Is Depression Really Biochemical?

Direct-to-consumer ads by drug companies have been highly successful in convincing doctors as well as patients (and their families) that mental illness has biological, indeed biochemical, roots. Surprisingly few people question that depression is due to a "chemical imbalance in the brain," even though the slightest bit of questioning would lead you on a search of the literature that uncovers zero evidence supporting such a theory. Saying that because SSRIs are effective in treating depression (for a minority population of depression sufferers), therefore depression is a disease of serotonin imbalance in the brain, is like saying saying that because I have unfocused thoughts in the morning unless I drink coffee, therefore there's a disease, Morning Unfocused Thought Disorder, that's caused by a chemical imbalance of adenosine in my brain. (Caffeine is an antagonist of adenosine receptors.) From there, it's only one step away to the chocolate-imbalance theory of lovesickness, and then but another short step to the (once well accepted by doctors) masturbation theory of insanity.

The biochemical-imbalance theorists have yet to reconcile the fact that for some people (those who respond to SSRIs), depression seems to involve serotonin whereas for others (those who respond to SNRIs) it seems to involve norepinephrine and serotonin, whereas for others (those who respond to drugs like mirtazapine) it seems to involve norepinephrine and dopamine and serotonin (or dopamine and norepinephrine in the case of bupropion), whereas for others (those who respond to tricyclics) it involves an intricate combination of imbalances related to actions at the serotonin and norepinephrine and dopamine transporters (SERT and NET and DAT), the H1 histamine receptor, the 1A and 2A serotonin receptors, α1 and α2 adrinergic receptors, the D2 dopamine receptor, and the muscarinic acetylcholine receptor. That's an awful lot of different types of "chemical imbalance," for one disease. The literature shows (see, e.g., the meta-analyses by Kirsch and others, and the STAR*D study) that depressed patients respond more-or-less equally well to any of the major categories of antidepressants, basically proving that the drugs are not highly specific in their effects on patient subpopulations. If they were indeed highly specific to certain subpopulations (if some patients specifically needed an SNRI, whereas others specifically needed an SSRI, whereas others needed a tricyclic, etc.) then the patient subpopulations would add up to more than 100% of the total patient population, based on how many people tend to respond to each type of drug.

And then there's the somewhat curious fact that tianeptine, an antidepressant that has been sold for many years under the name Coaxil in Europe and South America, is actually a selective serotonin reuptake enhancer (not inhibitor). So apparently, some depression is caused by too much (rather than too little) free serotonin.

Studies that have tried to induce depressive symptoms in normal subjects by altering their neurotransmitter balances have failed to do so. (E.g., Salomon et al., "Lack of behavioral effects of monoamine depletion in healthy subjects," Biological Psychiatry, 1 January 1997, 41:1, 58–64.) This elementary result is rarely discussed.

For more on this general subject, I recommend the paper "The Chemical Imbalance Explanation for Depression: Origins, Lay Endorsement, and Clinical Implications" by Christopher M. France, Paul H. Lysaker, and Ryan P. Robinson, in Professional Psychology: Research and Practice, 2007, 38:4, 411–420 (full PDF here).

In a J Clin Psychiatry 59: 4–12, researchers from the US National Institute of Mental Health Laboratory of Clinical Science caution: "[T]he demonstrated efficacy of selective serotonin reuptake inhibitors…cannot be used as primary evidence for serotonergic dysfunction in the pathophysiology of these disorders." Yet the medical industry (from clinicians to drug makers to advocacy groups) continues to promote a serotonin-imbalance theory of depression, as if it's accepted fact. It's not only not fact, it's a bit bizarre.

The Zoloft web site promotes Zoloft (an SSRI) as a treatment for Major Depressive Disorder (MDD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Posttraumatic Stress Disorder (PTSD), Premenstrual Dysphoric Disorder (PMDD), and Social Anxiety Disorder. As the authors of a recent (2005) paper in PLoS Medicine noted: "For the serotonin hypothesis to be correct as currently presented, serotonin regulation would need to be the cause (and remedy) of each of these disorders. This is improbable, and no one has yet proposed a cogent theory explaining how a singular putative neurochemical abnormality could result in so many wildly differing behavioral manifestations." See Lacasse, J.R., and Leo, J. (2005), "Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature," PLoS Med 2(12):e392.

