New Genetic Study Could Transform Approach to Mental Health
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Have you had your vitamin D levels checked lately? If not, you may be one of the majority of Americans who have insufficient levels of this vitamin, which is crucial for brain health.
Often called the “sunshine vitamin,” vitamin D is actually a hormone that plays a role in everything from immune response to mood and mental health. Low levels of vitamin D have also been associated with dementia and cognitive decline—and millions of Americans are at risk.
Maintaining optimal vitamin D levels won’t just protect your brain from dementia—it will boost your mood, promote mental health, and improve your immunity.
When the National Health and Nutrition Examination Surveys (NHANES) monitored the vitamin D status of more than 71,000 Americans from 2001-2018, results showed that:
In other words, just over one-third (34.5 percent) of people studied had sufficient levels of vitamin D. Severe and moderate deficiencies were more common during the wintertime, as well as among certain populations—females, non-Hispanic black populations, and individuals ages 20-29.
Overall, the most significant predictors of severe vitamin D deficiency were: age, sex, ethnicity, season, sun-protective behaviors, lower BMI, lower socioeconomic status, drinking alcohol, and less milk consumption.
These numbers echo the findings at Amen Clinics. All patients receive vitamin D tests, and a surprising number of them have low levels. Modern lifestyle choices, like sunscreen application and less time spent outdoors, have diminished vitamin D levels.
Therefore, it’s a good idea to check your vitamin D levels the next time you visit a doctor. A simple blood test, called 25-hydroxyvitamin D level, will let you know where you fall in the range of results:
Deficient: <30 ng/mL (nanograms per milliliter)
Low-Normal: 30-50 ng/mL
Normal: 30-100 ng/mL
Optimal: 50-100 ng/mL
Ensure you receive the actual number of your result—not just the category it falls in (such as “normal”). You want to reach the optimal range to offer the best protection against a range of health issues.
Low levels of vitamin D have been associated with more than 200 conditions, from depression and dementia to autism and heart disease. On the other hand, optimal levels will support both physical and mental health in numerous ways.
Related: 7 Reasons to Take Vitamin D
Numerous studies have linked vitamin D to effects on the brain. A 2014 study found that vitamin D prevented cognitive decline and enhanced the synaptic function in the hippocampus of aging rats. Those given higher vitamin D3 diets were able to perform complex memory tasks, unlike rats with low or normal dietary amounts of vitamin D.
That’s because, as the study noted, vitamin D helps regulate calcium and is responsible for diverse functions in various tissues, including the brain. The authors cited increasing evidence associating vitamin D with maintaining cognitive function (and its deficiency with accelerated cognitive decline with age).
These findings have been echoed in human studies, too. A 2022 study linked vitamin D with better cognitive function. Subjects with higher brain concentrations of vitamin D showed 25-33 percent lower odds of dementia or mild cognitive impairment (MCI) before death.
Similarly, research from 2015 determined that those with deficiencies in vitamin D had greater rates of decline in episodic memory and executive function, compared to those with adequate levels. And participants with MCI had lower levels of vitamin D than those who were cognitively healthy.
These findings backed up an earlier study, published in the journal Neurology in 2014, that tracked 1,658 people over the age of 65 over an average of six years.
Researchers found that not getting sufficient vitamin D may more than double the risk of developing dementia in older populations—a 53 percent increase. And those who were severely deficient had a 125 percent increased risk, compared to participants with normal vitamin D levels.
These results were similar when looking at Alzheimer’s disease. Participants with lower levels of vitamin D were nearly 70 percent more likely to develop Alzheimer’s. Severe deficiency was associated with a 120 percent increase in the likelihood of developing the disease.
Related: What’s the Difference Between Alzheimer’s Disease and Dementia?
The links illustrated above are not surprising, because we know that vitamin D receptors are present throughout the brain. Vitamin D plays a crucial role in protecting cognitive function, learning, and making memories.
A study published in the Journal of Alzheimer’s Disease points to another possible reason for the link between cognitive decline and vitamin D. It suggested that vitamin D may stimulate the immune system, helping rid the brain of beta-amyloid, which are the plaques seen in Alzheimer’s disease.
What does this mean about the connection between vitamin D and Alzheimer’s disease? If low vitamin D is linked to dementia risk and cognitive decline, researchers were quick to ask: Does vitamin D prevent dementia? And could vitamin supplements help?
A Canadian study published in 2023 explored this link between vitamin D supplementation and dementia in 12,388 individuals who did not have dementia. Researchers reported that “vitamin D exposure was associated with significantly longer dementia-free survival and lower dementia incidence rate than no exposure.”
Furthermore, in 2024, a systematic review of literature explored the potential relationship between vitamin D deficiency and risk of cognitive impairment or dementia. The resulting meta-analysis considered 23 studies on the subject.
Results showed that vitamin D deficiency was associated with a higher risk for dementia (1.42 times the risk) and a 34 percent elevated risk for cognitive impairment. But vitamin D was non-linearly related to dementia risk, meaning that benefits peak at a certain level.
This review established optimal vitamin D levels at 77.5-100 nmol/L vitamin D for reducing dementia risk and >40.1 nmol/L for decreasing risk of Alzheimer’s disease.
Maintaining optimal vitamin D levels won’t only protect your brain from dementia—it will boost your mood, promote mental health, and improve your immunity. Here are three ways to make sure you’re getting enough of this crucial vitamin:
In this video, Amen Clinics integrative nutritionist Cindy Santa Ana reveals the other nutritional supplements your body needs to fully activate vitamin D.
Click below to tune in:
While vitamin D deficiency is a common problem among Americans today, making simple lifestyle changes can help.
By maintaining optimal levels of this crucial vitamin, you’ll receive a neuroprotective boost that helps the brain function better over the long haul—leading to better mental health and less risk for debilitating conditions like dementia.
Cui A, Xiao P, Ma Y, Fan Z, Zhou F, Zheng J, Zhang L. Prevalence, trend, and predictor analyses of vitamin D deficiency in the US population, 2001-2018. Front Nutr. 2022 Oct 3;9:965376. doi: 10.3389/fnut.2022.965376. PMID: 36263304; PMCID: PMC9573946.
C.S. Latimer, L.D. Brewer, J.L. Searcy, K. Chen, J. Popović, S.D. Kraner, O. Thibault, E.M. Blalock, P.W. Landfield, & N.M. Porter, Vitamin D prevents cognitive decline and enhances hippocampal synaptic function in aging rats, Proc. Natl. Acad. Sci. U.S.A. 111 (41) E4359-E4366, https://doi.org/10.1073/pnas.1404477111 (2014).
Shea MK, Barger K, Dawson-Hughes B, et al. Brain vitamin D forms, cognitive decline, and neuropathology in community-dwelling older adults. Alzheimer’s Dement. 2023; 19: 2389–2396. https://doi.org/10.1002/alz.12836
Miller JW, Harvey DJ, Beckett LA, Green R, Farias ST, Reed BR, Olichney JM, Mungas DM, DeCarli C. Vitamin D Status and Rates of Cognitive Decline in a Multiethnic Cohort of Older Adults. JAMA Neurol. 2015 Nov;72(11):1295-303. doi: 10.1001/jamaneurol.2015.2115. PMID: 26366714; PMCID: PMC5023277.
Littlejohns, T., Henley, W., Lang, I., Annweiler, C., Beauchet, O., Chaves, P., et al. (2014). Vitamin D and the risk of dementia and Alzheimer disease. Neurology 83, 920–928. doi: 10.1212/WNL.0000000000000755
Masoumi A, Goldenson B, Ghirmai S, Avagyan H, Zaghi J, Abel K, Zheng X, Espinosa-Jeffrey A, Mahanian M, Liu PT, Hewison M, Mizwickie M, Cashman J, Fiala M. 1alpha,25-dihydroxyvitamin D3 interacts with curcuminoids to stimulate amyloid-beta clearance by macrophages of Alzheimer’s disease patients. J Alzheimers Dis. 2009;17(3):703-17. doi: 10.3233/JAD-2009-1080. PMID: 19433889.
Ghahremani M, Smith EE, Chen HY, Creese B, Goodarzi Z, Ismail Z. Vitamin D supplementation and incident dementia: Effects of sex, APOE, and baseline cognitive status. Alzheimers Dement (Amst). 2023 Mar 1;15(1):e12404. doi: 10.1002/dad2.12404. PMID: 36874594; PMCID: PMC9976297.
