and the close them and watch the lights.
222. Jump on the bed/couch.
223. See how many times you can use the word ‘definitely.’
224. Think about your favourite building (and visit it).
225. Do a cartwheel, headstand, or handstand.
226. Create a Venn diagram.
227. Go for a bike ride.
228. Spin in circles and then try to walk straight.
229. Let go.
230. Ask why.
231. Shake your head back and forth quickly.
232. Blubber your lips like a horse.

233. Find beauty in ordinary things.
234. Clean out your purse/wallet.
235. Eat something crunchy.
236. Eat something soft.
237. Take something out of storage.
238. Leave work at work.
239. Keep your favourite xmas ornament out all year.
240. Notice people’s xmas trees through their living room windows.
241. Brush your teeth with the opposite hand.
242. Give up a bad habit.
243. Think about all the compliments you’ve been given and believe them.
244. Put your feelings into words and recognise them as something separate from your identity.
245. Do the opposite of what you want to do when you’re feeling unwell.
246. Leave a cheerful message on someone’s voicemail (or your own).
247. Clean your floors.
248. Clean your toilet.
249. Decide, right now, to be happy.
250. Make birthday cards and plan to mail them.
251. Clean unused files and programs from your computer.
252. Hold the door open for someone.
253. Dust.
254. Sign up to get free stuff on your birthday (register Starbuck’s card, Vera’s Burger Shack, PaJo’s Fish & Chips, Marble Slab, Sephora, Orange Julius…).
255. Eat something yellow.
256. Let someone go in front of you in a line.
257. Put change in an expired meter.
258. Tip generously.
259. Make a donation to a charity (even just $1).
260. Make a kind wish for someone.
261. Give money to a street musician.
262. Pick up trash in your neighbourhood.
263. Fix something that is broken or needs mending.
264. Leave change in a vending machine.
265. Ask someone to recommend a recipe.
266. Offer to make or buy someone coffee (this can be the stranger behind you in line).
267. Look people in the eye.
268. Listen sincerely to people (maybe ask someone to tell you a story).
269. Share your umbrella with a stranger.
270. Have flowers delivered to a friend (or yourself).
271. Buy yourself a treat.
272. Put up a funny `lost` poster and see who responds.
273. Offer to do a someone a favour.
274. Embrace your mistakes.
275. Clean your bedroom.
276. Eat a healthy snack.
277. Measure your carbon footprint (and make plans to reduce it).
278. Be especially good to your body.
279. Choose to be an affirming person.
280. Give the benefit of the doubt.
281. Make kindness a priority.
282. Ask someone to recommend some music you`ve never heard.
283. Try to create no waste.
284. Give yourself a hand massage.
285. Eat (a small piece) of dark chocolate.
286. Stand and sit tall.
287. Bounce a ball.
288. Feel the rain on your face/skin.
289. Look up a famous philosopher and get a quote.
290. Do some math (long division or whatever your level is).
291. View problems as challenges to be overcome.
292. Listen to a podcast.
293. Masturbate or have sex.
294. Take a nap.
295. Learn binary.
296. Learn a card trick (and show it to someone).
297. Write a letter to your future children/grandchildren.
298. Read the newspaper (the whole thing).
299. Play on a swing.
300. Remember a time when you felt accomplished.
301. Contemplate which era you would visit if you had a time machine.
302. At the end of your work day, write down 3 positive work related things.
303. Write a letter to your future self.
304. Give yourself a head massage.
305. Know you’re loved.
306. Lie down and relax for 5min.
307. Clean your bathroom.
308. Think before you speak.
309. Eat a fruit.
310. Eat a vegetable.
311. Put clean sheets on your bed.
312. Go on an adventure (visit a new neighbourhood, shop at a different grocery store…).
313. Feel the wind.
314. Laugh at something that isn’t funny.
315. Look at nature photos.
316. Clean behind the fridge/stove.
317. Touch your toes (you can bend your knees if needed).
318. Do as many squats/lunges as you can.
319. Scrunch up your face.
320. Stand without moving for 1min.
321. Do alternate nostril breathing (close your left nostril with your forefinger and breathe in through your right. Then, close your right nostril with your thumb and breathe out through your left. Inhale through your left, close the left nostril and release the right, and breathe out through the right. Repeat a few times.).
322. Inhale in 1 breath and exhale in 3 separate breaths.
323. Hum.
324. Breathe in and out rapidly through your nose (aim for 3 breaths/sec).
325. Breathe in as much as you can and fully exhale to get all the air out (it helps if you pull in your stomach at the end of your exhale).
326. Give yourself a shoulder massage.
327. Find reasons to agree.
328. Find reasons to love yourself and your life.
329. Spend an extra second with every thing you do.
330. Allow yourself to not like something that isn’t healthy for you.
331. Get rid of 1 thing.
332. Create a new habit by doing something everyday (this can take 15 -60 days).
333. Be disciplined.
334. Recall the most severe weather you have experienced.
335. Don’t worry.
336. Make a list of new things you learned this week.
337. Set 3 goals for the day and do them.
338. Think of something you have to look forward to.
339. Tell yourself, ‘I’m awesome,’ frequently (even if/especially you make a mistake).
340. Learn to stop. Set a time limit for a task (choose a time that is shorter than the task would require to be completed) and let yourself stop. You can finish your task at a later time.
341. Scream.
342. Instead of thinking ‘what if’ think ‘next time.’
343. Let go of negative relationships.
344. Read out loud.
345. Shake someone’s hand.
346. Balance on one leg and then the other (if you want to make this more difficult, you can try lifting one leg into the air and closing your eyes).
347. Do something silly.
348. Recognise the work you’ve done, the progress you’ve made and celebrate your successes.
349. Don’t make excuses.
350. Be courteous.
351. Focus your imagination and efforts on becoming a positive person.
352. Don’t curse.
353. Create a visualisation of a happy place (if you already have one, go there).
354. Choose 11 activities to add to this list.

Friday, December 3, 2010

Gifts for Someone Who is Depressed

Another re-post from last year.

This could be for the holidays or a special occasion or just because. The best gift is your support, but presents are nice too. The following list is compiled from ideas I found on the interweb and my own ideas. There are of course many wonderful gifts you could give to any person, but I tried to make this more specific for depressed people by choosing gifts that are not only presents, but will enhance their life in a healthy and positive way.

* Ask them to do something healthy for you -bake a cake, make a cd, play a song if they play an instrument. Some people might be more willing to engage in activity if they’re not concerned about the cost/benefit to themselves. Eventually, an individual has to choose to things by and for themselves, but a little help getting started can go a long way.

* Make them some homemade food. Self-care can be difficult when depressed and appetite particularly can fluctuate. Having nutritious, wholesome, and comforting food at hand can make the difference between a person eating or not.

* Pretty paper or a nice journal. There can be a lot of CBT homework and scheduling; having some brightly coloured paper might encourage someone to fill out their 3 positive events for that day, for example.

