Why Women Must Exercise for Mental Health

By Claudia Reardon, M.D.

Exercise has mental health benefits for men and women of all ages.  However, there are unique factors to consider in thinking about the mental health benefits of exercise for women in particular.  Compared to men, women have a two-fold increased prevalence of major depression throughout their reproductive life cycle.  Exercise can be a very useful treatment for depression in women at any of a number of different times in their lives:   

• During pregnancy and breastfeeding:  Depression is highly prevalent in women of childbearing age.  Medications are often necessary to treat moderate to severe depression.  However, many women wish to avoid treatment with medications during pregnancy and while breastfeeding.  At least one study has shown that women who exercised regularly reported less depression in the first and second trimesters compared with women who did not exercise.  The American College of Obstetricians and Gynecologists has recommended 30 minutes of moderate exercise on most days.

• During the postpartum period:  Exercise can also help to treat and prevent postpartum depression.  One study has shown that postpartum women who exercised three times per week had less depression than postpartum women who did not exercise. 

• During the premenstrual period:  Exercise can be useful to treat physical and emotional premenstrual symptoms.  It is less clear if exercise by itself can treat the most severe of premenstrual syndromes (called “premenstrual dysphoric disorder”), but it is still a first-line treatment strategy that most physicians would recommend. 

• During menopause:  Several studies have shown that aerobic exercise can improve both depression and insomnia occurring during menopause.  Additionally, lower intensity exercise such as yoga has been shown to improve psychological well-being in menopausal women.

Importantly, women may experience barriers to exercise.  Here are some examples of these barriers, and strategies to help address them:

• Childcare issues:  Women are often responsible for childcare, which makes it difficult for them to find opportunities to exercise.  Gyms that offer childcare services can be helpful.  Also, partners can share the workload. 

• Intimidation:  Some women may feel uncomfortable working out in the coed environment of a gym.  Consider taking women-only exercise classes, or walking or doing other exercise with women exercise buddies.

• Self-consciousness about appearance:  If a woman is already uncomfortable about her appearance, then she might worry that she’s drawing even more attention to her body by exercising, especially if wearing skimpy sports clothes.  One strategy is to try walking, which can be done almost anywhere and in almost any type of clothing.

• Guilt:  Women, especially those who are family caretakers, sometimes describe feeling guilty about taking time for themselves to exercise.  Remember, it is not a selfish thing to exercise.  You are taking time to improve your physical and emotional health, which will allow you to more effectively be there for others.  Besides, you deserve to experience the benefits of exercise!   

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Talking to Kids about the Earthquake in Japan

By Adair Parr, M.D.

Our hearts and condolences go out to the people of Japan and the families involved in the earthquake and subsequent tsunami in Japan last week. 

Everyone has seen the live images, captured on cell phones and video cameras, coming from Japan.  They are vivid, dramatic, compelling, and scary.  We have all watched the coverage on television and online as more and more photos and videos circulate showing the massive tsunami wave rolling over the sea wall, shaking houses and buildings, fires, explosions,  and the massive destruction afterwards.  The subsequent explosions of the nuclear reactor and news of a nuclear reactor meltdown near Sendei, Japan are also extremely disturbing. 

Our 24 hour news cycle enhances the impact of these images which can be traumatizing for viewers of all ages.  Media has a particularly powerful influence on children and adolescents, and the pictures it shows shapes a child’s perception of the world.  Young children watching images of disaster believe that the event is happening in real time, and they’re in danger.  At such times, helping children feel safe and protected in their own home and community is important.  Parents should keep in mind the following tips when viewing photos and videos during and after disasters:

• Be vigilant!  Not all sources of media provide warnings about upcoming traumatic images.
• Viewing traumatic images may be re-traumatizing.
• Limit children’s exposure to media coverage of the event.
• Co-view media coverage of the trauma and discuss content with children and adolescents.
• Encourage children to draw, write, play music, and exercise in ways to express their feelings about the traumatic events.
• Maintain structure and family routines. 

HealthyMinds.org has more information on how to talk to your children about disasters.

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How Much Sleep Do Kids Need?

By Gariane Gunter, M.D.

Children these days are busier than ever!  I often hear from parents that it is such a rush to fit everything in and still get the kids to bed on time.  I struggle with the same dilemma at my house.  As a mom, I understand how difficult early bedtimes can be, however, as a psychiatrist, I know why an adequate sleep schedule is so significant for our child's physical and emotional health.   

The American Academy of Pediatrics Guide to Your Child's Sleep provides some helpful guidelines regarding just how much sleep children need at different stages in their development. Keep in mind that these numbers reflect total sleep hours in a 24-hour period. So if your child still naps, you'll need to take that into account when you add up his typical sleep hours.

Birth-6 Months, children need 16-20 hours
6-12 Months, children need 14-15 hours
Ages 1-3, children need 10-13 hours
Ages 3-10, children need 10-12 hours
Ages 11-12, children need 9-12 hours
Teenagers need 10-12 hours of sleep per night

Kids need a lot of sleep, huh?!  Children and teens who are sleep deprived may show some difficult behaviors.  They may display frequent irritability, overreact emotionally, have difficulty concentrating, forget things easily, wake often during the night, and may even display hyperactive behaviors.

Teaching kids how to keep a nighttime routine that gets them to bed early will help your children be at their best.  Sweet Dreams!

