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with health education, both TM and PE showed significantly greater reductions over three months on PTSD symptoms, depression and total mood disturbance. TM was found to be non-inferior to PE for treating PTSD symptom severity and comorbid depression.39 • A meta-analysis of nine RCTs assessed effects of TM on blood pressure, assuming that chronic stress may play a role in initiating and maintaining hypertension in some individuals. Results showed clinically meaningful reductions in systolic and diastolic blood pressure after a median duration of 15 weeks’ practice.40 Mindfulness-based stress reduction techniques have also been shown to offer benefit in the treatment of anxiety, warranting further research in this area.33 CBT CBT aims to identify and replace unhelpful thought and behaviour patterns with more positive approaches, through a range of behavioural and cognitive interventions. Efficacy and effectiveness of CBT for treating anxiety disorders is well established for both short-term and long-term management and it is regarded as being a useful first-line intervention.5,36,41 However, it requires motivation and commitment, as well as access to a trained practitioner. Diet It can be difficult to determine a cause and effect relationship between poor quality diet and mental disorders. However, a growing number of observational studies reinforce a link between poor diet and risk of depression. A 2010 Australian study reviewed 1046 women and found that a diet favouring vegetables, fruit, meat, fish and wholegrains was associated with lower odds for major depression or dysthymia and for anxiety disorders. Conversely, a diet based around processed, refined foods and high sugar intake was associated with a higher negative heath score.5,32,42 HEALTH VITAMINS MINERALS AND SUPPLEMENTS 85 Studies examining the effect of dietary improvement, minimisation of caffeine, alcohol and nicotine offer positive preliminary data.31,36 Key points/summary • Good mental health is not merely the absence of a mental disorder, but a positive state of balance and the foundation for wellbeing and effective functioning. • A range of factors determine our mental health. These include life experiences, the cumulative effects of stress, our levels of resilience, physical health and levels of support. • Alcohol, smoking, diet and exercise are modifiable lifestyle factors known to impact mental health. • The ability to cope with stress is integral to good mental health, with accumulative, ongoing stress often playing a part in development of anxiety and depression. This may also manifest as a range of somatic symptoms such as headache, muscle tension, fatigue and exhaustion, sleep disturbance, panic attacks, digestive disturbances, etc. References 1. Mentalhealth:strengtheningourresponse \\\\\\\\\\\\\\\[Internet\\\\\\\\\\\\\\\]. World Health Organisation. 2018 \\\\\\\\\\\\\\\[cited 2021 Apr 15\\\\\\\\\\\\\\\]. Available from: https://www.who. int/news-room/fact-sheets/detail/mental-health- strengthening-our-response 2. headsup.org.au/your-mental-health/what-is-good- mental-health 3. Jacka FN, Mykletun A, Berk M. ‘Moving towards a population health approach to the primary prevention of common mental disorders’. BMC Med, 2012 Nov 27; 10: 149. doi: 10.1186/1741-7015-10-149. PMID: 23186355; PMCID: PMC3534562. 4. beyondblue.org.au 5. Sarris J, Moylan S, Camfield D, Pase M, Mischoulon D, Berk M, Jacka F, Schweitzer I. ‘Complementary medicine, exercise, meditation, diet and lifestyle modification for anxiety disorders: A review of current evidence’. Evid Based Complement. Alternat Med, 2012. 6. Panossian A. ‘Understanding adaptogenic activity: Specificity of the pharmacological action of adaptogens and other phytochemicals’. Ann NY Acad Sci, 2017; 1401. 7. Anghelescu IG, Edwards D, Seifritz E, Kasper S. TO PAGE 86 Taking a patient focused mental health related medical history. A detailed history is vital to uncover likely contributing factors to enable treatments to be tailored to suit the patient’s needs. QUESTIONS TO ASK COMMENTS AND COUNSELLING How would you describe your main symptoms? Is there anything you have tried already? Pregnant or breast- feeding? Coffee and other sources of caffeine – how much per day? Follow-up Look for any underlying psychological issues and recommend specialised follow-up if needed. Stress, anxiety and other mood disturbances can also be accompanied by a range of somatic symptoms. Explore disturbances with sleep, digestion and presence of fatigue, headaches, etc. Any prescription medicines, lifestyle modification or complementary medicine (CM)? For how long and what was the degree of success? Avoid recommending any pharmaceutical preparations (including CMs). If reduction is recommended, this should be undertaken slowly in a graded manner to avoid exacerbation of symptoms. CMs and therapies may take one to three months to show full benefit. An initial follow- up after a few weeks would be useful to check adherence and progress with any recommended treatments. How long have you suffered this and how often? Where persistent stress and exhaustion are present, appropriate intervention can help mitigate against onset of anxiety or depression. It may also be beneficial to refer the patient to their GP for professional assessment and management. Current medications? There is a need to be mindful of possible medicine interactions with use of some CMs. Alcohol, nicotine and other substance use? Check for any unhelpful coping behaviours that can lead to a substance-use problem and may aggravate an anxiety condition. However, reduction of these may need to be undertaken gradually and carefully, to not exacerbate anxiety. Exercise – type, frequency, duration? Physical activity levels are an indicator of self-care, and regular physical exercise improves mental health. Australian guidelines broadly recommend at least 30 minutes of moderate-intensity physical activity on most days of the week. And any amount is better than none. Previously sedentary patients middle-aged and over may benefit from a health assessment before beginning an exercise program. Introducing the new look Australasian College of Pharmacy Now is a great time to become part of the College community. Visit acp.edu.au to learn more and sign up for updates. A new year, a new look... 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