Conditions We Treat in Mankato

We treat all types of disorders, such as depression, bipolar disorder, addiction and chronic pain, using a team approach, tailored to your needs. Our experts offer comprehensive evaluations to assess psychological and physical concerns. A team of medical professionals will work with you to set goals, develop a customized plan based on your needs and monitor your progress.

View the list of conditions we treat below:

• ADHD in adults
• ADHD in children
• Anxiety
• Bipolar disorder
• Chronic pain
• Depression
• Drug addiction
• Eating disorders
• Headaches
• Low self-esteem
• Mental illness
• Postpartum depression
• Post-traumatic stress disorder (PTSD)
• Sleep disorders

ADHD in adults

Adult attention-deficit/hyperactivity disorder (ADHD) is a mental health disorder that includes a combination of persistent problems, such as difficulty paying attention, hyperactivity and impulsive behavior. Adult ADHD can lead to unstable relationships, poor work or school performance, low self-esteem, and other problems.

Though it's called adult ADHD, symptoms start in early childhood and continue into adulthood. In some cases, ADHD is not recognized or diagnosed until the person is an adult. Adult ADHD symptoms may not be as clear as ADHD symptoms in children. In adults, hyperactivity may decrease, but struggles with impulsiveness, restlessness and difficulty paying attention may continue.

Treatment for adult ADHD is similar to treatment for childhood ADHD, though some ADHD medications approved for children are not approved for adult use. Adult ADHD treatment includes medications, psychological counseling (psychotherapy) and treatment for any mental health conditions that occur along with ADHD.

Symptoms

Some people with ADHD have fewer symptoms as they age, but some adults continue to have major symptoms that interfere with daily functioning. In adults, the main features of ADHD may include difficulty paying attention, impulsiveness and restlessness. Symptoms can range from mild to severe.

Many adults with ADHD aren't aware they have it — they just know that everyday tasks can be a challenge. Adults with ADHD may find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social plans. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings and outbursts of anger.

Adult ADHD symptoms may include:

• Impulsiveness
• Disorganization and problems prioritizing
• Poor time management skills
• Problems focusing on a task
• Trouble multitasking
• Excessive activity or restlessness
• Poor planning
• Low frustration tolerance
• Frequent mood swings
• Problems following through and completing tasks
• Hot temper
• Trouble coping with stress

What's normal and what's ADHD?

Almost everyone has some symptoms similar to ADHD at some point in their lives. If your difficulties are recent or occurred only occasionally in the past, you probably don't have ADHD. ADHD is diagnosed only when symptoms are severe enough to cause ongoing problems in more than one area of your life. These persistent and disruptive symptoms can be traced back to early childhood.

Diagnosis of ADHD in adults can be difficult because certain ADHD symptoms are similar to those caused by other conditions, such as anxiety or mood disorders. And many adults with ADHD also have at least one other mental health condition, such as depression or anxiety.

When to see a doctor

If any of the symptoms listed above continually disrupt your life, talk to your doctor about whether you might have ADHD.

Different types of healthcare professionals may diagnose and supervise treatment for ADHD. Seek a provider who has training and experience in caring for adults with ADHD.

Causes

While the exact cause of ADHD is not clear, research efforts continue. Factors that may be involved in the development of ADHD include:

• Genetics. ADHD can run in families, and studies indicate that genes may play a role.
• Environment. Certain environmental factors also may increase risk, such as lead exposure as a child.
• Problems during development. Problems with the central nervous system at key moments in development may play a role.

Risk factors

Risk of ADHD may increase if:

• You have blood relatives, such as a parent or sibling, with ADHD or another mental health disorder
• Your mother smoked, drank alcohol or used drugs during pregnancy
• As a child, you were exposed to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• You were born prematurely

Complications

ADHD can make life difficult for you. ADHD has been linked to:

• Poor school or work performance
• Unemployment
• Trouble with the law
• Alcohol or other substance abuse
• Frequent car accidents or other accidents
• Unstable relationships
• Poor physical and mental health
• Poor self-image
• Suicide attempts

Coexisting conditions

Although ADHD doesn't cause other psychological or developmental problems, other disorders often occur along with ADHD and make treatment more challenging. These include:

• Mood disorders. Many adults with ADHD also have depression, bipolar disorder or another mood disorder. While mood problems aren't necessarily due directly to ADHD, a repeated pattern of failures and frustrations due to ADHD can worsen depression.
• Anxiety disorders. Anxiety disorders occur fairly often in adults with ADHD. Anxiety disorders may cause overwhelming worry, nervousness and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by ADHD.
• Other psychiatric disorders. Adults with ADHD are at increased risk of other psychiatric disorders, such as personality disorders, intermittent explosive disorder and substance abuse.
• Learning disabilities. Adults with ADHD may score lower on academic testing than would be expected for their age, intelligence and education. Learning disabilities can include problems with understanding and communicating.

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ADHD in children

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.

Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.

While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.

Symptoms

The primary features of attention-deficit/hyperactivity disorder include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they're noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.

ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

There are three subtypes of ADHD:

• Predominantly inattentive.The majority of symptoms fall under inattention.
• Predominantly hyperactive-impulsive. The majority of symptoms are hyperactive and impulsive.
• Combined. The most common type in the U.S., this is a mix of inattentive symptoms and hyperactive-impulsive symptoms.

Inattention

A child who shows a pattern of inattention may often:

• Fail to pay close attention to details or make careless mistakes in schoolwork
• Have trouble staying focused in tasks or play
• Appear not to listen, even when spoken to directly
• Have difficulty following through on instructions and fail to finish schoolwork or chores
• Have trouble organizing tasks and activities
• Avoid or dislike tasks that require focused mental effort, such as homework
• Lose items needed for tasks or activities, for example, toys, school assignments, pencils
• Be easily distracted
• Forget to do some daily activities, such as forgetting to do chores

Hyperactivity and impulsivity

A child who shows a pattern of hyperactive and impulsive symptoms may often:

• Fidget with or tap his or her hands or feet, or squirm in the seat
• Have difficulty staying seated in the classroom or in other situations
• Be on the go, in constant motion
• Run around or climb in situations when it's not appropriate
• Have trouble playing or doing an activity quietly
• Talk too much
• Blurt out answers, interrupting the questioner
• Have difficulty waiting for his or her turn
• Interrupt or intrude on others' conversations, games or activities

Additional issues

In addition, a child with ADHD has:

• Symptoms for at least six months
• Several symptoms that negatively affect school, home life or relationships in more than one setting, such as at home and at school
• Behaviors that aren't normal for children the same age who don't have ADHD

Normal behavior vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.

The same is true of hyperactivity. Young children are naturally energetic — they often are still full of energy long after they've worn their parents out. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they're different from their friends or siblings.

Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.

When to see a doctor

If you're concerned that your child shows signs of ADHD, see your pediatrician or family doctor. Your doctor may refer you to a specialist, but it's important to have a medical evaluation first to check for other possible causes of your child's difficulties.

Causes

While the exact cause of attention-deficit/hyperactivity disorder is not clear, research efforts continue. Factors that may be involved in the development of ADHD include:

• Genetics. ADHD can run in families, and studies indicate that genes may play a role.
• Environment. Certain environmental factors, such as lead exposure, may increase risk.
• Development. Problems with the central nervous system at key moments in development may play a role.

Risk factors

Risk factors for attention-deficit/hyperactivity disorder may include:

• Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder
• Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• Maternal drug use, alcohol use or smoking during pregnancy
• Premature birth

Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this. Many issues in childhood can lead to difficulty sustaining attention, but that's not the same as ADHD.

Complications

Attention-deficit/hyperactivity disorder can make life difficult for children. Children with ADHD:

• Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
• Tend to have more accidents and injuries of all kinds than do children who don't have ADHD
• Tend to have poor self-esteem
• Are more likely to have trouble interacting with and being accepted by peers and adults
• Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions

ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:

• Learning disabilities, including problems with understanding and communicating
• Anxiety disorders, which may cause overwhelming worry, nervousness
• Depression, which frequently occurs in children with ADHD
• Disruptive mood dysregulation disorder, characterized by irritability and problems tolerating frustration
• Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures
• Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals
• Bipolar disorder, which includes depression as well as manic behavior
• Tourette syndrome, a neurological disorder characterized by repetitive muscle or vocal tics

Prevention

To help reduce your child's risk of attention-deficit/hyperactivity disorder:

• During pregnancy, avoid anything that could harm fetal development. For example, don't drink alcohol, use recreational drugs or smoke cigarettes.
• Protect your child from exposure to pollutants and toxins, including cigarette smoke and lead paint (found in some old buildings).
• Limit screen time. Although still unproved, it may be prudent for children to avoid excessive exposure to TV and video games in the first five years of life.

