Higher blood pressure is linked to LESS cognitive decline

From Streit S et al. Ann Fam Med 1 March 2019 and reported by Sarfaroj Khan UK Clinical Digest 13 March 2019

In my GP career treatment of blood pressure for the general population has become more intensive as time has gone on. This hasn’t always resulted in better long term outcomes overall. Indeed, the target systolic blood pressure, the upper measurement, has been moved from 130 to 140 in the last few years because of this.

A Dutch study of over a thousand patients over the age of 75 showed that those with a systolic blood pressure under 130 showed more cognitive decline than those with a blood pressure over 150 when they had mental functioning tests a year later.

Those with higher blood pressures had no loss of daily functioning or quality of life.

As aggressive blood pressure control in those with diabetes is standard treatment, it is worth knowing this. Perhaps further studies in this subgroup of patients would be worth doing. I have seen reports of impaired kidney function when blood pressure levels are “optimal” but low too.

Another study regarding blood pressure management reported in the British Journal of Sports Medicine indicates that blood pressure reduction of almost 9mm Hg in hypertensive patients when regular structured exercise is undertaken. This is of a degree similar to most anti-hypertensive medications. (Reported in BMJ 5 Jan 2019)

 

 

Hypoglycaemia: the neglected complication

Adapted from Hypoglycaemia: the neglected complication by Sanay Kalra et al.

Indian J Endocrinol Metab. 2013 Sep-Oct; 17(5): 819-834

Hypoglycaemia is an important complication of glucose lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycaemic control invariably increases the risk of hypoglycaemia. A six fold increase in deaths due to diabetes has been found in patients with severe hypoglycaemia compared to those not experiencing severe hypoglycaemia.

Repeated episodes can lead to hypoglycaemia unawareness. Complications  of hypoglycaemia include stroke, heart attacks, cognitive dysfunction, retinal cell death and loss of vision. Apart from this there are the effects on quality of life regarding sleep, driving, employment, exercise and travel.

To maintain good glycaemic control, minimize the risk of hypoglycaemia and thereby prevent complications, there are steps that need to be taken: recognise risk factors for hypoglycaemia, use appropriate self monitoring of blood sugar, select treatment regimens that have little or no risk of incurring hypoglycaemia and teach health care professionals and patients how to avoid hypoglycaemia.

Although the DCCT showed that complications were reduced when blood sugars were brought under a HbA1C of 7%, other trials have noted a three fold risk of hypoglycaemia when the level is reduced under 6.5%. This tends to negate any improvements in long term complications.

Insulin users are most at risk. Those who have had diabetes for more than 15 years are particularly at risk. The DARTS study showed that the risk of severe hypoglycaemia was 7.1% for type one patients, 7.3% for type two patients and 0.8% for type twos on sulphonylureas. This causes increased cost for their healthcare as hospitalisation for around a week is needed in the average case.

The majority of hypos are due to medications but there are other potential causes such as: pancreatic or islet cell tumours, dietary toxins, alcohol, stress, infections, sepsis, starvation and excessive exercise.

In diabetics not eating enough food was the most common cause. Others were physical exercise, insulin miscalculation, stress, overtreating a high blood sugar, and impaired glycaemic awareness.

Nocturnal hypoglycaemia is seen in half of diabetic children, particularly under the age of 7. Dead in bed syndrome causes 5-6% of all deaths in type one youngsters.  Contributory factors are increased exercise that day or delayed meals.

In type two patients additional causative factors are alcohol ingestion and liver disease and duration of insulin over ten years. As in type ones there tends to be more hypoglycaemic unawareness as the person ages. In type twos  there is a 9 fold increase in deaths in those with hypoglycaemic unawareness.

Severe hypos in elderly patients increase the risk of dementia, functional brain failure and cerebellar ataxia. There are clear signs of neuronal death in specific brain areas at post mortem in these patients and a history of fits make these more extensive.

Hypos in elderly patients promote cardiac ischaemia. Arrhythmias are more likely due to catecholamine release during hypos. Prolonged QT intervals lead to increased heart rate, fibrillation and sudden cardiac death.  Inflammatory cytokines are released during hypos, abnormalities of platelet function and the fibrinolytic system occur.

Hypos can cause double vision, blurred vision and dimness of vision.  Blindness can occur due to retinal cell death.

Recurrent hypos make people feel powerless, anxious and depressed. Acute hypos cause mood swings, irritability, stubbornness and depression.  Quality of life scores are worse in patients with recurrent hypos.

