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.

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Need to relax? How meditation can help you stay calm

By ElanaMiller, M.D., Resident Psychiatrist, UCLA Follow @ElanaMD 

Arshya Vahabzadeh, M.D., Resident Psychiatrist, Harvard University/Mass.General/McLean

Follow @VahabzadehMD

For many of us, daily life doesn't lend itself well to relaxation and reflection. We find ourselves running around from task to task. We wake up hurriedly, rush to work, get bombarded with calls and emails throughout the day, speed through meals, try to fit in a workout, and schedule time with friends / spouses / kids. . . which leaves us with little to zero time for ourselves. It's a tough way to live, day in and day out. Meditation is one tool we can use to find some calm.

Put simply, meditation is the practice of focused, mindful attention. One starts focusing on the breath, following the breath in and out. Inevitably, we get distracted, and our mind wanders: Did I feed the dog? That was so annoying what Bill did at work today. Oh, I'm getting distracted, I'm so bad at meditating! 

This is okay - and even expected. When the mind wanders we simply bring the focus back to the breath. When a very strong emotion of physical sensation calls our attention away, we can make that sensation the new object of meditation, watching as it gets stronger or weaker. When the sensation isn't so strong anymore, we return to the breath. Training the mind is like training a puppy - when it runs away, we bring it back, over and over.

So how does this simple practice help cultivate relaxation in daily life?

1. Meditation helps you stay in the present

So much of our time is spent in the past and the future that we rarely are present in the moment. We spend so much time remembering, regretting, planning, and worrying that we miss the moments of joy and spontaneity that are right in front of us.

Meditation helps train the mind to focus on the present moment. Instead of regretting things we can't change, or worrying about bad things that haven't even happened yet, we can learn to accept and appreciate our current circumstances.

2. Meditation teaches you how to redirect your mind

Sometimes we get caught up thinking (obsessing!) about a big problem, and we have the idea that if we just think hard enough we can solve it - but that's rarely the case. The best insights usually come in those "in between" moments - in the shower, when you're driving, when you're enjoying a cup of tea.

But even if we're aware that worrying and ruminating won't solve our problems, we don't know how to shut our minds off. Meditation can teach you this skill! Like any skill, it requires practice. But with dedicated practice, even five or ten minutes a day, we can learn how to let go of worries and redirect our mind to the present moment.

3. Meditation teaches you to be more aware of your thoughts and emotions

Too often we have a thought and react to it without considering why. We get angry at someone and start yelling. We hear a critical remark and get defensive. Instead of taking our thoughts and assumptions as facts and immediately reacting (possibly saying or doing something we'd regret), we can pause and consider what's really going on. 

Maybe we feel angry but are really hurt. Maybe we feel defensive because part of what the other person said is true. Meditation teaches us to be more aware of our deepest thoughts and emotions, so that we can choose to react to conflict in a wise way.

4. Meditation helps you tolerate difficult emotions

Some people have a misunderstanding that meditation somehow helps you get rid of all negative emotions - after all, isn't that what enlightenment is?

The truth is, though, that painful emotions like sadness, anger, and shame are part of being human. We make things worse when we fight against these emotions or blame ourselves for having them.

Instead of getting caught up in the narratives of our emotions, we can learn to experience them just as they are. Anger can feel like a tightness and burning of the chest. Shame can be a flushed feeling of the face and churning feeling in the stomach. Meditation teaches us to experience these emotions without getting caught up in the story.

Does Meditation really work? What are the basic elements?

According to a government survey, almost 1 in 10 adults use meditation each year to help them cope with conditions such as anxiety, depression, pain, stress, insomnia, and symptoms associated with chronic illness. It is believed that meditation can improve the ability to focus attention and improve how we handle our emotions. These improvements may have broader benefits for our daily lives including personal relationships.

Researchers have linked meditation to some beneficial changes in the human body. Some experts have suggested that meditation may dampen down our body’s sympathetic nervous system, the system responsible for our “fight or flight” response. There is also continuing interest on how meditation can alter different parts of the brain, although the answer remains unclear and research is ongoing.

The National Center for Complementary and Alternative Medicine, a federally funded research organization, suggests that there are several elements that are important when you are trying any type of meditation. These elements include finding a quiet location, a comfortable posture, being able to focus your attention, and having an open attitude to the experience.

Interested in learning more about how meditation can help you lead a happier and more relaxed life?

Check out zenpsychiatry.com where Elana Miller, M.D., blogs about integrative strategies to be happy, live well, and fulfill your greatest potential. To get tips and helpful advice sent straight to your inbox, sign up for her free newsletter.

