How to cope with losing the pet you love

“Hey, something’s up with Molly. She’s not right.”

On Monday, April 8, we were getting ready in my house like any other day. I was going to Harrisburg, my wife was getting ready for school and the kids were eating breakfast. It was around 6:45am. Molly, our ten year old German Sheppard, was having trouble walking. She had an old leg injury, but it didn’t usually bother her like that. She was stumbling and just looked off.

Hmm.

I let her out to the backyard to load my car, as per usual. When I got back from the garage, she was lying down and panting. Not like her at all.

We made a vet appointment, but by the time my wife got home from work it was apparent it was more serious than that. I was in Harrisburg, ironing a shirt in my hotel room, when I gave Brenna the number for the vet. She ran Molly to the veterinary hospital, and I could feel a chasm opening in my chest. My father in law had run over to watch the kids, and he said, “Mike, Molly really doesn’t look good. She’s having trouble walking.Be prepared.”

Brenna had the kids hug Molly goodbye before she went to hospital with her, just in case. I’m glad she did.

Molly collapsed in the lobby of the hospital. They put her on a journey and ran her back. I was at a dinner that I abruptly left, and I was in the car, in the parking lot of the hotel room, when Bren called me back. She put the Vet on speaker phone, and the very nice woman sadly explained that Molly had a tumor around her heart. There was nothing we could have done, and nothing we could do.

I was able to get home in time. And we said goodbye.

Losing a pet is agonizing. I’d been through it once before, but it was my childhood dog. Losing the dog that your rescued and raised from puppyhood to old age is horrible. She was our practice child. We got her before we were married, before kids, before I was an elected official, before books. Molly was with us for more than 1/4 of our lives. Losing her has created a puppy-shaped hole in our lives.

Broadly speaking, some thoughts:

It’s gonna take time: It’s been about two weeks now. We’re getting there, but still have plenty of moments where we just burst into tears. I mean, the last time I cried was…yesterday. This is gonna take time. A lot of time.

The grief comes in waves: Let me acknowledge how lucky I am. I still have my parents and most of the people in my life who are close to me. So, this was one of the worst grief-laden experiences I’ve ever had. And it comes it waves. The first couple of days are horrible. Then it fades. And then out of nowhere…you find a dog hair. Or you drop food that the dog would normally eat. And it feels like you’ve been punched in the gut and you’re a weeping mess. Best advice I can give: Ride the storm. It fades. And it does get easier. Try to remember that.

Try to put your pain in perspective: Bren and I have both repeatedly commented on how we thought she had more time – how badly we wanted more time with Molly. What’s helped me get through that? I try to remember everything that went right. We had her for ten years. We gave her love and attention and time – and a lot of money caring for her, haha (side note: PET INSURANCE IS A GREAT IDEA). But Molly was found in a box in downtown Allentown. She was sick with hookworms. She should have died. But we took her into our home and loved her for ten wonderful years–and for those ten years she loved us and our kids and was with us for our greatest and darkest moments. More time would have been wonderful. But to have a friend like this for so long – and to remember the time you had together – makes a world of difference.

Yes, saying something on Facebook does help: Every time one of my friends posted on FB that they had lost a beloved pet, I said how sorry I was. And, in recent years, with an older dog, it always occurred to me – I’d write that update one day. When the time came, I was floored. I did it just to update people with what was happening in my life. I was blown away at the responses – how kind they were – and how much better they made me feel. When I returned to Harrisburg a day later, I had members, staffers, lobbyists telling me how sorry they were. Someone even mailed me a stuffed dog with a sweet note (I don’t know who you are, but if you’re reading this, thank you so much).

Those messages of support made a world of difference. I remain so touched by their kindness, but I was reminded that losing a pet is largely universal. So many know that pain. Share yours with others and let them be there for you, too.

The absence is louder than any scream: Being home alone has been the worst. Not having Molly in the living room staring at me. Begging to go out. Looking for attention. I can feel her absence like it’s physical. There are no more little noises anymore. No more tinkling of her dog tags. No more claws against the hard wooden floors.

Be prepared for that. I don’t have a solution yet, except time.

The loss of routines: Every morning, I wake up. Molly runs to the bed, pacing, grunting. She’s gotta pee. I let her out. She does her business and runs back to the door, jumping. I feed her. Then I gotta let her out again. For nearly ten years this was our dance, right up until the morning of the day she died. Before we go to bed, we let the dog out. At 4pm, she gets dinner. Every time I go to the kitchen, I check her water dish to refill it as necessary.