Zhang XX, Wang HR, Meng-Wei, Hu YZ, Sun HM, Feng YX, Jia JJ. Association of Vitamin D Levels with Risk of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of Prospective Studies. J Alzheimers Dis. 2024;98(2):373-385. doi: 10.3233/JAD-231381. PMID: 38461506.
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.
Facebook-f X-twitter Youtube WordPress Considering that anxiety is the world’s most common mental disorder, you would think everyone would have a good understanding of it.
Considering that anxiety is the world’s most common mental disorder, you would think everyone would have a good understanding of it. That’s not what people with anxiety say. In fact, individuals with anxiety disorders continue to face many hurtful myths and stigma surrounding the condition.
It’s time to clear up those untruths. Understanding anxiety from personal perspectives puts you in a better position to offer the appropriate support. Here are 10 things that people with anxiety wish you knew.
As a legitimate mental health condition, an anxiety disorder extends beyond the everyday worries that we all experience.
According to the World Health Organization (WHO), anxiety affected 4% of the population worldwide, or 301 million people, in 2019.
Since the pandemic, the prevalence of mental health concerns like anxiety has only risen, especially in our youth. Among all ages, the WHO reported a 25% increase in anxiety and depression in just the first year of COVID-19.
Related: Kids in Crisis: The Pandemic’s Toll on Childhood Mental Health
Unfortunately, the organization’s stats also show that only one in four people with anxiety receive treatment for it. This means many people are suffering in silence. And, to add to their struggle, their loved ones often hold misconceptions about what they’re going through.
While anxiety is part of being human—especially in the face of stressful events or life changes—anxiety disorders involve heightened symptoms that interfere with daily life. For example, people with generalized anxiety disorder can feel excessive worry, nervousness, and fear about everyday responsibilities and events, even ones that aren’t threatening.
Related: What’s the Difference Between Situational Anxiety an Anxiety Disorder?
In addition, they may have trouble managing their stress. As a result, they can feel overwhelmed and have trouble carrying out daily tasks. They may experience debilitating effects like panic attacks.
As a legitimate mental health condition, an anxiety disorder extends beyond the everyday worries that we all experience.
Most people think of anxiety as being solely a psychological problem. But it’s also associated with a host of physical symptoms, such as:
If a friend or family member is often feeling unwell physically, it could be a sign of anxiety.
People who don’t personally struggle with debilitating anxiety may, even without realizing it, minimize others’ symptoms. Dismissive statements like “It’s all in your head” only add to feelings of loneliness and despair.
Instead, practice active listening and patience. Don’t try to convince them to feel differently, say they should “just snap out of it,” or tell them to “look on the bright side.” Instead, validate their experience and express your willingness to listen and provide support.
Many people with mental health conditions like anxiety disorders feel misunderstood, judged, shamed, isolated, fearful, or minimized. Therefore, it’s crucial to make them feel heard, seen, and cared for. This can be as simple as saying, “I’m sorry you’re going through this” and “I’m here if you need to talk.”
While listening and supporting someone with anxiety is always a good idea, it’s best to avoid making assumptions or giving advice when they haven’t asked for it. For example, some people might think they’re being helpful by saying, “Have you tried meditation?” or by sharing the benefits of positive thinking.
Unless the person you’re speaking to has directly asked for advice, offer an ear rather than recommendations. If they do ask for your assistance, you may choose to share helpful resources but do so without expectation or judgment.
Anxiety will look different from person to person. There are different categories of anxiety disorders, such as:
In addition, anxiety is not a single or simple disorder. Through more than 30 years of brain SPECT imaging, Amen Clinics has determined that there are actually seven brain patterns associated with anxiety and depression. (These two conditions occur together 75% of the time.)
Single photon emission computed tomography (SPECT) measures blood flow and activity in the brain. This advanced technology helps psychiatrists see areas of the brain that have healthy activity levels, too much activity or not enough. According to brain scans, the seven types of anxiety and depression are:
Related: 7 Types of Anxiety and Depression (eBook)
Accordingly, each individual will experience different symptoms, with different levels of severity. Some days, a person with anxiety may be relatively high functioning. Other days, simply leaving the house can feel like a challenge.
There are multiple causes of anxiety disorders, with both genetic and environmental factors potentially increasing risk. These factors include:
However, keep in mind that anxiety is not the same as stress. As the American Psychological Association notes, stress and anxiety may produce similar mental and physical symptoms. But anxiety can be present even without any external stressors.
Press Play to See What Anxious People Should Never Do
In this video, Dr. Daniel Amen provides a brief overview of the “don’ts” for anyone who is dealing with anxiety disorders.
Click below to tune in:
Sometimes, people with anxiety can’t follow through on things. They aren’t being flaky, difficult, or cruel; they may simply struggle with tasks that other people might consider routine. For example, social anxiety can make it difficult to face gatherings and events.
It’s common for people with mental health disorders to feel guilty or burdensome to the people they love. If they’re unable to follow through with a commitment, be understanding and tolerant of their situation. And, if they do follow through, be flexible and avoid making unrealistic expectations or demands.
If people with anxiety could simply “stop worrying” to please others, they probably would. But anxiety can make even simple tasks feel like impossible achievements. Their loved ones quizzing or accusing them about what they haven’t been able to accomplish is only likely to fuel their anxiety.
Anxiety is associated with hidden side effects like trouble concentrating, low moods, and suicidal thoughts. Difficulties like racing thoughts and even full-on panic attacks may not be immediately apparent to the people around them.
Moreover, anxiety often breeds more anxiety. And the toll can be both physical and mental, leading to exhaustion.
Some people expect stereotypical warning signs like nail biting or hyperventilating in those who struggle with anxiety, but you may never see these occur. Many symptoms are internal and undetectable.
Without a comprehensive treatment plan, people with anxiety disorders may feel like they need to medicate with substances such as cannabis, alcohol, or prescribed benzodiazepines. But these “solutions” can actually cause more anxiety and other problems, such as addiction and memory issues.
The good news is, although anxiety symptoms can be debilitating, drug-free treatment options can be effective in reducing them. For example, there are various natural ways to cope with anxiety, from diet and exercise to deep breathing and nutritional supplements.
Determining the underlying brain patterns of anxiety is a helpful first step in creating a targeted treatment plan. Anxiety is often associated with overactivity in the basal ganglia, but other brain areas may also show abnormal activity, depending on which of the 7 types of anxiety/depression someone has.
Related: 10 Ways a Brain Scan Can Help My Anxiety
In other words, when it comes to anxiety treatment, what works for one person with anxiety may not work for another—or could even make their symptoms worse. For personalized help managing anxiety, seek out a qualified mental health professional.
Anxiety is not just about feeling nervous—it’s a deeply rooted condition that affects thoughts, behaviors, and even physical health. Many people with anxiety long for support but often struggle to communicate their needs. If you want to support someone with anxiety, here are key ways to offer genuine, meaningful help.
It can be tempting to offer reassurances like, “Just relax,” or “There’s nothing to worry about”” but these statements can feel dismissive to someone struggling with anxiety. Instead, try saying:
This validation helps them feel seen and heard, rather than brushed off.
While it’s important to encourage someone with anxiety to take small steps outside their comfort zone, pressuring them can make things worse. Instead of pushing them into situations they’re not ready for, offer gentle encouragement:
This allows them to feel supported rather than forced into discomfort.
Every person with anxiety has different needs. Some may appreciate distractions, while others may prefer space. Ask simple, direct questions:
Respecting their response builds trust and strengthens your relationship.
Understanding anxiety from personal perspectives can help you be a more supportive friend, partner, or family member. Learning about how anxiety affects the brain, triggers stress responses, and influences decision-making allows you to offer more thoughtful support.
With more people than ever living with anxiety symptoms, we must all make it a priority to spread greater understanding and awareness, ensuring we’re part of the solution.
World Health Organization. Anxiety disorders, Sept. 27, 2023. https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
American Psychological Association. What’s the difference between stress and anxiety? February 14, 2022. https://www.apa.org/topics/stress/anxiety-differenc
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.
Bad drivers, traffic jams, road construction, detours—they can make anyone feel angry, frustrated, or stressed. Too often, this leads to road rage. And in some cases, it can be deadly.
Take the tragic case of little Aiden Leos, for example. In 2021, a young mother was driving her 6-year-old son to kindergarten in Orange County, California, when a white sedan abruptly cut her off in the carpool lane. The mother, Joanna Cloonan, made a hand gesture as she merged away from the carpool lane. Then she heard a loud noise and her son, Aiden, said “Ow.”