The Code of Federal Regulations under which direct-to-consumer drug advertising is regulated states that an advertisement may be cited as false or misleading if it "[c]ontains claims concerning the mechanism or site of drug action that are not generally regarded as established by scientific evidence by experts qualified by scientific training and experience without disclosing that the claims are not established and the limitations of the supporting evidence…" Direct-to-consumer advertisements are also forbidden to include content that "contains favorable information or opinions about a drug previously regarded as valid but which have been rendered invalid by contrary and more credible recent information." Despite this, we still find (for example) the Paxil website saying: "Paxil can help restore the balance of serotonin (a naturally occurring chemical in the brain) -- which helps reduce the symptoms of anxiety and depression." (Retrieved 24 Mar 2013.) And yet the FDA has never cited a pharmaceutical company for these sorts of falsehoods, presented over and over again in their advertising about antidepressants. There simply is no evidence that depression is caused by an imbalance of serotonin (or anything else) in the brain, any more than anxiety among smokers is caused by a lack of nicotine in the brain.

It would be easier to accept the many neurotransmitter-imbalance theories of depression if the drugs in question worked with the same high degree of efficacy that, say, aspirin works for a headache or that insulin does for diabetes, but in fact the drugs work so poorly that the number one bestselling drug in America right now is an adjunctive drug sold on the basis of helping antidepressants work better (Abilify). When I mentioned to a (non-depressed) friend of mine that the retail price of a month's worth of Abilify (5mg, 30 pills) is a thoroughly unconscionable $683 (making Abilify many times more valuable than pure gold), his comment was: "Why don't you just go lease a new Acura and see if that doesn't cheer you up? It's cheaper, and more satisfying."

Personally, I think he's right. Everybody on Medicare and Medicaid who's receiving Abilify at low or no cost right now (via government subsidy) should be offered a choice: continue to receive Abilify, or let Uncle Sam put you in a new Acura.

I wonder what people would choose?

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Benefits of Drug Testing in Schools (Drugteststrips)

Drug testing programs in school serve as an effective deterrent for all students. It helps them stay away from drugs and makes school a drug-free and safe learning environment. In this article, we will discuss about some benefits of drug testing in schools.

Ensures confidentiality:

Drug test kits help in identifying the drug abusing students. The best part about them is that they don't embarrass the students and intrude their privacy. Students can easily take the test at school without going to any hospital or lab.

Fear of being found guilty will decrease drug use:

School-going children may get into drug abusing habits due to various factors such as failure in academic performance, broken family relationships and company of peers addicted to drugs. Administering drug tests at schools would lead to a sense of fear among students and decrease the tendency to use drugs. This fear will act as a preventive for drug use.

Creates a safer learning atmosphere:

Drug tests would lead to an environment free from drug abuse. Drug use leads to unsocial and harmful behavior in drug abusing students. Research shows, students who are used to drugs tend to become violent and aggressive, bring harmful weapons to schools. Conducting drug tests would eliminate such behavior and will make schools a safer place for learning.

Better academics:

Research shows that students under the influence of drugs will not be attentive to their academics and will not participate in any non-academic or extracurricular activity in schools because they deviate from the usual schedule. Drug testing prevents students from drug abuse and thus creates a conducive atmosphere for learning and there is overall improvement in academic performance.

Educate students to live a healthy life:

While conducting drug tests, it is a good idea to spread awareness about the harmful effects of drug abuse. Tell them how it affects them mentally, physically and socially.

Use reliable drug test kits:

Drug testing among students is a sensitive matter. It may offend them and may impact them mentally. Therefore, the results should be accurate. Inaccurate results may depress the children. Hence it is advised to use reliable test kits. Always purchase from a reputed dealer.

Also make sure that the drug test kits you purchase are FDA approved and are set to SAMHSA cut-off levels. They are more likely to be accurate.

So the next time you suspect student drug abuse, don't hesitate to conduct drug testing in your school - it has many benefits.

Drug Test Strips is an online store offering reliable, easy to use and FDA approved drug testing kits at affordable prices. Our marijuana test strip is a rapid urine screening test. This thc test strips is easy to use and can be performed without the use of an instrument.

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Markets in almost nothing

...Nothing important to human beings in rich countries, that is.

One of the first things I noticed when I started studying economics was that goods that can't be bought and sold are basically ignored. That might be fine for determining prices of stuff (especially if people have quasilinear utility), but when you have massively incomplete markets, the basic big results of first-year microeconomics - the welfare theorems - go totally out the window. In addition, to get comprehensible results for the prices and quantities of exchange-able goods, you need to make a lot of heroic assumptions about the non-exchange-able goods - in other words, when people spend most of their time working for things that money can't buy, their behavior toward the things that money can buy gets a lot more complicated.