And just like that, those routines are gone. Brace yourself. That part is awful. 

Helping the kids: Our kids are 8 and 6. They’ve never known a world without Molly in it. They were, of course, besides themselves – they cried so hard that night. We snuggled with them and told them as appropriately as possible what had happened: She had cancer and had died. Auron, the older one, is more curious: Had she died with her eyes open? How had she died? I answered both of those questions later – without my daughter around.

The night she died we sat on the couch together and spoke about how much we loved her. We told the kids this would hurt – that it would take time – and that they could cry on our shoulders. We let them go late into school the next morning but we did bring them in together – we thought it was better for them to be surrounded by friends. Their teachers and classmates were SO KIND they even made cards. 

Both kids reacted differently. Ayla – my youngest – now walks around with a stuffed German Sheppard that we got her (named Molly, obviously). She brings it to school and says it helps. We got one for Auron too, but I have no idea where it is now – he didn’t really use or need it.

Broadly speaking, my experience with the kids has been this: Let them lead. They want to talk about Molly? Go right ahead. They don’t? Let it go. But just telling them to express their emotions, that death is a part of life, that you love someone so they have no regrets when they are gone and that we were there for them if they needed us – that made a world of difference, I think.

Take the punch: I had an already scheduled appointment with my therapist the other day, and naturally, this is largely what we discussed. I’d been working on trying to be more present and less in my head, and I asked him how to reconcile the pain of grief with that concept. His answer was great: You do it to take the punch. You do it to get stronger, because grief is an non-negotiable part of life.

Take the punch. It was worth every moment. I miss Molly deeply. And will for what I imagine will be the rest of my life. To quote a tweet I once saw: Owning a dog is like borrowing happiness from the future. My family and I are now in our repayment plan, but if you hold to that metaphor, the happiness we borrowed was like an investment. It was repayed countless times over. Dealing with this grief is rough but manageable. We will get there, and we will be dog owners again, both because it’s what we want and I think what Molly would have wanted for us. This house isn’t the same without a four legged friend, and when the grief has passed to a manageable level, we’ll be there again.

Anyway, thanks for reading. I hope this was as helpful for you to read as it was for me to write.

Six ways that humanity once treated mental illness (which would probably kill you today) – Part 2

Hello! On Monday, I published Part 1 of a historical look at the ways in which mental illness was once treated. Here’s Part 2. It’s not any better.

4. Fever therapy

Some general basics here: You don’t just get a fever because your body hates you. Fevers occur when your body has an infection, and your temperature raises to fight off the foreign germ invaders.

Keep this in mind, and allow me to introduce you to Hilda, a patient who was suffering from what the early 20th century referred to as “general paresis of the insane,” (or GPI) caused by advanced syphilis. Hilda was confined to a psychiatric clinic in Austria when she came down with a pretty serious fever. She recovered from the fever…and her psychosis.

How they thought it worked

Hilda’s doctor, Dr. Julius Wagner-Jauregg, attributed Hilda’s sudden recovery to the fever. Using other GPI patients, Wagner-Jauregg began to experiment by injecting patients with a slew of other illnesses, including streptococcal bacteria (strep throat), tuberculin (tuberculosis) and malaria (freakin malaria).

However, for many, the therapy actually worked:

“Patients who previously behaved bizarrely and talked incoherently now were composed and conversed normally with Dr. Wagner-Jauregg. Some patients even appeared cured of their syphilis entirely. Here in the twenty-first century it may not seem like a favorable bargain to trade one awful disease for another, but at least malaria was treatable with quinine, a cheap and abundant extract of tree bark.”

Fever therapy (also known as Pyrotherapy) was used as late as the 1930s, when special machines were constructed to induce a fever.

But, actually….

The therapy did work…for GPI. And GPI only. And it did have the nasty side effect of giving someone whatever deadly illness they were injected with, complete with a 15% chance of…death.

The problem, of course, is that this wasn’t understood. Pyrotherapy (side note: this is the greatest name ever, because it sounds like you are being healed with fire) worked by killing the microorganisms which caused GPI, but there was no such equivalent for other forms of mental illness.

Meanwhile, pyrotherapy was used to treat a variety of different psychiatric disorders, including depression and schizophrenia. New, exciting ways were brought in to treat fevers to, expanding to everything from typhoid to electric blankets. Observations at the time showed that the therapy could work in very limited circumstances, but most of the time, there was no improvement.