When she pulled the car over, Cloonan saw that her son had been shot. She called 911 and the boy was rushed to the hospital, but sadly, he couldn’t be saved. The 6-year-old died in a senseless road rage incident.
In an interview with “Good Morning America” following the road rage shooting, Cloonan described her son, saying, “He was beautiful and he was kind and he was precious, and you killed him for no reason.”
The young boy’s mother will never be the same. Her life will be forever impacted by the emotional trauma of the horrific killing of her child. “He meant the world to me, and it feels like my life is over,” Cloonan said in an interview with Good Morning America. “That was my baby. I’ve never, never thought pain like this could exist.”
Many people experience frustration while driving, but what happens in the brain to make some drivers become so enraged they snap?
The brain-imaging work at Amen Clinics, shows that when there is abnormal activity in certain areas of the brain, it may contribute to anger, impulsivity, violent behavior, and other issues associated with road rage.
The Department of Motor Vehicles (DMV) defines road rage as “aggressive or violent behavior stemming from a driver’s uncontrolled anger at the actions of another motorist.” Aggressive driving is more common than you might imagine, causing 66% of traffic fatalities, according to statistics.
Related: Does Anger and Violent Behavior Mean You’re a Bad Person?
Nobody likes being the victim of dangerous driving, and it can make you feel anxious or angry. Data shows that about half of all drivers who are the victim of road rage behavior respond with aggressive behavior by making a rude gesture, shouting, honking their horn, tailgating, or flashing their lights.
In some cases, this leads to an escalation of rage and aggressive behavior. Drivers may:
Think road rage is only a problem for other drivers? You might be surprised. Many of us exhibit aggressive driving habits without realizing it. Take a moment to answer these questions honestly:
If you answered “yes” to any of the above, you may be an aggressive driver prone to road rage. Often, aggressive driving isn’t just about traffic—it’s a sign brain health issues or a sign of stress bubbling over from other areas of life. Crowded roads can act as a pressure cooker, and when another driver does something that seems inconsiderate (even if it’s unintentional), that pressure can erupt.
Other driving behaviors may also contribute to road rage in fellow drivers, such as:
If you engage in these driving habits, you may put yourself at risk of being involved in a road rage incident. It’s a good idea to reflect on your behavior and get to the root cause.
The human brain is involved in everything you think, do, and feel, and it’s involved in every decision you make while driving. The brain-imaging work at Amen Clinics shows that when there is abnormal activity in certain areas of the brain, it may contribute to anger, impulsivity, violent behavior, and other issues associated with road rage.
Amen Clinics uses single photon emission computed tomography (SPECT), a brain-imaging technology that measures blood flow and activity in the brain. Here’s a look at what over 250,000 SPECT scans from tens of thousands of patients at Amen Clinics reveals about road rage and the brain.
In general, there are three important brain systems that can play a role in road rage behavior.
The ACG and surrounding areas of the frontal lobes are involved in shifting your attention from one thing to another. When the ACG is working effectively you’re more able to roll with the circumstances of the day. However, if this part of the brain works too hard, there’s a tendency to get locked into negative thoughts or behaviors.
Something happens to some drivers when they get behind the wheel of a car; a territorial animal comes growling to the surface. When another driver makes an unsafe move, they can’t just express frustration, call the person a bad name, and continue driving.
Instead, the anger festers, and they get locked into a course of aggressive action—swearing, gesturing, chasing, or harassing the other driver. This is due to trouble with shifting attention.
Related: Getting Unstuck
Some examples of attention shifting issues in the ACG brain include:
The temporal lobes are located on either side of the brain below the temples and behind the eyes. The temporal lobes are involved in emotional stability and mood control among other important processes.
Brain scans show that when there is abnormal activity in this area, it can be associated with temper problems, aggressive behavior, emotional outbursts, and violence. Abnormal activity in the temporal lobes is often seen in people with a condition called intermittent explosive disorder.
Located in the front part of the brain, the PFC is involved in impulse control, planning, judgment, empathy, and more. On SPECT scans, low activity in the PFC is linked to impulsivity, poor judgment, and trouble with planning.
These issues can make a person do something or say something they shouldn’t that they will regret later.
In addition to these brain function issues, psychological factors such as chronic stress may also contribute to road rage.
For some people, road rage isn’t just a random emotional outburst—it’s a sign that their brain is stuck in a chronic state of stress and overactivation. When stress builds up over time, it alters brain function, making it harder to stay calm in frustrating situations.
Related: How Chronic Stress Rewires Your Brain (and What To Do About It)
Stress isn’t just a feeling; it physically changes the brain. When someone experiences ongoing stress—whether from work pressure, financial struggles, or personal challenges—the brain becomes wired for overreaction. Here’s how:
Not everyone reacts to stress the same way. Some people stay composed, while others spiral into rage. Several factors influence how stress impacts road rage, including:
Understanding how stress rewires the brain gives us a critical tool for managing road rage. By calming the brain, reducing daily stress, and improving self-regulation skills, drivers can stay in control—even in the most frustrating traffic situations.
Be careful when you notice yourself or another driver becoming furious with road rage. It can quickly turn into a downward spiral.
That’s what was happening with a 37-year-old attorney. When other drivers cut him off, he would chase them, and on two occasions, he got out of his car and bashed in their windows with a baseball bat.
After the second incident, he decided he needed to see a mental health professional and made an appointment at Amen Clinics. He said, “If I don’t get help for this, I’m sure to end up in jail.”
His brain scan revealed two abnormal findings:
Following recommendations to calm activity in the ACG and temporal lobes helped him gain better control over his anger and avoid future road rage issues.
When a road rage incident begins, remind yourself that you are responsible for your actions and take steps to diffuse the situation. If you’re getting angry or find yourself thinking about engaging in aggressive driving behaviors, follow these tips.
On a day-to-day basis, you can minimize the risk of road rage by working to optimize your brain function.
Press Play to Discover How to Calm Your Temper
In this video, Dr. Daniel Amen reveals several of the calming strategies he shares with the people who visit Amen Clinics to learn how to deal with out-of-control anger issues.
Click below to tune in:
If you’re suffering from uncontrolled anger or violent behaviors, or you’re getting into trouble by impulsively saying or doing the wrong thing, seek mental health treatment and consider getting a brain scan to find out if there is abnormal activity in the brain.
With a treatment plan that is targeted to your individual brain’s needs, you can stabilize your emotions and behaviors for a more peaceful life—even when you’re on the road.
National Institute of Mental Health. (2024). Bipolar disorder. https://www.nimh.nih.gov/health/statistics/bipolar-disorder
Mooney, B. (2022, May 29). Bipolar disorder often misdiagnosed as major depression, leading to improper treatment. U.S. Medicine. www.usmedicine.com/related/bipolar-disorder-often-misdiagnosed-as-major-depression-leading-to-improper-treatment/
Drake, K., & Kubala, K. (2022, March 23). Is it bipolar disorder or ADHD? www.dbsalliance.org/education/bipolar-disorder/rapid-cycling-bipolar/
Lublóy Á, Keresztúri JL, Németh A, Mihalicza P. Exploring factors of diagnostic delay for patients with bipolar disorder: a population-based cohort study. BMC Psychiatry. 2020 Feb 19;20(1):75. doi: 10.1186/s12888-020-2483-y. PMID: 32075625; PMCID: PMC7031950.
Azorin, Jean-Michel et al. “The Impact of Bipolar Disorder on Couple Functioning: Implications for Care and Treatment. A Systematic Review.” Medicina (Kaunas, Lithuania) vol. 57,8 771. 29 Jul. 2021, doi:10.3390/medicina57080771
Gillette, H., & Jelinek, J., LCSW, ACSW, RDDP. (2024, November 15). What are the signs a manic episode is ending?Medical News Today. www.medicalnewstoday.com/articles/324380
Gold AK, Peters AT, Otto MW, et al. The impact of substance use disorders on recovery from bipolar depression: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder psychosocial treatment trial. Australian & New Zealand Journal of Psychiatry. 2018;52(9):847-855. doi:10.1177/0004867418788172
Gabriel FC, Oliveira M, Bruna De M Martella, Berk M, Brietzke E, Jacka FN, Lafer B. Nutrition and bipolar disorder: a systematic review. Nutr Neurosci. 2023 Jul;26(7):637-651. doi: 10.1080/1028415X.2022.2077031. Epub 2022 May 24. PMID: 35608150.
