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Anemia (iron-poor blood) can fatigue and make a person feel listless. Hypothyroidism (hormone imbalance) can flatten or even agitate mood. Mood changes may also occur from the psychological stress of coping with a medical condition or may be caused by the illness itself or by the medications used to treat it. This is why it's so important to obtain a differential diagnosis--a diagnosis that evaluates all possibilities for symptoms. "Substance-induced mood disorder" is the diagnosis if mood changes are the direct result of substances such as drugs, alcohol, medications, or exposure to toxins. When diagnosing mental illness, some disorders use specifiers to better define symptoms. In the realm of mood disorders, there are numerous specifiers that help to uniquely describe the course, type, intensity, special features, and cycling patterns. Documenting specifiers is a complex undertaking, one that you and your mental health professional should talk about openly and often. The more information you have about the uniqueness of your diagnosis, the more specialized your treatment plan can be made. Another important consideration is to look for additional mental disorders. Children and adults who experience a mood disorder typically experience other comorbid disorders. Another way of understanding comorbidity is to think of a thunderstorm. The one event, the heavy rainfall, might lead to another event--a flood. A rainstorm doesn't always lead to flooding, but the storm increases the likelihood of flooding. So, having a mood disorder can set the stage for also experiencing an anxiety disorder, a substance use disorder, or a personality disorder. There can be considerable overlap between and among mental illnesses, which is why obtaining an accurate diagnosis is crucial. Each of us is born with the capacity for loving friendliness. Yet only in a calm mind, a mind free from anger, greed, and jealousy, can the seeds of loving friendliness develop; only from the fertile ground of a peaceful mind can loving friendliness flower. We must nurture the seeds of loving friendliness in ourselves and in others, help them take root and mature. Loving friendliness works miracles.

We have the capacity to act with loving friendliness. We may not even know we have this quality in ourselves, but the power of loving friendliness is inside us all. Loving friendliness is one of the four sublime states defined by the Buddha, along with compassion, appreciative joy, and equanimity. All four states are interrelated; we cannot develop one without the other. One way to understand them is to think of different stages of parenthood. When a young woman finds out she is going to have a child, she feels a tremendous outpouring of love for the baby she will bear. She will do everything she can to protect the infant growing inside her. She will make every effort to make sure the baby is well and healthy. She is full of loving, hopeful thoughts for the child. Like metta, the feeling a new mother has for her infant is limitless and all-embracing; and, like metta, it does not depend on actions or behavior of the one receiving our thoughts of loving friendliness. As the infant grows older and starts to explore his world, the parents develop compassion. Every time the child scrapes his knee, falls down, or bumps his head, the parent feels the child's pain. Some parents even say that when their child feels pain, it is as if they themselves were being hurt. There is no pity in this feeling; pity puts distance between others and ourselves. Compassion leads us to appropriate action; and the appropriate, compassionate action is just the pure, heartfelt hope that the pain stop and the child not suffer. As time passes, the child heads off to school. Parents watch as the youngster makes friends, does well in school, sports, and other activities. Maybe the child does well on a spelling test, makes the baseball team, or gets elected class president. The parents are not jealous or resentful of their child's success but are full of happiness for the child. This is appreciative joy.

Thinking of how we would feel for our own child, we can feel this for others. Even when we think of others whose success exceeds our own, we can appreciate their achievement and rejoice in their happiness. To continue in our example: Eventually, after many years, the child grows up. He finishes school and goes out on his own; perhaps he marries and starts a family. Now it is time for the parents to practice equanimity. Clearly, what the parents feel for the child is not indifference. It is an appreciation that they have done all that they could do for the child. They recognize their limitations. Of course the parents continue caring for and respecting their child, but they do so with awareness that they no longer steer the outcome of their child's life. This is the practice of equanimity. Adding to the problem is another process known as "serotonin steal," which happens when inflammation in the gut causes the microbiota to divert tryptophan away from the brain. As we've already discussed, tryptophan is a key ingredient used to make serotonin--less tryptophan means less serotonin. In fact, observations of this process reveal subjects' experiences of increased anxiety, insomnia, and depression. So one school of thought goes like this: heal the inflammation, heal the immune system, and you'll heal the psychiatry. With more than 70 percent of our immune system based in the gut and regulated by gut bacteria, it's clear this region of our body and its collective of microorganisms steer the ship of our health. People with upset in the gut microbiome may even experience an increased number of colds and flus. I don't find it coincidental that depression has long been linked to weak immune systems and a higher frequency of illness. Nor is it a coincidence that, perhaps more than any other approach we take at the Center, restoring balance to the gut microbiome restores good health throughout the body, from head to toe. What most people don't know is that certain strains of bacteria reduce cortisol levels, which decreases stress, and therefore in turn decreases depression. A 2015 study indicates a lot of promise from the introduction of certain bacteria to the gut to relieve stress and anxiety, specifically by reducing the output of cortisol.