If your child has ADHD, to help reduce problems or complications:

• Be consistent, set limits and have clear consequences for your child's behavior.
• Put together a daily routine for your child with clear expectations that include such things as bedtime, morning time, mealtime, simple chores and TV.
• Avoid multitasking yourself when talking with your child, make eye contact when giving instructions, and set aside a few minutes every day to praise your child.
• Work with teachers and caregivers to identify problems early, to decrease the impact of the condition on your child's life.

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Anxiety

Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. You may avoid places or situations to prevent these feelings. Symptoms may start during childhood or the teen years and continue into adulthood.

Examples of anxiety disorders include generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. You can have more than one anxiety disorder. Sometimes anxiety results from a medical condition that needs treatment.

Whatever form of anxiety you have, treatment can help.

Symptoms

Common anxiety signs and symptoms include:

• Feeling nervous, restless or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety

Several types of anxiety disorders exist:

• Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.
• Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.
• Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders or depression.
• Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they've occurred.
• Selective mutism is a consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.
• Separation anxiety disorder is a childhood disorder characterized by anxiety that's excessive for the child's developmental level and related to separation from parents or others who have parental roles.
• Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.
• Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.
• Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of abusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.
• Other specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don't meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.

When to see a doctor

See your doctor if:

• You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life
• Your fear, worry or anxiety is upsetting to you and difficult to control
• You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety
• You think your anxiety could be linked to a physical health problem
• You have suicidal thoughts or behaviors — if this is the case, seek emergency treatment immediately

Your worries may not go away on their own, and they may get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It's easier to treat if you get help early.

Causes

The causes of anxiety disorders aren't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety. Inherited traits also can be a factor.

Medical causes

For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.

Examples of medical problems that can be linked to anxiety include:

• Heart disease
• Diabetes
• Thyroid problems, such as hyperthyroidism
• Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma
• Drug abuse or withdrawal
• Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications
• Chronic pain or irritable bowel syndrome
• Rare tumors that produce certain "fight-or-flight" hormones

Sometimes anxiety can be a side effect of certain medications.

It's possible that your anxiety may be due to an underlying medical condition if:

• You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder
• You didn't have an anxiety disorder as a child
• You don't avoid certain things or situations because of anxiety
• You have a sudden occurrence of anxiety that seems unrelated to life events and you didn't have a previous history of anxiety

Risk factors

These factors may increase your risk of developing an anxiety disorder:

• Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.
• Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.
• Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress or ongoing worry about finances.
• Personality. People with certain personality types are more prone to anxiety disorders than others are.
• Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.
• Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.
• Drugs or alcohol. Drug or alcohol use or abuse or withdrawal can cause or worsen anxiety.

Complications

Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:

• Depression (which often occurs with an anxiety disorder) or other mental health disorders
• Substance abuse
• Trouble sleeping (insomnia)
• Digestive or bowel problems
• Headaches and chronic pain
• Social isolation
• Problems functioning at school or work
• Poor quality of life
• Suicide

Prevention

There's no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:

• Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
• Stay active. Participate in activities that you enjoy and that make you feel good about yourself. Enjoy social interaction and caring relationships, which can lessen your worries.
• Avoid alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a support group to help you.

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Bipolar disorder

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

• Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).
• Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.
• Cyclothymic disorder. You've had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
• Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

• Abnormally upbeat, jumpy or wired
• Increased activity, energy or agitation
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Distractibility
• Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

• Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
• Marked loss of interest or feeling no pleasure in all — or almost all — activities
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
• Either insomnia or sleeping too much
• Either restlessness or slowed behavior
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Thinking about, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.

And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

• Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
• Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

• Having a first-degree relative, such as a parent or sibling, with bipolar disorder
• Periods of high stress, such as the death of a loved one or other traumatic event
• Drug or alcohol abuse

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

• Problems related to drug and alcohol use
• Suicide or suicide attempts
• Legal or financial problems
• Damaged relationships
• Poor work or school performance

Co-occurring conditions

If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

• Anxiety disorders
• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Alcohol or drug problems
• Physical health problems, such as heart disease, thyroid problems, headaches or obesity

Prevention

There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

• Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.
• Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.
• Take your medications exactly as directed. You may be tempted to stop treatment — but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.

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Chronic illness and chronic pain

Chronic pain is persistent, lasting for months or even longer. Chronic pain is considered a health condition in itself.

With acute pain, you typically know exactly where and why it hurts. Your elbow burns after a scrape or you feel pain at the site of a surgical incision. Acute pain is triggered by tissue damage. Its purpose is to alert you to injury and protect you from further harm.

With chronic pain, you might not know the reason for the pain. For example, an injury has healed, yet the pain remains — and might even become more intense. Chronic pain can also occur without any indication of an injury or illness.

Causes of pain

At the most basic level, pain begins when particular nerve endings are stimulated. This might result from damage to your body tissues, such as when you cut yourself. Pain can also result from damage or disruption to the nerves themselves. Sometimes pain occurs for no known cause, or long after an injury has healed.

Pain can affect any part of your body. Some of the most common forms of pain are back and neck pain, joint pain, headaches, pain from nerve damage, pain from an injury, cancer pain, and pain-related conditions such as fibromyalgia (a disorder that causes widespread musculoskeletal pain).

Pain from tissue damage

Pain is your body's way of alerting you to danger and letting you know what's happening in your body. You perceive pain through sensory nerve cells. These are the same type of cells that transmit information from your senses, allowing you to smell, see, hear, taste and touch.

The nerve cells that respond to pain are part of the peripheral nervous system — which includes all of the body's nerves except those in the spinal cord and brain (the central nervous system). Peripheral nerve cells align into a network of fibers that carry messages from skin, muscles and internal organs to your spinal cord and brain. The messages take the form of electrical currents and chemical interactions.

The peripheral nerve fibers have special endings that can sense different types of harmful stimuli — anything that damages or threatens to damage tissues in your body. It could be a cut, pressure, heat, inflammation, even chemical changes. Injuries, illnesses and surgery all can cause tissue damage.

These specialized nerve endings are called nociceptors (no-sih-SEP-turs). You have millions of them in your skin, bones, joints, muscles and connective tissues, as well as in the protective membranes around your internal organs.

In response to tissue damage, nociceptors at the source of the injury relay pain messages in the form of electrical impulses. These pain messages travel along a peripheral nerve to your spinal cord.

This type of pain is referred to as nociceptive pain. It may be mild or severe. It may be sharp, stabbing, throbbing, burning, stinging, tingling, nagging, dull or aching. Ouch!

The pain pathway

In your spinal cord, specialized nerve cells filter and prioritize messages from the peripheral nerves. These nerve cells act like gates, controlling which messages get through to your brain — and at what speed and strength.Severe pain, as from a burn, is processed as an urgent warning, triggering your muscles to pull your hand away from the stove. Some pain messages, such as from a scratch or an upset stomach, are relayed more slowly or with less strength.

From the spinal cord, pain messages travel to the brain. Your brain responds by sending back messages that promote the healing process. For example, the brain can signal your autonomic nervous system, which controls blood flow, to send additional white blood cells and platelets to help repair tissue at an injury site. Your brain can also signal the release of pain-suppressing chemicals.

Pain results from a series of complex electrical and chemical changes involving your peripheral nerves, spinal cord and brain. 

 

Pain caused by nerve damage

Sometimes pain results from damage to one or more peripheral or spinal nerves. This can happen as a result of an accident, infection, surgery or disease. The damaged nerves will misfire and send pain signals spontaneously, rather than in response to an injury.

This type of pain, called neuropathic pain, is often described as burning, freezing, numbing or tingling. It can also create a "pins and needles" sensation. A common form of neuropathic pain occurs when diabetes damages the small nerves in the hands and feet, producing a painful burning sensation.

Another form of neuropathic pain happens when pain pathways in the peripheral nerves and spinal cord become persistently activated. This process, called sensitization, amplifies the pain message. It's out of proportion to or even disconnected from the original disease or injury. This is what happens in so-called phantom limb pain — even though an injured limb is gone, the pain transmission pathways along the nerves are still activated, as if the limb is still there.