Eisner L, Eddie D, Harley R, Jacobo M, Nierenberg AA, Deckersbach T. Dialectical Behavior Therapy Group Skills Training for Bipolar Disorder. Behav Ther. 2017 Jul;48(4):557-566. doi: 10.1016/j.beth.2016.12.006. Epub 2017 Jan 6. PMID: 28577590; PMCID: PMC6145450.
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.
When most people think of bipolar disorder, they picture intense mood swings—manic highs and depressive lows. But bipolar disorder is far more complex than that. Many individuals live with this condition for years without knowing it because their symptoms don’t match the classic extremes. Instead, they experience lesser-known signs of bipolar disorder that are easy to overlook or misinterpret.
According to the National Institute of Mental Health, about 4.4% of US adults will experience bipolar disorder at some point in their lives. Yet research shows that nearly 70% are misdiagnosed early on, and over one-third remain misdiagnosed for more than a decade. Why? Because the hidden signs of bipolar disorder often mimic other mental health conditions—or are dismissed entirely.
These subtle symptoms can leave people wondering: Is it mood swings or bipolar disorder? If you or someone you love struggles with emotional ups and downs, irritability, impulsivity, or periods of high energy that don’t quite seem “normal,” it’s worth a closer look.
In this article, we’ll explore the unrecognized symptoms of bipolar disorder, how they may show up in daily life, and what steps to take if you think bipolar disorder could be the cause.
Research shows that nearly 70% are misdiagnosed early on, and over one-third remain misdiagnosed for more than a decade.
Many people assume bipolar disorder always involves extreme manic episodes, but that’s not the case. There are several types of bipolar disorder, including bipolar 1, bipolar 2, and cyclothymia. When it comes to bipolar 1 vs bipolar 2 and cyclothymia, the latter two involve milder forms of mania (hypomania), making them harder to recognize.
RELATED: The Surprising Differences Between Bipolar 1 and Bipolar 2
These episodes may not disrupt daily life in obvious ways, which is why people often don’t realize they have a mood disorder. The early signs of bipolar disorder in adults can include subtle mood shifts, impulsive behaviors, chronic irritability, and periods of extreme productivity.
Often, these symptoms can be spotted by those around you or if you’re aware and tracking your own behaviors. Unfortunately, there are often missed symptoms or confusing bipolar disorder signs most people miss that aren’t always discussed in mental health circles.
Related: What Your Doctor Might Be Missing About Your Bipolar Disorder
Bipolar disorder is frequently mistaken for other mental health conditions, leading to delayed or incorrect treatment. This can be devastating if you’re unsure of how to talk about your symptoms with your doctors.
Other mental health conditions can “mask” early symptoms of bipolar disorder in adults, so it’s just as important to know the most common misdiagnoses to talk about it early.
Press Play for More on Bipolar Disorder vs ADHD
In this video, Dr. Steven Storage, a psychiatrist at Amen Clinics, discusses three key dissimilarities in these two mental health conditions.
Traditional mental health assessments often focus on depressive symptoms rather than mood fluctuations, which means bipolar disorder can go unnoticed. A 2020 study found the average delay in diagnosing bipolar disorder can be 10 to 15 years from the onset of symptoms. This delay can prevent people from getting the right treatment early on.
Bipolar disorder doesn’t always involve extreme mood swings or obviously dramatic behavioral changes. Here are some lesser-known symptoms or often unrecognized symptoms of bipolar disorder:
Bipolar disorder isn’t just about mood swings—it affects your relationships, work, and daily routines in profound ways.
Research shows that having bipolar disorder has a negative impact on relationships. In part, this is can be due to intense emotional reactions, impulsive behaviors, and periods of withdrawal.
Loved ones may feel confused by sudden shifts in mood and energy levels. Communicating your concerns and being transparent about what you’re each going through can help you find solutions to common problems when dealing with bipolar disorder.
After a hypomanic episode, many people with bipolar disorder can experience what’s known as a “bipolar hangover”—a period of exhaustion, regret, and emotional depletion.
These post-hypomania hangovers can lead to feelings of guilt or embarrassment over actions taken during a hypomanic phase. It can also make it harder to recognize the pattern of mood swings because the emotional crash can be mistaken for ordinary stress or fatigue rather than a sign of the underlying condition.
Some people turn to alcohol, caffeine, or drugs to manage their fluctuating moods. Research reveals up to 60% of people with bipolar disorder struggle with substance abuse at some point in their lives.
However, self-medicating only worsens symptoms and increases the risk of long-term consequences. It is critical to your mental and physical health and safety to speak openly and honestly with your mental health professional and physician about using alcohol, marijuana, or other substances to self-medicate.
If you suspect that you or someone you love may have bipolar disorder, here are some questions to start:
Tracking your mood patterns over time can help identify hidden signs of those high and low emotions. To help identify the bipolar disorder signs most people miss, or if you just don’t know where to start, here’s a breakdown of what a mood journal should include:
If you or a loved one exhibit these symptoms, early intervention for bipolar disorder is key, according to a review in the American Journal of Psychiatry. Tracking symptoms as soon as they appear can simplify the diagnosis process and development of an effective treatment plan.
Some bipolar disorder interventions include:
Related: Cognitive Behavioral Therapy: What Is It and Who Can Benefit?
Bipolar disorder isn’t always obvious, but recognizing the hidden signs can be life changing. If you or someone you love struggles with mood swings, impulsivity, or unexplained emotional shifts, seeking a comprehensive mental health evaluation is the next step.
To help rule out other mental health conditions, such as ADHD, clinical depression, and schizophrenia, consider seeking an evaluation that includes brain SPECT imaging. This functional brain imaging technology helps detect underlying brain activity patterns associated with a variety of mental health problems.
This leads to a more accurate diagnosis and more effective treatment. With the right treatment plan for bipolar disorder, stability, balance, and a fulfilling life are possible.
National Institute of Mental Health. (2024). Bipolar disorder. https://www.nimh.nih.gov/health/statistics/bipolar-disorder
Mooney, B. (2022, May 29). Bipolar disorder often misdiagnosed as major depression, leading to improper treatment. U.S. Medicine. www.usmedicine.com/related/bipolar-disorder-often-misdiagnosed-as-major-depression-leading-to-improper-treatment/
Drake, K., & Kubala, K. (2022, March 23). Is it bipolar disorder or ADHD? www.dbsalliance.org/education/bipolar-disorder/rapid-cycling-bipolar/
Lublóy Á, Keresztúri JL, Németh A, Mihalicza P. Exploring factors of diagnostic delay for patients with bipolar disorder: a population-based cohort study. BMC Psychiatry. 2020 Feb 19;20(1):75. doi: 10.1186/s12888-020-2483-y. PMID: 32075625; PMCID: PMC7031950.
Azorin, Jean-Michel et al. “The Impact of Bipolar Disorder on Couple Functioning: Implications for Care and Treatment. A Systematic Review.” Medicina (Kaunas, Lithuania) vol. 57,8 771. 29 Jul. 2021, doi:10.3390/medicina57080771
Gillette, H., & Jelinek, J., LCSW, ACSW, RDDP. (2024, November 15). What are the signs a manic episode is ending?Medical News Today. www.medicalnewstoday.com/articles/324380
Gold AK, Peters AT, Otto MW, et al. The impact of substance use disorders on recovery from bipolar depression: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder psychosocial treatment trial. Australian & New Zealand Journal of Psychiatry. 2018;52(9):847-855. doi:10.1177/0004867418788172
Gabriel FC, Oliveira M, Bruna De M Martella, Berk M, Brietzke E, Jacka FN, Lafer B. Nutrition and bipolar disorder: a systematic review. Nutr Neurosci. 2023 Jul;26(7):637-651. doi: 10.1080/1028415X.2022.2077031. Epub 2022 May 24. PMID: 35608150.
Eisner L, Eddie D, Harley R, Jacobo M, Nierenberg AA, Deckersbach T. Dialectical Behavior Therapy Group Skills Training for Bipolar Disorder. Behav Ther. 2017 Jul;48(4):557-566. doi: 10.1016/j.beth.2016.12.006. Epub 2017 Jan 6. PMID: 28577590; PMCID: PMC6145450.
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.
Have you ever wondered why dramatic news stories easily get you into panic mode, but warnings about the everyday habits that threaten your health don’t phase you?
This kind of mismatch is called the risk perception gap, a phenomenon that influences how our brains prioritizes fear. If there’s a news alert about contaminated vegetables, for example, people will rush to throw out all their groceries and warn their loved ones about it.
