It took some leg work, but Continuum Mental Health Service has been approved to provide services to Canadian Veterans.

Through Blue Cross / Medavie, we are now able to access coverage for qualified members of the Canadian Armed Forces (including veterans) and Royal Canadian Mounted Police.

We are very excited about this! We have worked with CAF members and veterans in the past, but without this coverage we have been limited in the scope of service we were able to provide. The interactions we have recently had with VAC Rehabilitation Services has given us great hope that, together with VAC, Warren can effectivley work with veterans who live with PTSD, historical trauma, and family stress, just to name a few.

If you or someone you know belonging to the above mentioned groups of - lets face it - heros, please call me at 780-977-1465, and I will do everything I can to make sure you get the help you need.

Thank you!

Christina Krywko

So, a little while back I discovered that Philips no longer produces the goLITE BLU, and doesn’t have a new product to replace it. This is very unfortunate as we have direct experience with this product and have found it to be a very helpful therapy light with all the features we want, and have no trouble recommending it. You can still find them around (Amazon, Walmart, etc), but it won’t be long before they are extinct, and we’re left scrambling to find another product to recommend. Since Continuum already has the goLITEs, we won’t be buying a new one. This means we won’t have the hands-on experience with a new lamp any time soon.

I’ve done a little bit of research and have found what appears to be a good replacement. Of course, without actually using these lamps, we can’t say any more than the reviews I’ve found online.

Circadian Optics has a few different models, all with Ultra Bright UV free 10,000 Lux Full Spectrum LED Lights. I’ve highlighted below two of these; one desk lamp and one portable. I’ve included the links to Circadian Optics website for you to look them over yourself. You can also check out the other models to see if there is anything that fits your needs better.

Circadian Optics Lumine Light Therapy Lamp (https://circadianoptics.com/products/lumine) is the corded desk lamp, with one-touch operation and 3 levels of brightness.

Weight: 0.88 lbs

Dimensions: 6.6 x 6.6 x 3.75 inches (just smaller than my hand)

Where to buy: Direct from Circadian Optics (follow the link above) it’s $54.99USD

On Amazon.ca I found it for $151.99CDN

I couldn’t find it on Costco.ca or Walmart.ca

Circadian Optics Luxy Light Therapy Lamp (https://circadianoptics.com/products/luxy) is a portable lamp that can be corded, but also runs off a USB power supply. It also has one-touch operation and 3 levels of brightness.

Weight: 0.35 lbs

Dimensions: 3.25 x 3.5 x 1.25 inches (about palm sized)

Where to buy: Direct from Circadian Optics (follow the link above) it’s $49.99USD

On Amazon.ca it’s advertised at $49.99CDN

At Costco.ca it’s listed at $39.99CDN

At Walmart.ca it’s listed at $99.99 and they say it’s almost sold out … pressure sales.

If you want to do your own research, here are a few things to remember:

- Intensity: The typical recommendation is to use a 10,000-lux (or equivalent) light box. A box with a lower lux rating can be used, but the daily use sessions will probably be longer in duration.

- UVB Light: The UVB light produced by light therapy lamps is typically low, but UVB can be very damaging to eyes and skin. Make sure the lamp you are looking at filters out as close to 100% as possible.

- Light Source: There are two main light sources SAD lamps us; Compact fluorescent bulbs and LEDs.

o The compact fluorescent bulbs diminish in intensity over time and normally last only two years before they need to be replaced.

o LED lamps last for approximately 50,000 hours of use before the intensity drops off

Our recommendation is to look for the lamps with the LEDs. You don’t have to keep track of when you need to replace bulbs, and don’t have to second guess whether or not the lamp is fully effective.

- Power Source: When reading the specs of each lamp, keep in mind how you will be using it. It is recommended to use the lamp for 20 to 30 minutes (read the manufacturers suggestion) in the morning to start your day off energized. If you have a busy morning schedule, you will probably want a cordless lamp that you can carry around the house with you. If you typically sit and eat breakfast, that may be an ideal time to use the lamp. Therefore, a corded lamp may be for you.