As for Wagner-Jueregg? He, too, won a Noble prize. Apparently, they are not as hard to get as one would previously expect!

5. Hydrotherapy

Nothing’s calmer than a nice, relaxing bath to destress you after a long, tough day, right? Well, what about being soaked in icy cold towels and made to stay in a bath overnight?

Wait, what?

How they thought it worked

According to this 2015 Psychology Today article, in older times, mental illness was thought about in “spiritual terms” – and water was seen as an antidote. As a result, water became to be viewed as a common cure to a variety of mental illnesses. This became particularly prominent in the 18th century, when two types of hydrotherapies became prominent:

• The douche (shower), in which a “constant torrent of water could either cool the heat of madness or rouse the melancholic.”
• The balenum (bath), which was just meant to calm someone down.

With the rise of psychiatric hospitals, the practice became more prominent and a variety of different pieces of equipment were developed for the practice, including bath boxes, dunking devices (I don’t think they mean those carnival games) and more.

While this all sounds relatively harmless, in it’s more extreme forms, the therapy could be downright cruel and dangerous. According to one review, in some cases, “A patient could expect a continuous bath treatment to last from several hours to several days, or sometimes even over night.”

But, actually….

The therapy faded from prominence in the early 20th century as other bad ideas replaced this one (insulin shock, electroshock and more).

Here’s the thing though: While forcing someone to do anything against their will is almost always a bad thing, taking a bath can be good for your mental health, so this therapy wasn’t entirely off base! According to this Guardian article, taking a bath can increase your core temperature. This, in turn, is associated with a “moderate but persistent” mood increase.

So, hop on into the tub! Just…don’t strap yourself in. Bad call there.

6. Trephination

Trephination is the fun-filled process by which a hole was cut in someone’s skull. It is one of the oldest forms of therapy, with evidence for the practice dating all the way back to 6500 BCE. Its use wasn’t just confined to mental illness; no no, that would at least limit those who suffered from this God-awful practice. Instead, trepanning was used for a variety of illnesses, including seizures, migraines and head wounds, as well as pain.

Is was used as recently as the Renaissance, around which time one can assume that it began to occur to practitioners that cutting a big ole hole in someone’s skull was not necessarily the greatest practice.

How they thought it worked

Similar to hydrotherapy above, trephination was used because of a different understanding of mental illness. The hole cut in one’s skull would allow for bad spirits to get out, or good spirits to get in. This, in turn, would relieve mental illness.

At the same time, trephination had other uses. Skull discs would be collected and used as good luck charms or amulets, and in ancient Egypt, the scrapings of a skull were used to make potions (hey, why let a good thing go to waste!)

What is even more remarkable is that these operations did not kill everyone on the spot. There is ample evidence that many survived the procedure, as evidenced by skull regrowth among those who had the operation.

But, actually….

Do I really need a “but, actually” section here? Drilling holes in the skulls of people is, generally speaking, a bad practice, m’kay?

Now, that being said, there are exceptions to every rule, and skull-holes has those exceptions as well. In limited instances, such as in the case of brain injury, and specifically epidural and subdural hematomas.
Of course, skull removal is never used for mental illness at this point. Thank God.

Six ways that humanity once treated mental illness (which would probably kill you today) – Part 1

In the course of doing research on mental illness and treatments, I have come across some absolutely wild methods of treating mental illness from older times. Some had roots in science of the moment – others were just really, really bad guesses. Most were very cruel, but in all fairness, it’s easy to say that now.

Anyway, here’s a look at six ways which humanity once treated mental illness. Today is Part 1, and Part 2 will publish Thursday.

1. Electroshock therapy

You may know shock therapy from plays like One Flew Over the Cookoo’s Nest or that episode of Quantum Leap which gave me nightmares for years:

How they thought it worked:

With shock therapy, the premise was simple: They hooked you up to a machine and sent as many as volts as possible into your screaming, aching body. The electrocution would induce a seizure; this, in turn, was thought to improve mental illness like depression and schizophrenia.

The therapy wasn’t usually quite as ugly as portrayed in popular media, but according to Jonathan Sadowsky, who wrote a book on electroshock therapy, it wasn’t too far off: Electroshock therapy was often used in mental hospitals to “control difficult patients and to maintain order on wards.”

Oh, and not for nothing, but electroshock therapy was also used as a way to “cure” homosexuality. Yeah.