* A day out. Ask them to go for a walk with you. Take them to a movie or concert. Bear in mind, they might not be in their best mood. So don’t necessarily expect the outing to be overly joyous, but do know that even if it seems you are only helping a small amount, that amount can be greater to your guest. In short, don’t put expectations on them to respond in a particular way.

* A plant or pet. Things like pets you need to be careful with; they might not have the energy to train a puppy. Something like a Siamese fighting fish might be more appropriate. Sometimes when a person is depressed they can be resistant to caring for another person/thing. If the gift dies, don’t be angry. Offer whatever emotional support they need to take care of this new thing; it might seem a simple skill, but even the easy stuff gets difficult in difficult times.

* Something comforting such as a blanket, stuffed animal, new socks, or hot chocolate packages.

* A picture (or pictures) of them by themselves or with someone else doing something memorable. It’s easy to forget that you were ever happy when you’re depressed.

* Money, gift cards, or offer to pay bills. That alone can alleviate a lot of stress.

* Adopt a child or endangered animal in their name. Encourage them to write letters to the child or stay updated with conservation through the newsletters that are mailed to sponsors.

* Enroll them in a class. Exercise is extremely good and an activity like yoga could help with mindfulness while they exercise. But any class (cooking, academic) that encourages social activity and skill building is good.

* A book. But a positive book, not one with a sad story and a sad ending. Self-help books are also an option, but these can be personal. Give them the opportunity to tell you it’s not quite the right book, but they would like something similar.
Garth Kroeker has a good reading list.

* Music. This can be given either as a cd/mp3 or an instrument. I recommend Glenn Gould’s 1955 recording of the Goldberg Variations.

* A light box. Very helpful for seasonal as well as chronic depression.

* A comedic dvd or cd.

It might sound cynical, but when giving a gift that involves the receiver and another person, be sure they like that other person. The thought always counts, and they will most likely appreciate the gesture, but it’s also nice to have something tangible. I don’t mean this to sound materialistic, most of the above suggestions can be done at little cost, only that concrete reminders of healthy times/relationships can last longer than thoughts which can become easily distorted or forgotten by the depression. The other option is to let them choose their companion (for example, give them two movie tickets, but don’t suggest they have to take you. Do encourage them however, to take someone. Adding a social activity to a pleasurable one can make it that much better.).

*** Avoid things like alcohol

* This site has some humourous gifts, but exercise caution when practicing irony.

Holiday Survival Guide

This is a re-post from last year.

The holidays can be a particularly lonely time for people. Even for those who look forward to the holidays, they can still be overwhelming. The following is a list of some things that may be helpful.

* Create/buy an especially thoughtful gift for someone who has supported or helped you.

* Do the above for someone random- a person on the street, pick an address from the phone book, or a needy family.

* Donate to charity. Clean out your closet and give what you don’t need to a local shelter.

* Volunteer. Help out in soup kitchens or with the red cross. Spend time with the elderly who might not have family visiting.

* Breathe. Holidays are chaotic and you may be forced to spend time in the company of people you dislike. Take time for yourself. Leave the party to go for a quiet walk. Find an empty room where you can read a book for a while. Sit in your car and listen to music for a few minutes.

* Be nice to people you don’t like.

* Host a dinner for a few people you are close to. Cooking for other people can be very therapeutic (in my case, this oftentimes leads to food poisoning, but the activity of cooking and sharing is still a positive event).

* Take a trip. I don’t encourage people to avoid difficulties, but sometimes you need a break so why not take that trip to Paris during the holidays?

* Exercise. This is something I always recommend, but the holidays can be especially lethargic times so it is important to maintain your exercise regime. Going for a run can also get you of a crowded, or empty, house.

* Make sure you have enough medication if your doctor will be taking time off.

* Remember, you don’t have to listen to Christmas music. At times this may be unavoidable, but in your home you can listen to whatever you like, even on Christmas morning. Some people may weary of the holiday music that is played in stores as early as November 1, so listen to your ipod while shopping.

* Do not feel obligated to anyone to do anything.

* Avoid alcohol.

* Eat nutritious foods as well as the delicious ones. And eat in moderation.

* If people start bickering, say something nice about them or someone they are talking about.

* Accept gifts graciously.

* Keep an emergency plan in place. Know where the hospital is if you’re out of town. Keep a list of friend’s numbers or call lines.

* Don’t abandon your regular activities. Keep doing all the things you normally do to stay healthy.

Thursday, November 11, 2010

Eating in Montreal

Good food is good for the soul and one of the pleasures of life.

I will continue to update this over the next couple of weeks.

St. Viateur Bagels – Sooooo delicious. Warm, soft, and sweet. 5/5

Cheskies – They didn’t have challah when I was there, but their rugala was very good and their chocolate croissant was ok. The walnut-fruit croissant didn’t do anything for me. I found the pastry to be flaky, but too dry. 3/5

Suite 88 – Delicious and reasonably priced chocolates (about $2 per piece or $3.50 for a chocolate bar). I had an apple martini chocolate shooter, a dark chocolate cup with warm white chocolate in it, two chocolate bars (caramel and orange, both milk chocolate), a caramel truffle, a maple dark hot chocolate, and a pumpkin milk hot chocolate. The hot chocolates are so thick it’s like drinking a melted chocolate bar…wonderful.

Formagerie Hamel (Atwater Market) – The baklava was good, but unremarkable, could have been sweeter. The cupcake was a little dry and I wouldn’t buy one there again.

Des Caraibes - The food was nicely flavoured and the portions were large. A decent place for a $10 meal. 4/5

Patati Patata – Very good poutine with red wine gravy. The fries could have been slightly crispier and it was a bit scanty on the curds. 4.5/5

AA – My first poutine, so I remember it as good, but the creepy old guy who stared at me the whole time has marred my experience. The chicken burger was an over mayonaised diner classic. Andre, one of the owners, was noticeably more hospitable than the surly waitress. 4.5/5 (poutine) 2/5 (burger)

La Banquise – A poutine place with 20+ varieties. Had one with sausage, hot peppers, and tobasco sauce (Kamikaze), one with turkey, bacon and onions in peppercorn sauce (Danse), one with ham and cheese (Hawaii 5.0), and one with guacamole, sour cream and tomatoes. Both were very good, but the fries could have been crispier. 4/5

The Main (Like Schwartz’s but without the line-up) – Bought a pound of smoked meat. I guess it was good but it didn’t do anything for me. I’ve been told this is one of the best places for smoked meat in the city. 5/5

Divine Chocolates – I had a dark chocolate, sea salt caramel which was delicious, but their stuff was pricey (the individual chocolates are comparable to other shops at about $2 a piece, but the chocolate bars are about $8). 4.5/5

Marius and Fanny – I had an orange caramel chocolate; the chocolate wasn’t great, but the filling was very good. I also had a passion fruit macaroon which was delicious.

