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Study: For Sleep Problems In Older Age, Try Mindful Meditation

(Fairy Heart/flickr)

(Fairy Heart/flickr)

Insomnia is insidious, infuriating and often debilitating.

For anyone who has suffered with eyes-wide-open at 4 a.m. it’s not terribly surprising that more and more Americans (particularly older people and women) are being prescribed serious drugs to help them sleep.

But these medications, known as benzodiazepines, have been linked to numerous health problems, ranging from an increased risk of dementia, to car crashes and falls. And once you’re on them, it’s hard to stop, as I can attest from personal experience. While debate continues over the safety and effectiveness of these medications, a small study suggests that an alternative approach may offer some relief.

Research published online by JAMA Internal Medicine found that a practice of mindful meditation — basically just focusing on breathing and remaining in the present moment while observing your thoughts easily drift by — may help certain people with sleep problems. “Mindfulness meditation practices resulted in improved sleep quality for older adults with moderate sleep disturbance…” the report concludes.

The study, by researchers at the University of Southern California in Los Angeles, reflects a growing body of evidence showing that the practice of “mindful meditation” can be used as a low-cost, non-drug intervention that can, in certain cases, reduce stress and help with other physical and mental health woes.

Here’s more from the JAMA release:

Sleep disturbances are a medical and public health concern for our nation’s aging population. An estimated 50 percent of individuals 55 years and older have some sort of sleep problem. Moderate sleep disturbances in older adults are associated with higher levels of fatigue, disturbed mood, such as depressive symptoms, and a reduced quality of life… Continue reading

A Miracle Drug For Binge Eating? Not So Fast, Says Therapist

(Bloody Marty/Flickr)

(Bloody Marty/Flickr)

By Jean Fain
Guest Contributor

For more than 20 years, my binge-eating patients have wished for a magic wand. And for all that time I told them there is no wand — there are only strategies that require awareness and effort to get a handle on their eating.

Last week, when the FDA announced it had approved Vyvanse for the treatment of binge eating disorder (BED), I found myself at an uncharacteristic loss for words. With headlines touting a magical cure for this most common adult eating disorder, I feared there was nothing I could say to stop the stampede for this next, new drug.

The news, in and of itself, is hopeful. Vyvanse (lisdexamfetamine dimesylate) has been the subject of rigorous research, first for ADHD, and now for BED. In two good-sized studies with more than 700 adult participants diagnosed with moderate to severe binge eating, this central nervous system stimulant proved more effective at reducing binge days per week than placebo for three months.

What’s more, the FDA’s approval has proven a good opportunity for a drugmaker, U.S-based Shire, and leading eating disorder associations — the National Eating Disorder Association and Binge Eating Disorder Association — to coordinate a nationwide educational campaign. If even a fraction of the estimated 2.8 million Americans diagnosed with the disorder get help as a result of the campaign’s public service announcements and new website, there’s reason to be hopeful.

There’s also reason to be cautious. Consider some of the issues before you take tennis great and Shire spokesperson Monica Seles’ advice to “talk with your doctor.” To help you do that, here are the pros and cons in my clinical experience and that of my colleagues.

But first, if you’re unclear on what constitutes binge eating disorder, here’s how the Binge Eating Disorder Association defines it:

“Routinely eating far more food than most adults would in a similar time period under similar circumstances.” Binge eaters typically feel out of control during a binge, and afterward, they’re consumed with guilt, self-disgust and embarrassment. Other hallmarks of the disorder: eating extremely fast, in secret, to the point of uncomfortable fullness, even when not hungry. Unlike other eating disorders, people with BED don’t try to “undo” excessive eating by throwing up, taking laxatives and other excessive actions.

OK, so here are a few points to consider…

Pros:

•More Treatment Options

With the FDA’s first and only approved medication for BED, patients now have another way into treatment: their family doctor. Rather than seeking out a psychotherapist or a nutritionist, which many are reluctant to do, they might feel more comfortable asking their physician about a prescription and other treatment options for this lesser-known eating disorder, which was only recognized two years ago as a distinct disorder by the American Psychiatric Association.

•Fewer Binge Days

Vyvanse has been shown to markedly reduce, if not eliminate, binge episodes in two studies, both funded by Shire. According to last month’s JAMA Psychiatry study, participants who got a daily dose of 50-70 mg, reduced the frequency of binge days per week from about five to less than one over the course of 12 weeks. By comparison, those taking placebo continued to binge more than two days per week. What’s more, half the participants taking the 70 mg dose stopped binging after four weeks, compared to one fifth of those taking placebo.