But, actually…

The idea behind the practice was sound; it’s the execution of shock therapy that caused the damage. Even in the 1960s, there was ample evidence that electroshock therapy could be successful. However, patients who underwent the practice at the time were often did not give informed consent (agree to the treatment with a full understanding of its potential risks and benefits) and reported the process to be terrifying and painful. Severe memory loss and brain dysfunction often occurred as a result of the treatment.

Thankfully, this practice has been reformed significantly. It’s still used for severely and treatment resistant depression, as well as a few other select disorders. According to the Mayo Clinic, patients are placed under general anesthesia (as opposed to being very awake and very much in pain) and a small electrical current is sent straight to their brain, resulting in a small seizure. And, unlike prior versions, ECT has shown real promise in fighting depression, with success rates as high as 83%.

2. Insulin Shock therapy

Getting electrocuted not enough fun for you? My friend, allow me to introduce you to insulin shock therapy, the process by which patients were intentionally overdosed with insulin and sent into a coma. Yes, that’s right, it’s diabetes…on purpose.

How they thought it worked:

The therapy was first discovered by accident in 1927 by Dr. Manfred Sakel, who injected a morphine-addicted woman with insulin and noticed a remarkable recovery. Said Dr. Sakel:

“My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells … a reduction in the energy spending of the cell, that is in invoking a minor or greater hibernation in it, by blocking the cell off with insulin will force it to conserve functional energy and store it to be available for the reinforcement of the cell.”

Over the course of a two month period, schizophrenics were injected with a massive dose of insulin until they slipped into a coma. Patients were selected based on those who had a good prognosis for recovery and were thought to have the physical strength to endure the therapy.

Studies in the 1930s and 40s showed that as many as 70% of people showed improvement with insulin shock.

But, actually…

A paper in 1953 by Dr. Harold Bourne debunked the therapy, noting that any recoveries likely occurred because the patients were already on their way to a recovery. Further studies with randomly selected patients showed that insulin therapy showed absolutely zero difference with medication…except, you know, the self-induced diabetes coma.

The therapy disappeared from the United States by the 1970s.

3. Lobotomies

Not sure what the word “lobotomy” means? Well, let’s look at its origins: “lobe” means part of the brain, and “tomy” is a medical suffix for cutting. So, that means…

…oh. Oh, dear.

Yes, a lobotomy is just that: Removing a piece of the brain in order to make the rest of it function better.

Clearly, the logic here is wanting. Broken arm? Cut it off. Twisted your ankle? Time to amputate!

How they thought it worked:

Back in the day (as recently as the 1950s), lobotomies were used for the treatment of a variety of mental illnesses, including schizophrenia and bipolar disorders (then called manic depression). It was invented in by Dr. Antonio Egas Moniz in 1935. Fun fact: Moniz was awarded to Nobel Prize for Medicine in 1949 for the lobotomy – a move so out of step with reality that there was an unsuccessful effort to revoke the Prize from Moniz.

In the first lobotomies, known as “ice-pick lobotomies” (yes, really):

“As those who watched the procedure described it, a patient would be rendered unconscious by electroshock. Freeman would then take a sharp ice pick-like instrument, insert it above the patient’s eyeball through the orbit of the eye, into the frontal lobes of the brain, moving the instrument back and forth. Then he would do the same thing on the other side of the face.”

In the end, an estimated 50,000 lobotomies were performed in the United States.

But, actually…

According to Dr. Barron Lerner, a medical historian and professor, “The main long-term side effect was mental dullness,” which included damage to a person’s “personality, inhabitations, empathy and ability to function on their own.” Another contemporary source found that a mere 1/3 of people benefitted, while 1/3 had no change, and 1/3 were made worse. So, a cure with a 1:1 chance of doing more harm than good. Neat.

Some patients did show an improvement in their mental illness. But many showed an overall loss in emotions. It got so bad that the Soviet Union – not exactly known as a vanguard of human or civil rights – banned the practice in 1950. Fortunately, as a result of increasing concerns over the operation and the advent of successful anti-psychosis drugs, lobotomies largely fell out of favor in the 1950s.

Religion and suicide

About two weeks ago, I was able to participate in a Jewish Federation event on mental health and stigma. The participants included myself, a psychologist, the head of our local NAMI Chapter and a Rabbi. Much of the information I heard during this presentation was things that I had heard before, but the newest perspective actually came from the Rabbi, who discussed what happens with Jews who do die by suicide.