And when I think about it, I realize that people do spend much of their time working for things that they can't possibly buy. Here are some examples of things that can't be purchased in any market, even with one hundred billion dollars or a million tons of gold:

* Love

* The respect of your peers

* A feeling of career "success"

* The ability to fit in with other human beings

* Close friends

* Your family being proud of how your life turned out

* The feeling of being good at what you do

* Dignity

There are many more examples. It's not a question of whether these things should or shouldn't be traded in markets. It's simply that they cannot be.

Now, of course you can purchase things that help you get the items listed above. You can buy a cell phone that will help you hang out with your friends or meet your lover for a date. You can buy a car that takes you to where your friends are, or where your job is. Etc. But markets won't get you all the way there. If you want a hamburger, in contrast, markets will get you all the way there - just slap down the cash and the burger is yours.

Also, some of you may be thinking "But, people who make more money get more respect and are seen as more successful!" And this is (often) true. But that's not the same thing as exchanging money for respect. Exchange is voluntary - I give you some good (or some financial asset, e.g. money, that represents claims to goods), and you give me some other good. But when you get respect for being rich, you are not giving up your money in order to get more respect. (Sometimes you can engage in conspicuous consumption, but that's a bit different.) So "money leads to respect" does not mean that there is a market for respect.

Others of you may be thinking "OK, well, some people are born with these non-exchange-able things. Those lucky people have higher baseline utility, but I don't see how this changes how markets work." Ah, but here's a key point: Many of these non-exchange-able goods can be produced. Good relationships, for example, are not something you are born with - they take time and effort to build. Similarly, the respect that comes with a successful career requires that you put a lot of work into the career.

So, basically, markets provide only a limited slice of the things that humans want. In fact, I'd argue that in rich countries in which food and security are not a problem for the majority of people, the vast bulk of our effort is spent producing non-exchange-able goods like "success", "respect", "love", and "relationships".

We live in a world of Massively Incomplete Markets.

What does this mean for economics? First of all, it may help explain a lot of the phenomena we see in markets. For example, a lot of people's "leisure" time is spent working at the production of (non-exchangeable) love and relationships; this could be the source of "consumption-leisure complementarites" and other phenomena that describe people's behavior toward work and leisure.

A second example: Though people in rich countries work a bit less than people in poor countries, the super-rich often work very hard (at least, the ones I know do). This is a puzzle for the type of simple utility functions used to explain labor-leisure choice in macroeconomic models. Why do the super-rich work? It could be because working itself provides them with utility, or it could be because working enables them to produce the feelings of self-worth and capability that their huge bank accounts can't possibly buy in any market.

A third example: People may choose to be unemployed for a very long time if the new jobs on offer represent a loss of "dignity" (due to, for example, their family or spouse seeing the new job as a "step down" in their career). This could lead to search frictions that might explain a lot of long-term unemployment. Dignity concerns also probably affect wage demands, which could lead to sticky real wages in addition to the more commonly used sticky nominal wages.

A fourth example: People notoriously like minimum wages better than government handouts like the EITC, even though most economists agree that the EITC is a lot more efficient. Why? Probably because "earned" income gives people a feeling of dignity, while "handouts" reduce dignity. The former can only produced through work, not bought in a market.

So I think that non-exchange-able, but producible, goods might have an absolutely enormous impact on economic behavior of all kinds. What gets exchanged in markets is heavily dependent on what must be produced outside of markets.

Also, I think that non-exchangeable producible goods should have an impact on our analysis of human welfare and government policy. Assuming that all consumption can be bought with money leads one to support policies like the EITC, but these policies may be extremely sub-optimal when goods like dignity are brought into the equation. Additionally, government should think about how its policies discourage the formation of human relationships - for example, by subsidizing low-density suburban sprawl that makes it hard to meet people.

Now, of course, in the most general sense, incomplete markets are a technological problem. After all, when the Beatles sang "Money can't buy me love," money couldn't even buy you hair. Someday we may get the ability to buy our emotions and desires from vendors. That will be a very weird day! But for now, Massively Incomplete Markets define our world.

(Note: I'm sure people have thought very long and hard about this already, but I don't know the literature, so feel free to recommend papers in the comments or on Twitter!)