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THE DIVIDE: Transgender Mental Health Disparities - why they exist & what we can do…

By Anthony Dobner, Medical Student
Reviewed by Claudia Reardon, M.D.

The Basics…

A transgender individual is someone with the desire to live and be accepted as a member of the opposite sex. This can be accompanied by the wish to make his or her body as congruent as possible with the preferred sex. A transsexual individual is someone who has taken measures, through surgery or hormone therapy, to achieve their desire of living and being accepted as a member of the opposite sex. In general, transgender individuals prefer to be addressed using pronouns and other culture norms that are congruent with their preferred gender identity.

Mental Health Issues Affecting Transgender Individuals…

Lesbian, gay, bisexual, and transgender individuals (LGBT) in general are 2-3 times more likely than the general population to suffer from anxiety and depression. This is probably because anyone who experiences discrimination is more likely to have anxiety or depression.

Almost half of transgender individuals report having attempted suicide. Transgender individuals are also more likely to suffer from substance abuse compared to the general population. Interestingly, transgender individuals who are accepted by their families are less likely to abuse substances. Also, transgender individuals who undertake hormone therapy are less likely to report depressed mood.

Barriers…

Many LGBT individuals experience unintentional discrimination from health care professionals. This may be because they use behavior and language that make assumptions about sexuality. Examples of this include assuming a lesbian or transgender woman does not need to receive education on condoms because she will “never have to worry about getting pregnant.” Research indicates that other barriers include:

• Homophobia
• Assumptions of heterosexuality (or homosexuality in transgender individuals)
• Real or perceived lack of confidentiality
• Lack of training
• Insurance policies and laws that create loopholes for employers that do not provide coverage to domestic partners.

5 Tips for Overcoming Disparities & Receiving Quality Health Care...

SEEK friends and allies who love and accept you for who you are no matter what. Research shows that having a strong support system decreases depression and suicidal ideation.

ASK friends and allies what resources are available in your community. Some communities have LGBT-specific clinics. Smaller communities may not have these services, but there may be individual clinicians who have experience working with LGBT patients.

TALK to your doctor! He or she should care about you and want you to be happy and healthy but may not know the best way to address your unique needs. Don’t be afraid to bring up the issue if they don’t. Refer them to this excellent resource for clinicians who want to improve the accessibility of their clinics for transgender individuals.

ENCOURAGE your doctor to use gender neutral language during your visit, and on surveys, signs, and intake forms.

SUPPORT efforts in your community to pass laws that change language in insurance policies that make it difficult for LGBT individuals to receive quality care.

For more information, check out this great resource for transgender individuals on a variety of health care issues.

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What You Should Know About Binge Eating Disorder: 3 Doctors Discuss

By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD

Holly Peek, M.D., MPH Follow @PsychGumbo

Mona Amini, M.D., MBA Follow @MonAmiMD

What Causes Binge Eating Disorder? 

With up to 4 million Americans having binge eating disorder, it's a significant health issue for our nation.  Binge eating disorder has a wide variety of causes, and sometimes it can be caused by several different reasons, even in the same individual.

To understand why someone develops binge eating disorder, we need to recognize binging triggers. These triggers often result in binging behavior, and they are often negative feelings or thoughts toward body shape, weight, or food. Triggers to binging may also include worry, anxiety, difficult relationships with loved ones, or even boredom. Some people binge eat because it helps them numb these feelings in the short term. But later, they find the binge eating to be harmful to their own self-perception.

Sometimes dieting may be a major factor for binge eating. While dieting tends to happen after binge eating disorder has started, missing meals or not eating enough can lead to binging episodes. If left untreated, binging behaviors become more and more ingrained and harder to control.

Depression has also been linked to binge eating disorder. People who have depression or have been depressed in the past are more at risk. Binge eating is also higher in people who have bipolar disorder or anxiety disorder. Some evidence suggests that it may be more common in people who have addictions to recreational drugs.

Binge eating disorder may be more common in families where the condition is already present. Therefore it seems that our genetics are also an important factor to consider. Researchers continue to explore more scientific explanations on why binge eating disorder happens including studying the neurochemicals and pathways of the brain. 

How is Binge Eating Disorder Treated? 

The treatment goal for binge eating disorder focuses on binge eating and weight control. Treatment also addresses conditions that commonly occur with binge eating disorder, including depression, difficulty in work or relationships, and distortions in body image.

Treatment outcomes are generally good with psychological treatment often being more helpful than medication based management, although in some cases both are used. There is evidence that cognitive behavioral therapy (CBT), a type of talk therapy, is successful in treating binge eating disorder. Multiple research studies point to benefits with its use. CBT works by disrupting the “binge-diet cycle” by promoting healthy and structured eating patterns, improving body shape and weight concerns, and encouraging healthy weight-control behaviors.