Apparently, in Judaism (like many other religions), a strict interpretation of suicide views the action as a major sin, and those Jews should not be buried in a Jewish cemetery. Thankfully, this Rabbi believes (like many others) that those who do die by suicide are clearly ill at the time of their death; thus, they should not be “punished” for that action and should be allowed to be buried in a Jewish cemetery.

This entire conversation had me thinking about suicide and religion. Are there differences in suicide rates by religion? What about those with no religion – do they have higher or lower suicide rates? How can religion help or hurt someone’s mental health?

The relationship, as best I can tell, is complicated. According to a 2016 study on the subject:

We found that past suicide attempts were more common among depressed patients with a religious affiliation (OR 2.25, p=.007). Suicide ideation was greater among depressed patients who considered religion more important (Coeff. 1.18, p=.026), and those who attended services more frequently (Coeff. 1.99, p=.001). We conclude that the relationship between religion and suicide risk factors is complex, and can vary among different patient populations.

This study would obviously suggest that religion and suicide are positively correlated. But, as a 2017 article from the American Sociological Association notes, the real relationship is more complicated – and that largely depends on where in the world you are discussing:

A Michigan State University sociologist reports in The Journal of Health and Social Behavior that religious participation affects suicide rates differently around the world, and in Latin America particularly, high religious involvement is associated with low suicide rates.

In contrast, in East Asia, where residents are reportedly more secular, higher levels of religious involvement are connected to higher suicide rates. A one percent increase in religious participation is associated with a one percent increase in suicide rates in East Asia.

Statistics for the United States generally follow with the statistics for Latin America, although the link between religious participation and low suicide rates is not as pronounced in the United States.

An interesting 2017 article from the Huffington Post makes a similar argument but from a reverse perspective: That it is atheists, not religiously affiliated people, who have a “suicide problem.”

When I started this entry, I was curious to see what religions have higher or lower rates of suicide. I now see that it’s not that simple. Religion and suicide are related, and that makes sense, of course. On one hand, religion can give people additional joy, purpose and value. Fear of divine punishment can also serve as a powerful motivator to keep people from killing themselves. However, religion can also alter perspectives and force negative value judgments.

My conclusion: The relationship between religion and suicide is complicated and depends on a variety of factors.

As always, let us know what you have to say in the comments below!

No, you cannot “implant” the idea of suicide

One of the great myths of suicide is that you shouldn’t talk about it with someone (particularly younger people) because doing so may somehow “implant” the idea of killing oneself into someone’s head. That’s categorically, unquestionably not true, and I wanted to take a moment to discuss the idea.

The idea that we can unintentionally encourage suicide by discussing it is a frightening prospect because it leaves us powerless. One of the things that many mental health advocates say (and this certainly includes me!) is that we must discuss suicide and mental health. However, there is a persistent fear that discussing suicide may cause someone to consider attempting the act.

There’s good news though: It’s just not true.

There is ample evidence to back up the notion that discussion of suicide doesn’t increase suicidal ideation or attempts; indeed, thankfully, the opposite is true. According to a 2014 review on just this subject:

None [of the studies reviewed] found a statistically significant increase in suicidal ideation among participants asked about suicidal thoughts. Our findings suggest acknowledging and talking about suicide may in fact reduce, rather than increase suicidal ideation, and may lead to improvements in mental health in treatment-seeking populations. Recurring ethical concerns about asking about suicidality could be relaxed to encourage and improve research into suicidal ideation and related behaviours without negatively affecting the well-being of participants.

This is great news, particularly for anti-suicide and mental health programs, as it means that you can talk about suicide without supposedly putting the idea of suicide into someone’s head.

That doesn’t mean, of course, that suicide and mental health can just be discussed in a willy-nilly sort of way; there must be specific guidelines to these conversations.

According to this article from Psychology Today, these conversations can range from casual to serious. Addressing the issue is important, but it doesn’t have to be done in an ultra-serious way. Asking your child about high-profile suicides in the news, asking their thoughts, inquiring about their feelings and state of mind – these are all positive ways of addressing the subject.

The article also does a good job of explaining what to do if someone you know or love says that they have had thoughts of suicide. It notes that many of us have had those thoughts at some point, and that isn’t inherently dangerous. What is dangerous is if these thoughts are persistent, overwhelming or come with specific plans. That’s when more action may be needed.

So, the summary is this: Talk about suicide with your children or others you care about. Do so in a way that is factual and avoids glamourizing the issue, but in a caring and supportive way. This will not encourage the idea of suicide – indeed, it will help prevent it.