Thai Phon – A bit pricey for thai food ($10 per plate) and the pad thai was almost all noodles, but the spices were very good. 3.5/5

Patisserie Chez de Gaulle(231 St. Viateur) – The ‘religieuse,’ a large, chocolate mouse filled pastry glazed with chocolate and topped with a smaller, caramel coated caramel mouse filled puff, was beyond heavenly and well worth the $4. The chocolatine ($2.50) was very good; the pastry was light and moist with the sweetness that is butter. I also had a St. Honore which was a custard filled pastry with jam in the middle topped with whipped cream, fruit, chocolate, and cream puffs which themselves were topped with burnt sugar.

Poutine Lafleur – This place had a few varieties of poutine. I had the regular poutine and the all-dressed poutine (steak, ham, onions, green peppers, and mushrooms). Both were delicious. The gravy had a unique and flavourful combination of spices. Just up the street is a small coffee shop, CafĂ© Boutique, which sells fancy condiments (cranberry-maple-balsamic salad dressing, cranberry-blueberry-green tea salad dressing, onion confit…)

Parentheses – This is a small, cozy coffee shop well suited to the antique neighbourhood in which it resides. The chocolatine was slightly overcooked. They also had a small selection of chocolate truffles which I didn’t try.

Boulangerie Banette – The chocolatine was way overcooked. 1/5

Boulangerie Laura – The chocolatines and croissants looked overcooked, so I didn’t bother with them, but I did have a chocolate puff which was made of nice, flaky pastry and nicely sugary. The baklava was sticky and sweet (though I always prefer my greek desserts saturated in honey). 3.5/5

Les Chocolats Briimstone – This was a small little store jam filled with delicious looking treats including a large selection of imported chocolate bars (one had bacon in it), homemade chocolates, homemade fudge, and other treats. I had a blueberry port chocolate, a love potion (strawberry and spice) chocolate, and a raspberry, white-chocolate bar. One of my favourites was the white-chocolate lemon truffle - tart and sweet! Also, the owner is super friendly. 5/5

Souvlaki George – This was one of the worst meals I’ve ever eaten. It was so bad, I couldn’t even force myself to finish. The gyro had a decent enough pita and tzatziki, but the meat was unidentifiable and was flavoured with a mishmash of indistinguasible spices that left a horrible taste in my mouth for hours. The fries, for the poutine or as a side, tasted dry and previously frozen. The gravy for the poutine was completely bland but, all considered, it doesn’t do anything to save the dish. 1/5

Pizza St. Henri – The pizza is like any other cheap pizza and the poutine is flavourless and made with frozen fries. 1/5

Rotisserie Italienne – This is a small restaurant with delicious, homemade Italian food. The pizzas are traditional thin crust. I had the 4 Season Pizza which came with ham, clam, mushrooms, and red peppers (a different slice for each). I also had the Plat Mix Pasta which is a sample of 3 different pastas and sauces for 2 people. The red wine was watery, but actually gained flavour with the food and complimented the food nicely. Almost all of the dishes are under $10 (for a full plate of pasta). They also do delivery.

Les Chocolats de Chloe - These were very fine chocolates. I had the banana and the passion fruit. Both had distinct flavours without being overpowering and the banana didn't taste at all artificial. 5/5

Bitoque - A BYO restaurant with wonderful decor, food and service. The food isn't cheap, but is comparable to other restaurants in this category (table d'hote costs $30 - $40) and there is more than enough food to fill you up. 4.5/5

Bacon & Egg Poutine – This was invented by my friend and entails frying cut-up bacon (3+ pieces) in butter, add in poutine (without disposing of any of the grease in the pan), add in 1-2 eggs. A heart attack to end all heart attacks. 5/5

Poutine Review Site:

Restaurant Review Site:

Saturday, October 30, 2010

This is Your Brain on Music – A Review

This is Your Brain on Music (Daniel J. Levitin) is one of the best popular science books I’ve read. I find the subject matter personally appealing and the author does a good job a discussing scientific ideas in a manner accessible by the general public.

The problems I did have with the book were not a fault of the author’s, but of my own tendency to not enjoy such books. He insulted physics at least twice (in fairness, his aim was to make an endearing joke poking fun at a discipline the majority of the population does find annoying) and I found his use a musical references to be superfluous. Even if I was familiar to the music he was using as examples, the usage of these examples still went overboard at times.

The last third of the book, as with the first few chapters, was more science based with fewer personal tangents. The chapter What Makes a Musician? was appealing to me both as an amateur musician and for the psychological parallels between learning new musical skills and learning new behavioural and cognitive skills. In this chapter he references a study in which the results indicated that a predisposition toward talent can be overridden by practice. He also emphasises the importance of caring about what you are doing, “…caring leads to attention, and together they lead to measurable neurochemical changes. Dopamine, the neurotransmitter associated with emotional regulation, alertness, and mood, is released, and the dopaminergic system aids in the encoding of memory traces.”

Another quote: “Although music certainly uses brain structures and neural circuits that other activities don’t, the process of becoming a musical expert…requires many of the same personality traits as becoming an expert in other domains, especially diligence, patience, motivation, and plain old-fashioned stick-to-it-iveness.” The importance of these qualities to overcoming any psychological illness is obvious.

Final Rating: For people without a background in music or neuroscience, this is a wonderful book. For those with a background, it is still entertaining and one can easily skim through sections they find trivial.

Tuesday, October 5, 2010

Photo Therapy

This is really just a subdivision of art therapy with the medium being photography. It can be used on its own as an exercise to do a sort of ‘inventory’ of the self. Or, it can be used as an adjunct to other therapies and CBT exercises.

One exercise is to use the following subjects (or your own ideas) to compose a autobiographical photo essay of about 6-12pictures. Another idea is to examine each subject individually, particularly in how you relate to it (what I mean is to not use the camera or the work as a way of separating yourself from your thoughts/feelings, but instead to use it as a way to add a new and different perspective. In other words, regard this as an exercise in mindfulness).

- A beautiful/memorable place
- Favourite colour, activity, texture, food…anything of which you have a favourite
- Life chart (home grew up in, schools attended…)
- Feelings (play, anger, depression, joy, sorrow, laughter, loss, hardness, softness, trust, sharing…)
- Future self (perceptions of growing old, how you would like to see yourself, aspirations)
- Your world (your view and interactions – your regular bus, the type of coffee you drink, the drawer at work where you hide all your candy)
- How the landscape effects you
- Portraits of people whom you admire
- Light, time, patterns
- Pictures of you doing pleasurable activities. This is especially beneficial if you include another person in the activity to take the photographs of you.

A twist on the project is that for photographs representing negative feelings or beliefs, use a program such as photoshop to create a positive image. As an added bonus, you will be learning a new skill (photo editing) or refining skills you already possess. This is something I believe is important in all therapies which, in my opinion, spend too much time focusing on the negative and too little time focusing on the positive and on change.

Friday, July 23, 2010

Therapeutic Pets

In 1857 British novelist George Eliot wrote, “Animals are such agreeable friends. They ask no questions and they pass no criticism.”

