Are Some Jobs More Stressful Than Others?

Everyone has bad days on the job—a project that you put hours into bombs or a task you need to accomplish is difficult and stressful. But are some jobs harder overall on our mental health than others? Depression may be more likely to occur in some professions, research suggests. And according to a new study by researchers at the National Institute for Occupational Safety and Health, suicides in the workplace, while not commonplace, are on the rise. Their research, published in the March 16 online edition of the “American Journal of Preventive Medicine,” showed that 270 people committed suicide in the workplace in 2013, a 12% increase over 2012.

Men and those over 65 were more likely to commit suicide in the workplace than others. Law enforcement jobs -- police officers, firefighters, and detectives -- had the highest rate of workplace suicides with 5.3 suicides for every 1 million workers. Farmers, ranchers, fishermen, and forestry workers came in next with 5.1 suicides per one million. The authors also noted that minorities may be at a greater risk for workplace suicide compared to non-workplace suicides. Their research did not include military jobs.

This month’s “JAMA Psychiatry” also addressed the topic in a “Viewpoints” op-ed co-authored by two medical interns from New York who said that being a physician, especially a young intern, may leave some people vulnerable to mental illness and suicide. Doctors are twice as likely to kill themselves compared to non-physicians, and female doctors are three times more likely to do so than their male counterparts, according to the American Foundation for Suicide Prevention (AFSP). According to AFSP, though, the workplace can be an ideal place for suicide prevention programs. Their Interactive Screening Program (ISP), for example, is an anonymous online survey that IDs at-risk people and connects them with support. The NFL and the Boston Police Department have used the program. The authors of the “Lancet Psychiatry” op-ed say some work programs, like one at the U.S. Air Force, have successfully addressed workplace depression and mental illness in a variety of ways. One initiative: The USAF designates certain supervisors as mental health “gatekeepers.” Their job is to identify at-risk employees and channel them to screening and mental health services.

Want more info on managing workplace stress? Read about APA’s Partnership for Workplace Mental Health. Learn more about the American Foundation for Suicide Prevention’s ISP program by contacting the Program Director at isp@afsp.org. Read Mayo Clinic’s article: Work-Life Balance: Tips to Reclaim Control.

by Mary Brophy Marcus, health writer, APA

For more news and wellness info from APA, follow us on Twitter and Facebook.

The Power of Words: Addressing the Stigma of Mental Illness

Jenna Bowen, medical student, University of Wisconsin

Reviewed by Claudia Reardon, MD

Crazy.  Insane.  Deranged. Mad.  Lunatic. —Misused as nouns, adjectives and lay-diagnoses, their use perpetuates stereotypes of the wide variety of people who experience mental illness.

Maybe you know someone or, more likely, a number of people who experience depression, anxiety, bipolar disorder or other brain disorders.  According to the National Institute of Mental Health, 1 in 4 American adults and 1 in 5 American youth experience a form of mental illness every year. People with mental illness are teachers, accountants, neighbors, sisters, fathers and friends. Anyone you know could be experiencing mental illness, but afraid to come forward and be treated. Maybe that person is you.

People living with mental illness continue to have an identity that is beyond a diagnosis, similar to other medical conditions. While managing mental illness may be challenging at times—similar to challenges faced by people with diabetes, high blood pressure, or other medical illness— there is greater difficulty in getting the treatment needed because of feelings of shame and stigma surrounding mental illness. However, treatment for mental illness works. Research shows the majority (65 percent to 80 percent) of individuals with mental disorders will improve with appropriate treatment and ongoing monitoring. People with mental illness need to know that they will continue to be seen as people – your brother, best friend, daughter —and not “crazed” or “insane” if they appropriately seek help for a treatable medical condition that they happen to be experiencing.

Bring Change 2 Mind, an organization aimed to end stigma and discrimination surrounding mental illness, offers recommendations to reduce your impact on the stigma surrounding those with mental illness.

• Use "person first" vocabulary. When we say a person is schizophrenic, we make their mental illness fully define their identity. Instead, be clear that this is a disease that individuals manage and live with— "He is living with schizophrenia."
• Avoid the verb "suffers" when discussing mental illness. Instead, choose, "lives with mental illness" or "is affected by mental illness."
• There are many phrases and terms; "crazy," "nuts", "psycho", "schizo", "retard" and "lunatic" that may seem insignificant, but really aren't.