I hope this post helps all those who are interested in trying light therapy for their seasonal affective disorder! There is a lot of information out there, it’s just scattered and not all of it is easy to read.

If anyone out there has had direct experience with a lamp, please share it here! The best reviews always come from someone who has used the product in their daily life!

** Disclaimer: Continuum Mental Health Services Ltd, nor anyone directly associated with CMHS, benefit in any way (financial or otherwise) from any producer or distributor of light therapy lamps. The information provided here is based on our own research and experience with these lamps.

Well, here goes nothing. This is the first blog post I have ever done. Wish me luck

I find it hard to believe that we didn't have even one post in 2016. The year sort of ran away on us. And here we are already 2-1/2 months into 2017. I guess you could say our little CMHS baby has started to stretch and grow. We have continued to develop relationships with colleagues, and expanded the services we provide. And, of course, we try to be available to our clients as much as possible.

My own role in CMHS has evolved more than I had ever expected. Don't worry, it's all in a VERY good way. I have been able to assist some of our clients with paperwork (insurance, government, etc) and developing a budget plan. I have also helped with research, and even to get to appointments. But the most enjoyable thing I do with our clients is talk! Most of the time it is just a quick chat as we set up an appointment. But there are times when Warren is not available, and a client needs to talk out their troubles. I consider myself extraordinarily lucky to have been allowed to be a part of the journey our clients are on. I can't share any of these experiences, but believe me, we work with some pretty amazing people!

Recently, I was invited to participate in the 4th annual Women's Symposium in Westlock, in celebration of International Women's Day. It was a very informative, fun day. I met many interesting women, and heard some remarkable stories. I feel we are living in an exciting time, with women getting closer and closer to complete equality. My hope is that in the not-so-distant future we don't feel the need to have an International Women's Day. I would like to see us celebrate the strength of the human spirit, regardless of gender, race, religion, identity or age.

My plan for this blog is to give readers (clients and non-clients alike) a place to ask questions (no specifics please, this is not a private forum) or make suggestions to Warren and myself on ways we can improve our services, improve this web site, or topics / issues we should look in to. Please feel free to comment. We look forward to hearing from you!

Christina Krywko

Continuum MHS

We spent a good part of the day in Westlock yesterday. We attended the Rural Kids Matter meeting, and the team is doing great. We helped crunch some stats for the group, and have edited the info again today for approval. Nearly half of kids entering shool in the region will require some assistance in one of the developmental areas addressed in the 2014 report on the region. Overall, in each area specifically looked at, the Westlock/Thorhild region children are right around the provincial averages, slightly above the average in the majority of areas.

We met with the Westlock Associate Medical Clinic, and look to develop that relationship. They were quite busy, but we agreed to meet to discuss options.

We also met with the Westlock Primary Care Network, and have discussed the gaps in service in Mental Health. Being a Tier 4 service, we do not overlap with the existing Tier 3 and Tier 2 services in the area. (See the explanation of the Tier system here: http://www.health.alberta.ca/documents/Creating-Connections-2011-Strategy.pdf)

The biggest barrier seems to be the reliance on NGOs (Non-Governmental Organizations) for Tier 4 services. People struggling at the level of Tier 4 often have many social and financial difficulties. We continue to try to network to be creative to broaden funding sources for people.

ADHD is one of the most diagnosed conditions in children, yet it is one of the most underdiagnosed conditions in adulthood. There is a lot of confusion as to what ADHD is and is not. There are also a lot of myths regarding ADHD.