I agree that they may be agreeable most of the time, but they most definitely ask questions (Can I eat that? Can we go now? Now? Now?), and pass criticism (If I can’t eat that, now, I will bite you).

One book on animal assisted therapy says, “And cats do have some behavioural problems.”

The therapeutic value of animals can be increased by combing it with volunteering. Some programs ask volunteers to bring their own animals in to patients and there are also programs where volunteers take working dogs out public to aid in training them.

Below are some of the positives and negatives of pet ownership.

Benefits –
* Increases exercise. Going out for walks, riding horses, or chasing kittens.
* Source of companionship. Even just the presence of something alive can be vitally invigorating.
* Helps build relationship skills. You might notice some things about how you treat yourself or others when you pay attention to how you treat your pet and learn what is and is not effective.
* Allows for meeting new people. Dog walking, clubs, going to the pet store.
* Increases responsibility and pride. It is one thing to be responsible for yourself when ill, but a great deal of worthiness can come from taking care of something else, sick or not.
* Adds structure and routine. A pet will ensure you get you out of bed in the morning to feed or walk it (and if you have a cat, very likely it will get you out of bed several times throughout the night as well). Also, especially with dogs, feeding and exercise will also be more scheduled
* Cute and furry (possibly).
* Commitment. It can be a healthy process to make a weighted decision and committing to it long-term.

Costs –
* Too much time with only your pet may cause you to lose the ability to verbally engage with other humans.
* Responsibility. Undertaking ownership of a pet that is too demanding, or having too many pets, may increase stress.
* Claws, teeth, fur, and bodily fluids.
* Abusing your pet. When you are manic or depressed or anxious and don’t want to be touch and something touches you, you may strike out. Generally speaking, it is also very easy to abuse animals verbally and physically. Though this may be on a smaller scale, it is not healthy for either animal or owner.
* Limits social outings. There might be places you can’t go because you can’t bring your pet or leave it behind for some time. Some people may be allergic and can’t come to your home.
* Commitment. Maybe not so much with fish, though they can live up to 10 years. But other animals need to be fed and cleaned. They also need a home, so moving internationally would be more difficult, though not impossible, with a pet.
* Cost. Food, litter, accessories, vet bills can add up (however, you can choose the type of pet you want based on your budget).

The scientific therapeutic value of pets is not compelling, but this may be due to flaws in study designs. Scientific American Mind has a very good article looking at anecdotal versus scientific evidence.

Dogs, horses, and dolphins are probably the most famous animal assisted therapy animals. Rabbits, other rodents, and birds are also used. Cats are used as well, but I am curious as to the frequency of this (there is a reason cats are not generally supposed to be out of bags).

Horses and dolphins have a particular character to them which can increase bond. I waver on the issue of swimming with dolphins, but I am not against it. More easily accessible though are stables offering trail rides which can be a casual way of engaging with a larger animal.

I have said a lot of negative things about cats here, but they are undeniably unique and wonderfully engaging animals.

Thursday, July 15, 2010


Magnetoencephalography (MEG) is an imaging technique sharing components of EEG and fMRI. It uses the fluctuating electrical activity in the brain which induces a magnetic field in the active region which can then be measured using magnetometers. The magnetometers are commonly referred to as SQUIDs (Superconducting Quantum Interference Devices). There are different orientations of the magnetometers – single, axial gradiometer, planar gradiometer – which are positioned above the head.

As with all superconductors, a very cold environment must be provided. SQUIDs are typically cooled with liquid helium which is maintained at its boiling temperature of 4K (for a reference point, liquid nitrogen freezes in liquid helium) and stored in a giant thermos called a dewar.

SQUIDs are sensitive to very small magnetic fields on the order of 5×10−18 T.
The magnetic fields generated in the brain are on the order of 10-15T. The Earth’s magnetic field is about 5.0 × 10-5T. So in order to obtain a signal clean of any ambient noise, the process must take place in a highly shielded room, including a very thick door with a strong vacuum seal (the room is similar to a vault). The walls of the room are composed of layers of aluminium and a ferromagnetic material.

In comparison to the MEG, an EEG measures electrical activity directly and requires electrodes to be applied directly to the head. Also, direct measures of electrical activity can become distorted as the signal passes through ions and the skull, whereas such distortion is not obtained with MEG.

There are fewer safety concerns with an MEG than an MRI since there is no large magnetic field involved. The images obtained can be combined with images obtained in fMRI studies by measuring specific points on the head after the MEG and then overlaying the two images.

Here is a paper that discusses in more detail MEG and EEG.

Thursday, July 8, 2010

Exercise Prohibition in Eating Disorders Programs

Earlier this year it had been brought to my attention that there exists eating disorder (ED) programs which prohibit exercise. Presumably, this is to encourage weight gain and discourage over-exercising. However, the idea is absurd and archaic in my opinion. Regular monitoring puts stress on patients and staff, and diverts energy from healing.

As with food, exercise can not be avoided in daily life and a complete ED program would integrate healthy exercise as it does healthy eating.

Additionally, exercise has been proven to improve mood and can also give patients a sense of responsibility and independence.

Certain precautions when dealing with patients who may be physically compromised such as with low blood pressure need to be considered. However, in an ED program all exercise is monitored by a medical staff member trained to handle emergencies.

Depending on the physical status of the patient, varying degrees of intensity of exercise could be tolerated. Because of the specific nature of eating disorders, mindful engagement with the body should be encouraged in all exercise routines. This is easily accomplished with a moderate activity such as yoga (St. Paul’s Hospital in Vancouver incorporates yoga into their ED program).

References: 1, 2, 3, 4

Tuesday, June 29, 2010

Clapping Therapy

I absolutely love clapping in music (though other supposed music lovers I know detest it). As it turns out, there is a ‘clapping therapy’ also know as interactive metronome training.

Interactive Metronome® was developed in 1994 by Jim Cassily, a recording engineer … who taught piano lessons on the side, discovered that I.M. helped his autistic students. Not only did they get the timing down, it also helped them with attention, concentration, coordination, language processing, reading skills and control of aggression.

One study on children with attention and coordination disorders found, “...Interactive Metronome training may address deficits in visuomotor control and speed, but appears to have little effect on sustained attention or motor inhibition.”

A case study: “This child's participation in a new intervention for improving timing and coordination was associated with changes in timing accuracy, gross and fine motor abilities, and parent reported behaviors.”

A study on children with ADHD: “The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD.”

A Parkinson’s study: “These results suggest that computer-based motor training
regimens might be useful for improving or retaining motor function in Parkinson’s disease.”

Another Parkinson’s study: “This study provides evidence for the potential of cueing to improve gait in PD-CI. Only individuals with mild CI were included, and the effect with increased CI and different types of dementia requires further evaluation.”

A Parkinson’s study which examines an alternative to the audio metronome: “Rhythmic somatosensory cueing may be a viable alternative for auditory cueing and is robust to changes in walking speed and visual distractors.”