Driving ability is affected by hypos. The affected driver can inadvertently cross lanes and speed and generally drive worse.

Hypos at night may be recognised by sleep disturbance, morning headaches, chronic fatigue and mood changes. In young children fits and bed wetting may occur.

Hypos at work can be awkward, embarrassing and frightening. Hypos are particularly dangerous for those who work at heights, underwater, on railway tracks, oil rigs, coal mines, handling hot metals or heavy machines.

Expert medical advice and planned action counselling can help workers. So can self blood glucose testing, healthy food options in canteens, flexible meal times, arrangements to carry and use emergency glucose/sugar, storage and disposal sites for medications and sharps, and time off for medical appointments. Work time and productivity due to hypos can be reduced and nocturnal hypos can also have a knock on effect the next day.

Hypos in children tend to be increased in summer months when they are more active. In adults, intense prolonged exercise following an episode of recent severe hypoglycaemia can damage skeletal muscle and the liver and can cause severe neurological symptoms.

Travelling long distances, particularly over times zones can cause insomnia, tiredness, stress, reduced appetite, nocturia,  gastric disturbance, muscle aching and headaches. Psychological symptoms include low mood, irritability, apathy, malaise, poor concentration. These deficits in both physical and mental performance can profoundly affect decision making.

The fear of hypos can affect patients more profoundly than the fear of long term complications.  Withholding of insulin can occur. Sometimes patients refuse to start it when they need it and sometimes they miss out their doses.

About 30% of type one patients are affected by hypoglycaemia unawareness and under 10% of type two patients are thus affected. Duration of insulin use is the main common factor.

Educating patients about how to detect, treat and prevent hypoglycaemia must be understandable to the patient and their family.

In 2013 the ADA recommended that insulin users test their blood sugars 6-8 times a day.

Basal insulin needs to be matched to the patients needs. If hypos persist, particularly overnight, switching to pump therapy may help.

Newer diabetic medications, which do not cause low blood sugars such as the gliptans and gliflozins, may be preferable in type two patients who have multiple co-morbidities, are elderly,  who live alone, are at high risk of falls, and who have hypoglycaemia unawareness or who otherwise could not effectively deal with a hypo.

 

 

 

Bring back the 50s ?: Mothers in full time work are significantly stressed

Being a working mother doesn’t just feel stressful, it alters your physiology.

Researchers at the universities of Manchester and Essex studied 6025 people. They collected information about their working and home lives. Hormonal levels and blood pressure were checked too.

When 11 biomarkers of stress were tested, these were 40% higher in women who worked full time and were raising two children at the same time. One child raised the levels by 18%.  Part time workers, job sharers and those with flexible working arrangements were fewer hours were worked had less stress.  Flexible working or remote working with no reduction in hours did not lower stress levels.

The authors said, ” Work-family conflict is associated with increased psychological strain, with higher levels of stress and lower levels of well being. Parents of young children are at particular risk of family-work conflict.

http://www.manchester.ac.uk/discover/news/working-mothers-up-to-40-more-stressed/

When do you stop getting benefits from exercise?

From Danielle Baron’s article in International Medical News 10 August 18

As with many different health interventions, there is a sweet spot between doing enough of it and doing too much of it. Too little, and it is not effective. Too much and you could cause unexpected negative repercussions.  The subject of exercise has been investigated regarding its effect on mental health.

Over 1.2 million USA citizens were asked about their exercise habits and their mental wellbeing between 2011 and 2015 by researchers at the Centers for Disease Control and Prevention.

All exercise types improved mental health but popular team sports were particularly effective in boosting mental health. The optimal duration of exercise was between 30 and 60 minutes a session, three to five times a week.

Sessions of longer than 90 minutes or done more than 23 times a month however, were related to WORSE mental health.

The authors conclude that blanket advice on exercise could be improved by being more specific about the types, durations and frequencies that were more likely to improve mental health and that further studies could be helpful.

Chekroud SR et al. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross sectional study. Lancet Psychiatry. Published online 8 August 2018. doi: 10.1016/S2215-0366(18)30227-X

My comments: Oh dear! Well, I’ve got the duration right at 40 minutes but I hate team sports (because I’m useless at hand to eye or foot coordination) and I aim to exercise every day, which these researchers considered “excessive”.  Maybe the team sports were more beneficial because of the socialisation aspect as well as the physical aspect. Maybe less than 23 times a month made it something to look forward to and a dopamine hit , “I’ve achieved that” rather than a black mark ” I failed to do my exercise session”   as I tend to think about it. I can see the downsides of exercise addiction reflected in this piece of research. 