Be an advocate for those that you know, and the many that you don’t know, who are living with some form of mental illness by breaking down stigma, and being conscious of language surrounding brain disorders. To learn more check out:

·         Bring Change 2 Mind

·         NAMI – Stigma Busters

·         Resource Center to Promote Acceptance, Dignity and
 Social Inclusion Associated with Mental Health (SAMHSA)

·         Mental Health Terminology:  Words Matter

Study highlights lack of access to mental health care

By Arshya Vahabzadeh,MD 
 @VahabzadehMD

A new study from the CDC’s National Center for Health Statistics once again highlights that too many people living with mental health conditions are not getting needed care.

Study authors Laura A. Pratt, PhD, and Debra J. Brody, MPH, found that nearly 8% of Americans aged 12 and up had depression (moderate or severe depressive symptoms in the past 2 weeks). The rate of depression was twice as high among people living below the poverty level, 15%.

 Far more alarming, the study showed yet again that people with depression are going untreated. While nearly 90% of people with severe depressive symptoms reported difficulty with work, home, or social activities related to their symptoms, only about one-third (35.3%) had seen a mental health professional in the past year, according to the study. Among those with moderate depressive symptoms, only 1 in 5 had seen a mental health professional.

While there are many reasons people don’t get needed mental health care, including mental health stigma and lack of access, discrimination in mental health coverage by insurance companies shouldn’t be among the reasons. Federal law now requires that insurers cover mental health illnesses the same as physical ailments, such as heart disease, diabetes and cancer.


However, many people don’t know their rights when it comes to getting mental health treatment. To address this glaring problem, the American Psychiatric Association has released a new poster --
available to mental health professionals -- that explains in simple terms your rights under the law and what to do if you think your rights are being denied. Download a copy at www.psychiatry.org/parity.

Adult Bullying in the Workplace

By Brad Zehring, DO

I would rather be a little nobody, then to be an evil somebody - Abraham Lincoln

Typically, when bullying is talked about it is in the context of children or adolescents during some level of schooling. Rarely do we think about bullying as an adult issue. However, much more attention has been focused on adult bullying – more specifically, adult bullying in the workplace.

According to various sources, citing research and survey’s, it has been reported that as many as 1 in 4 adults will face some form of bullying in their career.  It is important to point out the differences between constructive criticism, workplace conflict, and bullying. Workplace bullying focuses on the person rather than the performance or task being completed by the person. In addition, the person being targeted feels powerless to stop it. Making the situation worse, is when the adult being bullied goes to management to report the offense and the abuse is minimized or discounted altogether. Complicating the issue further is the difficulty verbalizing what is taking place or being unaware that what is occurring is bullying, leading to worsening suffering.

What are some forms of workplace bullying?

As discussed earlier, workplace bullying can be described as an extreme pattern where the person is isolated apart from his/her performance or task. Some examples of workplace bullying are: being left-out of work-related social events, coworkers refusing to help when asked, coworkers leaving the room when you enter or routinely arriving to meetings late that when you call them, being yelled at, put down, or disciplined in front of your coworkers. These are some of the ways that workplace bullying presents, but it is not an exhaustive list.

How workplace bullying is harmful

For individuals who are being bullied in the workplace, their desire to go into work day after day is diminished and their satisfaction in their performance and with their employer decreases.  Many reports discuss the loss of productivity when job satisfaction decreases. Beyond the psychological stress (depression, anxiety, PTSD, etc) – which should not be minimized, stress from bullying can lead to physical illness such as stroke, heart attacks, chronic fatigue or dissatisfaction in an person’s personal life – including leading to suicide. There are many reports documenting poor job satisfaction negatively affecting all areas on one’s life. Feeling accomplished and satisfied in a career can lead to a happier personal life and vice versa.