Interestingly, later that day, those same people will grab fast food, even though we all know that poor diet is linked to health issues like diabetes and heart disease. In general, we tend to overestimate the danger posed by rare events and underestimate more prevalent risks.
In this blog, we will unpack why our brains work this way, how it affects the decisions we make, and what we can do to focus on the real dangers.
Have you ever wondered why dramatic news stories easily get you into panic mode, but warnings about the everyday habits that threaten your health don’t phase you? This kind of mismatch is called the risk perception gap.
The risk perception gap is the discrepancy between how risky something actually is based on statistics or facts and how risky people think it is based on their personal beliefs, feelings, or instincts. According to research, this is a case of risk misperception where people categorize threats based on emotions rather than rationality or reason.
For instance, some people may have an intense fear of occurrences like plane crashes, even though they are very rare, yet they underestimate more common and fatal risks like car accidents or heart disease. Such misperception leads to complacency or unnecessary fear as people try to manage real-world risks.
Our brains often rely on mental shortcuts, also known as cognitive biases, to simplify information processing.
These biases can be useful in quick decision-making, especially when managing complex life situations in limited time. Even so, cognitive bias and fear usually work hand in hand, bypassing logical thinking in favor of past experiences or instincts.
So, what are some of the most common cognitive biases? Here are four mental shortcuts that distort thinking:
This is an important element of the risk perception psychology that explains how we judge the probability of an event based on how easily we can recall instances or examples. In most cases, this results from the level of attention some of these events receive from the media.
For example, after hearing about a plane crash, you are more likely to believe that air travel is riskier than it actually is. You may overestimate such a risk just because that memory is still fresh in your mind.
Related: Phobias: Types, Causes, Symptoms, and Treatments
Our brains are hardwired to focus more on negative information than positive or neutral information. Naturally, your mind is attracted to negative emotions, experiences, or events because they are usually viewed as threatening or urgent.
For instance, if you see numerous positive reviews about a product but only one negative review, you’re more likely to focus on and remember the negative review. This can influence your decisions based on fear and caution rather than rationality.
Probability neglect is the cognitive bias where emotions like excitement or fear can cloud your judgment, making you overlook the actual likelihood of an event taking place.
For instance, watching a horror movie can make you so scared that you believe something dangerous could be lurking around you. This feeling of fear can make you exaggerate the risk in your mind and overlook the reality of the matter.
This is about how we tend to rely heavily on the first bit of information we come across, to make judgements or decisions. This piece of information is called the anchor. Anchoring bias causes your brain to cling to the first information you received and use it to judge everything that follows.
As an example, let’s say you hear that a certain purse costs $1,000. That price will stick in your mind. But later when you see a similar bag being sold for $700, it will feel like a bargain even though it’s still costly.
To understand how the brain assesses risk, let’s begin by examining the key areas and processes involved in rational and emotional thinking:
This part of the brain processes emotions, especially fear. Once the amygdala senses a potential threat, it initiates an immediate emotional response that is meant to protect you.
This usually happens even before the logical regions of your brain get time to assess the situation. This is why you may react impulsively, and in some cases, overestimate risks based on emotions rather than reason.
This region is responsible for advanced-level thinking processes like planning, rational decision-making and impulse control. In essence, this is the part of the brain that helps in logical risk assessment. It allows you to carefully weigh facts.
That said, whenever you have strong emotions like fear, your prefrontal cortex gets overpowered by the amygdala. That results in distorted judgment, which can cause you to prioritize immediate emotional reaction instead of careful reasoning.
Related: What Is the Executive Center of the Brain?
Media coverage plays a significant role in influencing how our brains perceive risks. Research shows that through dramatic and emotionally charged reporting, the media heavily amplifies threats that are unlikely to actualize.
Unusual events like terrorist incidents, shark attacks, or airplane crashes often grab public attention as they trigger intense emotional reactions. That can lead to distorted risk perception, whereby, as a viewer, your fears become misaligned with the actual probabilities.
Social media algorithms often highlight shocking content, which induces fear. It makes uncommon occurrences seem more frequent than they actually are. As a user, you find yourself constantly worrying about rare dangers while overlooking everyday risks.
Press Play to Find Out Why We’re Addicted to Fear
In this video, health and wellness expert and bestselling author Tana Amen shares why she stopped watching the news and how you need to take notice of what’s driving your fears.
Click below to tune in:
This gap between rare vs. real dangers often goes unnoticed, more so because of the dramatic headlines that steal the spotlight. While we’ve been conditioned to focus on the rare dangers, the risks that quietly affect our environment, physical, and mental health tend to slip under the radar.
Having a clear understanding of the brain and risk assessment will save you from unnecessary panic and help you to focus on avoiding or addressing the real dangers.
Factors like lack of exercise, poor diet, excessive alcohol, and smoking continue to pose major health risks. Similarly, chronic stress, among other untreated mental health-related issues, have been silently eroding the quality of life for many.
At the same time, people have been exposing themselves to long-term air pollution, among other invisible health hazards, oblivious to the fact that they contribute to diseases and premature death. These are the real dangers, but unfortunately, they receive far less attention.
Related: Toxic Brain Quiz: 23 Everyday Toxins That Destroy Thinking
Understanding why you fear the wrong things is just the first step. Next, it’s important to focus on practical ways to restructure your thinking. Rather than relying on fear-based assumptions, you can rewire your response patterns by taking the following simple steps:
These are tactics that will help you identify your distorted thought patterns and replace them with more rational perspectives.
For instance, if you are always assuming the worst when someone doesn’t respond to your messages right away, pause and ask yourself, “Is there real evidence that something is wrong, or am I just jumping to conclusions?” Consider alternative explanations; “Perhaps, they haven’t seen the messages yet.”
If you notice that your emotions are taking over in any situation, pause and redirect your focus on your breathing, sounds, or even the physical sensations around you. These exercises will calm your nervous system, allowing you to think more clearly.
In today’s world, where there is constant media fearmongering, it’s a good idea to get familiar with basic probabilities. Researchers in Germany suggest adopting a habit of questioning any dramatic claims you come across. Always ask, “How likely is this risk?” This will allow you to focus on real concerns.
Say no to living in a constant state of unnecessary fear. Understanding the way your brain works can help you redirect your focus to risks that matter rather than exaggerated threats. The good news? The risk perception gap isn’t permanent. You can rewire it with intention and practice.
All you have to do is begin with one small action. At the end of the day, take time to reflect on a fear you’ve always had and ask, was it about facts or just feelings? Noticing when it’s your emotions or objective data that are influencing your fears is how you are going to reshape your worldview over time.
Also, limit the amount of time you spend every day consuming content that makes you feel overwhelmed with fear. Remember, five minutes of watching doom-laden news can hijack your emotional state for days. Replace that with reading a self-help book, engaging in mindful meditation, or some other form of relaxation.
Slovic, P. (Ed.). (2000). The perception of risk. Earthscan Publications. https://doi.org/10.4324/9781315661773
Slovic, P., & Weber, E. U. (2002). Perception of risk posed by extreme events. Center for Hazards and Risk Research, Columbia University. https://www.ldeo.columbia.edu/chrr/documents/meetings/roundtable/white_papers/slovic_wp.pdf
Slovic, P., & Peters, E. (2012). The perception gap: Recognizing and managing the risks that arise when fears do not match the evidence. Risk Analysis, 32(6), 1033–1044. https://doi.org/10.1111/j.1539-6924.2012.01817.x
Brown, V. J. (2014). Risk perception: It’s personal. Environmental Health Perspectives, 122(10), A276–A279. https://doi.org/10.1289/ehp.122-A276
Heuckmann, B., & Krüger, F. (2022). Approaching the risk perception gap: Effects of a subject matter knowledge-based intervention in a health context. Journal of Biological Education, 57(5), 1006–1021. https://doi.org/10.1080/00219266.2021.2009005
Posner, E. A., & Masur, J. (2011). Regulation, unemployment, and cost-benefit analysis. John M. Olin Program in Law and Economics Working Paper No. 571. University of Chicago Law School. https://chicagounbound.uchicago.edu/cgi/viewcontent.cgi?article=1384&context=law_and_economics
Institute of Medicine (US) & National Research Council (US) Committee on the Science of Adolescence. (2011). Biobehavioral processes. In The science of adolescent risk-taking: Workshop report. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK53414/
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.