BMJ: How to get a better sleep if you work night shifts

From Optimising sleep for night shifts by Helen McKenna and Matt Wilkes 3rd March 2018

Night shift work happens when your body would rather be asleep. Alertness, cognitive function, psychomotor co-ordination and mood all reach their lowest point between 3am and 5am.

After a night shift is over, the worker has to try to sleep when the body would prefer to be awake. This shift away from the circadian phase compounds the fatigue and can lead to chronic  sleep disturbance. There is  more likelihood of occupational accidents, obesity, type 2 diabetes, heart disease and breast, prostate and colorectal cancers. Psychological and physical well being is affected and accidents or near misses when travelling home are much more likely to occur.

Performance on the night shift gets worse as people get older and it takes longer to recover from a night on.

On average most people sleep about 8 hours a night.  Some people cope with sleep deprivation better than others. Performance will be impaired after two hours of sleep deprivation and gets worse as sleep debt accumulates. Therefore before starting a set of night shifts it is wise to sleep in the morning before, avoid caffeine that day,  and if you can take a nap in the afternoon between 2pm and 6pm.  For a nap to be most effective you need 60-90 minutes asleep.

When you start the shift, try to fit in a nap of about 30 minutes if this is the sort of job that allows this, but have a coffee immediately before the nap, and don’t have any more caffeine after the nap.  Sleeping longer than 30 minutes can make you feel groggy as you move into deep sleep and are the roused from it. Caffeine can help performance but you also want to try to sleep the next morning. Avoid it for the 3-6 hours before you plan to go to sleep in the morning. If you are doing critical tasks especially between 3-5am it is wise to build in more checks to your work.

Working in bright light can perk you up on the night shift.

When it comes to eating you are probably best to eat your main meal immediately before the night shift then eat just enough to feel comfortable as the shift goes on.

Jet lag improves at the rate of one day for every hour you are out of phase.  Circadian adaptation is therefore impossible during short term rotating shift work. Therefore you have to do your best to optimise your sleep between the shifts so as to keep the sleep debt minimal.

If you can possibly arrange lifts home or travelling home on public transport after a night shift, do so.

You can try to improve the situation by wearing sunglasses in daylight on the way home, avoiding electronic device screens, using blackout blinds, ear plugs and eye masks or even white noise generators.  A warm bath and then sleeping in a not cold but cool room and wearing woollen nightwear may help. Melatonin taken in the morning after a night shift has been shown to improve sleep duration by up to 24 minutes. Avoid alcohol and caffeine as these won’t help. Drugs such as Zopiclone can improve sleep if taken during the day but it can be addictive and needs a prescription.

After a run of night shift work you may get into the swing of your regular routine by having a 90 or 180 minute sleep, as this is one or two sleep cycles,  or sleeping in to noon and then getting up and getting outside for some exercise in bright light. Do your best to include meals at the usual times and socialise a little.  You will also need to pay attention to paying back your sleep debt by going to bed earlier than usual and sleeping in later than usual for a few days. It is best to avoid day time naps during the recovery from shift phase.

The path to sleep optimisation is an individual thing. Feel free to experiment.

BMJ: It doesn’t take much alcohol to damage your brain cells

Adapted from BMJ 24 February 18 Alcohol link to dementia is “robust” by Jacqui Wise

Chronic heavy drinking should be recognised as a major risk for dementia say French researchers.

They looked at over 31 million French adults discharged from hospital between 2008 and 2013. Over 1.1 million people had been diagnosed as having dementia.  In 57% of those with early onset dementia alcohol use was considered to be the cause.

Drinking more than 6 units of alcohol a day for a man and 4 units for a woman put you in the risk category of “heavy drinking” according to the World Health Organisation. This level will make both men and women more than three times more likely to develop dementia than they otherwise would.

Michael Schwarzinger said, ” The link between dementia and alcohol use is likely a result of alcohol leading to permanent structural and functional brain damage. Alcohol disorders also increase the risk of high blood pressure, diabetes, stroke, atrial fibrillation, and heart failure, which in turn increase the risk of vascular dementia. Heavy drinking is also associated with smoking, depression and low educational attainment which are also risk factors for dementia.”

Clive Ballard from the University of Exeter Medical School said, ” This study is immensely important. This evidence is robust and the public need to know about the relationship between alcohol consumption and dementia.”