How to prevent or deal with workplace bullying
While recognizing or speaking up about workplace bullying can be a difficult task - it is important not to be silent about bullying experiences, whether personal attacks or witnessed attacks on colleagues, or isolate from those that may be able to help. Currently, states are working on anti-bullying bills to encourage healthy workplace environments, but fostering a workplace for your coworkers that doesn’t tolerate bullying is key. Many organizations provide or contract with mental health professionals willing to discuss, advise, and help an individual navigate the process. It is important to document your concerns and be specific and concise with the message you are trying to convey if you feel you are being bullied. Despite how difficult it may be, it is important to approach the bully or go to your supervisor with a calm demeanor and discuss your concerns rationally. Lastly, it is important to have an open mind about the situation. Sometimes it may be that the “bully” does not realize how his/her actions have affected you. Approaching them, or the situation, calmly will provide an environment for understanding and increase the probability for change.

How to "Bully-Proof " Kids

Tweet

Williams’ death reminds us that a patient’s relief might be a warning sign

By H. Steven Moffic, MD

One of my favorite movie moments is when Robin Williams signs on as an edgy D.J. by exclaiming "Good Morning, Vietnam" from the 1987 movie of the same name. Sometimes, I played the audio over and over, as if it could promise a good day. As he did so often, he found a way to not only lighten the sadness, but to do it in such a way that might be constructively critical.

Surely, the real life mornings were not often happy ones, as so many of our troops died or ended up with post-traumatic stress disorder (PTSD) from that war. It is a lesson we are still learning, so that movie and his role is worth seeing again soon.

Now, after his reported suicide, that good morning seems more like a final good night.

Although he is probably best known for his manic comedy, he also played many serious roles. Most ironically now, he won an academy award in 1997 for playing an empathic therapist in the film “Good Will Hunting.”
Indeed, beloved entertainers like Robin Williams have a therapeutic role of sorts for society in the sense that they provide some relief—even if briefly—for the grief and stress of everyday life. For playing that societal role, such people become a repository for our hopes, dreams and demons. As we know for so many famous entertainers, it is not easy for them to have a successful private life—a private life that the public also tries to invade, as if they were related to us.

What we do know publicly is that Williams suffered from chronic depression and intermittent substance abuse. It is reported that he received treatment, including entering rehab just last month. Obviously, money to get the best treatment was not an issue, though how good the treatment was will remain unknown. We do know, however, that wealthy VIPs often receive treatment just as poor as low-income folks without resources. We also know that occasionally depression is a terminal illness, though that ending is not predictable.

Beyond the public information, and despite the understandable curiosity, this is not the time, nor should it ever be the time, to speculate about his diagnosis and reasons for committing suicide. In fact, the so-called "Goldwater Rule," called that for the inappropriate professional speculation about presidential candidate Barry Goldwater, ethically prohibits such speculations on the part of psychiatrists like myself.

Given this professional ethical principle, as well as the family's request for privacy, is there anything we can still learn from this apparent tragedy? The most intriguing detail that caught my attention was his last tweet and Instagram on July 31. Reportedly, he had wished his daughter a happy 25th birthday.

Why might this positive communication be of importance to us?

It reminded me of the only patient I ever had who committed suicide, long ago, when I was a resident in training. In the second session, the depression of this elderly man seemed to be less severe, but after that session he walked into Lake Michigan and drown. In the psychological autopsy, I never forgot the warning that when a depressed patient starts to seem better, they actually can be at higher risk for suicide.

Risky time

Why is that time of apparent improvement a risky time? The person can have more energy, then plan and complete a suicide. They may also feel relief at their decision, causing others to paradoxically feel relief. That is one of the reasons why it is so common to hear of the genuine surprise that the suicide occurred, as the person seemed to be happier.

What this means, not only for professionals, but for the public, is not to take at face value if a depressed person seems better. Be sure there is a sound explanation for the apparent improvement. 

Our only consolation must be that entertainers like Robin Williams keep on living in the form of their life’s work, like the movie “Good Morning, Vietnam,” that is so ubiquitously available nowadays. Even so, it would not be surprising if at the times we laugh once again at Robin William's humor, that the laughter will also be accompanied by some tears of grief.

Bio

H. Steven Moffic, MD, is a Life Fellow of the APA. Currently, he blogs regularly for Psychiatric Times, Behavioral Healthcare, and The Hastings Center's Over 65.

This blog was originally published in Behavioral Healthcare. Tweet

Spreading Hope!