Experienced mental health professionals can tell if someone is likely to have clinical depression, anxiety disorders, or anger issues. By asking about a person’s symptoms, they may recognize symptom clusters associated with ADD/ADHD, obsessive-compulsive disorder (OCD), or bipolar disorder.
However, what most psychiatrists and psychologists cannot do—and will never be able to do—is to know the underlying brain biology of the patients they treat. That’s because most mental health professionals don’t use functional brain imaging as part of their evaluation process.
Why is this so important?
In this blog, you’ll discover how functional brain imaging can help you find out what’s causing your mental health symptoms, so you can get the most effective treatment plan for your needs.
Functional brain imaging can help you find out what’s causing your mental health symptoms and which treatments will be most effective for you.
Without using functional brain scans—such as SPECT (single photon emission computed tomography) or QEEG (quantitative electroencephalogram)—your doctor cannot tell if your inattention, depression, compulsions, mood swings, or aggression is from:
If mental health professionals don’t look at the brain, they are unnecessarily flying blind. That can lead them to miss important diagnoses, give the wrong treatment plan, and hurt the people they are entrusted to help.
Jason is a prime example of how not looking at the brain can be life-threatening. He was 18 and in his first year in college at the University of Rhode Island when he first started hearing voices and having visual hallucinations.
Based on his symptoms, the university psychiatrist diagnosed him with schizophrenia and told his parents he would need to be on antipsychotic medication for the rest of his life. But the medication triggered suicidal thoughts.
Horrified, his mother called Amen Clinics, where Jason underwent a functional brain-imaging study.
Jason’s SPECT scan showed evidence of a past brain injury affecting his left temporal lobe, which when damaged is often involved in mood instability, dark thoughts, and hallucinations. It also showed low activity in his frontal lobes (where focus, forethought, and planning occur).
When he was 5 years old, Jason jumped headfirst into an empty bathtub and was unconscious for a brief period. He also had sustained several concussions from wrestling and playing soccer.
Since the age of 5, Jason had struggled with low-grade depression. His symptoms worsened when he was 12 years old and experienced bullying at school.
While at college, Jason started hearing voices. They constantly made mean comments about him and others. Often, the voices would speak at the same time. In addition, he began seeing gory visions of his own death, including being strangled by a snake.
After a comprehensive evaluation at Amen Clinics, including his personal history, SPECT brain scans, neuropsychological assessments, and more, his diagnosis changed.
Jason didn’t have schizophrenia. Rather, he had experienced a psychotic depression, which had been made worse by the prior brain injury, undisciplined thought patterns, and chronic stress.
Jason stopped taking his antipsychotic medication and began supporting his brain recovery with healing nutrients and cognitive behavioral therapy (CBT). He also did multiple sessions of hyperbaric oxygen therapy (HBOT) to help heal his prior brain injury.
Within 4 months, Jason was remarkably improved and the following year he was back at school. If no one had ever looked at his brain and put him on a more effective treatment plan, his life would have been very different.
Functional brain imaging takes psychiatry from a generalized symptom-cluster diagnostic and treatment specialty without any biological evidence to a more objective specialty, one that is solidly based on using state-of-the-art brain mapping tools to help optimize the patient’s brain function.
Besides completely changing the way mental health professionals diagnose mental health disorders, functional imaging leads to completely different treatment protocols to improve brain function.
By finding the root causes of your symptoms—such as exposure to toxic mold, Lyme disease, or a past head injury—you can get more targeted treatment that works.
For example, if your depressive symptoms are related to toxic mold exposure, it’s unlikely that antidepressant medications are going to help. Unless you eliminate the mold, you’re going to continue struggling with low moods.
Similarly, if Lyme disease is causing psychotic episodes, but you’re diagnosed with schizophrenia, antipsychotics won’t work. You have to treat the underlying infection.
When brain scans help a psychiatrist get to the root causes, you’re more likely to feel better faster.
Looking at the brain also leads to more natural strategies to treat mental health conditions. Seeing areas of the brain that are either overactive or underactive helps physicians pinpoint lifestyle habits to optimize brain function.
If you’re struggling with mental health symptoms that aren’t responding to traditional treatments or psychiatric medications, it’s a good idea to consider a brain scan. Additional biological information can be so helpful in discovering why you feel depressed, anxious, angry, or unfocused. And it can give you a clearer roadmap to healing.
American Psychological Association Website
What Is Psychiatry?
https://www.psychiatry.org/patients-families/psychotherapy
Accessed April 18, 2025
How Long Will It Take for Treatment to Work?
https://www.apa.org/ptsd-guideline/patients-and-families/length-treatment
Accessed April 18, 2025
Jacob, J., Stankovic, M., Spuerck, I. et al. Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis. BMC Psychol 10, 171 (2022).
Law C, et al. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychol Res Behav Manag. 2019 Dec 24;12:1167–1174.
Wilson G, et al. The Use of Eye-Movement Desensitization Reprocessing (EMDR) Therapy in Treating Post-traumatic Stress Disorder—A Systematic Narrative Review. Front Psychol. 2018 Jun 6;9:923.
NIH: National Library of Medicine
National Center for Biotechnology Information
Psychotherapy and Therapeutic Relationship
https://www.ncbi.nlm.nih.gov/books/NBK608012/
Accessed April 18, 2025
Vermani M, et al. Rates of Detection of Mood and Anxiety Disorders in Primary Care: A Descriptive, Cross-Sectional Study. Prim Care Companion. 2011;13(2):PCC.10m01013.
Swift J, Callahan J. Decreasing treatment dropout by addressing expectations for treatment length. Psychother Res. 2011 Mar;21(2):193-200.
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.
Although talk therapy can be beneficial or even transformational for many people, it does not work for everybody. The American Psychological Association (APA) reports that about 75% of people who enter psychotherapy (also called talk therapy or just therapy) show some benefit from it—including improved emotional and psychological well-being, as well as associated positive changes in the brain and body.
The American Psychological Association reports that about 75% of people who enter psychotherapy show some benefit from it – but what about the other 25%?
But what about the other 25% who find therapy not effective? For a number of reasons—such as misdiagnosis, one-size-fits-all treatments, or failing to recognize underlying medical conditions—a significant number of individuals are not getting the results they want from therapy. In some cases, therapy may even make things worse.
If you are struggling with talk therapy not working, you may be relieved to know there are reasons why traditional therapy may not be enough for you. Here’s how to recognize when therapy is not working, more information about why talk therapy doesn’t work for everyone, and what to do when therapy fails.
Because talk therapy is a process, and progress is highly individual, it can be difficult to discern if it is working for some individuals. While some find relief upon their first appointment, others feel it after a few sessions.
Generally, treatment takes a few months. According to the APA, it takes about 15 to 20 sessions for 50% of trauma patients to improve, based on self-reported symptom measures. However, it also suggests that people with co-occurring conditions or certain personality issues may need longer treatment (perhaps 12-18 months) for therapy to work.
Regardless, there are markers of improvement that should be met, even in the early stages of therapy. Here are five signs that therapy is not working:
There are many explanations for therapy failure. Here are some of the top reasons why therapy is not effective for an estimated 25% of people who try it.
Physical health and mental health are closely tied to each other. If treating the mental health condition with therapy is not working, it may be that you have an unaddressed medical condition.
For example, infections like Lyme disease are associated with mental disorders like depression and anxiety as are long-term physical illness (i.e., arthritis, asthma, cancer, chronic fatigue, diabetes, epilepsy, heart problems, and high blood pressure).
Psychotherapy is not a one-size-fits-all solution for treating mental health disorders. There are many different types available, and for good reason. Not all mental health conditions are alike. Some require a specific approach.
For example, exposure and response prevention (ERP), a type of cognitive behavioral therapy, is the primary and most effective psychotherapeutic approach for treating obsessive-compulsive disorder (OCD), according to research. In fact, general talk therapy can make OCD worse.
Additionally, talk therapy may be ineffective for some trauma survivors. Eye movement desensitization and reprocessing (EMDR) therapy has been shown to be effective in treating PTSD, according to research, which may be a better method for some. The temperament of some individuals may call for an entirely different approach like art therapy.
The quality of the alliance or connection between the client and therapist plays a major role in therapy outcomes, research shows. It should be characterized by empathy, a nonjudgmental attitude, and mutual respect. This creates a safe space for clients to discuss their concerns openly. If that is not happening, it may be a poor fit.
Perhaps the therapist doesn’t have experience with your issues, is culturally insensitive, or you simply don’t like their personality. While not the norm, there are poor therapists too.