A study in schizophrenic patients found that, “…patients with marked negative symptoms performed best when their actions were more stimulus-driven [marked by metronome] than willed [consciously attempting to perform well] strengthens the case that negative schizophrenic symptoms reflect a disorder of willed action.”

A paper published by the Institute for Applied Psychometrics looks at four different timing therapies and has a long list of references for further reading.

According to a site which sells the IM, “The device can strengthen motor skills, including mobility and gross motor function, and improve many fundamental cognitive capacities such as planning, organizing and language.”

Clapping itself is used in conjunction with music therapy in the treatment of autism, dementia, and Alzheimer’s.

As far as I can tell, there has been no clinical research investigating the specific effects of clapping on mood. But it is exercise, so I imagine a heavy regime of clapping could boost mood.

A song about clapping that refuses to let you dwell in a bad mood:

Thursday, June 17, 2010

Lithium and Suicide

An article in the British Journal of Psychiatry examined the relationship between lithium levels in drinking water and risk of suicide. The analysis was done by a team in Japan.

“We found that lithium levels were significantly and negatively associated with SMR [standardised mortality ratio] averages for 2002–2006. These findings suggest that even very low levels of lithium in drinking water may play a role in reducing suicide risk within the general population.”
And UBC’s very own Dr. Allan Young had some words to say on the matter, particularly on the possible future debate of whether or not lithium should be added to drinking water:
“It would be most unfortunate if these findings became little more than a factual curiosity, of the sort that bright students sometimes use to highlight the limitations of a professor’s wisdom… It would be surprising if lithium in drinking water were not to raise a…panoply of questions… Following up on these findings will not be straightforward or inexpensive, but the eventual benefits for community mental health may be considerable.”

The following studies provide support for decreased suicidality with lithium treatment. However, all of these studies are done by the same group of authors, more or less. As well, there are some conflicts of interest between the authors and companies producing pharmaceuticals, including lithium.

The findings indicate major reductions of suicidal risks (attempts > suicides) with lithium maintenance therapy in unipolar >/= bipolar II >/= bipolar I disorder, to overall levels close to general population rates. These major benefits in syndromes mainly involving depression encourage evaluation of other treatments aimed at reducing mortality in the depressive and mixed phases of bipolar disorder and in unipolar major depression.$=relatedreviews&logdbfrom=pubmed

Results from 33 studies (1970-2000) yielded 13-fold lower rates of suicide and reported attempts during long-term lithium treatment than without it or after it was discontinued. Although greatly reduced, these rates remain above those estimated for the general population. Evidence for substantial, if incomplete, protection against suicide with lithium is supported by more compelling evidence than that for any other treatment provided for patients with mood disorders. Studies of commonly used, but incompletely evaluated, alternative treatments are required, and further protection against premature mortality can be anticipated with better protection against bipolar depression.$=pmtitlesearch4

There is no definitive evidence from this review as to whether or not lithium has an anti-suicidal effect.$=relatedreviews&logdbfrom=pubmed

Protection against suicide with lithium is incomplete, but rates of suicides plus attempts during lithium treatment may approach general population base rates.$=relatedreviews&logdbfrom=pubmed

The findings indicate major reductions of suicidal risks (attempts > suicides) with lithium maintenance therapy in unipolar >/= bipolar II >/= bipolar I disorder, to overall levels close to general population rates.$=relatedreviews&logdbfrom=pubmed

Risks of completed and attempted suicide were consistently lower, by approximately 80%, during treatment of bipolar and other major affective disorder patients with lithium for an average of 18 months. These benefits were sustained in randomized as well as open clinical trials.$=relatedarticles&logdbfrom=pubmed

The findings support growing evidence of lower risk of suicidal acts during closely monitored and highly adherent, long-term treatment with lithium and indicate that treatment adherence is a potentially modifiable factor contributing to antisuicidal benefits.$=relatedarticles&logdbfrom=pubmed

Studies done by some different people:

In view of the fact that a placebo-controlled mortality study under long-term conditions is neither ethically nor practically feasable, our findings cannot prove definitively that long-term lithium treatment counteracts factors responsible for the excess suicide and cardiovascular mortality of affective disorders. However, our observations are compatible with such a notion.

The findings suggest that ongoing lithium treatment is associated with a lower suicide risk. Whether this is due to lithium's mood-stabilizing properties, to lower suicide risk per se in the patients who remain in treatment, or to a specific antisuicidal effect of the lithium ion cannot be determined since patients were not randomized to discontinue treatment. This methodological shortcoming is shared with every study in the field. All results regarding the influence of lithium on suicide rates must therefore be interpreted with extreme caution.

The reduction in suicide attempts, in both responders and non-responders, indicates that lithium possesses a specific anti-suicidal effect besides its mood-stabilising property.

Friday, May 7, 2010

Cooking Therapy

Many people claim that cooking is a de-stressing activity. It is certainly a great activity for mindfulness with all of the sensory information (kneading dough, smell of cinnamon, steam and heat, colours…)

And cooking does have many therapeutic values.

Physically, it requires motor coordination, range of movement, and muscle strength in the arms, hands, and everywhere else (from standing). The physical sensory information during cooking is also important (for safety, testing doneness…)

Cooking is often viewed as an art form as much as a science. The cognitive processes of problem solving (what can I substitute for milk?) and puzzle solving (following steps) can aid with memory and attention. Furthermore, the process of cooking involves structured planning (buying groceries) and time management skills. When mistakes are made, improvisation and flexibility of the mind are brought into play. The complexity of a recipe and individual experimentation can further enhance these skills, as well as add new spices to the cupboard.

As to why people regard cooking as de-stressing, cooking can increase self-esteem, competence, pride, and perceptions of abilities. A sense of humour and light-heartedness about one’s own limitations may occur when a mistake is made or things just don’t quite turn out to be edible.

Cooking can provide the opportunity increase social relationships. One can join a cooking class or a community cooking group. In both, or even if cooking solo, the product can be shared with others at dinner parties, potlucks, bake sales, and gifts further expanding the network.

On an intimate note cooking can provide comfort (especially in the winter when a warm oven is running). It can add a romantic quality to relationships that one desires to be romantic. A particular recipe can get one in touch with their domestic roots. It can also be a time of reminiscence, perhaps an old recipe your grandmother used to make or her handwriting on a recipe card.

A daily routine connect you to your home, life, family, and vitality by allowing you to nurture yourself and others.

Cooking can raise awareness about nutrition and this information can be used when ordering in restaurants.

Without going too much into eating disorders, cooking provides a necessary framework and indeed most hospitals have a cooking group as part of treatment.

A person with an eating disorder may already be adept at cooking as it is not unusual for such people to collect recipes and cook frequently, though without eating the product themselves.

Cooking groups in treating eating disorders offer the same benefits as above, but in addition they can decrease anxieties associated with food. Cooking in treatment programs is still social, but it also redefines and explores relationships and their context with food. There may be special activities such as mother/daughter cooking classes or role playing in the kitchen.