Other influences on pain

An injury or illness that is extremely painful for one person might be only slightly bothersome for another. Why is this? A person's response to pain is heavily influenced by many individual traits, as well as psychological, emotional and social factors.

When pain messages reach your brain, they pass through the emotional and thinking regions, as well as the physical sensation region. A person's experience of pain is shaped by the complex emotional and cognitive processing that accompanies the physical damage or sensation. So pain really is in your head as well as your body.

Factors that can influence how sensitive you are to pain and how you respond to it include:

• Genetics. Your genetic makeup affects how sensitive your body is to pain signals and how you perceive pain. Some evidence suggests that the tendency to develop neuropathic pain after a nerve injury also can have a strong genetic component. Genetic factors will also influence your response to pain medications.
• Gender. Women report more frequent pain, more severe levels of pain and longer-lasting pain than men do. It's not known whether this is due to biological differences or psychological and social factors.
• Long-term health problems. Many chronic illnesses and conditions, such as fibromyalgia, migraine headaches and irritable bowel syndrome, are associated with pain.
• Psychological factors. Pain is more prevalent in individuals with depression, anxiety or low self-esteem. An exaggerated pessimism or "catastrophizing" of pain can also make it worse.
• Social factors. Stress and social isolation add to the experience of pain. Research also suggests that lower education levels, lower income and being unemployed are linked to a higher prevalence of pain.
• Past experiences. Your memories of past painful experiences can influence your current experiences. If you had a bad experience with a dentist or have never been to a dentist and are very nervous about it, even a minor probe can produce a strong pain response. And pain itself can predispose you to more pain: The most consistent risk factor for developing a painful condition is a previous episode of pain.
• Other individual factors. Your upbringing, coping strategies and general attitude can affect how you interpret pain messages and how you tolerate pain. So can your expectations as to how you "think" you should feel or react.

The impact of pain

Pain is common and complex — and a burden. Pain interferes with your ability to take part in your daily activities. It can negatively affect your relationships and interactions with others. It can sap your energy and make you feel less healthy overall. The more severe the pain, the heavier a toll it takes on your well-being.

Fortunately, many different treatment options are available to help manage both acute pain and chronic pain. Your attitude and lifestyle will also play a key role. If you approach any painful condition with a positive attitude and a willingness to change, you're likely to be successful in coping with your pain.

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Depression

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

• In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
• In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

• Memory difficulties or personality changes
• Physical aches or pain
• Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
• Often wanting to stay at home, rather than going out to socialize or doing new things
• Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any healthcare professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

• Call your doctor or mental health professional.
• Call the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. Use that same number and press "1" to reach the Veterans Crisis Line.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes

It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

• Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
• Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
• Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

• Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
• Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
• Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
• Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation
• History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
• Abuse of alcohol or recreational drugs
• Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
• Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

• Excess weight or obesity, which can lead to heart disease and diabetes
• Pain or physical illness
• Alcohol or drug misuse
• Anxiety, panic disorder or social phobia
• Family conflicts, relationship difficulties, and work or school problems
• Social isolation
• Suicidal feelings, suicide attempts or suicide
• Self-mutilation, such as cutting
• Premature death from medical conditions

Prevention

There's no sure way to prevent depression. However, these strategies may help.

• Take steps to control stress, to increase your resilience and boost your self-esteem.
• Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
• Get treatment at the earliest sign of a problem to help prevent depression from worsening.
• Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

Learn about diagnosis and treatment.

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Drug addiction

Drug addiction, also called substance use disorder, is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication. Substances such as alcohol, marijuana and nicotine also are considered drugs. When you're addicted, you may continue using the drug despite the harm it causes.

Drug addiction can start with experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent. For others, particularly with opioids, drug addiction begins with exposure to prescribed medications, or receiving medications from a friend or relative who has been prescribed the medication.

The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.

As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good. As your drug use increases, you may find that it's increasingly difficult to go without the drug. Attempts to stop drug use may cause intense cravings and make you feel physically ill (withdrawal symptoms).

You may need help from your doctor, family, friends, support groups or an organized treatment program to overcome your drug addiction and stay drug-free.

Symptoms

Drug addiction symptoms or behaviors include, among others:

• Feeling that you have to use the drug regularly — daily or even several times a day
• Having intense urges for the drug that block out any other thoughts
• Over time, needing more of the drug to get the same effect
• Taking larger amounts of the drug over a longer period of time than you intended
• Making certain that you maintain a supply of the drug
• Spending money on the drug, even though you can't afford it
• Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
• Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm
• Doing things to get the drug that you normally wouldn't do, such as stealing
• Driving or doing other risky activities when you're under the influence of the drug
• Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug
• Failing in your attempts to stop using the drug
• Experiencing withdrawal symptoms when you attempt to stop taking the drug

Recognizing unhealthy drug use in family members

Sometimes it's difficult to distinguish normal teenage moodiness or angst from signs of drug use. Possible indications that your teenager or other family member is using drugs include:

• Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
• Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
• Neglected appearance — lack of interest in clothing, grooming or looks
• Changes in behavior — exaggerated efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behavior and in relationships with family and friends
• Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

Recognizing signs of drug use or intoxication

Signs and symptoms of drug use or intoxication may vary, depending on the type of drug. Below you'll find several examples.

Marijuana, hashish and other cannabis-containing substances

People use cannabis by smoking, eating or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried.

Signs and symptoms of recent use can include:

• A sense of euphoria or feeling "high"
• A heightened sense of visual, auditory and taste perception
• Increased blood pressure and heart rate
• Red eyes
• Dry mouth
• Decreased coordination
• Difficulty concentrating or remembering
• Slowed reaction time
• Anxiety or paranoid thinking
• Cannabis odor on clothes or yellow fingertips
• Exaggerated cravings for certain foods at unusual times

Long-term (chronic) use is often associated with:

• Decreased mental sharpness
• Poor performance at school or at work
• Reduced number of friends and interests

K2, spice and bath salts

Two groups of synthetic drugs — synthetic cannabinoids and substituted or synthetic cathinones — are illegal in most states. The effects of these drugs can be dangerous and unpredictable, as there is no quality control and some ingredients may not be known.

Synthetic cannabinoids, also called K2 or Spice, are sprayed on dried herbs and then smoked, but can be prepared as an herbal tea. Despite manufacturer claims, these are chemical compounds rather than "natural" or harmless products. These drugs can produce a "high" similar to marijuana and have become a popular but dangerous alternative.

Signs and symptoms of recent use can include:

• A sense of euphoria or feeling "high"
• Elevated mood
• An altered sense of visual, auditory and taste perception
• Extreme anxiety or agitation
• Paranoia
• Hallucinations
• Increased heart rate and blood pressure or heart attack
• Vomiting
• Confusion

Substituted cathinones, also called "bath salts," are mind-altering (psychoactive) substances similar to amphetamines such as ecstasy (MDMA) and cocaine. Packages are often labeled as other products to avoid detection.

Despite the name, these are not bath products such as Epsom salts. Substituted cathinones can be eaten, snorted, inhaled or injected and are highly addictive. These drugs can cause severe intoxication, which results in dangerous health effects or even death.

Signs and symptoms of recent use can include:

• Euphoria
• Increased sociability
• Increased energy and agitation
• Increased sex drive
• Increased heart rate and blood pressure
• Problems thinking clearly
• Loss of muscle control
• Paranoia
• Panic attacks
• Hallucinations
• Delirium
• Psychotic and violent behavior

Barbiturates, benzodiazepines and hypnotics

Barbiturates, benzodiazepines and hypnotics are prescription central nervous system depressants. They're often used and misused in search for a sense of relaxation or a desire to "switch off" or forget stress-related thoughts or feelings.

• Barbiturates. Examples include phenobarbital and secobarbital (Seconal).
• Benzodiazepines. Examples include sedatives, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).
• Hypnotics. Examples include prescription sleeping medications such as zolpidem (Ambien, Intermezzo, others) and zaleplon (Sonata).

Signs and symptoms of recent use can include:

• Drowsiness
• Slurred speech
• Lack of coordination
• Irritability or changes in mood
• Problems concentrating or thinking clearly
• Memory problems
• Involuntary eye movements
• Lack of inhibition
• Slowed breathing and reduced blood pressure
• Falls or accidents
• Dizziness

Meth, cocaine and other stimulants

Stimulants include amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin, Concerta, others) and amphetamine-dextroamphetamine (Adderall, Adderall XR, others). They are often used and misused in search of a "high," or to boost energy, to improve performance at work or school, or to lose weight or control appetite.