By Matt Goldenberg D.O.
@docgoldenberg 
“You treat a disease, you win, you lose. You treat a person, I guarantee you, you'll win, no matter what the outcome.” 

I whole-heartedly agree with that statement. However, I cannot take credit for those words. Those are the words of Robin Williams, or more specifically, the words of his character in Patch Adams.

I want to discuss the disease called depression. I will start by first discussing the diagnosis and the signs and symptoms of depression. I will then follow up with my thoughts on the various treatment options for depression and the strategies I employ with my patients to improve their outcomes. None of my thoughts and suggestions should serve in place of a formal consultation with a mental healthcare provider. However, I hope shedding light on mental health diagnoses like depression will lift the veil and social stigma on these chronic diseases that impact so many people.

Psychiatry has come a long way in the last decade. This is a time of continued discovery and increasing public awareness. The leaders of our professional organization, the American Psychiatric Association (APA), have suggested that we as mental health professionals are under a microscope. I agree that we are and I also strongly believe that we are up for the challenge. School shootings and celebrity suicides and overdoses have increasingly put a focus on mental health. Psychiatry has significantly improved the outcomes, treatment options and the prognosis of patients with mental illness. However, we still are unable to decrease the prevalence of the diseases we treat or prevent them. We know that the brain changes during an episode of depression and our treatments help it to return to normal (see the image below). Although we are getting closer, we still currently do not have widely accessible blood or imaging tests that can confirm our diagnosis or localize the area of disease.

I can say with certainty, however, we are able to accurately diagnose patients. We are able to identify medications, psychotherapies and other treatments that patients with a specific diagnosis or cluster of signs and symptoms often benefit from. There is strong evidence that our treatments decrease symptomatology and disability and improve quality of life, clinical outcomes and a patient’s prognosis.

Psychiatrists are trained to view the patient as a “whole person”. Psychiatry is a field of medicine whose assessment by definition includes all of the biological, psychological and social aspects of a patient’s life. We listen for the psychological and social factors that can contribute to disease. Oftentimes, the “whole story” can be more telling than only focusing on specific symptoms of a given disease. There is a saying, throughout all fields of medicine, that “most patients have not read the textbook.” In other words, patients usually do not present exactly as the textbook says they should. Stress and psychological factors can mimic chest pain, shortness of breath, gastrointestinal problems and a whole host of other diseases. If we do not step back and get the whole story, we can miss the root cause or the exacerbating factors of many manageable diseases which are of the mind.

Many of the diseases we treat, such as depression, are chronic illnesses which require lifelong treatment. Our treatments can improve a patient’s mental health and coping skills and decrease their symptomatology and substance use. We know through decades of research that these are modifiable risk factors for suicide. Therefore, Psychiatrists have the training and tools necessary to decrease a patient’s risk of attempting suicide. Our treatments have the potential to not only significantly improve the lives of our patients, but also the lives of their families and everyone who comes into contact with them. Anyone who tells you otherwise is misleading, misinformed or both.

I hope this information and the blogs to follow will give you hope. Mental illness can include symptoms which can be devastating and complications which can be life-threatening. However, it is important to state again, these are treatable diseases. If you or someone you know, would like to talk to someone, call your primary care doctor or your insurance company for a referral to a Psychiatrist. A true multi-disciplinary team also includes therapists, psychologists, nurses and social workers. You are never alone. You can call the national suicide helpline 24 hours a day, seven days a week (1-800-273-TALK (8255) or visit www.suicidepreventionlifeline.org). There are also local crisis lines likely available in your area and are an internet search away. If you are ever feeling unsafe, or fearing for the safety of a loved one, you can call 911 or go to the nearest emergency department.

It is time for everyone to understand that there is no shame in getting help for depression, much as there is no shame in getting help with diabetes or high cholesterol. Even if you have never suffered from depression, there is a lot you can learn.

Together we can raise awareness and spread truth and hope. I know that if we spread knowledge, and ignore the misinformation, we will overcome the complacency and ignorance that is so pervasive today. That is how we can best honor those we have lost. That is how we can best prevent the next death from mental illness and addiction.

Tweet

Depression & Cancer

By Brad Zehring, DO @DrZehringDO

“Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul”  - Jim Valvano

But, what happens when it does?