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Engaging with Others made easy through Hypnotherapy (Neil S Harris)

Having concerns engaging with others is also know or social anxiety disorder as it is more commonly known, is one of the most common forms of anxiety disorders. It refers to the fear of being judged or being watched due to one's low confidence and insecurity. This extreme fear that others might negatively evaluate you may devastatingly affect a person's everyday life. People who suffer from this condition usually also suffer from depression and suicidal tendencies. They have lower educational attainment and are unable to keep their job. They are also more abusive of drugs and alcohol and are more likely to remain single. Some physical and emotional symptoms include shaking hands and body, stuttering, excessive sweating, over-blushing, difficulty in speaking aloud, and nausea. There is also the constant feeling of being watched by everyone and the fear of being embarrassed.

No one is born with this condition. It is usually triggered by past traumas or unpleasant experiences. With the use of advanced hypnotherapy techniques and with the help of a skilled hypnotherapist, Social Anxiety can be effectively treated. No one has to live with it if they do not want to. Hypnotherapy is effective in treating social anxiety for the following reasons:

Hypnotherapy digs deeper into the problem by accessing the subconscious. It eventually helps the person understand why he/she is suffering from that condition. This is more effective than medications like anti-depressants prescribed by doctors. Anti-depressants usually only gives short term relief. As soon as the medication is stopped, the problem returns because the root cause of the problem was not treated.

Hypnotherapy for various types of social phobia focuses one's thoughts on the positive, eradicating the negative ones. Hypnosis changes a person's pessimistic self-image. This is done by helping the social phobic challenge the undesirable thoughts and beliefs linked to one's social phobia. A more positive and productive perspective is established when the individual has stepped away from negative feelings, thoughts, and behaviors. This promotes a sense of self which is more relaxed and balanced.

Many practitioners coming from different fields do believe that hypnotherapy provides the best treatment for social anxiety disorder but hardest part for most is admitting they have a problem. Of course, it is important to consult a mental health professional first in order to get the right diagnosis. Hypnotherapy does not subject any patient at any risk because it is done in a clinical setting.

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Is Depression Built in Stages? (globalcompliancepanel.com)

Depression, in simplistic terms, is the situation of being in a state of sadness over a lengthy period of time. Of course, it is already mentioned that this is a simplistic definition, because if it were that simple; the world would have been a happier place to live in for many people with depression! Depression is not something similar to a cold or a headache. It is not something that appears quickly and goes away as quickly.

Symptoms are not exclusive
Depression is a deeply rooted psychological malady that is difficult to understand in simple terms. Of course, people who have depression do exhibit a few common symptoms like sadness, listlessness, anxiety, moroseness, disinterest in matters of daily living and the like; but so do normal people. We all experience what may be called a bad day in office (not literally speaking though, because we should include home too here).

Difficult parameters
So, how is a person who has depression different from the rest if these symptoms and behaviors exist in all kinds of people? It is said that depressed people are in this state of mind over a long period of time. But how long? That should be the defining parameter. The medical profession is not clear if a person who has been through a low for a couple of weeks should be called a depressed person and be bracketed with someone who has been though it for a couple of years. And how does it feel to 'graduate' from the two-week period to the two-year period? Is the behavior the same over this period of time, or it is graded? These are the real challenges psychiatrists encounter while treating people with depression.

Some stages
Based on the pace at which depression builds up in a person's mind; medical science usually classifies depression according to the following stages:
oMajor;
oManic or bipolar;
oDysthymic;
oCyclothymic;
oPostpartum;
oSeasonal.

What are these stages for?
These are what may be called the various phases, but we have to be clear about what these stages really mean: These are more of a frame of reference for doctors than something that is irrefutable. This is certainly not a watertight compartmentalization of the condition. There is no reason to believe that one could be less treatable or more severe than another.

For whose benefit?
These gradations are made to give doctors a kind of benchmark with which to approach the problem. To the patient himself, absolutely no difference is made. A person with chronic depression has more things to worry about and feel down than to estimate the stage he is in. For the patient, his family and the lay public alike; there is no serious sense out of these stages. They do serve a limited, academic purpose, which is to help doctors slot the patient and use as an assessment tool, nothing more; nothing less.

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New Patents Aim to Reduce Placebo Effect

The pharma industry has a big problem on its hands: Placebos are getting to be way too effective. Something needs to be done. But what? What can you do about placebo response? The old saying "It is what it is" would seem to hold true in this case.

One answer: come up with low-placebo-response study designs, and patent them if possible. (And yes, it is possible. But we're getting ahead of the story.) 