They may fail in helping you to work towards a goal, break ethical boundaries, or talk too much about themselves. Think of finding the right therapist like trying to find the right medication. It may take a few tries to find the right one.
Too often therapy fails because the patient has been misdiagnosed. Unfortunately, misdiagnosis is very common—particularly with primary care physicians.
One study found alarmingly high misdiagnosis rates from primary care physicians: 65.9% for major depressive disorder, 92.7% for bipolar disorder, 85.8% for panic disorder, 71.0% for generalized anxiety disorder, and 97.8% for social anxiety disorder. It’s critical to get an accurate diagnosis from a qualified mental health professional.
Sometimes it’s not the right time for therapy. When basic needs are threatened like proper income, shelter, food, and transportation due to job loss, divorce, or other factors, therapy may need to wait for those needs to be taken care of first. Sometimes an individual may just not be ready to undergo the process of therapy.
Sometimes therapy fails due to misconceptions or inaccurate expectations. One study found that most of the clients involved incorrectly believed it would take just six sessions to resolve their problem, which led to higher dropout rates. Therapy may require a greater investment with time and money than an individual wants to give.
If you’re struggling with therapy, try some of these steps and brain-based alternatives to talk therapy:
Understanding why therapy isn’t working for you and taking steps to improve its effectiveness or trying other innovative therapies can put you on a path to healing.
American Psychological Association Website
What Is Psychiatry?
https://www.psychiatry.org/patients-families/psychotherapy
Accessed April 18, 2025
How Long Will It Take for Treatment to Work?
https://www.apa.org/ptsd-guideline/patients-and-families/length-treatment
Accessed April 18, 2025
Jacob, J., Stankovic, M., Spuerck, I. et al. Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis. BMC Psychol 10, 171 (2022).
Law C, et al. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychol Res Behav Manag. 2019 Dec 24;12:1167–1174.
Wilson G, et al. The Use of Eye-Movement Desensitization Reprocessing (EMDR) Therapy in Treating Post-traumatic Stress Disorder—A Systematic Narrative Review. Front Psychol. 2018 Jun 6;9:923.
NIH: National Library of Medicine
National Center for Biotechnology Information
Psychotherapy and Therapeutic Relationship
https://www.ncbi.nlm.nih.gov/books/NBK608012/
Accessed April 18, 2025
Vermani M, et al. Rates of Detection of Mood and Anxiety Disorders in Primary Care: A Descriptive, Cross-Sectional Study. Prim Care Companion. 2011;13(2):PCC.10m01013.
Swift J, Callahan J. Decreasing treatment dropout by addressing expectations for treatment length. Psychother Res. 2011 Mar;21(2):193-200.
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.
Have you or a loved one experienced mental health issues that had an unknown or mysterious cause? Were you prescribed psychiatric medication that addressed some symptoms but aggravated or created others? Or have symptoms not considerably improved with standard treatments?
That’s what happened to Juan, a 22-year-old college student. He had been taking psychiatric medications for more than a decade, but they weren’t working. He was struggling at school, trying to cope with unwanted medication side effects, and dealing with additional mental health problems that had developed.
Why wasn’t Juan getting better?
Drawing on this fascinating case study from Amen Clinics, this blog explores a common culprit that can lead to mental health symptoms as well as brain fog and memory loss. You’ll also learn how this underlying biological factor impacts mental well-being, how to find out if it might be driving your own mental health issues, and how to protect your overall health.
Thousands of SPECT scans at Amen Clinics have shown that immune system issues and infections must be considered when evaluating brain and mental health—especially when mental health symptoms aren’t improving with typical treatments.
Juan had used stimulant medication to control his attention deficit hyperactive disorder (ADHD) since he was only 10 years old. As a child, he’d exhibited classic symptoms. He was easily distracted and had difficulty remaining seated or following instructions.
By the time he entered Amen Clinics as a 22-year-old pre-law college student, additional mental health symptoms were surfacing. Despite a high IQ, he was failing at school, struggling with depression, and experiencing suicidal thoughts for the first time ever.
Ritalin, his ADHD medication, improved his focus, but it also had major drawbacks, making Juan irritable, impatient, moody, and agitated. Even in Juan’s childhood, his mother noted these effects, but his family became resigned to his “grumpy” personality. He also experimented with alcohol abuse as an adolescent but quit when he was exhibiting noticeably aggressive behavior.
By college, he was having trouble sleeping. For his anxiety, now elevated due to his poor grades in school, he received a prescription for Xanax, but the medication caused memory problems.
At Amen Clinics, Juan’s SPECT scan showed overall low activity in his brain at rest, showing a toxic pattern that is unusual in someone so young. But, unlike in those with ADHD, activity improved with concentration. Why did his resting SPECT scan look so abnormal?
After ruling out possibilities like drug and alcohol use, environmental toxins, severe anemia, and a past history of oxygen deprivation (such as from a near drowning or heart attack), clinicians conducted an infectious disease panel.
Results revealed that Juan had been exposed to multiple infections in his past: Lyme, the Epstein Barr virus, Toxoplasma gondii, Mycoplasma pneumoniae, and Human Herpesvirus 6 (HHV-6). Because both Lyme disease and HHV-6 compromise immune system function, Juan became more susceptible to other infections.
Infections that mimic ADHD and infections that mimic depression can send people down a troublesome path. Taking prescription drugs for these mental health issues doesn’t get to the root cause of the symptoms and may lead to other issues.
Ultimately, Juan simply needed to be treated for his infections while building a stronger immune system. After treatments, Juan enjoyed marked improvements in his mood, temper, focus, and grades. He was even able to discontinue his ADHD medication—and successfully received his law degree.
Related: Can Lyme Disease Change Your Personality?
When it comes to possible hidden causes of mental illness, many culprits can contribute. One common correlation—often overlooked—exists between internal infections and mental health. From cancers and HIV/AIDS to allergies and autoimmune diseases, infections can trigger symptoms that mimic ADHD, depression, and more.
To understand the link between immunity, infections, and mental health, it’s important to review the functions of the immune system. This crucial system of the body defends against attackers, both internal and external. Through these attacks, it strengthens to better handle future threats.
External attackers could be bacteria, viruses, or parasites, while internal invaders include cancer cells. In addition to providing defense, the immune system regulates tolerance—for example, how well you handle potential environmental triggers, such as allergens.
Back in 2016, 33 scientists worldwide wrote an editorial in the Journal of Alzheimer’s Disease about how the medical community often overlooks infectious diseases as an underlying cause of cognitive issues. They cited more than 100 studies demonstrating that significant stress or other immune system suppressants can activate dormant viruses in the brain.
The field of psychiatry that studies the link between the immune system and mental health is still in relatively early development, but experts believe it shows promise. According to a 2021 article published in Brain, Behavior, and Immunity Health, scientists have long hypothesized a link between mental states and immune response.
Authors, citing research from 1985, noted that these speculations occurred long before the founding of psychoneuroimmunology, which is the area of research that studies these interactions. They added that in the previous decade, experts were increasingly exploring how to harness the immune system to improve psychiatric patients’ outcomes—an emerging field called immunopsychiatry.
Immune disorders fall into one of five categories, all of which impact your brain health—and therefore your mental health:
Related: What is Mild Cognitive Impairment?
Fortunately, illness does not always follow exposure to infectious diseases. Based on many factors—the strength of your immune system, the level of exposure, your stress levels, and your daily lifestyle habits—you may not get sick when exposed.
Here are some tips to keep your immune system strong:
Related: Is Your Cat Making You Crazy?
In this video, Dr. Eboni Cornish, Amen Clinics’ Functional Medicine Director for its Eastern division, shares the best supplements to promote a healthy immune system.
Click below to tune in:
Thousands of SPECT scans at Amen Clinics have shown that immune system issues and infections must be considered when evaluating brain and mental health. And it’s especially crucial when mental health issues aren’t improving with standard treatments, such as in Juan’s case.
If you want to reduce your risk of developing mental health symptoms, take steps to strengthen your immune system, and limit your risks for and exposures to infectious diseases. Future research will undoubtedly continue to advance our understanding on the relationship between the brain, the immune system, and mental health.
De Picker LJ. The future of immunopsychiatry: Three milestones to clinical innovation. Brain Behav Immun Health. 2021 Jul 30;16:100314. doi: 10.1016/j.bbih.2021.100314. PMID: 34589805; PMCID: PMC8474175.