•Possible Weight Loss

Because Vyvanse has yet to be studied as a weight loss aid, it’s approved only in the treatment of binge eaters, not the overweight or the obese. That said, study subjects who took Vyvanse lost about 10 pounds. The potential weight loss may come as welcome news to bingers taking an off-label prescription for an antidepressant or anti-seizure medication. A common side effect of most antidepressants is weight gain. While binge eaters are often thrilled with the weight loss that the anti-seizure drug Topomax can facilitate, they’re none too pleased by the mental impairment.

Cons:

•Greater Risk of Abuse/Dependency

There’s a reason Vyvanse is a controlled substance with a black box warning. The potential for abuse and dependence is a real risk. Take it from psychiatrist Daniel Carlat, editor in chief of The Carlat Psychiatry Report, who expressed his reservations in a recent email exchange:

“I’m concerned that the FDA’s approval of Vyvanse for binge eating disorder is going to worsen our problems with stimulant abuse,” Carlat says. Continue reading

Child Psych: How Not To Lose It On The Umpteenth Snow Day

Jim D/flickr

Jim D/flickr

By Steve Schlozman, MD

Yes, it’s still snowing. More. And more.

Even writing the word “snow” now makes me cranky at this point. I never thought I would actually long for the morning commute.

But, I did in fact sign up to be available for my kids, and this is actually a bigger problem right now than any of us expected. The weather in Boston has of course been unprecedented, and while it would be foolish and infantile to act like it is anything other than a royal pain in the backside, we’d also be committing a big fat empathic failure if we didn’t acknowledge just how stir crazy we’re going.

I have developed new sympathy for my daughter’s hamster; she see’s the same cage, the same scene, the same everything, day in and day out.

But, alas, my kid’s hamster cannot work scissors, or a remote control for the television, or engage in any sort of higher order thinking, such as hitting her big sister in the back of the head with a pillow.

In the interest of the city not losing it’s collective mind, and in the interest of genuine public health, may we offer some suggestions. You’ve gotta mix it up right now. If there was a Super Bowl of day-killing, we’d be having a major parade by now. Sundown is still a long ways off. Here are ten tips to pass the day with minimal damage

Screen Time
I wouldn’t fret too much about TV or computer time. Limit the screen time in a way that makes sense to you, and limit what they watch. My family had to put the kabash on Dance Moms, for example It just got a bit too toxic. But use entertainment, in a family way if possible, and set the boundaries around what is watched as well as for how long. For example — say something like: at noon, you can watch/play (fill in the blank with appropriate program) for one hour. Then you can watch/play (fill in the blank with appropriate show) at 4 pm again.

Jigsaw puzzles

I know. “Boring,” your kids will sing. But puzzles have a unique appeal around a living room table. That burst of satisfaction when two pieces fit together has got to be neurobiologically driven. It just feels so good. Thirty minutes or more with a good jigsaw puzzle, even one you’ve done before, is both calming and rewarding.

Food

Speaking of calming and rewarding, don’t forget to feed ‘em, and don’t indulge in excess either. Remember that for most kids, there is structure during the day in the form of lunchtime and recess and activity time. I’m a big believer in free and unstructured time, but in recent days we’ve been closing in on Lord of the Flies territory. Feed ‘em at the table and then let them move onto other things. The meal should take around 20 minutes. You might get more time out of it if you bake something. (That’s the length of the average meal at school)

Go Outside Continue reading

Heroes And Zeroes Of Snowpocalypse 2015: The Good, The Bad And The Ugly

A plow rolls down the street as people trudge on foot down Joy Street on Beacon Hill Monday. (Jesse Costa/WBUR)

A plow rolls down the street as people trudge on foot down Joy Street on Beacon Hill Monday. (Jesse Costa/WBUR)

Snow can mean stress. Especially relentless snow that leads to cancellations, gridlock, cabin fever, hard labor with a shovel.

“The continual frustrations of managing kids at home, battling the commute to work, and dealing with the ongoing uncertainty around new crippling snowfall would make even the most easygoing person irritable,” says Massachusetts General Hospital psychiatrist Dr. Gene Beresin.

But stress is a test. It can bring out the best in a person, or the worst — the hero or the zero.

What have you witnessed in blizzard-ridden Boston? A hero — a neighbor who snow-blows out five other neighbors’ sidewalks? Or a zero — a neighbor who blows the snow off his car, right onto your car’s hood?