Placebo effect has always been a problem for drug companies, but it's especially a problem for low-efficacy drugs (psych meds, in particular). An example of the problem is provided by Eli Lilly. In a March 29, 2009 press release announcing the failure of Phase II trials involving a new atypical antipsychotic known as LY2140023 monohydrate or mGlu2/3, Lilly said:

In Study HBBI, neither LY2140023 monohydrate, nor the comparator molecule olanzapine [Zyprexa], known to be more effective than placebo, separated from placebo. In this particular study, Lilly observed a greater-than-expected placebo response, which was approximately double that historically seen in schizophrenia clinical trials. [emphasis added]

Fast-forward to August 2012: Lilly throws in the towel on mGlu2/3. According to a report in Genetic Engineering and Technology News, "Independent futility analysis concluded H8Y-MC-HBBN, the second of Lilly's two pivotal Phase III studies, was unlikely to be positive in its primary efficacy endpoint if enrolled to completion."

Lilly is not alone. Rexahn Pharmaceuticals, in November 2011, issued a press release about disappointing Phase IIb trials of a new antidepressant, Serdaxin, saying: "Results from the study did not demonstrate Serdaxin’s efficacy compared to placebo measured by the Montgomery-Asberg Depression Rating Scale (MADRS). All groups showed an approximate 14 point improvement in the protocol defined primary endpoint of MADRS."

In March 2012, AstraZeneca threw in the towel on an adjunctive antidepressant, TC-5214, after the drug failed to beat placebo in Phase III trials. A news account put the cost of the failure at half a billion dollars.

In December 2011, shares of BioSante Pharmaceutical Inc. slid 77% in a single session after the company's experimental gel for promoting libido in postmenopausal women failed to perform well against placebo in late-stage trials.

The drug companies say these failures are happening not because their drugs are ineffective, but because placebos have recently become more effective in clinical trials. (For evidence on increasing placebo effectiveness, see yesterday's post, where I showed a graph of placebo efficacy in antidepressant trials over a 20-year period.)

Some idea of the desperation felt by drug companies can be glimpsed in this slideshow (alternate link here) by Anastasia Ivanova of the Department of Biostatistics, UNC at Chapel Hill, which discusses tactics for mitigating high placebo response. The Final Solution? Something called The Sequential Parallel Comparison Design.

SPCD is a cascading (multi-phase) protocol design. In the canonical two-phase version, you start with a larger-than-usual group of placebo subjects relative to non-placebo subjects. In phase one, you run the trial as usual, but at the end, placebo non-responders are randomized into a second phase of the study (which, like the first phase, uses a placebo control arm and a study arm). SPCD differs from the usual "placebo run-in" design in that it doesn't actually eliminate placebo responders from the overall study. Instead, it keeps their results, so that when the phase-two placebo group's data are added in, they effectively dilute the higher phase-one placebo results. The assumption, of course, is that placebo non-responders will be non-responsive to placebo in phase two after having been identified as non-responders in phase one. In industry argot, there will be carry-over of (non)effect from placebo phase one to placebo phase two.

This bit of chicanery (I don't know what else to call it) seems pointless until you do the math. The Ivanova slideshow explains it in some detail, but basically, if you optimize the ratio of placebo to study-arm subjects properly, you end up increasing the overall power of the study while keeping placebo response minimized. This translates to big bucks for pharma companies, who strive mightily to keep the cost of drug trials down by enrolling only as many subjects as might be needed to give the study the desired power. In other words, maximizing study power per enrollee is key. And SPCD does that.

SPCD was first introduced in the literature in a paper by Fava et al., Psychother Psychosom. 2003 May-Jun;72(3):115-27, with the interesting title "The problem of the placebo response in clinical trials for psychiatric disorders: culprits, possible remedies, and a novel study design approach." The title is interesting in that it paints placebo response as an evil (complete with cuplrits). In this paper, Maurizio Fava and his colleagues point to possible causes of increasing placebo response that have been considered by others ("diagnostic misclassification, issues concerning inclusion/exclusion criteria, outcome measures' lack of sensitivity to change, measurement errors, poor quality of data entry and verification, waxing and waning of the natural course of illness, regression toward the mean phenomenon, patient and clinician expectations about the trial, study design issues, non-specific therapeutic effects, and high attrition"), glossing over the most obvious possibility, which is that paid research subjects (for-hire "volunteers"), who are desperate, in many cases, to obtain free medical care, are only too willing to tell researchers whatever they want to hear about whatever useless palliative is given them. But then Fava and his coauthors make the baffling statement: "Thus far, there has been no attempt to develop new study designs aimed at reducing the placebo effect." They go on to present SPCD as a more or less revolutionary advance in the quest to quelch placebo effect.