Tzeng NS, Chang HA, Chung CH, Kao YC, Chang CC, Yeh HW, Chiang WS, Chou YC, Chang SY, Chien WC. Increased Risk of Psychiatric Disorders in Allergic Diseases: A Nationwide, Population-Based, Cohort Study. Front Psychiatry. 2018 Apr 24;9:133. doi: 10.3389/fpsyt.2018.00133. PMID: 29740354; PMCID: PMC5928780.
Itzhaki RF, Lathe R, Balin BJ, Ball MJ, Bearer EL, Braak H, Bullido MJ, Carter C, Clerici M, Cosby SL, Del Tredici K, Field H, Fulop T, Grassi C, Griffin WS, Haas J, Hudson AP, Kamer AR, Kell DB, Licastro F, Letenneur L, Lövheim H, Mancuso R, Miklossy J, Otth C, Palamara AT, Perry G, Preston C, Pretorius E, Strandberg T, Tabet N, Taylor-Robinson SD, Whittum-Hudson JA. Microbes and Alzheimer’s Disease. J Alzheimers Dis. 2016;51(4):979-84. doi: 10.3233/JAD-160152. PMID: 26967229; PMCID: PMC5457904.
Fernando A, Tokell M, Ishak Y, Love J, Klammer M, Koh M. Mental health needs in cancer – a call for change. Future Healthc J. 2023 Jul;10(2):112-116. doi: 10.7861/fhj.2023-0059. PMID: 37786642; PMCID: PMC10540791.
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.
Did you know that humans have used fermentation to produce and preserve food for roughly 13,000 years?
It’s true. And, as it turns out, this ancient practice of fermentation has proved to be vital to human health. Indeed, modern science continues to reveal significant health benefits—such as better gut health, immune health, brain health, and more—from consuming fermented foods.
That’s because fermented foods are rich in probiotics, which are healthy microorganisms or “good bugs” that surprisingly provide us with health benefits when we consume them. Common examples of fermented foods include sauerkraut, kimchi, miso, unsweetened Greek yogurt, kombucha, and kefir.
An exciting new study from researchers at the University of Virginia School of Medicine suggests that a common strain of probiotics found in many fermented foods may help reduce anxiety and depression.
Remarkably, an exciting new study from researchers at the University of Virginia School of Medicine suggests that a common strain of probiotics found in many fermented foods may help reduce anxiety and depression by positively influencing gut bacteria and neurotransmitters. It’s an important finding in terms of understanding the association between fermented foods and mental health and the gut-brain connection.
Here’s what you need to know about probiotics for depression and fermented foods and anxiety, plus a list of probiotic-rich foods to enjoy.
There’s a communication system between your gut and brain called the gut-brain axis or simply the gut-brain connection. Some refer to the gut as the “second brain” because your gut is lined with nearly 170 million neurons.
These neurons are in near constant, bidirectional communication with your brain. The neuronal network of the gut, called the enteric nervous system, manages the functions of the gastrointestinal (GI) tract.
Communicating primarily through the vagus nerve, there are both physical and biochemical messaging between these two areas of the body that can influence the health of the other. What’s more, the microorganisms in your gut appear to play a vital role in this communication.
In an animal study published in December 2024, UCLA researchers demonstrated causal evidence that the gut’s microflora has a direct influence on messaging between the gut and brain through the vagus nerve. It’s another piece of the puzzle in helping scientists understand how probiotics affect the brain.
Considering all the neurons in your GI tract and the direct communication it has with the brain, it makes sense that gut health and mood are closely linked. When your gut health is off, you are more likely to have mental health problems and vice versa.
Related: Long COVID, Inflammation, and the Gut-Brain Axis
This is evident in scientific studies. For example, inflammatory bowel disease is associated with higher rates of anxiety and depression, research has found.
Research points to other connections, too. Although it is not fully understood, increased intestinal permeability (more commonly known as “leaky gut” syndrome) and the inflammation it causes is believed to play a role in a number of mental health conditions – including:
To help protect and/or boost your mental health, it is necessary to have a basic understanding of how your microbiome works and take steps to keep it healthy. You might be surprised to learn the extent of your gut’s microorganisms.
Collectively, bacteria, yeast, and other microorganisms total about 100 trillion! That is 10 times the total number of cells in the rest of your body. This community of microorganisms is called the microbiome.
The microbiome plays an essential role in the synthesis of neurotransmitters—such as glutamate, GABA, serotonin, and dopamine. Serotonin has a strong influence on mental well-being.
Related: 9 Natural Ways to Balance Dopamine
Maintaining a balanced ratio of healthy bugs to harmful ones in your microbiome is key to gut health. Optimally, in a healthy gut, beneficial bugs make up about 85 percent of the microflora, while harmful bugs are limited to roughly 15 percent.
Of course, there are times when the balance is temporarily disrupted. However, when lifestyle factors lead to chronic disruption, problems arise in your gut—and your mental health can suffer.
The following lifestyle factors can negatively impact the balance of microflora in your microbiome:
In this video, Amen Clinics Integrative Nutritionist Cindy Santa Ana reveals what helps and what hurts the health of your microbiome to enhance overall wellness:
The good news, though, is that you have a lot of power to make a difference in the health of your microbiome. Fermented foods can bolster the gut microbiome, helping to create a healthier mix of microbes and even strengthening intestinal walls to protect against leaky gut.
According to recent research, consuming fermented foods routinely may help your mental well-being by improving your gut health.
In the new University of Virginia study mentioned earlier, researchers discovered that Lactobacillus (a “good bug” commonly found in fermented foods) appears to help the body to manage stress better and may help prevent anxiety and depression in animal subjects.
This research is particularly important because it isolates Lactobacillus from other microorganisms that commonly live in and on our bodies. The study suggests that Lactobacillus may potentially influence mood disorders in humans by calibrating the immune system.
Specifically, the researchers found that a lack of Lactobacillus was highly associated with worsening depression and anxiety symptoms in the animal subjects. Also, they found the bacteria appears to help to maintain levels of an immune mediator known to manage the body’s response to stress, helping to keep depression at bay.
The study validates previous research exploring the link between frequently consumed fermented foods and lowered symptoms of depression and anxiety—and improved cognition as a result of reduced anxiety symptoms.
While medical doctors are not yet suggesting probiotics for depression, the evidence so far points to fermented foods being important to a balanced mood.
If you want to include foods that help with depression and anxiety in your diet, consider these popular Lactobacillus-rich fermented foods:
Fermented foods are safe and healthy for most people. However, in some instances, fermented food products (and particularly raw fermented foods) may not be suitable for pregnant women and infants, elderly individuals, and people with health issues such as digestive disorders, compromised immune systems, and histamine intolerance. These individuals should consult a medical doctor before adding fermented foods to their diet.
Keep in mind that for some individuals, adding probiotic cultures to their digestive systems can cause some temporary discomfort, gas, and bloating. The new microorganisms may not immediately mix well with the existing microorganisms, leading to a temporary period of adjustment in the gut microbiome. But with time, the gut typically adapts.
Merchak A et al. Lactobacillus from the Altered Schaedler Flora maintain IFNγ homeostasis to promote behavioral stress resilience. Brain Behav Immun. 2024 Jan:115:458-469.
Michel K et al. How big is the little brain in the gut? Neuronal numbers in the enteric nervous system of mice, Guinea pig, and human. Neurogastroenterol Motil. 2022 Dec;34(12):e14440.
Jameson, KG et al. Select microbial metabolites in the small intestinal lumen regulate vagal activity via receptor-mediated signaling. IScience. 2024 Dec 27;28(2):111699.
Leone D et al. Psychological Characteristics of Inflammatory Bowel Disease Patients: A Comparison Between Active and Nonactive Patients. Inflamm Bowel Dis. 2019 Jul 17;25(8):1399-1407.
Wasiak J and Gawlik-Kotelnicka O. Intestinal permeability and its significance in psychiatric disorders – A narrative review and future perspectives. Behav Brain Res. 2023 Jun 25:448:114459.
Karbownik, MS et al. Association Between Consumption of Fermented Food and Food-Derived Prebiotics With Cognitive Performance, Depressive, and Anxiety Symptoms in Psychiatrically Healthy Medical Students Under Psychological Stress: A Prospective Cohort Study. Front Nutr. 2022 Mar 3;9:850249.
Facebook-f X-twitter Youtube Table of Contents A massive new genetic study is challenging the way we define mental illness, and confirming that the brain is
Facebook-f X-twitter Youtube Table of Contents In the last decade, the question “What is CTE?” has been asked and searched online more than ever before.