An interesting study done this year examining the effect of cooking shows on students eating habits:

“A television show on nutrition and cooking may be influential in changing students' knowledge, but it seems to have little impact on dietary behaviors. With a recent increase in popularity of cooking shows, future research should investigate the impact an extended cooking and nutrition show series might have on young adult viewers.”

Oh, and also cooking can be fun; that’s just what I’ve heard.

References (because I needed them): 1

Wednesday, April 7, 2010

Full Moon, Strange Behaviours, and Medical Emergencies

I was going to write an article on this, but I found an excellent review with many interesting highlights in the Canadian Medical Association Journal:

Past beliefs regarding the association of full moon and human behaviour may have been due to the extra light at night, “Even partial sleep deprivation over the course of a single night can induce mania…”

“At the Bethlehem (or Bedlam) Hospital in London, inmates were chained and flogged at certain phases of the moon "to prevent violence."”

“Why, then, is the belief in a "lunar effect" still so strong? Explanations include: a lack of understanding of physics, psychological biases (e.g., selective recall or selective perception), sensationalism, and the entertainment value of a belief in lunar influence.”

According to wiki, research has indicated there is an effect of light on menstruation (which often has an effect on mood and behaviour, but no direct correlation with the full moon.

Here is another article demonstrating no significant effect of lunar cycle on hospital activity.

Some popular culture trivia - according to Joss Whedon, the affective period of a full moon on werewolf activity is actually 3 nights (astronomically there are 8 phases of the moon each lasting 3.69 days).

Friday, March 26, 2010

Vitamin G (B2)

Vitamin G is what they used to call Riboflavin/B2 in the old days (I’m guessing because the discoverer’s name was Gyorgi). More on B vitamins here.

It functions in body growth and red blood cell production and helps in releasing metabolic energy (from fats, ketone bodies, carbohydrates, and proteins).

Indications of riboflavin deficiency include cracked lips; inflammation of the mouth and tongue; mouth sores; sore throat; oily, scaly skin rashes on the scrotum, vulva, or area between the nose and lips; red, itchy eyes that are sensitive to light; and iron-deficiency anemia. The nervous symptoms of riboflavin deficiency include numbness of the hands and decreased sensitivity to touch, temperature, and vibration.

Sources include lean meats, eggs, legumes, nuts, green leafy vegetables, dairy products, and milk provide riboflavin in the diet. Breads and cereals are often fortified with riboflavin.

Because riboflavin is destroyed by exposure to light, foods with riboflavin should not be stored in glass containers that are exposed to light.

The RDA for adults is about 1.1 – 1.3mg.

Toxicity is extremely unlikely, except in cases of injections. Riboflavin is water soluble and any excess is excreted through the urine.

Friday, March 19, 2010


The relation rock climbing = dangerous = possible psychiatric disorder does get mention in the DSM-IV (masochism is one diagnosis). But this is a pretty tenuous relationship even within the DSM.

Climbing, indoor or outdoor, isn’t nearly as dangerous as it is scary, and it’s not terribly frightening either.

But where it is either of those things, there is a wonderful opportunity to develop self-confidence, risk-taking (the good kind – where fear would otherwise hold you back from achieving a goal), trust (in the person belaying you), and to overcome anxieties such as may be associated with heights (after you fall a couple of times you realise it’s perfectly safe. You can then train yourself to take bigger falls).

Besides the above, climbing has many other advantages in aiding with mental health.

• It is a very supportive social outlet. Climbers, sometimes even ones who don’t like each other, tend to support and encourage each other.
• It’s exercise - with all of the associated mental health goodness.
• It can help with problem solving skills as you need to assess the route both before and during climbing in order to choose your next move.
• It brings greater awareness to the body and what it, and you, are capable of. You might need to train to do a specific move or you might just try something and be amazed at the efficiency and pliability of the human body.

There isn’t much climbing specific research in relation to psychiatry, but this article found that climbers, regardless of their skill level, had “internal motivational orientation and positive physical self-perception.”

This is an article with some interesting details in its study design (participants had to pay in order to participate), but it supports my opinion, so I’m going to cite it. The study (which included five days of rock climbing) found an “increase in formal and informal social interactions, motivation to learn, and optimism to learn, and [a] decrease in symptoms…”

Friday, March 12, 2010

Is it ok for a therapist to accept/give gifts?

Is it ok for a therapist to accept gifts?
This is something that varies between therapists, with some drawing an absolute boundary at ‘no, not ever.’ While certain gifts such as those of large monetary value, of cash itself, should be gently and graciously turned away, small trinkets of acknowledgment and gratitude can be accepted. The hurt that could be caused by such a rejection may not justify rigid boundaries. The intent of gift should be examined in any case and if gift giving becomes overly compulsive, acceptance of the gifts would need to stop.

Is it ok for a therapist to give gifts?
Yes. Because presents are shiny and they make people happy. Seriously though, at certain times gift giving may be appropriate and alleviate loneliness. Again, the gift should have little or no monetary value. Something like a card during the holiday season or on a birthday would be acceptable.

Wednesday, March 10, 2010

Managing Your Time During Session

Fifty minutes goes by quickly, and a lot happens in a week, so it can be frustrating when session has ended and you haven’t discussed all of the issues important to you. Of course, there is never going to be enough time to discuss everything, but it is important that what is most relevant to you is covered.

Here are some suggestions that may help you optimise your time with your therapist:

* Keep track of important events and feelings that occur throughout the week. Make some brief notes if you have trouble remembering details later, but do not put any lengthy descriptions on your list. Give yourself some time before session to review your important topics and prioritise which events you most want to discuss.

* Make notes during session. A lot of different thoughts will occur and a lot of conversation will be exchanged. If your memory is poor, which is common during emotional states, you may have trouble later recalling advice you had intended to remember or thoughts that came up but didn’t fit into the conversation at the time.

* Make a list after session of things you would like to discuss the following week. Review and edit this list before your next visit.

* Allow for developments. Don’t be too strict in how you want the session to go. Let conversations, relationship dynamics, and topics develop naturally and work on what comes up.

* Keep an eye on the clock. You may have to postpone one discussion in order to ensure another is given air.

* Recognise avoidance behaviours which waste time and alter ambivalence in order to get more work done.

* Don’t worry if you feel like you’re wasting your time talking about ‘trivial’ topics; a lot of therapy is in the how you address any topic. Use your time in session to practice healthy behaviours and challenge new thinking models.

Monday, March 1, 2010

Rabbit Syndrome

Rabbit syndrome (RS) is a rare extrapyramidal condition in which a person has involuntary, fine, rhythmic movements along the vertical axis of the mouth at a frequency of approximately 5 Hz. The syndrome is associated with long-term use of older antipsychotics and may appear either during treatment or after discontinuation (3). The absence of involvement of the tongue and persistence in Stage 1 non-REM sleep (2) distinguishes RS from tardive dyskinesia (TD).

Similar to TD, however, RS may be triggered or intensified in physically or cognitively stressful situations.