It’s important that we have these conversations with people we love, and do so without fear of “implanting” the idea of suicide. This goes for schools, parents – really, all of us.

Six medically backed treatments for depression – which make absolutely zero sense (part two!)

Earlier in the week, I published part one of this article – six medically backed treatments for depression which make absolutely zero sense. Here’s part two!

Warmth

According to a multiple studies, people suffering from severe depression found relief when their core body temperatures were raised. We’re not talking a fluffy blanket here, either: We’re talking a hardcore warm bath in temperatures reaching 104-degrees Fahrenheit. Incidentally, the more depressed someone was, the more likely they were to find relief, which could offer some hope for people who suffer from treatment-resistant depression.

Another study found that depressed individuals who had their body temperatures raised showed less depressive symptoms than those who had their body temperatures raised, but by a much lower amount. In other words, more heat made someone feel better. And the difference, according to the report’s write-up, was “dramatic” – not a word often used when describing depression treatment!

Does this mean warming up can cure all? No. Of course not. But it does show a promising potential cure, one that needs more study to be truly evaluated. But, there are more cures which are even more effective, such as….

Getting smashed in the head with an electro-magnet (Transcranial Magnetic Stimulation)

Allow me to introduce you to Transcranial Magnetic Stimulation, one of the goofiest (and potentially more effective) treatments for depression that there is.

Transcranial Magnetic Stimulation (TMS) is a type of therapy used for treatment resistant depression. What is it? Well, here:

In a nutshell, it involves being tapped in the head thousands of times (as many as forty over a ten second period) by an electromagenet. The electromagnet is supposed to wack you in the head in a region which corresponds to your brain’s center for mood control. As a result, your depression is supposed to increase.

Yes, this sounds terrible and painful, but it’s not, at all. I actually had TMS and absolutely noticed an improvement – one that decreased six months later, but is still there. Depending on a variety of factors (your own depression, insurance and availability), it’s a significant commitment. I had about 35 sessions over a seven week period. You sit down, get strapped in (again, not as bad as it sounds) and the tapping begins. The magnet hits you about 40 times over a four second period, then it rests for twelve seconds, and the cycle repeats for twenty minutes. Let me emphasize this: THIS IS NOT PAINFUL. I fell asleep repeatedly and texted my way through the other sessions. It’s kind of annoying and does take a session or two to get used to. It is also a time commitment: While you can miss a day or two, you can’t go on vacation in the middle of the session and expect it to still be effective.

Does it work? Yes. It did for me and I’m not crazy (well, I mean, I am, but that’s besides the point): Studies have found TMS having a success rate as high is 58% in terms of lessening symptoms, while other studies found that as 75% of people who had TMS reported that the benefits lasted for at least over a year.

That being said, if you’re looking for a treatment which smacks you less, allow me to direct you to our final item on this list….

Meditation

Breathe in. Breathe out. Focus on your navel. Feel better.

Really.

Meditation has gained a ton of prominence in recent years, and rightfully so: For as little as ten minutes a day, it’s been shown to reduce stress, lengthen your attention span, reduce memory loss and improve sleep, among many other positive changes.

And that works with depression too? Yep.

The most effective type of meditation for beating depression is mindfulness meditation, which is a specific type of meditation in which you sit still, calm down, and focus your mind on the present moment.

In a recent study of people with mild depression, people who underwent mindfulness meditation showed reduced rates of developing full-blown depression when compared to a control group.

Of course, that’s not all. A massive, systematic review of 18,573 citations on mindfulness meditation  showed that mindfulness meditation was moderately effective in treating pain and anxiety.

How does this work? Probably more than just one way. But, according to Dr. John Denninger of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Meditation trains the brain to achieve sustained focus, and to return to that focus when negative thinking, emotions, and physical sensations intrude — which happens a lot when you feel stressed and anxious,”

I mean, when you think about this, it makes perfect sense. Meditation can help you calm down, focus your mind and avoid negative thoughts. This isn’t a matter of just sitting still and being chill. Depression changes your way of thinking. Meditation can help make it right again.

New postpartum drug highlights continuing divide between the rich and the poor

Let’s start with the good news: For the first time ever, the FDA has approved a drug specifically designed to deal with postpartum depression (PPD). The drug is called Zulresso, and it is produced by Sage Therapeutics.

We know that PPD can be absolutely devastating. According to the article linked above, as many as one in nine women are hit by PPD. So the availability of a clinically successful drug designed specifically for PPD can be a godsend.