My comment: I was really sad to read this report in the BMJ as I do love a nice glass of full bodied red when I’m eating a big lump of fatty spiced meat or a smelly gorgonzola. I was also dismayed to see what they regard as heavy drinking. 175 mls of most wines will be 2 units so two of them a day and you are three times more likely to get dementia, if you are a woman. I dread to think what a two week all inclusive holiday does to your brain. It is  always best to know these things before you get too batty to care. 

Eat green leafy vegetables to give your brain many extra years

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If you eat one or two portions of green leafy vegetables a day you could have a brain 11 years younger than you otherwise would.

That is the conclusion of a longitudinal study of almost a thousand elderly  people in the USA. Compared to people who rarely or never ate green vegetables there was a very marked difference in brain function over time.

This seems to be due to the folate, phylloquinone and lutein in the foodstuffs.

So eat up and protect your brain. If like me, you prefer your salad well dressed and your vegetables laced with fat and garlic and spices look around the site for our recipes. Spinach in a cheese and garlic sauce, and buttered peas and leeks are my favourites.

Adapted from BMJ 13 Jan 2018 from an article in Neurology

 

 

 

 

 

 

 

 

A sleep expert tells us how to improve jet lag

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Adapted from an article by Richard A. Friedman’s article, “Yes, your sleep schedule is making you sick” published in the New York Times March 10 2017

Jet lag makes everyone miserable and here is what you can do about it.

 

We have a circadian rhythm that is 25 hours long and it is almost in synchronicity with the 24 hour day. Jet lag messes this up big time. Everyone who has experienced it knows that jet lag makes you feel tired, out of sorts, renders concentration difficult and makes you moody.

If you are flying from New York to Rome for instance and arrive early in the morning Rome time,  the best way to reduce jet lag is to keep on eye shades in the plane and dark glasses on the ground till your New York 7am has been reached. This will be about lunch time in Rome.

Melatonin is also an important factor. As it starts getting dark your pineal gland starts to produce melatonin around 2 or 3 hours before your sleep time. If you take a melatonin supplement earlier than this is can become possible for you to fall asleep earlier than you otherwise would.

Surprisingly, if you take melatonin in the early morning, it can fool your brain into thinking it slept longer, at least to some extent, and does not make you more tired during the day.

So this is the fix for jet lag. Travel east and you’ll need morning light and evening melatonin. Go west and you’ll need evening light and morning melatonin. 

If you are a night owl, who can’t sleep at midnight because it’s too early for you, take a small dose of melatonin a few hours before the desired bedtime. They can also try exposure to bright lights at progressively earlier times in the morning, which also should make it easier to fall asleep earlier. You

should also avoid the blue light that smartphones and computers emit in the evenings. You can wear special glasses that block blue light if this is a problem.

Richard A. Friedman is a professor of clinical psychiatry and director of psychopharmacology clinic at the Weill Cornell Medical College.

Better quality of life reported for young type one diabetics with lower HbA1c levels

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Better quality of life reported for young type one diabetics with lower HbA1c levels

Summarised from Independent Diabetes Trust Newsletter Sept 17

An international study of almost 6,000 young people showed that lower HbA1c levels were associated with a higher quality of life scores between the study age range of 8 to 25 years.
Those who reported the lowest quality of life scores were aged 19 to 25 and females had lower scores than the males across every age range.
The study showed that advanced ways to measure food intake, more frequent blood sugar testing, and taking exercise for 30 minutes a day, were all associated with higher satisfaction scores.
The researchers concluded that if young people have trouble controlling their diabetes, they should focus on the three factors that they can potentially control to make life easier.
Measure your food accurately
Test your blood sugar frequently
Exercise for at least 30 minutes a day

(Diabetes Care May 26 2017)

Damon Ashworth: At your most lonely you can still reach out for help

For Anyone Who Has Ever Struggled With Thoughts of Suicide and Death

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Suicide

In Australia in 2015, there were 3,027 deaths due to suicide for the year. This equates to 12.7 per 100,000, or 8.3 deaths by suicide each day.

76% of those who died by suicide were male, a ratio of more than 3:1. This ratio stays pretty steady for nearly all age groups, with males always dying from suicide at a higher rate than females.

According to the World Health Organisation, a person dies from suicide somewhere in the world every 40 seconds. Guyana has the highest suicide rate of any country in the world, with 44.2 per 100,000, but South Korea (28.9 per 100,000), Sri Lanka (28.8 per 100,000), Lithuania (28.2 per 100,000) and many other countries are also way too high. Based on the 2012 WHO findings, Australia was the 63rd highest country with 10.6 deaths by suicide per 100,000.