Signs and symptoms of recent use can include:

• Feeling of exhilaration and excess confidence
• Increased alertness
• Increased energy and restlessness
• Behavior changes or aggression
• Rapid or rambling speech
• Dilated pupils
• Confusion, delusions and hallucinations
• Irritability, anxiety or paranoia
• Changes in heart rate, blood pressure and body temperature
• Nausea or vomiting with weight loss
• Impaired judgment
• Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
• Mouth sores, gum disease and tooth decay from smoking drugs ("meth mouth")
• Insomnia
• Depression as the drug wears off

Club drugs

Club drugs are commonly used at clubs, concerts and parties. Examples include ecstasy or molly (MDMA), gamma-hydroxybutyric acid (GHB), flunitrazepam (Rohypnol ― a brand used outside the U.S. ― also called roofie) and ketamine. These drugs are not all in the same category, but they share some similar effects and dangers, including long-term harmful effects.

Because GHB and flunitrazepam can cause sedation, muscle relaxation, confusion and memory loss, the potential for sexual misconduct or sexual assault is associated with the use of these drugs.

Signs and symptoms of use of club drugs can include:

• Hallucinations
• Paranoia
• Dilated pupils
• Chills and sweating
• Involuntary shaking (tremors)
• Behavior changes
• Muscle cramping and teeth clenching
• Muscle relaxation, poor coordination or problems moving
• Reduced inhibitions
• Heightened or altered sense of sight, sound and taste
• Poor judgment
• Memory problems or loss of memory
• Reduced consciousness
• Increased or decreased heart rate and blood pressure

Hallucinogens

Use of hallucinogens can produce different signs and symptoms, depending on the drug. The most common hallucinogens are lysergic acid diethylamide (LSD) and phencyclidine (PCP).

LSD use may cause:

• Hallucinations
• Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
• Impulsive behavior
• Rapid shifts in emotions
• Permanent mental changes in perception
• Rapid heart rate and high blood pressure
• Tremors
• Flashbacks, a re-experience of the hallucinations — even years later

PCP use may cause:

• A feeling of being separated from your body and surroundings
• Hallucinations
• Problems with coordination and movement
• Aggressive, possibly violent behavior
• Involuntary eye movements
• Lack of pain sensation
• Increase in blood pressure and heart rate
• Problems with thinking and memory
• Problems speaking
• Impaired judgment
• Intolerance to loud noise
• Sometimes seizures or coma

Inhalants

Signs and symptoms of inhalant use vary, depending on the substance. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids and household aerosol products. Due to the toxic nature of these substances, users may develop brain damage or sudden death.

Signs and symptoms of use can include:

• Possessing an inhalant substance without a reasonable explanation
• Brief euphoria or intoxication
• Decreased inhibition
• Combativeness or belligerence
• Dizziness
• Nausea or vomiting
• Involuntary eye movements
• Appearing intoxicated with slurred speech, slow movements and poor coordination
• Irregular heartbeats
• Tremors
• Lingering odor of inhalant material
• Rash around the nose and mouth

Opioid painkillers

Opioids are narcotic, painkilling drugs produced from opium or made synthetically. This class of drugs includes, among others, heroin, morphine, codeine, methadone and oxycodone.

Sometimes called the "opioid epidemic," addiction to opioid prescription pain medications has reached an alarming rate across the United States. Some people who've been using opioids over a long period of time may need physician-prescribed temporary or long-term drug substitution during treatment.

Signs and symptoms of narcotic use and dependence can include:

• Reduced sense of pain
• Agitation, drowsiness or sedation
• Slurred speech
• Problems with attention and memory
• Constricted pupils
• Lack of awareness or inattention to surrounding people and things
• Problems with coordination
• Depression
• Confusion
• Constipation
• Runny nose or nose sores (if snorting drugs)
• Needle marks (if injecting drugs)

When to see a doctor

If your drug use is out of control or causing problems, get help. The sooner you seek help, the greater your chances for a long-term recovery. Talk with your primary doctor or see a mental health professional, such as a doctor who specializes in addiction medicine or addiction psychiatry, or a licensed alcohol and drug counselor.

Make an appointment to see a doctor if:

• You can't stop using a drug
• You continue using the drug despite the harm it causes
• Your drug use has led to unsafe behavior, such as sharing needles or unprotected sex
• You think you may be having withdrawal symptoms after stopping drug use

If you're not ready to approach a doctor, help lines or hotlines may be a good place to learn about treatment. You can find these lines listed on the internet or in the phone book.

When to seek emergency help

Seek emergency help if you or someone you know has taken a drug and:

• May have overdosed
• Shows changes in consciousness
• Has trouble breathing
• Has seizures or convulsions
• Has signs of a possible heart attack, such as chest pain or pressure
• Has any other troublesome physical or psychological reaction to use of the drug

Staging an intervention

People struggling with addiction usually deny that their drug use is problematic and are reluctant to seek treatment. An intervention presents a loved one with a structured opportunity to make changes before things get even worse and can motivate someone to seek or accept help.

An intervention should be carefully planned and may be done by family and friends in consultation with a doctor or professional such as a licensed alcohol and drug counselor, or directed by an intervention professional. It involves family and friends and sometimes co-workers, clergy or others who care about the person struggling with addiction.

During the intervention, these people gather together to have a direct, heart-to-heart conversation with the person about the consequences of addiction and ask him or her to accept treatment.

Causes

Like many mental health disorders, several factors may contribute to development of drug addiction. The main factors are:

• Environment. Environmental factors, including your family's beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use.
• Genetics. Once you've started using a drug, the development into addiction may be influenced by inherited (genetic) traits, which may delay or speed up the disease progression.

Changes in the brain

Physical addiction appears to occur when repeated use of a drug changes the way your brain feels pleasure. The addicting drug causes physical changes to some nerve cells (neurons) in your brain. Neurons use chemicals called neurotransmitters to communicate. These changes can remain long after you stop using the drug.

Risk factors

People of any age, sex or economic status can become addicted to a drug. Certain factors can affect the likelihood and speed of developing an addiction:

• Family history of addiction. Drug addiction is more common in some families and likely involves genetic predisposition. If you have a blood relative, such as a parent or sibling, with alcohol or drug addiction, you're at greater risk of developing a drug addiction.
• Mental health disorder. If you have a mental health disorder such as depression, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder, you're more likely to become addicted to drugs. Using drugs can become a way of coping with painful feelings, such as anxiety, depression and loneliness, and can make these problems even worse.
• Peer pressure. Peer pressure is a strong factor in starting to use and misuse drugs, particularly for young people.
• Lack of family involvement. Difficult family situations or lack of a bond with your parents or siblings may increase the risk of addiction, as can a lack of parental supervision.
• Early use. Using drugs at an early age can cause changes in the developing brain and increase the likelihood of progressing to drug addiction.
• Taking a highly addictive drug. Some drugs, such as stimulants, cocaine or opioid painkillers, may result in faster development of addiction than other drugs. Smoking or injecting drugs can increase the potential for addiction. Taking drugs considered less addicting — so-called "light drugs" — can start you on a pathway of drug use and addiction.

Complications

Drug use can have significant and damaging short-term and long-term effects. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol. Here are some examples.

• Methamphetamine, opiates and cocaine are highly addictive and cause multiple short-term and long-term health consequences, including psychotic behavior, seizures or death due to overdose.
• GHB and flunitrazepam may cause sedation, confusion and memory loss. These so-called "date rape drugs" are known to impair the ability to resist unwanted contact and recollection of the event. At high doses, they can cause seizures, coma and death. The danger increases when these drugs are taken with alcohol.
• Ecstasy or molly (MDMA) can cause dehydration, electrolyte imbalance and complications that can include seizures. Long-term, MDMA can damage the brain.
• One particular danger of club drugs is that the liquid, pill or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs.
• Due to the toxic nature of inhalants, users may develop brain damage of different levels of severity.