Now for the bad news: The cost and time period associated with Zulresso may put it far out of reach of many.

First, the cost: A whopping $34,000. That number might be slightly out of range for…you know, everyone not made of money.

As for it’s method of delivery? That’s another challenge: It has to be administered intravenously, over a 2.5 day period, in a certified clinic. That’s 2.5 days where a woman cannot work, cannot care for her baby (or the rest of her family). And let’s keep in mind, many women simply cannot afford to take 2.5 days off from work, and this is particularly true for hourly workers or those who are economically insecure.

Tragically – and unsurprisingly – women who need this help the most are also most likely to have this drug and its potential benefits out of reach. There are some women who are more likely to experience PPD, and unsurprisingly, in many cases, these are women who are more economically or socially vulnerable. These factors include job loss and a lack of other emotional, familial or financial support.

Simply put, this may mean that this new drug it is not an option for many. We know that tougher economic times – and tougher economic circumstances – lead to an increase in PPD cases. This treatment – both its costs and length of treatment – may be out of reach for many poorer women and their families.

To be clear, I’m not trying to poo-poo the potential success for Zulresso. I am trying to make a broader point though: Many areas of mental health treatment are, sadly, out of reach for the poorest among us. Hopefully, medical advances will continue to improve and make Zulresso’s life-saving benefits available for all women and families in society, regardless of their economic station in life.

Postpartum depression in…Dads?

I caught this article in Healthline and it made me want to further explore this topic: There is ample research which shows that Dad’s can suffer from Postpartum Depression, too.

First, a disclaimer. This is not an attempt to minimize the pain or severity of Postpartum Depression in Moms. This is not a #NotAllMen related entry, and please don’t take it that way. The evidence is clear – Postpartum Depression in women problem is real (with as many as one in seven women suffering), it is large and it is significantly more widespread than postpartum depression in men. Indeed, in my legislative career, I’ve worked on legislation which would help low income women be screened and treated for Postpartum Depression.

That being said, Postpartum does apparently hit Dads too, and I think its an issue worth exploring.

The Healthline article reviewed a variety of research on Postpartum in new fathers, which analyzed a variety of internet postings in blogs and chat rooms (yeah…not sure about that) and showed that many men suffered from symptoms about Postpartum and weren’t sure what to do or where to find information.

However, there is ample research – of a more rigorous, academic type – which shows that Postpartum does truly exist in men, so much so that it has a name: Paternal Postpartum Depression (PPD). This issue is widespread enough that there is an entire website dedicated to it. Postpartummen.com accurately notes that there are many symptoms of depression, but men often experience and express it differently, including through anger and alcohol. For what its worth, this is also something which I blogged about a couple of weeks ago.

How widespread is this issue? According to a study published in the Journal of American Medical Research, high – as many as one in ten men. The study also noted that the rates were slightly higher during the 3-6 month period, and PPD correlated moderately with maternal depression. Hormones are a big cause of maternal postpartum depression, but that’s also the case for men: Men experiencing PPD also have testosterone drops.

The good news is that treating PPD is just like treating any other disorder – as long as you are able to seek and find help, you’ll get there. As best I can tell, relying on therapists and support groups are widely accepted options to deal with PPD.

As always, I conclude by asking you for your opinion! Do you have experience with dealing or treating PPD? I’d love to hear your thoughts in the comments below!

 

A new nasal spray for depression

There’s a new anti-depressant treatment now available: Spravato. It’s related to Ketamine, and if it sounds familiar, there’s good reason for it: It’s biologically related to the party drug “Special K.”

Obviously there are major differences. This drug is a nasal spray and actually given in doctors offices – in other words, you won’t be taking this one home and having it in the morning like a standard anti-depressant. That is because, per this Vox article:

….because it can sedate patients and bring on out-of-body experiences, the FDA is only making it available through certified clinics, where patients are to be monitored for at least two hours after taking the drug.

This drug is meant for “treatment-resistant depression” – meaning those who have tried at least two other major depressant treatments and not had their depression ameliorated.

Operators of these clinics – no surprise – were overwhelmingly supportive of the FDA approval. From a USA Today article:

“This is an enormous deal in terms of access to care,” Levine said. “And the degree of advancement can’t be overstated. This is truly the best new option in over 60 years. And more will be coming down the pike.”

Treatment doesn’t work like standard medication. The same USA Today article told the story of Jonathan Herbst, who credited the drug with saving his life:

A financial services manager in Philadelphia, he began ketamine treatments in August – five or six treatments in the first two weeks, then one maintenance treatment every three or four weeks.