The most alarming thing about these findings is that our suicide rate is increasing, an extra 2.1 per 100,000 in only five years. The rate of suicide has also increased in the US by 24% from 1999 to 2014, after consistently declining the 14 years prior to that, according to data from the Centers for Disease Control and Prevention (Aboujaoude, 2016).

In the US it’s meant to be increasing due to the increasing use of antidepressants and their link to suicidality, to poor health insurance coverage, to the global financial crisis, increased divorce rates, greater opiate drug use, and the internet (Aboujaoude, 2016).

I’m not sure if all of these factors apply in Australia, but if over 11% of suicide-related search results are pro-suicide (Recupero, Harms & Noble 2008), then we need to counter-balance this with as much material as possible showing that suicide is neither the best option or the only option.

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Death

Homo sapiens, or humans, as far as I know, are the only species in the animal kingdom that are aware that one day they are going to die.

The first time I heard this it fascinated me, and made me wonder if life would be easier not being aware of the fact that one day we cease to exist.

Imagine it. Life is going well. Then suddenly it is no more. No worry about what the future holds. We are born. We experience life. Then suddenly we are no longer there. No fear. Just nothingness.

Being aware that we are going to die shapes and influences our lives much more than we would like to admit. A lot of our anxieties and phobias at their core are a fear of some type of loss or death.

Irvin Yalom says that whilst the actuality of death is the end of us, the idea of death can actually energise us.

If we don’t know when we will die, being in touch with the fact that one day everything will end is enough to overwhelm some people and make them panic.

For others, it is enough to make them follow the maxim of carpe diem and helps them to seize the day by appreciating everything that they have so that they can make the most of the precious time that they have left on this planet. Time that is really just a bright spark of lightness between two identical and infinite periods of darkness – one before we are born, and one after.

Death is the ultimate equaliser, for no matter how much we have achieved or done with our time on this planet, the truth is that we will all one day die.

It is also true that we will not know exactly when death will happen. It might be with a car accident tomorrow, from cancer in ten years time, motor neurone disease in twenty years time, a heart attack in thirty years time, a stroke in forty years time, or during our sleep in fifty years time. Who knows.

What I do know is that people struggle with the idea of death. Much like they struggle with the idea of life.

With so much uncertainty, how can we possibly plan for the future? How can we get the most out of life? and more importantly, is it even worth it?

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These are questions that I struggled with for a long time…

My Experience

I think I was about ten years old when I first expressed a desire to kill myself. I remember my mother saying that childhood should be the happiest time in my life, as it only gets harder after that, with more pressures and more responsibility. I’m pretty sure she meant that I should try to enjoy life whilst I’m young if I could, but all I heard was “LIFE SUCKS! IF YOU AREN’T COPING NOW, YOU NEVER WILL!” I became petrified of the future.

It didn’t get much better after that for me. I never felt like I fit in at school. I was 6″3 by the start of 9th grade, and felt like a freak; physically different from others and emotionally disconnected from my friends and family.

My happiest times growing up were when I became sick with croup and needed to be rushed to hospital on several occasions. During these times it suddenly it seemed like I was important. That people cared. They visited me. They asked me questions. They brought me gifts. And I could ask for whatever I wanted. Even a strawberry milkshake for breakfast. The best part was no pressure or expectations for once, and as many computer games as I wanted. It was pure bliss.

Once I became physically well again, it was back to performing however. To being what I thought everyone else wanted me to be. The result was that I became cut off from the real me, felt empty inside, and entirely miserable.

When I was younger, there was a death in my family from suicide on my mum’s side. It was devastating for everyone. It also contributed to a fear of mental health problems within our family. I don’t even know if it really started there, or if it just escalated after that. What I do know is that depression and suicide were scary things that we didn’t talk about, so I suffered alone.

I struggled with frequent suicidal ideation from the age of 10 until 25. Most of the time it was just when I was feeling stressed and overwhelmed, but it wouldn’t take much for me to think of death and ending it all as a way out of the emotional pain that I felt. Sometimes I would imagine crashing my car into oncoming traffic, but I really didn’t want to cause any harm or sorrow to anyone else. I thought of jumping off a bridge, or crashing my car into a tree, but worried about injuring myself without ending my life, and feared how much harder life would be if I also didn’t have my physical mobility on top of my mental health difficulties.