Other life-changing complications

Dependence on drugs can create a number of dangerous and damaging complications, including:

• Getting a communicable disease. People who are addicted to a drug are more likely to get an infectious disease, such as HIV, either through unsafe sex or by sharing needles.
• Other health problems. Drug addiction can lead to a range of both short-term and long-term mental and physical health problems. These depend on what drug is taken.
• Accidents. People who are addicted to drugs are more likely to drive or do other dangerous activities while under the influence.
• Suicide. People who are addicted to drugs die by suicide more often than people who aren't addicted.
• Family problems. Behavioral changes may cause marital or family conflict and custody issues.
• Work issues. Drug use can cause declining performance at work, absenteeism and eventual loss of employment.
• Problems at school. Drug use can negatively affect academic performance and motivation to excel in school.
• Legal issues. Legal problems are common for drug users and can stem from buying or possessing illegal drugs, stealing to support the drug addiction, driving while under the influence of drugs or alcohol, or disputes over child custody.
• Financial problems. Spending money to support drug use takes away money from other needs, could lead to debt, and can lead to illegal or unethical behaviors.

Prevention

The best way to prevent an addiction to a drug is not to take the drug at all. If your doctor prescribes a drug with the potential for addiction, use care when taking the drug and follow the instructions provided by your doctor.

Doctors should prescribe these medications at safe doses and amounts and monitor their use so that you're not given too great a dose or for too long a time. If you feel you need to take more than the prescribed dose of a medication, talk to your doctor.

Preventing drug misuse in children and teenagers

Take these steps to help prevent drug misuse in your children and teenagers:

• Communicate. Talk to your children about the risks of drug use and misuse.
• Listen. Be a good listener when your children talk about peer pressure, and be supportive of their efforts to resist it.
• Set a good example. Don't misuse alcohol or addictive drugs. Children of parents who misuse drugs are at greater risk of drug addiction.
• Strengthen the bond. Work on your relationship with your children. A strong, stable bond between you and your child will reduce your child's risk of using or misusing drugs.

Preventing a relapse

Once you've been addicted to a drug, you're at high risk of falling back into a pattern of addiction. If you do start using the drug, it's likely you'll lose control over its use again — even if you've had treatment and you haven't used the drug for some time.

• Stick with your treatment plan. Monitor your cravings. It may seem like you've recovered and you don't need to keep taking steps to stay drug-free. But your chances of staying drug-free will be much higher if you continue seeing your therapist or counselor, going to support group meetings and taking prescribed medication.
• Avoid high-risk situations. Don't go back to the neighborhood where you used to get your drugs. And stay away from your old drug crowd.
• Get help immediately if you use the drug again. If you start using the drug again, talk to your doctor, your mental health professional or someone else who can help you right away.

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Eating disorders

Eating disorders are serious conditions related to persistent eating behaviors that negatively impact your health, your emotions and your ability to function in important areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.

Most eating disorders involve focusing too much on your weight, body shape and food, leading to dangerous eating behaviors. These behaviors can significantly impact your body's ability to get adequate nutrition. Eating disorders can harm the heart, digestive system, bones, and teeth and mouth, and lead to other diseases.

Eating disorders often develop in the teen and young adult years, although they can develop at other ages. With treatment, you can return to healthier eating habits and sometimes reverse serious complications caused by the eating disorder.

Symptoms

Symptoms vary, depending on the type of eating disorder. Anorexia nervosa, bulimia nervosa and binge-eating disorder are the most common eating disorders.

Anorexia nervosa

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is a potentially life-threatening eating disorder characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight or shape. People with anorexia use extreme efforts to control their weight and shape, which often significantly interferes with their health and life activities.

When you have anorexia, you excessively limit calories or use other methods to lose weight, such as excessive exercise, using laxatives or diet aids, or vomiting after eating. Efforts to reduce your weight, even when underweight, can cause severe health problems, sometimes to the point of deadly self-starvation.

Bulimia nervosa

Bulimia (boo-LEE-me-uh) nervosa — commonly called bulimia — is a serious, potentially life-threatening eating disorder. When you have bulimia, you have episodes of bingeing and purging that involve feeling a lack of control over your eating. Many people with bulimia also restrict their eating during the day, which often leads to more binge eating and purging.

During these episodes, you typically eat a large amount of food in a short time, and then try to rid yourself of the extra calories in an unhealthy way. Because of guilt, shame and an intense fear of weight gain from overeating, you may force vomiting (purging bulimia), exercise too much, or use other methods, such as laxatives, to get rid of the calories (nonpurging bulimia).

If you have bulimia, you're probably preoccupied with your weight and body shape, and may judge yourself severely and harshly for your self-perceived flaws. You may be at a normal weight or even a bit overweight.

Binge-eating disorder

When you have binge-eating disorder, you regularly eat too much food (binge) and feel a lack of control over your eating. You may eat quickly or eat more food than intended, even when you're not hungry, and you may continue eating even long after you're uncomfortably full.

After a binge, you may feel guilty, disgusted or ashamed by your behavior and the amount of food eaten. But you don't try to compensate for this behavior with excessive exercise or purging, as someone with bulimia or anorexia might. Embarrassment can lead to eating alone to hide your bingeing.

A new round of bingeing usually occurs at least once a week. You may be normal weight, overweight or obese.

Other eating disorders

Other eating disorders include pica, rumination disorder and avoidant/restrictive food intake disorder.

Pica

Pica is persistently eating nonfood items, such as soap, cloth, talcum powder or dirt, over a period of at least one month. Eating such substances is not appropriate for the person's developmental level and not part of a specific cultural or social practice.

Persistently eating these nonfood items can result in medical complications such as poisoning, intestinal problems or infections. Pica often occurs along with other disorders such as autism spectrum disorder or intellectual disability.

Rumination disorder

Rumination disorder is repeatedly and persistently regurgitating food after eating, but it's not due to a medical condition or another eating disorder such as anorexia, bulimia or binge-eating disorder. Food is brought back up into the mouth without nausea or gagging. Sometimes regurgitated food is rechewed and reswallowed or spit out.

The disorder may result in malnutrition if the food is spit out or if the person eats significantly less to prevent the behavior. The occurrence of rumination disorder may be more common in infancy or in people who have an intellectual disability.

Avoidant/restrictive food intake disorder

This disorder is characterized by failing to meet your minimum daily nutrition requirements because you don't have an interest in eating; you avoid food with certain sensory characteristics, such as color, texture, smell or taste; or you're concerned about the consequences of eating, such as fear of choking. Food is not avoided because of fear of gaining weight.

The disorder can result in significant weight loss or failure to gain weight in childhood, as well as nutritional deficiencies that can cause health problems.

Avoidant/restrictive food intake disorder is not diagnosed when symptoms are part of another eating disorder, such as anorexia, or part of a medical problem or other mental disorder.

When to see a doctor

Because of its powerful pull, an eating disorder can be difficult to manage or overcome by yourself. Eating disorders can virtually take over your life. If you're experiencing any of these problems, or if you think you may have an eating disorder, seek medical help.

Urging a loved one to seek treatment

Unfortunately, many people with eating disorders may not think they need treatment. If you're worried about a loved one, urge him or her to talk to a doctor. Even if your loved one isn't ready to acknowledge having an issue with food, you can open the door by expressing concern and a desire to listen.

Be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders. Red flags that may indicate an eating disorder include:

• Skipping meals or making excuses for not eating
• Adopting an overly restrictive vegetarian diet
• Excessive focus on healthy eating
• Making own meals rather than eating what the family eats
• Withdrawing from normal social activities
• Persistent worry or complaining about being fat and talk of losing weight
• Frequent checking in the mirror for perceived flaws
• Repeatedly eating large amounts of sweets or high-fat foods
• Use of dietary supplements, laxatives or herbal products for weight loss
• Excessive exercise
• Calluses on the knuckles from inducing vomiting
• Problems with loss of tooth enamel that may be a sign of repeated vomiting
• Leaving during meals to use the toilet
• Eating much more food in a meal or snack than is considered normal
• Expressing depression, disgust, shame or guilt about eating habits
• Eating in secret

If you're worried that your child may have an eating disorder, contact his or her doctor to discuss your concerns. If needed, you can get a referral to a qualified mental health provider for treatment.

Causes

The exact cause of eating disorders is unknown. As with other mental illnesses, there may be many causes, such as:

• Genetics. Certain people may have genes that increase their risk of developing eating disorders. People with first-degree relatives — siblings or parents — with an eating disorder may be more likely to develop an eating disorder, too.
• Psychological and emotional health. People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior and troubled relationships.
• Society. Success and worth are often equated with being thin in popular culture. Peer pressure and what people see in the media may fuel this desire to be thin.