Are there side effects? You bet, and they sounds like a very fun time! They include: feeling disconnected from mind and body, dizziness, nausea, sedation, vertigo, decreased feeling or sensitivity, anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk. Additionally:

The FDA warned that esketamine distribution will be tightly controlled due to the potential for abuse, suicidal thoughts and sedation along with possible problems with attention, judgment and thinking.

It’s also worth noting that this drug’s approval did not come without real controversy over its effectiveness. This drug was approved after four clinical trials – three of which lasted only four weeks – and two of those short-term studies “did not meet the pre-specified statistical tests for demonstrating effectiveness.”

What do I think? I honestly have no idea. As usual: I’m not a Doctor. Go talk to your Doctor if you are interested. All I’m trying to do here is update my readers about this new drug. If you have treatment-resistant depression (high five, fellow sad people!), it is certainly worth exploring this option. Just be aware, however, that it’s still a relatively new drug with real side effects and some questions about its effectiveness. At the same time, however, there is clearly enough evidence to warrant its approval by the FDA, and there are absolutely people who credit this drug with making major improvements to their life.

And, as always: If you’ve had any experience with ketamine (good or bad!) or any thoughts to share, please write them in the comments below!

Is it better to see a therapist of your own race, gender or sexual orientation?

A friend of mine posted to Facebook the other day, seeking to see a therapist who was a woman and a person of color, like her. This stirred up the question in my mind: Is that a better outcome for someone?

In thinking about this question, I think the most important guideline here is obvious: It’s all about you. If you are more comfortable seeing someone whose demographics and experience match your own, then that needs to happen (although that can be a challenge). There is little more important to the ability to get real value out of therapy than the strength of the relationship between a patient and their therapist, and if having someone of your race and gender is important to you, than you should certainly do whatever you can to make that happen.

The good news, however, is that research indicates that having a therapist of your race or gender is not a requirement for positive outcomes, as long as you and your therapist are comfortable with any demographic differences.

In 2011, Brigham Young University conducted a meta analysis of studies (thanks to Joe El Caraballo for the catch). The meta analysis found:

  • There was a “moderately strong” preference for a therapist whose race/ethnicity matched the patients and a “tendency” for patients to view therapists of their own race/ethnicity more positively than other therapists.
  • However – and this is arguably more important – in terms of outcomes, the meta analysis found that there was “almost no benefit” when it comes to matching patients with therapists of the same race/ethnicity.

The analysis went on to note the importance of teaching cultural competency for all therapists, ensuring that they are able to appropriately treat patients from all walks of life. That was a theme in a Guardian article on the subject, which noted the importance of that competency. From the article:

Dior Vargas, a 28-year-old Latina mental health activist, recalls a therapist in college – her second one – who she stopped going to after realizing she was “culturally incompetent”.

“She wasn’t aware of how close-knit Latino families are. That they are a part of my decision-making process. My therapist didn’t understand that, she would say: ‘No, you need to stand up to your mother.’ That felt very disrespectful to me. Maybe sometimes you do, but the way she said it made me very defensive.”

The article also noted the challenges of gender from the perspective of an African-American male client and a white female therapist:

With one white female therapist, he says he felt his gender and race made her treat him like a threat that needed to be controlled. “She shut me down when I expressed anger. The response was you need to stop your anger, as opposed to “let’s work with that and figure out why you are angry,” which would have been a healthier therapeutic response, he says.

I think these two examples really cut to the heart of the issue. A “mirror match” isn’t necessary. Cultural competency and sensitivity is.

On a personal level, that’s been my experience. I’ve seen three therapists in my life who have really, truly made a positive difference, and all three were men. My counselor in college was gay, my first psychologist was a straight white Jewish male (so basically me), and my current psychologist is a straight Venezuelan immigrant. While these were characteristics which I obviously noticed, it’s never something that I felt made an impact in my therapeutic experience. That’s because they all understood my background.

In retrospect, I suppose that the Jewish therapist did understand some things about my upbringing and culture which would have been impossible for another therapist to truly understand, having not lived with it, but I never felt like this was a barrier. When I would explain things to them, they would fold that information into further conversations. They never judged, never questioned and never made me feel like I was wrong for feeling a certain way. While my upbringing wasn’t their experience, they never used their own experiences to color mine in a negative way.

As always, I’d love to hear what you have to say – what has been your experiences in this area? Positive? Negative? Let us know in the comments below!