Tell us your story about an act of kindness and/or ruthlessness during these snowstorms in the comments below. We posted this query on WBUR’s Facebook page and it has already yielded a bonanza of vignettes that reflect the great range of human behavior, including:

My neighbor plows us out every storm and refuses payment of any kind. They’re always there for us. A few weeks ago after the Boy Scout pinewood derby, my car got stuck and they sanded and pushed my car until it was freed. Today, I’m stuck at home with 3 boys, 2 with the flu and my husband is at work so getting outside for clean up has been hard. All of a sudden I heard a noise..they had pushed their snowblower down the street to my house to dig us out!!! Great friends and neighbors…..

We live in a condo/house with four apartments. We own, most of the others are rentals and the garage is common area. For the last three storms, the guy downstairs takes off to his girlfriend’s and does not come back until everything is cleaned. The other person just sits and waits it out until we are done cleaning. The third is a 92 year old man (God love him) who will go out but I worry about him so I will do his share. I wish we could leave it once to show the slackers how it feels but we have to get the kids to school.

If he’s not working, my neighbor will unfailingly come over and snowblow us out. He knows that I’m at home with two kids and that my husband works long hours. I use it as a lesson for my two year old – “look, our neighbor is using the snow machine in our yard! What can we do that’s nice for him?” We bake if we can, or even just make a card – I want my little guy to learn that you pay goodness forward however you can.

Our street in Dorchester is all about snow heroes. Whoever is out with a snowblower at the moment will do the full length of the sidewalk, a group of kids has been traveling the block clearing steps and driveways, and everyone just chips in to finish off the tough spots. Even neighbors who are away have made sure their snowblowers are accessible for others to borrow. When my husband was traveling last storm, our neighbor came by and took out my dog every time he went out with his dog! It makes the snow much more tolerable when we’re all in it together.

Just saw the snow plow go by and the guy across the street was clearing his driveway. Snow plow backed up cleared out the end of the driveway. My neighbor was so happy, he was almost dancing.

The woman across the street shoveled out her sidewalk by dumping on my sidewalk. Which meant walking it all across the street to do so. She has a backyard. And a neighbor shovels their snow into another neighbors fenced yard that is now high enough for her dogs to get out. That’s definitely a zero.

Continue reading

Related:

Beyond Sexual Assault: How One Victim Evolved Into An Activist

Ali Safran founded a website dedicated to supporting victims of sexual assault. (Courtesy of Erinn Lew)

Ali Safran founded a website dedicated to supporting victims of sexual assault. (Courtesy of Erinn Lew)

By Dr. Gene Beresin

Alison Safran is a 22-year-old who graduated from Mount Holyoke College in May 2014. She was the victim of a sexual assault as a senior in high school in one of Boston’s suburbs.

She initially didn’t confide in her parents because she was unsure that they’d understand. However, when her symptoms of post-traumatic stress disorder (PTSD) increased, she sought help from a clinician who referred her to the psychiatrist she is currently seeing. She has since improved immensely.

Ali’s story is about her resilience, but it’s also about how good can emerge from a terrifying experience.

Symptoms After An Assault

“After I was assaulted,” Ali said. “I developed what I now understand as PTSD symptoms, but at the time, I didn’t even know what PTSD was. I was miserable. My symptoms continued into my first year of college, which made an already stressful time even more difficult. It was hard to sleep and function normally.”

When Ali attended a local university, she was assigned to a co-ed dorm, under the conditions of her housing contract. This situation was not easy for her; her PTSD was at its peak and she filed a criminal complaint against her assailant, adding more stress to her life. It was very difficult for her to live near male students who were often partially undressed in the common room.

“Even though living in a co-ed dorm is a normal part of college life, dealing with being around men while I was engaged in the criminal justice process made me feel unsafe,” she said.

Stress Of A Co-Ed Dorm

While Ali, her parents and even her psychiatrist tried to release her from her dorm contract, the university declined until eventually the administration was persuaded to alter its stance by a member of the Board of Trustees. Ali felt that though her professors were understanding and helpful in providing accommodations when needed (i.e. missing class for court), the university administration itself did not understand or appreciate the impact of her living situation given the sexual assault and upcoming trial.

“My stress level was already far above that of the average college freshman. Despite the legal process I was pursuing, my school could have at the very basic level chosen to help me relieve some of that stress. It chose not to do so,” Ali said.