Depression is a multifactorial disorder that requires acknowledgement of the biological, psychological, and social aspects of a person’s life. Professionals in the mental health community describe this as the biopsychosocial model. It provides an understanding of the factors influencing a person’s mental and physical state of being.

When mental health professionals talk about depression they often do so in regards to Major Depressive Disorder (MDD). According to DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), 5 out of 9 criteria are needed to diagnose MDD. It requires a depressed mood or anhedonia (lack of enjoying what was previously enjoyed) for greater than 2 weeks including: disturbances in sleep, guilty/hopeless/worthless feelings, poor concentration, low energy, changes in appetite (weight loss or weight gain), psychomotor agitation or retardation, and suicidal ideation.

Depression affects your entire body. But, the physical aspects of depression are often overlooked. It is common for people with depression to experience weight changes, digestive problems, headaches, back pain, muscle and joint pain, and disruptions in sleep cycle. Many symptoms that are present in cancer.

Depression has been linked with many health problems, including cancer. Cancer is a heavy word. The enormity of the word brings many images to the forefront of our imagination: radiation, chemotherapy, losing hair, sickness, weakness, and death - among others. There is so much symptom overlap between cancer and depression it can be hard to recognize the etiology of the symptoms.

It is important that health care professionals, family members, and other caretakers are vigilant with a person’s mental well being after they are diagnosed with cancer. Even if a person has never experienced depression previously, their risk of depression is increased when they find out they have cancer. Research shows that the incidence of depression increases proportionately with the cancer’s progression. It is believed those with depression have increased likelihood of depression because of increased immune response (cytokines) within the body.

It is important not to assume that someone with cancer has an appropriate depressed mood due to his or her circumstances.  This is why it is important to screen for depression in those diagnosed with cancer. Screening for depression can help “tease out” symptoms related to depression and symptoms related to the cancer. Treating depression in patients with cancer can help them focus on their treatment and have the motivation to do everything needed to possibly achieve remission. Proper treatment gives them the ability to focus on their future. Cancer alone is enough, but when combined with untreated depression the results can be deadly.

After recognizing depression in someone with cancer, there are ways to treat depression in parallel with cancer treatment. There are two forms of treatment. One involves medication and the other involves psychotherapy, or talk therapy. The typical medications for depression are antidepressants like Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). These medications have been around for a long time and are generally well tolerated. They take anywhere from 2-6 weeks for clinical efficacy. These medications should be monitored with cancer treatment, as there can be drug interactions and side effects that may not be present in someone taking these medications without cancer. In addition to medications, psychotherapy can be effective. More specifically, Cognitive Behavioral Therapy (CBT) can help people change their negative thoughts about cancer and their future. For the most efficacious treatment a combination of both should be implemented.

Cancer is a serious illness and a well-developed multi-disciplinary approach is necessary to best treat the patient. Cancer can cause a lot of different disturbances in physical and mental health. It is important to have health professionals, like psychiatrists and psychologists, part of the treatment team to ensure proper treatment of the whole patient.

Tweet

How Psychotherapy Changes the Brain

By Serina Deen, MDMPH

When I first see patients for evaluation, they often tell me that they’ve debated starting a “biological” treatment such as medication, versus a “psychological” treatment such as psychotherapy. I’m happy to report that as brain imaging technology advances, we’re finding that this distinction may be obsolete. 

Psychotherapy is also “biological” in that it can lead to real functional and structural changes in the brain.   In fact, sometimes psychotherapy and medication produce surprisingly similar changes in the brain.  We still have a lot to learn about the topic, but below are some examples of what researchers have been finding so far.

Functional Changes in the Brain:
In one study, researchers at UCLA found that people who suffered from depression had abnormally high activity in an area of the brain called the prefrontal cortex.  Those who got better after they were treated with a type of therapy called interpersonal therapy (IPT) showed a decrease in activity in the prefrontal cortex after treatment.  In other words, IPT seemed to “normalize” brain activity in this hyperactive region.

Another study looked at people who have obsessive compulsive disorder (OCD), who tend to have an overactive area of the brain called the caudate nucleus.  Treatment with a type of therapy called cognitive behavior therapy (CBT) was associated with a decrease in the hyperactivity of the caudate nucleus, and the effect was most evident in people who had a good response to CBT.  In other words, the better the therapy seemed to work, the more the brain activity changed.