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Caring for the Mental Health of Your College Student

By Roberto A. Blanco, M.D.

A recently released national survey on the state of mental health for entering college students revealed that this year's freshmen class has the highest stress levels in the history of the 25 year survey.  There are several reasons.  According to study authors, students face increased competitiveness and demands in high school as well as more financial challenges due to today's economy.

Although it's an exciting time, your child's transition to college can be a difficult one - especially if he or she suffers from a mental illness.  Here are some things that you and your prospective college student should be thinking about prior to choosing a university and heading off to school:

1.    What can I do to ease the college transition? 

Some schools offer an orientation program over the summer to help students become comfortable with the campus and surroundings, learn organizational and study skills and socialize with fellow freshmen.  

Apart from these organized programs, it is important that, as a parent, you work on transition issues and independence.  Make sure that your child has all materials needed for school including an organizer and a computer.  If your child is getting psychiatric treatment, teach your son or daughter the importance of their medicines, therapy and attending their appointments regularly.  If they haven’t yet been self-administering their medications, before going to college, it is important that they learn and start taking their medicines without supervision.

If you have serious concerns about how your child will do with the college transition, you may want to consider schools close to home.  Depending on the amount of concern, it may be best to choose a school which would allow your child to drive home for the weekend if needed.

2.   What’s the quality of the college's mental health program?

Some colleges and universities do not have mental health services available through the school.  If they don’t, you need to understand how a student can go about getting help.  If the school is not in a major city, you need to make sure that there are enough providers close by so that your child can get the services that he or she needs in a timely manner.

Some universities have therapists but no psychiatric providers on staff.  Others offer both counseling and psychiatric services but put a cap on the number of appointments at the university mental health center prior to referring students out to the community.  All of this information should be provided by each individual school.  And you should know all of this information prior to committing to a particular school, especially if your child is likely to use mental health services.

3.    What is the educational environment of the university?

Some universities are known to be high-pressure, unforgiving environments.  This could be due to the rigor, expectations or challenges of courses.  Sometimes, this can be eased by a strong academic support team or advising system.  Often, peers can make the university culture overly competitive in unhealthy ways.  Some places are notorious for students stealing other students’ lecture materials and notes or not helping out when needed.  If your child is particularly sensitive to stress, it may be best to go to a school where the environment is more collegial and supportive.

Other schools are notorious for having easy access to drugs or alcohol on campus.  While drugs and alcohol are available at most schools, they are easier to get at some schools which are located in major cities or areas of high accessibility.  If your child has a history of drug or alcohol abuse, you should be extra considerate of these location factors.

4.    Will the financing of this school put my child in overwhelming debt?

While a good college education is one of the most important investments, your child should not mortgage his or her future by creating large amounts of unnecessary debt.  In addition, universities with higher tuition may necessitate your child working during school to avoid excessive debt.  This can also add stress.  If schools are relatively equivalent in meeting your child’s long-term career goals, choose the college which will put your child in a better financial position after he or she graduates.

Of course, after your children go to college, you will want to monitor how they are doing intermittently.  Particularly stressful times are usually at the beginning of school, around exam time (midterms and finals) and anytime a romantic relationship ends.  Checking in around these times may be the most beneficial.  If it turns out that they need more help than some parental TLC, make sure that they see a professional.

I hope that these suggestions have been helpful.  Feel free to leave comments or questions for further discussion.

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Yoga Helps Heal Heart & Emotional Scars of Cancer

By Felicia Wong, M.D.

“Cancer is a very alienating and existential disease. I know of no other common disease that immediately causes so much fear, anxiety, depression, confusion, and a sense of impending disaster in a patient or his/her significant others when they hear the word “cancer” for the first time.” --- Murray Krelstein, MD, a psychiatrist and cancer survivor.

Although oncologists, family members, and friends can provide significant sources of support, adding a mental health professional to a cancer patient’s treatment team is often helpful. Talking about the emotions and worries associated with cancer can be difficult, and it is important to have a therapist who is familiar with these situations. Additionally, cancer patients and survivors often suffer from sleep disorders, depression, anxiety, fatigue, and other mood changes.

Researchers at the University of Rochester Medical Center found that among patients receiving chemotherapy, over three-quarters suffer from insomnia. Those who suffer from insomnia are, in turn, more likely to suffer from fatigue and depression. For 65% of cancer survivors, insomnia continues even after the completion of chemotherapy.

Cancer is a diagnosis that affects both body and mind. So, it makes sense that cancer patients and survivors practice yoga to improve their quality of life.

While research on the use of yoga for cancer is relatively new, there have been recent studies confirming yoga’s mental health benefits. A Harvard Health Publication highlights the benefits of yoga for stress, depression, and anxiety:

- By reducing perceived anxiety, yoga appears to adjust stress response systems. This, in turn, reduces heart rate, lowers blood pressure, and can make breathing easier.

- There is evidence that yoga practices helps increase heart rate variability, an indicator of the body's ability to respond to stress more flexibly.

Optimizing wellness after a cancer diagnosis and beyond involves a complex integration of interventions that address both the mind and the body. Ideally, a psychiatrist is part of the cancer treatment team. However, if this is not available, please ask your doctor for referrals.

For additional resources on coping with cancer:
http://www.cancersupportivecare.com/live.html
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