RS also shares some similarities with Parkinson’s disease in that it may be associated with drug-induced parkinsonism and symptoms persist during stage 1 non-REM sleep.

Populations of the middle-aged to elderly, women, schizophrenics, and those with previous brain damage are more at risk for RS (1).

Of the older neuroleptics, haloperidol is most commonly associated with RS followed by
piperazinic phenotiazines (Fluphenazine, Perphenazine, Trifluoperazine). (1)

Of the atypicals, risperidone has the highest incidence of extrapyramidal symptoms.
Others include clozapine, olanzapine and aripiprazole (4). I have also seen a case report of quetiapine induced RS in a bipolar patient (5). Conversely, there was also a case study of RS being treated with quetiapine in a schizophrenic patient (6).

RS can be treated with anticholinergic agents such as benztropine, biperiden, procyclidine and trihexyphenidyl typically disappearing in a few days. However, there is the possibility that RS will reappear after stopping anticholinergic medications. A drawback to this treatment though is that the same agents may lead to the development of TD. (1)

A case report of olanzapine treated RS (7).

References: 1, 2, 3, 4, 5, 6, 7, 8

Friday, February 19, 2010

Choir Singing

Benefits of singing in a choir:

* Breathing exercises.
* Balance awareness - standing on both feet.
* Cognitive aspect of reading music.
* Facial movements involved in singing mimic those of positive mood states and can increase mood.
* Reading lyrics without singing as a rhythm exercise.
* Singing in a group increases social activity and it can be fun to sing live harmonies on a large scale. Most likely, the group will be a supportive and encouraging crowd.
* Challenging – musical range, length of breath…
* Rewarding when the music all comes together and you can listen to, and be a contributing part of, the harmony.
* Performance adds a new dimension to the interaction with the music and the additional pleasure of sharing the music with others.

Overall, singing in a choir increases awareness of self, others, and the relationship between the two.

This study showed that singing in a choir can improve mood and reduce stress hormone levels.

Another study examined the difference between singing and listening to music and found that active singing was required in order to see beneficial results.

If you are not an expert singer, churches will usually accept singers, regardless of faith. Other non-audition choirs can be found with a little searching of community centres.

A quote from ‘The Elegance of the Hedgehog’ regarding choirs:
“Every time, it’s a miracle. Here are all these people, full of heartache or hatred or desire, and we all have our troubles and the school year is filled with vulgarity and triviality and consequence, and there are all these teachers and kids of every shape and size, and there’s this life we’re struggling through full of shouting and tears and laughter and fights and break-ups and dashed hopes and unexpected luck-it all disappears, just like that, when the choir begins to sing. Everyday life vanishes into song, you are suddenly overcome with a feeling of brotherhood, of deep solidarity, even love, and it diffuses the ugliness of everyday life into a spirit of perfect communion.”

Other fun, group singing exercises include getting a few friends together to sing along to the Buffy musical or Dr. Horrible’s Sing-Along Blog.

Friday, February 5, 2010

When You Can’t Take Care of Yourself

Illnesses can be debilitating and everyday life duties (eating, bathing, paying bills, cleaning…) can become overwhelming. If you find yourself in a position where you can no longer keep up with it all, you may need to turn to someone else for support. Hospitalisation is one option, but if you are unable to get admitted or you don’t want to stay in a hospital, staying with a friend or family member is another option.

But it can be difficult to be away from home; Your routine is influenced by your home environment and there is a certain amount of comfort in routine, and all of your stuff is there.

Here are a few ways you can make your stay away from home more familiar:

• Bring some of your favourite objects with you: your favourite coffee mug, pictures, a comforting blanket, your own pillow, a plant, a food you like to eat for breakfast…
• Bring some activities with you: yoga mat, computer, word games, crafts…
• If you have any prior scheduled activities, keep them.
• Do what you can at your host’s house: help with the dishes, make a thank-you card, set the table, make coffee in the morning…any small task that will help you regain independence.
• Go home for short periods of time: spend your afternoons at your house in increasing amounts of time to regrow accustomed to living in that place on your own again. This can help reduce anxiety and also keep your place in order while your gone (e.g. bringing the mail in, feeding pets, watering plants…).

Most importantly, remember that it is ok to allow yourself to be taken care of and it is not a sign of weakness or laziness but is rather a sign of mature awareness of what you have to do to ensure you receive the best care (from yourself or others) possible.

Monday, February 1, 2010


The old class of antidepressants known as monoamine oxidase inhibitors are used in the treatment of smoking cessation as well as atypical and treatment resistant depression. They are also used for treating social anxiety, agoraphobia, panic disorder and borderline personality disorder.

The neurotransmitters serotonin, norepinephrine and dopamine are monoamines. In the gap between nerve cells - the synapse - used neurotransmitters are destroyed by an The enzyme called monoamine oxidase (MAO) degrades these neurotransmitters. And depression is associated with low levels of the neurotransmitters. MAOIs block the activity of this enzyme, increasing the availability of the neurotransmitters, and possibly relieving depressive symptoms.

There are two isoforms of monoamine oxidase, MAO-A (generally related to serotonin, melatonin, epinephrine and norepinephrine) and MAO-B (deaminates phenylethylamine and trace amines). Dopamine is equally degraded by both types
and different types of MAOIs act on either or both of these.
Early MAOIs are irreversible in that they permanently deactivate the MAO and the enzyme is not functional for about two weeks, when it has been replaced.
A few newer MAOIs, notably moclobemide, are reversible, meaning that they are able to detach from the enzyme to allow for regular processing.

MAOIs are also selective to the type of the MAO receptor. Some MAOIs inhibit both MAO-A and MAO-B equally, other MAOIs work on one group specifically.
Common MAOIs include Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan), Moclobemide (Aurorix, Manerix, Moclodura), Selegiline (Selegiline, Eldepryl, Emsam), Nialamide, Iproniazid (Marsilid, Iporzid, Ipronid, Rivivol, Propilniazida), Iproclozide, and Toloxatone.

The most common side effect when taking an MAOI is insomnia. Other common adverse reactions include dry mouth, dizziness, feelings of lightheadedness, an excessive drop in blood pressure when standing, constipation, and weakness. Men taking MAOIs may experience sexual side effects with such symptoms as erectile dysfunction, delayed or painful ejaculation, loss of sexual sensation and anorgasmia (inability to reach orgasm). Some women have reported sexual side effects such as decreased libido and vaginal dryness.

Less common side effects reported include rash, nausea, vomiting, stiff neck, flushing, feelings of fear, chest pain, and headaches.

Symptoms of MAOI overdose include severe anxiety, confusion, seizures or convulsions, severe drowsiness or dizziness, cold clammy skin, rapid and irregular pulse, fever, hallucinations, severe headache, coma, tremors/spasms, excessively high or low blood pressure, muscle stiffness, difficulty breathing, extreme sleep difficulties, or abnormal irritability.