Changes in Brain Volume:

People with chronic fatigue syndrome (CFS) suffer from debilitating fatigue.  People with CFS tend to have a decrease in a type of brain tissue called grey matter in the prefrontal cortex of the brain.  Researchers in the Netherlands gave people with CFS 16 sessions of CBT, and found significant increases in gray matter volume in the prefrontal cortex.  This seems to suggest that the CFS patients were able to “recover” some gray matter volume after CBT.

Similarities and Differences to Medications

Psychotherapy sometimes seems to work in similar ways as medications, and other times appears to have different mechanisms of action.

In the study mentioned previously about people with depression, both IPT and the antidepressant paroxetine (Paxil) showed a decrease in prefrontal cortex activity.  And with OCD patients, both CBT and the antidepressant fluoxetine (Prozac) produced similar decreases in activity in the caudate nucleus. 

However in a different study, the antidepressant Venlafaxine (Effexor) produced changes in different parts of the brain than IPT in depressed patients.  This shows that there is variability in how different treatments work in the brain.

How Psychotherapy Produces Brain Change

We now know that the brain keeps changing, even after we become adults.  Learning leads to the production of new proteins, which in turn can change connectivity in our brains in a process called neuroplasticity.   Indeed, researchers in Germany showed that certain neurochemicals involved in neuroplasticity increased in depressed patients who got better after a course of interpersonal therapy. 

Picking a Treatment that Works Best for You
Even though we know that both medication and psychotherapy can change our brain, we still have a long way to go in learning exactly how that happens and when to use what treatment. Given a specific mental illness, sometimes medications work best, sometimes psychotherapies are the best option, and sometimes it’s a combination of the two.  In addition, there are different types of psychotherapies that work for different illnesses, just as there are many different types of medications.  If you’re considering seeking help for mental illness, it would be helpful to talk with a trained professional about what would work best for you. 

Read tips on what to expect during your first visit with a psychiatrist  

"Let's Talk Facts" brochure on Psychotherapy

Brain Awareness blog post from NIMH Director Tom Insel, MD

APA Releases List of Five Uses of Psychiatric Medication to Question

Six tips for talking to your doctor about medication

For more information about psychotherapy

Tweet

Need a New Year’s Resolution? Try Exercise!

By Ahmed Raza Khan, MD, MPH
Follow@AhmedRazaKhanMD
Child and Adolescent Psychiatry Physician at Stanford University School of Medicine

Most people know that exercise is beneficial for cardiac health and is prescribed by physicians for the prevention and alleviation of various medical complications. But what if I told you exercise can also significantly benefit your mental health in more ways than one? Let’s take a look at some of the ways exercise can improve mental health and how to incorporate this into your new year’s resolution list!

Exercise and Depression Prevention:More than 350 million people in the world suffer from depression and it is the leading cause of disability worldwide.  Exercise has often been considered as a supplemental tool in treating depression, but recent evidence points to exercise playing a role in the prevention of future depressive episodes. These recent findings show that even low levels of physical activity (e.g., walking less than 150 minutes a week) can prevent future depression. There has been significant research in the last few years that links cardiovascular health’s role in the origin of depression. This would certainly be a plausible explanation for why exercise may prevent depression.

Alzheimer’s Disease Prevention:Alzheimer’s disease is a chronic, degenerative disease of the brain that affects over 25 million people in the world. This illness leads to a progressive mental decline, steering its victims to dependence on caregivers and, eventually, death. Amyloid plaques are abnormal clusters of protein fragments that are found in the brains of patients with Alzheimer’s disease and are thought to play a major role in its progression. Recent studies have found that people who exercised at or above the levels recommended by the American Heart Association had significantly lower numbers of amyloid plaques than those who exercised less. This was the case for even those who carried the APOE-e4 gene variant, which is an established risk factor for Alzheimer’s disease. When people with the APOE-e4 gene variant were compared, those with higher levels of exercise had lower levels of amyloid plaques.

Improving Cognitive Functioning:Exercise has been shown to increase cognitive functioning in rats. As rats get older, their memory tends to diminish and this appears to be due to a drop of nerve synapses in the hippocampus, the memory center of the brain. But after 12 weeks of voluntary running, both memory and hippocampus nerve synapses were restored in these rats.