Risk factors

Certain situations and events might increase the risk of developing an eating disorder. These risk factors may include:

• Being female. Teenage girls and young women are more likely than teenage boys and young men to have anorexia or bulimia, but males can have eating disorders, too.
• Age. Although eating disorders can occur across a broad age range — including childhood, the teenage years and older adulthood — they are much more common during the teens and early 20s.
• Family history. Eating disorders are significantly more likely to occur in people who have parents or siblings who've had an eating disorder.
• Mental health disorders. People with depression, anxiety disorder or obsessive-compulsive disorder are more likely to have an eating disorder.
• Dieting. People who lose weight are often reinforced by positive comments from others and by their changing appearance. This may cause some people to take dieting too far, leading to an eating disorder.
• Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress, which may increase your risk of an eating disorder.
• Sports, work and artistic activities. Athletes, actors, dancers and models may be at higher risk of eating disorders. Coaches and parents may unwittingly contribute to eating disorders by encouraging young athletes to lose weight.

Complications

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely you are to experience serious complications, such as:

• Significant medical problems
• Depression and anxiety
• Suicidal thoughts or behavior
• Problems with growth and development
• Social and relationship problems
• Substance use disorders
• Work and school issues
• Death

Prevention

Although there's no sure way to prevent eating disorders, here are some strategies to help your child develop healthy-eating behaviors:

• Encourage healthy-eating habits and avoid dieting around your children. Family dining habits may influence the relationships children develop with food. Eating meals together gives you an opportunity to teach children about the pitfalls of dieting and encourages eating a balanced diet in reasonable portions.
• Talk to your child. Because there are numerous websites that promote anorexia as a lifestyle choice rather than an eating disorder, it's important to talk to your child about the risks of unhealthy eating choices.
• Cultivate and reinforce a healthy body image in your children, whatever their shape or size. Talk to them about their self-image and offer reassurance that body shapes can vary. Don't criticize your own body in front of your children. Messages of acceptance and respect can help build healthy self-esteem and resilience that will carry children through the rocky periods of the teen years.
• Enlist the help of your child's doctor. At well-child visits, doctors may be in a good position to identify early indicators of an eating disorder. They can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance. These visits should include checks of height and weight percentiles and body mass index, which can alert you and your child's doctor to any significant changes.

If you notice a family member or friend with low self-esteem, severe dieting, frequent overeating or dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, reaching out with compassion may encourage the person to seek treatment.

Learn about diagnosis and treatment. 

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Headaches

Headache is pain in any region of the head. Headaches may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a viselike quality.

A headache may appear as a sharp pain, a throbbing sensation or a dull ache. Headaches can develop gradually or suddenly, and may last from less than an hour to several days.

Causes

Your headache symptoms can help your doctor determine its cause and the appropriate treatment. Most headaches aren't the result of a serious illness, but some may result from a life-threatening condition requiring emergency care.

Headaches are generally classified by cause:

Primary headaches

A primary headache is caused by overactivity of or problems with pain-sensitive structures in your head. A primary headache isn't a symptom of an underlying disease.

Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely to develop such headaches.

The most common primary headaches are:

• Cluster headache
• Migraine (with and without aura)
• Tension headache (also known as tension-type headache)
• Trigeminal autonomic cephalalgia (TAC), such as cluster headache and paroxysmal hemicrania

A few headache patterns also are generally considered types of primary headache, but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity.

Although generally considered primary, each could be a symptom of an underlying disease. They include:

• Chronic daily headaches (for example, chronic migraine, chronic tension-type headache, or hemicranias continua)
• Cough headaches
• Exercise headaches
• Sex headaches

Some primary headaches can be triggered by lifestyle factors, including:

• Alcohol, particularly red wine
• Certain foods, such as processed meats that contain nitrates
• Changes in sleep or lack of sleep
• Poor posture
• Skipped meals
• Stress

Secondary headaches

A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches.

Possible causes of secondary headaches include:

• Acute sinusitis
• Arterial tears (carotid or vertebral dissections)
• Blood clot (venous thrombosis) within the brain — separate from stroke
• Brain aneurysm (a bulge in an artery in your brain)
• Brain AVM (brain arteriovenous malformation) — an abnormal formation of brain blood vessels
• Brain tumor
• Carbon monoxide poisoning
• Chiari malformation (structural problem at the base of your skull)
• Concussion
• Dehydration
• Dental problems
• Ear infection (middle ear)
• Encephalitis (brain inflammation)
• Giant cell arteritis (inflammation of the lining of the arteries)
• Glaucoma (acute angle closure glaucoma)
• Hangovers
• High blood pressure (hypertension)
• Influenza (flu) and other febrile (fever) illnesses
• Intracranial hematoma (blood vessel ruptures with bleeding in or around the brain)
• Medications to treat other disorders
• Meningitis (inflammation of the membranes and fluid surrounding your brain and spinal cord)
• Monosodium glutamate (MSG)
• Overuse of pain medication
• Panic attacks and panic disorder
• Post-concussion syndrome
• Pressure from tight headgear, such as a helmet or goggles
• Pseudotumor cerebri (increased pressure inside the skull), also known as idiopathic intracranial hypertension
• Stroke
• Toxoplasmosis
• Trigeminal neuralgia (as well as other neuralgias, all involving irritation of certain nerves connecting the face and brain)

Some types of secondary headaches include:

• Ice cream headaches (commonly called brain freeze)
• Rebound headaches (caused by overuse of pain medication)
• Sinus headaches (caused by inflammation and congestion in sinus cavities)
• Spinal headaches (caused by low pressure or volume of cerebrospinal fluid, possibly the result of spontaneous cerebrospinal fluid leak, spinal tap or spinal anesthesia)
• Thunderclap headaches (a group of disorders that involves sudden, severe headaches with multiple causes)

When to see a doctor

Seek emergency care

A headache can be a symptom of a serious condition, such as a stroke, meningitis or encephalitis.

Go to a hospital emergency room or call 911 or your local emergency number if you're experiencing the worst headache of your life, a sudden, severe headache or a headache accompanied by:

• Confusion or trouble understanding speech
• Fainting
• High fever, greater than 102 F to 104 F (39 C to 40 C)
• Numbness, weakness or paralysis on one side of your body
• Stiff neck
• Trouble seeing
• Trouble speaking
• Trouble walking
• Nausea or vomiting (if not clearly related to the flu or a hangover)

Schedule a doctor's visit

See a doctor if you experience headaches that:

• Occur more often than usual
• Are more severe than usual
• Worsen or don't improve with appropriate use of over-the-counter drugs
• Keep you from working, sleeping or participating in normal activities
• Cause you distress, and you would like to find treatment options that enable you to control them better

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Low self-esteem

Low self-esteem can negatively affect virtually every facet of your life, including your relationships, your job and your health. But you can boost your self-esteem by taking cues from types of mental health counseling.

Consider these steps, based on cognitive behavioral therapy. 

1. Identify troubling conditions or situations

Think about the conditions or situations that seem to deflate your self-esteem. Common triggers might include:

• A work or school presentation
• A crisis at work or home
• A challenge with a spouse, loved one, co-worker or other close contact
• A change in roles or life circumstances, such as a job loss or a child leaving home

2. Become aware of thoughts and beliefs

Once you've identified troubling situations, pay attention to your thoughts about them. This includes what you tell yourself (self-talk) and your interpretation of what the situation means. Your thoughts and beliefs might be positive, negative or neutral. They might be rational, based on reason or facts, or irrational, based on false ideas.

Ask yourself if these beliefs are true. Would you say them to a friend? If you wouldn't say them to someone else, don't say them to yourself. 

3. Challenge negative or inaccurate thinking

Your initial thoughts might not be the only way to view a situation — so test the accuracy of your thoughts. Ask yourself whether your view is consistent with facts and logic or whether other explanations for the situation might be plausible.

Be aware that it can be hard to recognize inaccuracies in thinking. Long-held thoughts and beliefs can feel normal and factual, even though many are just opinions or perceptions.

Also pay attention to thought patterns that erode self-esteem:

• All-or-nothing thinking. You see things as either all good or all bad. For example, "If I don't succeed in this task, I'm a total failure."
• Mental filtering. You see only negatives and dwell on them, distorting your view of a person or situation. For example, "I made a mistake on that report and now everyone will realize I'm not up to this job."
• Converting positives into negatives. You reject your achievements and other positive experiences by insisting that they don't count. For example, "I only did well on that test because it was so easy."
• Jumping to negative conclusions. You reach a negative conclusion when little or no evidence supports it. For example, "My friend hasn't replied to my email, so I must have done something to make her angry."
• Mistaking feelings for facts. You confuse feelings or beliefs with facts. For example, "I feel like a failure, so I must be a failure."
• Negative self-talk. You undervalue yourself, put yourself down or use self-deprecating humor. For example, "I don't deserve anything better."