Tyramine, a compound found in many foods, beverages and other substances, has an effect on blood pressure. It is regulated by the MAO, so when taking an MAOI, tyramine can reach dangerous levels, resulting in critically high, and possibly fatal, blood pressure. Therefore, careful dietary restrictions need to be implemented while on a course of MAOIs.

Treatment with moclobemide does not have the same dietary restrictions as with other MAOIs, though caution should still be taken with foods high in tyramine.

A new study looked to re-examine the effects of MAOIs in treating bipolar disorder and found that they had positive treatment outcomes.

MAOIs have many negative drug interactions and combinations need to be monitored closely. Combinations of MAOI/TCA (tricylcic antidepressants) are risky, but possible.
Overall, it appears from the literature that the combination of MAOIs and TCAs can be relatively safe and effective in the treatment of patients whose depression is treatment-resistant. On the other hand, the risks associated with MAOI and TCA treatment have made this strategy relatively unpopular since the introduction of the newer agents.”

A 3 year follow up study confirms the safety of MAOI/TCA combos.

“The combination of amitriptyline and trimipramine with MAOIs appears to be safe, but imipramine and clomipramine should definitely be avoided because of the risk of fatal serotonin toxicity. It is usually thought best to start the MAOI and TCA treatment simultaneously at low dose or cautiously to add MAOI treatment to established TCA medication.”

Some old (1988) clinical evidence for MAOI/lithium combos:
“Lithium combined with phenelzine alleviated the symptoms of four severely depressed patients. Previously, all four patients had failed to respond to tricyclic antidepressants, and three had not responded to monoamine oxidase inhibitors.”

Two other studies indicate an MAOI/Li combo is beneficial. Both of these studies had their limitations, but really, what study doesn’t?

The following dietary precautions came from here.

Foods to Avoid

This list consists of foods with sufficient tyramine (in small or usual serving sizes) to create a dangerous elevation in blood pressure and which therefore should be avoided (McCabe, 1986).

• Alcoholic beverages - avoid Chianti wine and vermouth. Consumption of red, white, and port wine in quantities less than 120 mL present little risk (Anon, 1989; Da Prada et al, 1988; McCabe, 1986). Beer and ale should also be avoided (McCabe, 1986), however other investigators feel major domestic (US) brands of beer is safe in small quantities (1/2 cup or less than 120 mL) (Anon, 1989; Da Prada, 1988), but imported beer should not be consumed unless a specific brand is known to be safe. Whiskey and liqueurs such as Drambuie(R) and Chartreuse(R) have caused reactions. Nonalcoholic beverages (alcohol- free beer and wines) may contain tyramine and should be avoided (Anon, 1989; Stockley, 1993).
• Banana peels - a single case report implicates a banana as the causative agent, which involved the consumption of whole stewed green banana, including the peel. Ripe banana pulp contains 7 mcg/gram of tyramine compared to a peel which contains 65 mcg/gram and 700 mcg of tyramine and dopamine, respectively (McCabe, 1986).
• Bean curd - fermented bean curd, fermented soya bean, soya bean pastes contain a significant amount of tyramine (Anon, 1989).
• Broad (fava) bean pods - these beans contain dopa, not tyramine, which is metabolized to dopamine and may cause a pressor reaction and therefore should not be eaten particularly if overripe (McCabe, 1986; Anon, 1989; Brown & Bryant, 1988).
• Cheese - tyramine content cannot be predicted based on appearance, flavor, or variety and therefore should be avoided. Cream cheese and cottage cheese have no detectable level of tyramine (McCabe, 1986; Anon, 1989, Brown & Bryant, 1988).
• Fish - fresh fish (Anon, 1989; McCabe, 1986) and vacuum- packed pickled fish or caviar contain only small amounts of tyramine and are safe if consumed promptly or refrigerated for short periods; longer storage may be dangerous (Anon, 1989). Smoked, fermented, pickled (Herring) and otherwise aged fish, meat, or any spoiled food may contain high levels of tyramine and should be avoided (Anon, 1989; Brown & Bryant, 1988).
• Ginseng - some preparations have resulted in a headache, tremulousness, and manic-like symptoms (Anon, 1989).
• Protein extracts - three brands of meat extract contained 95, 206, and 304 mcg/gram of tyramine and therefore meat extracts should be avoided (McCabe, 1986). Avoid liquid and powdered protein dietary supplements (Anon, 1989).
• Meat, nonfresh or liver - no detectable levels identified in fresh chicken livers; high tyramine content found in spoiled or unfresh livers (McCabe, 1986). Fresh meat is safe, caution suggested in restaurants (Anon, 1989; Da Prada et al, 1988).
• Sausage, bologna, pepperoni and salami contain large amounts of tyramine (Anon, 1989; Da Prada et al, 1988; McCabe, 1986). No detectable tyramine levels were identified in country cured ham (McCabe, 1986).
• Sauerkraut - tyramine content has varied from 20 to 95 mcg/gram and should be avoided (McCabe, 1986).
• Shrimp paste - contain a large amount of tyramine (Anon, 1989).
• Soups - should be avoided as protein extracts may be present; miso soup is prepared from fermented bean curd and contain tyramine in large amounts and should not be consumed (Anon, 1989).
• Yeast, Brewer's or extracts - yeast extracts (Marmite) which are spread on bread or mixed with water, Brewer's yeast, or yeast vitamin supplements should not be consumed. Yeast used in baking is safe (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).

Foods to Use with Caution
This list categorizes foods that have been reported to cause a hypertensive crisis if foods were consumed in large quantities or stored for prolonged periods, or if contamination occurred. Small servings (1/2 cup, or less than 120 mL) of the following foods are not expected to pose a risk for patients on MAOI therapy (McCabe, 1986).
• Alcoholic beverages - see under foods to avoid.
• Avocados - contain tyramine, particularly overripe (Anon, 1989) but may be used in small amounts if not overripened (McCabe, 1986).
• Caffeine - contains a weak pressor agent, large amounts may cause a reaction (Anon, 1989).
• Chocolate - is safe to ingest for most patients, unless consumed in large amounts (Anon, 1989; McCabe, 1986).
• Dairy products - Cream, sour cream, cottage cheese, cream cheese, yogurt, or milk should pose little risk unless prolonged storage or lack of sanitation standards exists (Anon, 1989; McCabe, 1986). Products should not be used if close to the expiration date (McCabe, 1986).
• Nuts - large quantities of peanuts were implicated in a hypertensive reaction and headache. Coconuts and brazil nuts have also been implicated, however no analysis of the tyramine content was performed (McCabe, 1986).
• Raspberries - contain tyramine and small amounts are expected to be safe (McCabe, 1986).
• Soy sauce - has been reported to contain large amounts of tyramine and reactions have been reported with teriyaki (Anon, 1989), however analysis of soy sauce reveals a tyramine level of 1.76 mcg/mL and fermented meat may have contributed to the previously reported reactions (McCabe, 1986).
• Spinach, New Zealand prickly or hot weather - large amounts have resulted in a reaction (Anon, 1989; McCabe, 1986).