Another type of talk therapy used in treatment is interpersonal psychotherapy (IPT). IPT helps people express and manage their negative feelings without turning to food to cope. Research shows that 20 sessions of CBT and IPT can provide improvements for more than 70% of people with binge eating disorder.

Reading self-help guides like Overcoming Binge Eating by Christopher Fairburn in combination with therapy sessions can also have substantial benefits.

Medications may also be used to ease binge eating disorder symptoms. Serotonin selective reuptake inhibitors (SSRIs), commonly used for anxiety and depression, have been found effective for reducing some binge eating disorder symptoms as well. SSRIs can help with depression often occurring in people with binge eating disorder. Continued research will examine how other medications, including anti-obesity medication and mood stabilizers, may also treat people suffering from binge eating disorder. 

What Should I Say to My Friend / Family Member Who is Suffering?

It is important to take the approach of talking to your loved one with serious intent. Though some people can overcome eating disorders, seeking professional help usually has more lasting positive results. In seeking the care of a professional, both the patient and his/her family benefit from the information presented by the doctor. The first step to talking to someone you care about who has an eating disorder may feel nearly impossible.

• Patience is key. Being patient and learning facts about eating disorders will guide you (and your loved one). Due to the complexity of binge-eating disorders, communicating your concerns regarding their eating habits and other behaviors will initiate a cumulative effect.
• Be prepared for a range of responses. Rejection, denial, anger, and shame are just some of the emotions that your loved one may express when you approach her/him for the first time.
• Avoid judgment, criticism, and simple solutions to disorder. Instead, you should provide encouragement and compassion regarding their feelings and relationships. Your concern and support may be enough for them to seek professional help but know that this is not guaranteed.
• Recognize binge eating may be just tip of the iceberg. Understanding that binge eating disorder, or any eating disorder, involves food and weight issues as mere symptoms of a deeper and more complex behavioral problem will help your loved one realize they need to acquire healthier coping tools.
• Know when to ask for assistance. Don't forget that health professionals can alleviate some of the imminent issues that may need to be treated before full recovery is possible. 

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Talking to Men about Mental Health

By Sarah Johnson, M.D.

While visiting with my dad for Father’s Day last month, I was inspired to write about the importance of talking to the male species about mental health. When I was a medical student coming home over Christmas (hyper-vigilant about all potential medical issues as most med students are), I noticed a mole on my father’s forehead that looked cancerous to my post-dermatology rotation eyes. After nearly a year of “reminders” to go to the doctor and have it checked, he finally agreed and luckily it was benign.

Now that I’m a psychiatrist, I often get calls from patients and friends who are worried about the mental health of men in their lives (fathers, husbands, boyfriends, brothers, friends) but have met resistance when trying to talk about their concerns with these men.

Reflecting on my personal challenge of getting one of the important men in my life to have something as minor and non-stigmatized as a mole checked out, I would like to offer some suggestions to help start the mental health conversation with a man or anyone you believe may be suffering from a mental illness.

• Use “I” statements. People are less likely to feel attacked and be open to suggestions when approached with “I” statements. For example, “I am concerned that you seem down, and I would like for you to consider seeing a counselor because I care about you,” instead of “You seem depressed and need to see someone.”

• Present mental health conditions such as anxiety and depression as medical conditions - which they are (your brain is part of your body). Unfortunately, many individuals stigmatize mental illness and do not like to see themselves as suffering from one. One of my favorite questions to ask those who resist getting care for their mental health is, “Would you seek help for high blood pressure or diabetes?” Of course you would!

• Offer factual evidence regarding mental health conditions. Many patient resources are available at www.psychiatry.org/mentalhealth (check out the Let’s Talk Facts brochures you can print). It is helpful to realize that psychiatric conditions are common. Remind him that he’s not alone.

• Be encouraging and reassure him that he won't be seen as “less of a man” if he seeks help. Seeking help is a sign of strength.

• Ask him to consider seeking help rather than telling him. Most people are more likely to follow through with a task they view as unpleasant when they are asked rather than told.

• Be mindful and also take care of your own mental health needs. It can be very stressful and tiring to be close to someone suffering from an untreated mental illness. Use your family and friends for support and don’t be afraid to seek help yourself if you find you’re struggling with excessive worry.

We are lucky to live in a time when there are effective treatments readily available for mental health disorders. Try these tips the next time you start the mental health conversation with the important men in your life. Your support and care can make a big difference in his recovery. 

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