4. Adjust your thoughts and beliefs

Now replace negative or inaccurate thoughts with accurate, constructive thoughts. Try these strategies:

• Use hopeful statements. Treat yourself with kindness and encouragement. Instead of thinking your presentation won't go well, try telling yourself things such as, "Even though it's tough, I can handle this situation."
• Forgive yourself. Everyone makes mistakes — and mistakes aren't permanent reflections on you as a person. They're isolated moments in time. Tell yourself, "I made a mistake, but that doesn't make me a bad person."
• Avoid 'should' and 'must' statements. If you find that your thoughts are full of these words, you might be putting unreasonable demands on yourself — or on others. Removing these words from your thoughts can lead to more realistic expectations.
• Focus on the positive. Think about the parts of your life that work well. Consider the skills you've used to cope with challenging situations.
• Consider what you've learned. If it was a negative experience, what might you do differently the next time to create a more positive outcome?
• Relabel upsetting thoughts. You don't need to react negatively to negative thoughts. Instead, think of negative thoughts as signals to try new, healthy patterns. Ask yourself, "What can I think and do to make this less stressful?"
• Encourage yourself. Give yourself credit for making positive changes. For example, "My presentation might not have been perfect, but my colleagues asked questions and remained engaged — which means that I accomplished my goal."

You might also try these steps, based on acceptance and commitment therapy. 

1. Identify troubling conditions or situations

Again, think about the conditions or situations that seem to deflate your self-esteem. Once you've identified troubling situations, pay attention to your thoughts about them. 

2. Step back from your thoughts

Repeat your negative thoughts many times or write them down in an unusual way, such as with your nondominant hand. Imagine seeing your negative thoughts written on different objects. You might even sing a song about them in your mind.

These exercises can help you take a step back from thoughts and beliefs that are often automatic and observe them. Instead of trying to change your thoughts, distance yourself from your thoughts. Realize that they are nothing more or less than words. 

3. Accept your thoughts

Instead of fighting, resisting or being overwhelmed by negative thoughts or feelings, accept them. You don't have to like them, just allow yourself to feel them.

Negative thoughts don't need to be controlled, changed or acted upon. Aim to lessen the power of your negative thoughts and their influence on your behavior.

These steps might seem awkward at first, but they'll get easier with practice. As you begin to recognize the thoughts and beliefs that are contributing to your low self-esteem, you can counter them or change the way you think about them. This will help you accept your value as a person. As your self-esteem increases, your confidence and sense of well-being are likely to soar.

In addition to these suggestions, try to remember on a daily basis that you're worth special care. To that end, be sure to:

• Take care of yourself. Follow good health guidelines. Try to exercise at least 30 minutes a day most days of the week. Eat lots of fruits and vegetables. Limit sweets, junk food and animal fats.
• Do things you enjoy. Start by making a list of things you like to do. Try to do something from that list every day.
• Spend time with people who make you happy. Don't waste time on people who don't treat you well.

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Mental illness

Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.

Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.

A mental illness can make you miserable and can cause problems in your daily life, such as at school or work or in relationships. In most cases, symptoms can be managed with a combination of medications and talk therapy (psychotherapy).

Symptoms

Signs and symptoms of mental illness can vary, depending on the disorder, circumstances and other factors. Mental illness symptoms can affect emotions, thoughts and behaviors.

Examples of signs and symptoms include:

• Feeling sad or down
• Confused thinking or reduced ability to concentrate
• Excessive fears or worries, or extreme feelings of guilt
• Extreme mood changes of highs and lows
• Withdrawal from friends and activities
• Significant tiredness, low energy or problems sleeping
• Detachment from reality (delusions), paranoia or hallucinations
• Inability to cope with daily problems or stress
• Trouble understanding and relating to situations and to people
• Alcohol or drug abuse
• Major changes in eating habits
• Sex drive changes
• Excessive anger, hostility or violence
• Suicidal thinking

Sometimes symptoms of a mental health disorder appear as physical problems, such as stomach pain, back pain, headache, or other unexplained aches and pains.

When to see a doctor

If you have any signs or symptoms of a mental illness, see your primary care provider or mental health specialist. Most mental illnesses don't improve on their own, and if untreated, a mental illness may get worse over time and cause serious problems.

If you have suicidal thoughts

Suicidal thoughts and behavior are common with some mental illnesses. If you think you may hurt yourself or attempt suicide, get help right away:

• Call 911 or your local emergency number immediately.
• Call your mental health specialist.
• Call the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org.
• Seek help from your primary care doctor or other healthcare provider.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Suicidal thinking doesn't get better on its own — so get help.

Helping a loved one

If your loved one shows signs of mental illness, have an open and honest discussion with him or her about your concerns. You may not be able to force someone to get professional care, but you can offer encouragement and support. You can also help your loved one find a qualified mental health provider and make an appointment. You may even be able to go along to the appointment.

If your loved one has done self-harm or is considering doing so, take the person to the hospital or call for emergency help.

Causes

Mental illnesses, in general, are thought to be caused by a variety of genetic and environmental factors:

• Inherited traits. Mental illness is more common in people whose blood relatives also have a mental illness. Certain genes may increase your risk of developing a mental illness, and your life situation may trigger it.
• Environmental exposures before birth. Exposure to environmental stressors, inflammatory conditions, toxins, alcohol or drugs while in the womb can sometimes be linked to mental illness.
• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When the neural networks involving these chemicals are impaired, the function of nerve receptors and nerve systems change, leading to depression.

Risk factors

Certain factors may increase your risk of developing mental health problems, including:

• Having a blood relative, such as a parent or sibling, with a mental illness
• Stressful life situations, such as financial problems, a loved one's death or a divorce
• An ongoing (chronic) medical condition, such as diabetes
• Brain damage as a result of a serious injury (traumatic brain injury), such as a violent blow to the head
• Traumatic experiences, such as military combat or being assaulted
• Use of alcohol or recreational drugs
• Being abused or neglected as a child
• Having few friends or few healthy relationships
• A previous mental illness

Mental illness is common. About 1 in 5 adults has a mental illness in any given year. Mental illness can begin at any age, from childhood through later adult years, but most begin earlier in life.

The effects of mental illness can be temporary or long lasting. You also can have more than one mental health disorder at the same time. For example, you may have depression and a substance use disorder.

Complications

Mental illness is a leading cause of disability. Untreated mental illness can cause severe emotional, behavioral and physical health problems. Complications sometimes linked to mental illness include:

• Unhappiness and decreased enjoyment of life
• Family conflicts
• Relationship difficulties
• Social isolation
• Problems with tobacco, alcohol and other drugs
• Missed work or school, or other problems related to work or school
• Legal and financial problems
• Poverty and homelessness
• Self-harm and harm to others, including suicide or homicide
• Weakened immune system, so your body has a hard time resisting infections
• Heart disease and other medical conditions

Prevention

There's no sure way to prevent mental illness. However, if you have a mental illness, taking steps to control stress, to increase your resilience and to boost low self-esteem may help keep your symptoms under control. Follow these steps:

• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.
• Get routine medical care. Don't neglect checkups or skip visits to your healthcare provider, especially if you aren't feeling well. You may have a new health problem that needs to be treated, or you may be experiencing side effects of medication.
• Get help when you need it. Mental health conditions can be harder to treat if you wait until symptoms get bad. Long-term maintenance treatment also may help prevent a relapse of symptoms.
• Take good care of yourself. Sufficient sleep, healthy eating and regular physical activity are important. Try to maintain a regular schedule. Talk to your healthcare provider if you have trouble sleeping or if you have questions about diet and physical activity.

Learn about diagnosis and treatment.

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Postpartum depression

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Many new moms experience the "postpartum baby blues" after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically begin within the first two to three days after delivery, and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression isn't a character flaw or a weakness. Sometimes it's simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms — and enjoy your baby.

Symptoms

Signs and symptoms of depression after childbirth vary, and they can range from mild to severe.

Postpartum baby blues symptoms

Signs and symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Feeling overwhelmed
• Crying
• Reduced concentration
• Appetite problems
• Trouble sleeping

Postpartum depression symptoms

Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, eventually interfering with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin later — up to six months after birth.