Consistency in Exercise:Recent neuroscientific studies have shown that the cognitive benefit of exercise may have a window of time. In fact, rats that improved their cognitive functioning by exercise, had this improvement dissipate in 3-6 weeks of inactivity. This is similar to what is seen with muscle mass or heart rate when exercise is withdrawn. This evidence intimates that exercise is beneficial for the brain and should be performed consistently.

The American Heart Association is a great resource for planning the amount and type of exercise one needs. They recommend at least 30 minutes of moderate-intensity aerobic activity at least 5 days a week for a total of 150 minutes or at least 25 minutes of vigorous aerobic activity 3 days a week for a total of 75 minutes. An easy target to remember: 30 minutes a day, 5 days a week.

Tweet

How to Help Loved One w/ Postpartum Depression?

By Nada Stotland, MD, MPH

Postpartum depression simply means depression occurring after childbirth---any time from days after to up to a year after the birth of a baby. 

When we diagnosis depression---at any time in life---we don't mean the kind of "down" mood everybody experiences from time to time. We mean a real disease that causes symptoms including interference with sleep and appetite; thoughts of death; guilt; lack of interest in the activities of life; inability to feel pleasure---every day for weeks. It's a very painful, but fortunately very treatable, disease. 

Depression is particularly painful for a mother with a new baby. People are often telling her that this should be the happiest time of her life, that she should appreciate her good fortune in being able to conceive and bear a child when many others have so much trouble. 

Other people---and even the new mother herself--may also confuse the symptoms of depression with the inevitable interruptions of sleep and meals by the demands of a newborn and the common concerns about being a good mother. 

It's important to distinguish postpartum depression from postpartum psychosis. Postpartum psychosis begins within days after birth. The new mother with postpartum psychosis is seriously agitated, unable to relax. She is haunted by irrational ideas about herself and the baby--ideas, for example, that God wants her to send the baby to heaven or that the baby is a devil of some kind---and sometimes by irresistible urges to harm the baby. Postpartum psychosis is rare; it occurs after far fewer than 1% of births. It is a medical emergency. 

When postpartum psychosis is suspected, the new mother must be seen immediately by a physician, preferably a psychiatrist. 

Postpartum depression seems to be caused by a combination of genetics, the abrupt changes in hormones after birth, physical exhaustion, and the strain of adapting to a new role and the reactions and demands of friends and family. Postpartum depression is often a continuation of depression that was present, but not recognized, during pregnancy. In our society, we take it for granted that we shower medical and social attention on the pregnant woman---frequent visits to the obstetrician, baby showers---when all she has to do for the baby is to take good care of herself. 

After her baby is born---when she is exhausted from labor and delivery and when she has responsibility for the 24/7 care of a helpless infant--all that attention falls away. She may live far away from supportive family members. She may either have to go back to work before she is ready, or may feel isolated, away from the familiar duties and social contacts of the workplace. Usually there are no postpartum visits from nurses, and quality childcare is expensive and hard to find. Postpartum depression, although it occurs everywhere in the world, may be more common in our country for those reasons (occurs in about 15% of U.S. births). 

Postpartum depression can be successfully treated with psychotherapy and/or medication. Group therapy reassures the new mother that she's not alone and others are going through same issues. Family and friends can play major roles in the new mother's recovery. They should remind her that she is not responsible for her depression, and she can recover from it. 

Helping with her baby can be useful, but it's not a good idea to take over baby care completely; that will just make her feel more inadequate. 

It's better to take care of the mother herself. Offer simple diversions, like an outing, but without expecting them to treat depression. We don't want to make her feel unappreciative. Sympathize with her grief over missing the joys of new motherhood. Remind her of all the lovely things she planned and did for the baby before it was born, and point out what a good mother she is working to be. 

Depression makes people feel helpless and hopeless, so she may need encouragement to get the professional care she needs. Friends and family can help by contacting her family physician or obstetrician and by locating a mental health professional available to treat the new mother. With proper care, she will probably start to feel better within a few weeks.