The unfortunate failure on the part of her university preceded the recent focus on college campus sexual assaults, in which awareness has increased and schools are beginning to take steps to address the widespread problem. Continue reading

Gender Divide: Trans Youth Face Higher Mental Health Risk, Study Says

With the tragic death by suicide of transgender teenager Leelah Alcorn still in the news, Boston researchers are reporting that many transgender youth may be particularly vulnerable to a variety of mental health-related problems.

The new study published in the Journal of Adolescent Health found that transgender youth faced a higher risk of being diagnosed with a mental illness or related problem, compared to non-transgender teens.

Specifically, the study says:

Compared with non-transgender youth, transgender youth had an elevated probability of being diagnosed with depression (50.6% vs. 20.6%); suffering from anxiety (26.7% vs. 10%); attempting suicide (17.2% vs. 6.1%); and engaging in self-harming activities without lethal intent (16.7% vs. 4.4%).

Researchers suggest that primary care doctors should address gender identity more directly and routinely screen transgender adolescents for mental health concerns.

Sari Reisner, a research scientist at the Fenway Institute who was the lead author on the survey, says gender affirming care by pediatricians can have a positive impact on a child’s future mental health outcomes:

“Gender affirmation is a very important part of a person’s identity. If a person is not being seen for who they are it can be very distressing. So pediatricians present a very important entry point into care and can get youth who need services to the right place.”

According to the study:

…it is recommended that primary care providers include gender identity as part of a basic patient history. Training programs and continuing education programs for primary care providers and mental health providers should include gender identity education.

Providers should familiarize themselves with community resources for transgender youth.

Patients with a transgender identity or history should be recognized as having higher risk for mental health concerns and should be carefully screened and evaluated.

Patients identified with co-occurring transgender identity and mental health concerns should be seen by a mental health provider who is qualified to provide evidence-based care with sensitivity to the diversity of gender identity and expression.

Continue reading

Sweet Dreams: Study Finds Later Nights, Less Sleep Linked To Negativity

(eltpics via compfight)

(eltpics via compfight)

Sleep is the new Prozac. Or, put another way, sleep is emerging as one of the most potent weapons you can use to stave off depression, anxiety and a whole host of other physical and mental ills.

Here’s the latest pro-sleep research by psychologists at Binghamton University in New York. Their new paper, “Duration and Timing of Sleep are Associated with Repetitive Negative Thinking” is just published in the journal Cognitive Therapy and Research.

From the news release:

When you go to bed, and how long you sleep at a time, might actually make it difficult for you to stop worrying. So say Jacob Nota and Meredith Coles of Binghamton University in the U.S., who found that people who sleep for shorter periods of time and go to bed very late at night are often overwhelmed with more negative thoughts than those who keep more regular sleeping hours…

Previous studies have linked sleep problems with such repetitive negative thoughts, especially in cases where someone does not get enough shuteye. Nota and Coles set out to replicate these studies, and to further see if there’s any link between having such repetitive thoughts and the actual time when someone goes to bed.

They asked 100 young adults at Binghamton University to complete a battery of questionnaires and two computerized tasks. In the process, it was measured how much the students worry, ruminate or obsess about something – three measures by which repetitive negative thinking is gauged. Continue reading

Instead Of Therapy, Put A Little Thanksgiving Into Regular Family Dinners

Mark's postcards from Beloit/flickr

Mark’s postcards from Beloit/flickr

Anne K. Fishel, Ph.D.
Guest Contributor

When a colleague recently told me about her Thanksgiving tradition, it got me thinking about family dinners — a topic I consider every night around 7 pm and with every patient I see in family therapy.

Indeed, as a mental health provider, I sometimes feel I’d go out of business if families had regular dinners with one another. Truly. There are dozens of research studies that show that frequent family dinners promote kids’ mental and emotional well being — by lowering rates of depression, anxiety, eating disorders and substance abuse, for starters. Family meals also strengthen children’s resilience, self-esteem and sense of connectedness to their parents. Isn’t that exactly the goal of therapy?

It’s no wonder that I often have to stifle the urge to say, ‘Stop wasting your time here. Go home and eat dinner together.’

But, I’m well aware of how hard it is for busy, harried families to find time to sit down to dinner, and I’m always looking for new ways to unlock the benefits without adding any guilt or pressure. So, that is why my colleagues remarks sparked my interest. Here’s what she said:

“My sisters and I love Thanksgiving so much that our father makes a Thanksgiving-like meal throughout the year that he dubs ‘Harvest Dinner.’ We just can’t get enough of his mashed potatoes!”