First of all, we need to clarify a few terms. ADHD is the common diagnostic term. The older term ADD, is still used by many people although it is not the official medical diagnosis anymore. ADD is now diagnostically called ADHD, inattentive subtype. There is a myth that ADHD is overdiagnosed with a recent study showing that only one in five people with ADHD are adequately diagnosed and treated. I suspect the overdiagnosis myth comes from the query of ADHD in young boys usually under the age of 10 who prefer to be active rather than sit in a classroom. To be diagnosed with ADHD, it must be shown that the level of hyperactivity or inattention is outside of the normal range for a child of that gender, of that age. Diagnosis under the age of six is difficult and the vast majority of professionals that I have worked with our reluctant to diagnose or provide medications that young unless there is a severe impairment in social functioning. In these cases, regular appointments are made so the professionals can track growth as a decreased appetite is the most common side effect of the commonly used ADHD medications.

The most commonly recognized form of ADHD is the hyperactive subtype. Unfortunately, many people with the inattentive subtype go undiagnosed and the difficulties are not recognized. Additionally, many times behavior problems in children are diagnosed as ADHD when ADHD may not be present. I have seen both extremes of this particular problem over the years, where child who apparently has very clear behavior problems is treated for ADHD and behavior problems disappear, and other times were kids appeared to have ADHD medical treatment has no impact on the problems.

Mammoth hunting: ADHD is a medical/psychiatric disorder and it does have significant impact on individuals ability to be successful and their relationships. There are benefits to being ADHD which are often overlooked. People with ADHD tend to do better under stress. The leading theory as to why ADHD exists is that people with ADHD have a baseline arousal level much lower than the average person. To feel motivated to pay attention or to get going, they require high levels of external pressure. In the Hunter gatherer society, it is easy to see how these traits would be beneficial for a hunter or a warrior. The difference between a hunter gatherer society and modern society is they did not have a Monday to Friday workweek with a 7.75 hour workday. Nobody would expect a hunter warrior to perform routine tasks daily. When they were needed, when the pressure rose, they came into their own and performed well. Modern-day equivalents would be occupations such as being a paramedic, a firefighter, a trial lawyer, or an emergency room nurse or doctor.

An additional strength associated with ADHD is heightened creativity. We see these traits in actors, artists and musicians. There is some controversy regarding creativity and its association with ADHD, with some studies finding no such link. Many other studies do confirm the association with creativity and ADHD, so I will leave it for each person to assess the evidence for themselves and come to their own conclusions. I personally have noticed heightened creativity in the clients I work with who do have ADHD, but that in itself is not conclusive.

A couple decades ago, it was commonly thought that children outgrew ADHD as they moved into adulthood. We now know that about two thirds of children with ADHD will continue to have symptoms as an adult. The overt hyperactivity is often replaced with a sense of restlessness that is felt internally. We have also learned that emotional dysregulation is a core symptom of ADHD for many people. Many people are misdiagnosed as having personality disorders, mood disorders, or anxiety and often feel little relief from the treatments prescribed for those conditions. Making this even more confusing, is the high rates of comorbidities between anxiety, mood disorders and ADHD. A recent study has shown that over 90% of people who were diagnosed with one will also be a diagnosed with one of the other two and 60% of people will meet the diagnostic criteria for all three.

My experience has been that people often report experiences with depression and anxiety as those are often changes from the individuals normal functioning. With ADHD, it is always there and many people with ADHD do not realize that other people experience the world differently from them. Boredom and procrastination are almost universally reported by people with ADHD when asked about it. If the client is being treated for depression or anxiety, and they are experiencing minimal relief, it is usually a good idea to screen for ADHD as accurately identifying ADHD can mean the difference between barely functioning and remission of symptoms.

I will do a follow-up blog on ADHD looking at specific subpopulations such as women with ADHD, ADHD and bipolar II, and ADHD and SAD. It is becoming clear through the research of mental health conditions do not fit neatly in one category or another. It seems to make more sense when work backwards from which neurotransmitters appear to be impacted and in the case of ADHD, dopamine plays a central role. It makes sense that ADHD often occurs alongside seasonal affective disorder, bipolar II and atypical depression. Those disorders are rooted in dopamine as well.