Tweet

Depression in People with Parkinson’s Disease

By Dr Mizrab Khan MRCPsych Member of the Royal College of Psychiatrists, United Kingdom

Arshya Vahabzadeh, M.D. Resident Psychiatrist, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine Follow @VahabzadehMD

Since April is Parkinson’s Awareness Month, we wanted to discuss its connection to clinical depression.

Parkinson’s and Mental Health

Parkinson’s disease is a chronic and progressive neuropsychiatric condition that affects more than one million Americans, with over 60,000 people being diagnosed every year. People with Parkinson’s often develop physical symptoms such as tremors at rest, stiffness, and a general slowing of movement.

Today, there’s a better understanding of the psychiatric and mental health concerns of people with Parkinson’s disease. Parkinson’s disease affects several parts of the brain connected to control of mood. This may cause depression and other mental illnesses that harm the quality of life of people with Parkinson’s disease.

Depression in People with Parkinson’s

People with Parkinson’s disease often suffer from clinical depression (more than one third of individuals). Depressive symptoms include apathy as well as changes in sleep, appetite, and self-esteem. It’s far more than feeling sad or “blue” after being diagnosed with Parkinson’s. Studies show that clinical depression may even come before the development of physical symptoms of Parkinson’s. Becoming depressed is also thought to be independent of the physical symptoms, with some people with mild Parkinson’s developing severe mood symptoms. Detecting the depression may be more difficult in Parkinson’s disease because there’s an overlap between the signs of depression and the physical symptoms of Parkinson’s.

If someone with Parkinson’s disease is increasingly apathetic with changes in mood, sleep, appetite, or low self-esteem, then he or she should see a doctor for a psychiatric assessment. People with Parkinson’s are at a higher risk of suicidal thoughts and actions, so it’s important to pay close attention to these warning signs and seek a mental health evaluation.

Can Depression in Parkinson’s Disease be Treated?

Yes, just as depression can be treated for those without Parkinson’s, depression in people with Parkinson’s disease can be improved using both psychological and medication treatments. However, a personalized treatment plan should be created, and any antidepressant medication should be prescribed by a physician who is aware of the other medications that are commonly used in Parkinson’s disease. Ongoing research will help determine the best method to treat this depression.  

Tweet

Grief and Loss Never Take a Holiday

By Joshua Reiher, Medical Student

Reviewed by Claudia Reardon, M.D.

The holiday season is in full swing. This time of year is meant to celebrate life, love, family, and friends. However, the holidays can also be difficult, especially if you or someone you know has lost a loved one. Maybe you are grieving the loss of a grandparent, parent, child, sibling, spouse, friend, or pet. Loss is a normal part of being human, and we will all face it at some point. Other causes of grief that you may not have considered:

• A loved one suffering from severe mental illness
• Divorce or breakup after a long term relationship
• Miscarriage during pregnancy

When a person experiences loss, he or she is said to be grieving. Grief is a natural emotional and physical response to any loss.

• People feel a wide range of emotions such as sadness, anger, disbelief, denial, guilt, loneliness, regret, anxiety, acceptance, and many others.
• Physically, people may undergo weight and/or appetite changes, decreased energy, lack of concentration, disturbances in sleep, loss of interest in sex, headaches, and so on.

Grief is a personal and individual experience—no two people grieve the same way. There is no one right or wrong way of grieving as long as it does not lead to behaviors that harm yourself or others. Bereavement is the period of time a person goes through grief following the loss of a loved one. Bereavement varies in duration and intensity, but it can last a year or longer in some cases.

Everyone is different, and reactions to loss are influenced by many factors such as:  

• Cultural beliefs and religious traditions
• Access to support and community resources
• Relationship with the person who left / passed away
• Personality and mental health history  

When to ask for help

While coping after a loss is painful and challenging, most people eventually find effective ways to heal and return to their daily life activities such as school or work. Some people, however, have more difficulty with recovering from a loss, and their emotional and physical symptoms do not improve. They may develop a psychiatric illness called depression. If you are concerned about yourself or someone you know, there are many treatments available including:  

• Talk therapy
• Community support groups with other people who have similar experiences
• Medications such as antidepressants

Additional resources to consider:

• Mental Health America: Coping with bereavement
• Substance Abuse and Mental Health Services Administration: How to deal with grief
• American Cancer Society: Coping with grief during the holidays

Tweet