A much more common fantasy was developing a terminal illness that didn’t give me much time left to live. I would imagine people feeling sorry for me, telling me that they cared, and not putting any pressure on me so that I could finally live the life that I wanted to live rather than the life that I felt people wanted for me. Life generally seemed to suck. And death seemed like a great option…

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The Turning Point

But here is the thing. Life didn’t always suck. Being caught inside my head did. So did feeling alone and disconnected from others and the real me.

I now know that life is actually precious. And it isn’t as long as we’d sometimes like it to be.

The first thing that helped me realise this was when my host brother, who I lived with in California for a year when I was 16 and 17, was diagnosed with Ewing Sarcoma whilst I was doing my undergraduate studies at La Trobe University.

I had wished for a terminal illness for so long because I thought I was so bad and evil and such a worthless piece of crap, and here was a guy who was an absolute legend, suddenly sick with a life threatening illness. He didn’t want this, and neither did his family. It wasn’t fair, and it made me question a lot of things about life and our purpose in it.

In 2005, he was granted a wish by the Make-A-Wish foundation for he and I to go for an all expenses paid trip to Europe for two weeks. In Paris, walking along the Seine river, even though his body was riddled with cancer, he said to me “I just don’t get why people become depressed when there is so much beauty and good in the world!” I couldn’t believe what I heard. For the first time ever I felt and realised that it wasn’t what was happening in our life that shaped how we felt about it, but how we chose to view it.

When he passed away the following year, I was more devastated than I have ever been in my life. I still would do anything to be able to switch positions with him, as he truly was a great man, but what I do know is that his memory will never be forgotten.

Since then, especially after I sought psychological therapy during my Doctoral degree, my mission in life has been to reduce the level of distress felt by individuals who are struggling with mental health issues. I have tried the best I possibly could, but I am fully aware that I have also fallen way short at times of having the influence that I would love to be able to have to make a real difference in this world.

Just today I had the first client of mine that I am aware of who has recently tried to kill themselves. I am saddened by this, but also understand that we can never completely stop someone who is determined to do what they think is the best action for them to take.

All we can do is try to help them to stay safe, get them to see that all experiences generally pass, even the bad ones, and that if things have sometimes been not as bad as they are now in the past, then there is also a very good chance that things will once again not be as bad in the future.

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TO ALL.THOSE WHO ARE STRUGGLING:

Life sometimes sucks

So do other people

And so does the world

But you do not

I care about you

Even if I don’t know you

I want your life to get better

And I know that it can

If you are suffering

That is okay

Many people do

You are not alone

There are many things that can be done

Death is not the best option

Please seek help today

Life is worth living

It can get better

It did for me

I have not felt suicidal for the last six years

I have still experienced much pain

But I have also experienced much joy

And the ride has been worth it!

If you are struggling with the fear of death, please check out the book:
  • “Staring at the Sun: Overcoming the Terror of Death” by Irvin D. Yalom.
If you are struggling with lack of meaning and purpose in life, please check out the following books:
  • “Finding Flow: The Psychology of Engagement with Everyday Life” by Mihaly Csikzentmihalyi
  • “Finding Your Element: How to Discover Your Talents and Passions and Transform Your Life” by Ken Robinson and Lou Aronica
  • “Man’s Search for Meaning” by Viktor Frankl.
If you are being held back by fear and self-doubt, please check out the following books:
  • “The Confidence Gap” by Russ Harris and Steven Hayes
  • “Feel the Fear, And Do It Anyways” by Susan Jeffers
  • “Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead” by Brené Brown
If you are struggling with grief, please check out the following books:
  • “Why Bad Things Happen to Good People” by Harold S. Kushner
  • “On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss” by Elisabeth Kübler-Ross and David Kessler
If you want a more in depth analysis and understanding of the unsolved dilemmas of life, please check out the book:
  • “Existential Psychotherapy” by Irvin D. Yalom

 

DISCLAIMER: If the content of this post upsets you or you are struggling with suicidal ideation, planning or intent, please contact an appropriate help service where you live. If you are in Australia and cannot ensure your safety, please contact your local crisis and assessment treatment team (CATT) or call the following services:

  • Beyond Blue Helpline –   Call 1300 22 4636 24 hours / 7 days a week  
  • Suicide Help Line – 1300 651 251
  • Suicide Call Back Service – 1300 659 467
  • Lifeline – 13 11 14
  • SANE Australia – 1800 187 263
  • Relationships Australia – 1300 364 277
  • Mindset Clinic – 1800 614 434
  • Headspace – 1800 650 890 (ages 12-25)
  • Kids Helpline – 1800 551 800 (ages 5-25)