Depression is the most commonly diagnosed mental health condition, and the majority of cases are diagnosed by a family physician. It seems straightfrorward; you feel depressed, have a hard time accomplishing what you want to, and your relationships suffer. Your doctor has given you an antidepressant, and it doesn't seem to do much for you, so you try another. This time you feel worse. Your doctor refers you for counseling, which helps a bit, but you are still struggling.

This story is all too familiar. Depression isn't just depression. The trouble is, many people diagnosed with depression aren't depressed, at least not in the way that an antidepressant would help with. One of my pet peeves as a therapist is the confusion regarding depression, because of an issue called "Symptom Overlap." This means that symptoms in different disorders can be the same as symptoms in other disorders. Unfortunately, diagnostic tests are not available to identify the causes of the symptoms, so we play a game of trial and error.

There are several categories of depression in the DSM (Diagnostic and Statistical Manual), the guide used by most practitioners in North America to diagnose. There is much critique with how depression is dealt with in the DSM. People who feel depressed can actually experience a number of different "disorders" such as Major Depressive Disorder, Atypical Depression, Seasonal Affective Disorder, and Bipolar II. The root cause of these labels differs with three general causes. Serotonin, Dopamine, and Light.

Serotonin is in play when you feel sad, have trouble staying asleep, lose your appetite, and consistently stay depressed even if something good happens. This type of depression usually responds well to a SSRI (Sustained Release, Serotonin Reuptake Inhibitor) antidepressant.

However, if you have trouble getting out of bed in the morning, feel irritable, have an increased appetite, experience sensitivity to rejection, and experience mood improvement, briefly, when good things happen, you are likely experiencing Atypical Depression, which is related to the neurotransmitter Dopamine. An antidepressant will usually not help as it is working on a different neurotransmitter. None of the antidepressants on the market focus primarily on Dopamine. An older class of drugs, not commonly used, MAOIs (Mono-Amineoxidase Inhibitor) do effect dopamine, but there are serious potential side effects and dietary restrictions due to a reaction with tyramine, present in aged cheeses and wine, for example.

To make this more complicated, the frequency and timing of these "atypical" symptoms changes the diagnosis. If they happen only in winter, we call it SAD (Seasonal Affective Disorder).  Treatment is with natural light, but there is very high comorbidity with ADHD, another Dopamine based disorder.  If the symptoms are episodic, any time of the year, we call it Atypical Depression. If the symptoms are cyclical, with occasional hypomanic symptoms, we call it Bipolar II. Confused yet? Many of us are, with good reason. Adding confusion is the fact that we now know that anxiety and ADHD are highly comorbid with depression, as are issues with substance abuse. 

So where do we start? We need to look bigger, rather than right in the moment. We need family history, as these conditions run in families, and other family members experiences with what does and does not work helps guide us. Secondly, onset of symptoms, and the number of, and pattern of relapses helps narrow down diagnosis. Onset in childhood or adolescence separate from trauma suggests Dopamine, rather than Serotonin.  Third, we need to be open to trial and error. A combination of counseling and medications are often needed. We can effect our Serotonin levels through lifestyle changes much more easily than we can effect Dopamine levels. Therapy is a key component in recovery, regardless of the diagnosis.

I will go into more detail in subsequent blogs, as there is a lot of detail to clear up, but this gives an overview of one of the biggest areas of confusion in Mental Health diagnosis. When you meet with us, and you tell me things didn't work, I believe you! There is plenty of reason to see why people struggle with recovery.

On  this page we will post interesting findings in the research regarding mental health issues.

We attended a meeting in Westlock this afternoon with the great people at Rural Kids Matter. We have agreed to unofficially partner, and will try to help spread the word regarding this great resource. We will be adding a community partners page to the website to make networking easier once we get the information from Rural Kids Matter. We are looking forward to building relationships with the great people in the communities we offer services in.

We attended a meeting in Westlock this afternoon with the great people at Rural Kids Matter. We have agreed to unofficially partner, and will try to help spread the word regarding this great resource. We will be adding a community partners page to the website to make networking easier once we get the information from Rural Kids Matter. We are looking forward to building relationships with the great people in the communities we offer services in.