"This study represents a proof of principle," said Dr. Gerard Clarke, who presented the study's findings at the Society for Neuroscience 2015 Annual Meeting. "The question we are asking now is, can we advance this further and can we use these psychobiotics to deal with the stressors that we encounter on the roller coaster of life, or develop further psychobiotics for patients with stress-related disorders such as depression or anxiety?"[2] The answer to that question has yet to be fully vetted by our accepted systems of medical practice. As far as we here at The Center are concerned, however, the answer will undoubtedly be yes! Here are just a few fun things you can give away early in a conversation to build rapport and keep the back and forth alive. Opinions on Major Events or Ideas - If you're talking about a recent news event or an idea or concept that you have an opinion on, share your opinion. Don't be overbearing with your opinion (always be open to hear someone else out), but by sharing your own thoughts, you give away a bit of yourself to open up a relationship with that new person. They will see that sharing as an invitation to return it in kind. Your Name and Occupation - The simplest way to start any conversation is by telling someone who you are, and not just "Hi my name is Barry". You need to say your full name, what you do if it comes up and why you are in whatever location you are in. A Hobby or Activity You Enjoy - Bringing up activities or hobbies you enjoy will personalize you even more so than simply outlining an opinion. Mention a recent outing, describe what you do in your spare time, or talk about something you just learned related to your hobby. Your Spouse or Children - Mentioning your family can be a big way to build rapport and show that you are comfortable in a conversation. Do it casually and only if it's called for. Some people grow uncomfortable at the constant mention of children or spouses, so don't overdo it - just make casual mention so they feel more comfortable in your presence. Your Current Goal - Why are you talking to this person? If you're networking, make it clear what your business goals are. If you're looking for a date, feel free to admit it. Early honesty backed up with interesting conversation will endear you to many people quickly. Rather than avoiding something that matters to you, like exercise, you can learn to approach it.

When you identify and show up for activities that matter to you, you are approaching them. Doing so cultivates seconds, minutes, or hours of positive emotions--which increases your sense that life has meaning and purpose. Even if you're feeling depressed, this consonance between your values and your actions will bring benefits. In this situation, you are considering whether to approach, or avoid, an activity because there are both appealing and not-so-appealing qualities. In the case of the improvisation class, you want to show up but you're also terrified. If you value challenging yourself, learning a new skill, or increasing opportunities to socialize, then you might want to show up despite the fear. This situation feels like being caught between a rock and a hard place when you are trying to identify which is the least-bad option. Sticking to your values can help you prioritize which path to take. If you feel ill, but despise doctors, are you going to pick up the phone to make an appointment? On one hand, you will feel sick and the illness may become worse if untreated. On the other hand, you will need to endure the awkwardness of the visit and perhaps some tests. You value your well-being and having the energy to keep up with life, so you decide to call the doctor. Take note of whether your top values are exclusively self-oriented, focused on your own growth and development. Or perhaps they are exclusively other-oriented, more focused on relationships or the needs of others. Or maybe there's a combination. A focus on self versus other typically fluctuates throughout the course of life, and there is no magical balance. That said, if you find yourself leaning mostly one way or the other, you might want to check in with your intuitive self and ask: "Would prioritizing more balance be helpful on my path to improved well-being?" Perhaps you have not been prioritizing meaningful relationships or have been avoiding relationships completely. Alternatively, you could be so busy saying yes to others that your own health is being sacrificed. To identify your values, consider the next 6 to 12 months. In a journal or on the downloadable form, write down your answer to each of these questions.