Postpartum depression symptoms may include:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep (insomnia) or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities you used to enjoy
• Intense irritability and anger
• Fear that you're not a good mother
• Feelings of worthlessness, shame, guilt or inadequacy
• Diminished ability to think clearly, concentrate or make decisions
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Recurrent thoughts of death or suicide

Untreated, postpartum depression may last for many months or longer.

Postpartum psychosis

With postpartum psychosis — a rare condition that typically develops within the first week after delivery — the signs and symptoms are even more severe. Signs and symptoms may include:

• Confusion and disorientation
• Obsessive thoughts about your baby
• Hallucinations and delusions
• Sleep disturbances
• Paranoia
• Attempts to harm yourself or your baby

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

When to see a doctor

If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But if you experience any symptoms of postpartum baby blues or postpartum depression, call your doctor and schedule an appointment. If you have symptoms that suggest you may have postpartum psychosis, get help immediately.

It's important to call your doctor as soon as possible if the signs and symptoms of depression have any of these features:

• Don't fade after two weeks
• Are getting worse
• Make it hard for you to care for your baby
• Make it hard to complete everyday tasks
• Include thoughts of harming yourself or your baby

If you have suicidal thoughts

If at any point you have thoughts of harming yourself or your baby, immediately seek help from your partner or loved ones in taking care of your baby and call 911 or your local emergency assistance number to get help.

Also consider these options if you're having suicidal thoughts:

• Call your mental health specialist.
• Call the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org.
• Seek help from your primary doctor or other healthcare provider.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Helping a friend or loved one

People with depression may not recognize or acknowledge that they're depressed. They may not be aware of signs and symptoms of depression. If you suspect that a friend or loved one has postpartum depression or is developing postpartum psychosis, help them seek medical attention immediately. Don't wait and hope for improvement.

Causes

There's no single cause of postpartum depression, but physical and emotional issues may play a role.

• Physical changes. After childbirth, a dramatic drop in hormones (estrogen and progesterone) in your body may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed.
• Emotional issues. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive, struggle with your sense of identity or feel that you've lost control over your life. Any of these issues can contribute to postpartum depression.

Risk factors

Postpartum depression can develop after the birth of any child, not just the first. The risk increases if:

• You have a history of depression, either during pregnancy or at other times
• You have bipolar disorder
• You had postpartum depression after a previous pregnancy
• You have family members who've had depression or other mood stability problems
• You've experienced stressful events during the past year, such as pregnancy complications, illness or job loss
• Your baby has health problems or other special needs
• You have difficulty breastfeeding
• You're having problems in your relationship with your spouse or significant other
• You have a weak support system
• You have financial problems
• The pregnancy was unplanned or unwanted

Complications

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.

• For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming a chronic depressive disorder. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression.
• For fathers. Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby's father may also increase. And new dads are already at increased risk of depression, whether or not their partner is affected.
• For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, excessive crying, and attention-deficit/hyperactivity disorder (ADHD). Delays in language development are more common as well.

Prevention

If you have a history of depression — especially postpartum depression — tell your doctor if you're planning on becoming pregnant or as soon as you find out you're pregnant.

• During pregnancy, your doctor can monitor you closely for signs and symptoms of depression. He or she may have you complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy.
• After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of postpartum depression. The earlier it's detected, the earlier treatment can begin. If you have a history of postpartum depression, your doctor may recommend antidepressant treatment or psychotherapy immediately after delivery.

Learn about diagnosis and treatment. 

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Post-traumatic stress disorder (PTSD)

PTSD is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and good self-care, they usually get better. If the symptoms get worse, last for months or even years, and interfere with your day-to-day functioning, you may have PTSD.

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.

Symptoms

Post-traumatic stress disorder symptoms may start within one month of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.

Intrusive memories

Symptoms of intrusive memories may include:

• Recurrent, unwanted distressing memories of the traumatic event
• Reliving the traumatic event as if it were happening again (flashbacks)
• Upsetting dreams or nightmares about the traumatic event
• Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Avoidance

Symptoms of avoidance may include:

• Trying to avoid thinking or talking about the traumatic event
• Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

• Negative thoughts about yourself, other people or the world
• Hopelessness about the future
• Memory problems, including not remembering important aspects of the traumatic event
• Difficulty maintaining close relationships
• Feeling detached from family and friends
• Lack of interest in activities you once enjoyed
• Difficulty experiencing positive emotions
• Feeling emotionally numb

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

• Being easily startled or frightened
• Always being on guard for danger
• Self-destructive behavior, such as drinking too much or driving too fast
• Trouble sleeping
• Trouble concentrating
• Irritability, angry outbursts or aggressive behavior
• Overwhelming guilt or shame

For children 6 years old and younger, signs and symptoms may also include:

• Re-enacting the traumatic event or aspects of the traumatic event through play
• Frightening dreams that may or may not include aspects of the traumatic event

Intensity of symptoms

PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you're stressed in general, or when you come across reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.

When to see a doctor

If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they're severe, or if you feel you're having trouble getting your life back under control, talk to your doctor or a mental health professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.

If you have suicidal thoughts

If you or someone you know has suicidal thoughts, get help right away through one or more of these resources:

• Reach out to a close friend or loved one.
• Contact a minister, a spiritual leader or someone in your faith community.
• Call the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org.
• Make an appointment with your doctor or a mental health professional.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

If you know someone who's in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person to keep him or her safe. Call 911 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

Causes

You can develop post-traumatic stress disorder when you go through, see or learn about an event involving actual or threatened death, serious injury or sexual violation.

Doctors aren't sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of:

• Stressful experiences, including the amount and severity of trauma you've gone through in your life
• Inherited mental health risks, such as a family history of anxiety and depression
• Inherited features of your personality — often called your temperament
• The way your brain regulates the chemicals and hormones your body releases in response to stress

Risk factors

People of all ages can have post-traumatic stress disorder. However, some factors may make you more likely to develop PTSD after a traumatic event, such as:

• Experiencing intense or long-lasting trauma
• Having experienced other trauma earlier in life, such as childhood abuse
• Having a job that increases your risk of being exposed to traumatic events, such as military personnel and first responders
• Having other mental health problems, such as anxiety or depression
• Having problems with substance misuse, such as excess drinking or drug use
• Lacking a good support system of family and friends
• Having blood relatives with mental health problems, including anxiety or depression

Kinds of traumatic events

The most common events leading to the development of PTSD include:

• Combat exposure
• Childhood physical abuse
• Sexual violence
• Physical assault
• Being threatened with a weapon
• An accident

Many other traumatic events also can lead to PTSD, such as fire, natural disaster, mugging, robbery, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events.

Complications

Post-traumatic stress disorder can disrupt your whole life ― your job, your relationships, your health and your enjoyment of everyday activities.

Having PTSD may also increase your risk of other mental health problems, such as:

• Depression and anxiety
• Issues with drugs or alcohol use
• Eating disorders
• Suicidal thoughts and actions

Prevention

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what's happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.

Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health professional for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

Support from others also may help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.

Learn about diagnosis and treatment. 

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Sleep disorders

Sleep disorders are changes in the way that you sleep.

A sleep disorder can affect your overall health, safety and quality of life. Sleep deprivation can affect your ability to drive safely and increase your risk of other health problems.

Some of the signs and symptoms of sleep disorders include excessive daytime sleepiness, irregular breathing or increased movement during sleep, and difficulty falling asleep.

There are many different types of sleep disorders. They're often grouped into categories that explain why they happen or how they affect you. Sleep disorders can also be grouped according to behaviors, problems with your natural sleep-wake cycles, breathing problems, difficulty sleeping or how sleepy you feel during the day.

Some common types of sleep disorders include:

• Insomnia, in which you have difficulty falling asleep or staying asleep throughout the night.
• Sleep apnea, in which you experience abnormal patterns in breathing while you are asleep. There are several types of sleep apnea.
• Restless legs syndrome (RLS), a type of sleep movement disorder. Restless legs syndrome, also called Willis-Ekbom disease, causes an uncomfortable sensation and an urge to move the legs while you try to fall asleep.
• Narcolepsy, a condition characterized by extreme sleepiness during the day and falling asleep suddenly during the day.

There are many ways to help diagnose sleep disorders. Doctors can usually treat most sleep disorders effectively once they're correctly diagnosed.

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