I love the idea of bringing the special quality and spirit of Thanksgiving dinner to everyday meals. Two elements could easily translate to everyday dinners: sharing the workload, and focusing on more than just food. Continue reading

Silent Wars: Helping Vets Fight Mental Health Battles At Home

By Evan Bick
Guest Contributor

The movies have it wrong. Combat, at least in my experience, was not non-stop or action-packed. Those who have experienced it know that modern warfare usually involves a lot of starting and stopping. Long stretches of quiet, even boredom, can be broken in an instant.

I was deployed to Iraq as an infantry platoon leader in 2008-2009. During that time, there may not have been constant action but there was tension — my fellow soldiers and I were on edge most of time, soldiers among civilians, going on patrols in the northwest corner of Baghdad.

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

On our first day in the city, the leaders from the unit we were replacing took us on a walk through their area of responsibility. We saw the sidelong glances from civilians as Americans walked through their streets, hidden behind rifles and sunglasses, and weighed down by cumbersome body armor. We also saw an area filled with stark contrasts — stucco houses with gated courtyards in one neighborhood, and refugee camps for Iraqis displaced by ethnic violence in the next.

Deployment is a challenging experience even when it’s boring. Whether you are patrolling ‘outside the wire’ or working behind the scenes, the sense of danger is real and omnipresent. While deployed, soldiers typically work far longer hours, and with less opportunity for relaxation than they experience at their home station. Isolation from loved ones, of course, is an important challenge both for the deployed soldier and family members back home.

Even with all those challenges, the bigger battle for many veterans begins when they return home. Without a unit that shared in your experience of war, you can feel lost — more lost than you would ever feel on patrol. It’s easy to get trapped inside your own head, and to dwell on what did not go well, and what you should have done differently. The quick reflexes and adrenaline that may have helped keep you alive overseas are probably no longer helpful.

Strategies that kept you and your fellow soldiers safe, like driving fast and straight down the middle of a road, become dangerous, and loud noises or crowds may make some part of you feel like you’re back in the desert. Continue reading

When You’re Dealing With A Stressed-Out High School Junior: 5 Tips

By Steve Schlozman, MD
Guest Contributor

(Miguel Angel/Flickr)

(Miguel Angel/Flickr)

Sometimes things are so obvious we fail to take notice.

For example, if I tell you that high school students who plan on attending college are under a lot of pressure, your response might sound like, well, a 17-year-old:

“Duh,” you might say, “What else is new?”

This is not new, of course, but the pressure continues to get exponentially worse. Students from all walks of life are increasingly overscheduled, academically burdened and socially overwhelmed. We pile all this stuff on top of the already treacherous waters of adolescence, and it’s no wonder kids feel emotionally battered.

I started thinking more about this when a friend of mine from high school called about his 9th grade daughter.

“She’s 14,” my friend said, “And they’re telling her in the fifth week of school about college. Did we worry about college in 9th grade?”

No way.

I used to think that the pressure on high school teens was largely a regional issue. I was raised in the Midwest, so of course things weren’t quite so high-stress compared to here in Boston. But my friend was calling from Colorado, and this is therefore not a regional issue. What is clear, is that this pressure is not good for our kids.

Let’s look at some of the data:

•According to the Department of Education, there are around 2,675 nonprofit four-year undergraduate colleges in the United States.

•Although the number of students in high school continues to slowly decline, the number of students applying to college is steadily increasing. In 2011, there were about 20.4 million students enrolled in college, and that number is projected to reach about 23 million by 2020.

•One out of four teenagers submitted college applications in 2011, at an average of around $40 per application

•In 2001, the typical college admitted around 71 percent of its applicants. By 2011, this number dropped to around 65 percent. I could go on. The common application increases the overall number of applications that students complete, schools look to college acceptance rates as a means of measuring their success and they therefore pass this pressure onto their students, and students themselves are more and more led to view the junior year of high school as something akin to academic and extracurricular boot camp. I’ve seen students get freaked out even before the first week of 11th grade.

This this kind of systemic stress is not good for anyone. A 2008 study found that the increased rate of academic dishonesty on high school campuses stemmed, at least according to some students, from the increasingly high achievement bar that the students themselves experienced. This of course does not excuse cheating, but it is worth noting that both cheating and academic and social pressures seem to have grown in concert with one another. Continue reading