Up until this point in science, I don't think there had ever been any discussion, in a scientific paper, of a need to attack placebo effect as something bothersome, something that interferes with scientific progress, something that needs to be guarded against vigilantly like Swine Flu. The whole idea that placebo effect is getting in the way of producing meaningful results is repugnant, I think, to anyone with scientific training.

What's even more repugnant, however, is that Fava's group didn't stop with a mere paper in Psychotherapy and Psychosomatics. They went on to apply for, and obtain, U.S. patents on SPCD (on behalf of The General Hospital Corporation of Boston). The relevant U.S. patent numbers are 7,647,235; 7,840,419; 7,983,936; 8,145,504; 8,145,505, and 8,219,41, the most recent of which was granted July 2012. You can look them up on Google Patents.

The patents begin with the statement: "A method and system for performing a clinical trial having a reduced placebo effect is disclosed." Incredibly, the whole point of the invention is to mitigate (if not actually defeat) the placebo effect. I don't know if anybody else sees this as disturbing. To me it's repulsive.

If you're interested in licensing the patents, RCT Logic will be happy to talk to you about it. Download their white paper and slides. Or just visit the website.

Have antidepressants and other drugs now become so miserably ineffective, so hopelessly useless in clinical trials, that we need to redesign our scientific protocols in such a way as to defeat placebo effect? Are we now to view placebo effect as something that needs to be made to go away by protocol-fudging? If so, it puts us in a new scientific era indeed.

But that's where we are, apparently. Welcome to the new world of wonder drugs. And pass the Tic-Tacs.

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10 Ways to use the Relaxation Techniques to manage your Stress to the relationship (Boyd Rankin)

1. When you feel extremely stressed or you just had an argument, then go to a single room and sit on a couch or a Chair. Sit in an upright position. Then try to relax your muscles, starting at your feet and moving upwards. When you are stressed your body begins to produce chemicals that make our muscles tense. When you relax your muscles, you send a signal to the brain that the situation is better today and there is no need for the intense stress.

2. To focus on something else rather than the reason that causes stress. Although it may seem difficult to concentrate on anything, when you have the problem of the relationship, but you can't unless you try. Using the technique of relaxation step 1 will help you focus on the relaxation of your muscles, rather than stress.

3. Learn to use leisure as your comfort. There comes a time in the relationship when you just want to leave your partner for a little while and spend time on your own. It is important to have a few hobbies that can do in your free time, that help you to relax.

4 Yoga is one of the best relaxation techniques. It helps to improve your health and teaches you many methods that you can use in your daily life, to feel better. If your partner is interested then both of you can bring together yoga courses and learn the techniques to reduce stress.

5 Relationships often reach a point when you feel like it is that nothing in the relationship but the fights and arguments. In times like these it is very good way to reduce stress and boost your confidence in the relationship. All you need to do is close your eyes and think of the wonderful times you had with your partner. This will help your mind relax and give you a reason to try to improve your relationship.

6. Aromatherapy is another popular technique used today by many to reduce stress. Essential oils are used to change a person's mood in this therapy. You and your partner can do it together once you are in a good and peaceful atmosphere you can discuss things that are difficult to discuss when stressed.

7. You may have overlooked it all these years, but one of the most effective techniques to reduce stress is touch therapy. If you are both stressed out for a reason, then a simple touch of your loved one can create a lot of difference. Just holding hands with your partner sends a signal to the brain to reduce stress. If this is not the case, your partner, and then a hug from your children or parents can do the trick.

8. Breathing techniques become more and more popular these days. They only take about five minutes to run but can have a very good effect in the reduction of stress.

9. There are many treatments available on the market that allows to learn new ways to reduce stress. Mediation is one of these techniques which are always popular because of its efficiency. It teaches you how to control your thoughts and help achieve a positive attitude towards life.

10 Exercises and a healthy diet are probably the most underestimated stress reduction techniques. They help in many ways to reduce stress. If you can spare some time to run, jog or swim every day, then you will see yourself the difference. Endurance training is also very effective. A healthy diet is extremely important to maintain your health during stressful times.

Relaxation techniques can you find exactly how to stop your stress to the relationship altogether, but they will help you to reduce stress that affects your physical and mental functioning. If you are able to reduce stress and take control of your mind, then you will be able to stop your relationship stress once and for all.

Treatment...

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