Tag: mental health

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.

The Parkland tragedy continues, as two survivors kill themselves

Originally, this entry focused on Sydney Aiello’s tragic suicide. I finished it early Sunday morning. And by Sunday afternoon, came to the tragic realization that it needed to be updated.

First: Parkland survivor Sydney Aiello died by suicide last week. The young teenager had survived the massacre at Stoneman Douglass High School, which claimed 17 lives.

According to Sydney’s mother, Sydney “struggled with survivor’s guilt and was diagnosed with post-traumatic stress disorder in the year following the tragedy. And while she reportedly never asked for help, she struggled to attend college classes because she was scared of being in a classroom.”

Like all Stoneman students, Sydney was affected by the tragedy. Like far too many, she lost a friend:

Sydney Aiello & Meadow Pollack

Sydney lost her “longtime friend,” Meadow Pollack, in the shooting.

Next: The second victim. On Sunday afternoon, news broke that a second Parkland survivor had killed themselves. It was a sophomore male, and he, like Sydney, shot himself. As I type this entry, much is unknown about this student, including his name. Unfortunately, the notion of a suicide contagion effect is very, very real – and it is highly possible that this is what we are witnessing here.

The ugly truth is that a trauma never ends when the bullets stop firing. There are always long-term after effects. According to a 2018 survey:

  • Nearly 22% of people who had been raped had also attempted suicide at some point in their life.

  • Approximately 23% of people who had experienced a physical assault had also attempted suicide at some point in their life.

  • These rates of suicide attempts increased considerably among people who had experienced multiple incidents of sexual (42.9%) or physical assault (73.5%). They also found that a history of sexual molestation, physical abuse as a child, and neglect as a child were associated with high rates of suicide attempts (17.4% to 23.9%)

  • People with a diagnosis of PTSD are also at greater risk to attempt suicide. Among people who have had a diagnosis of PTSD at some point in their lifetime, approximately 27% have also attempted suicide.

There is no easy, glib solutions here, but there are ways to mitigate suicide risk after a traumatic event. The American Psychiatric Association lists a few helpful ways to deal with a traumatic event, including:

  1. Keeping informed but avoiding over-saturation with an event.
  2. Learning about local resources and sharing that information.
  3. Remembering that you are not alone and talking with family and friends about your experiences.
  4. Remembering that anxiety and depression after an event are normal, and seeking help if this continue or if you become overwhelmed.

There is, as always, a relatively standard thread here: If you endure a traumatic event, seek help. You are not alone, you are not weak or foolish, and you didn’t deserve whatever happened to you. Therapy – or even just talking to someone – can make a powerful difference.

I have a tendency with these blog entries to take smaller events and turn them into larger points. That’s a conscious decision informed by my experience with mental illness. But I want to conclude this entry by making sure we don’t lose sight of Sydney Aiello or the second student, name currently unknown.

It goes without saying: Sydney and others affected by Parkland didn’t deserve what happened to them. It’s a human tragedy. But Sydney and her classmates spent much of their time after the shooting advocating for a better world. I hope that some good comes of this tragedy, and I hope it is done, at least in part, in memory of Sydney, this second student, and all those affected by this tragedy.

Video games can help fight depression

When it comes to mental illness, video games often get a bad rap. There is a ton of talk in the media about how video games cause violent behavior (it’s not that simple) and how video game addiction is a real thing (it is, but not as big of a problem as some may lead you to believe).

Don’t get me wrong – video games can be very bad for your mental health, particularly if you overdo it and become withdrawn, ignore your real life obligations or substitute games for real world interaction. That being said, there is also ample evidence which demonstrates that video games can be really good for depression.

This Geek & Sundry article lays the case out nicely. It notes that different games can have different, positive purposes (MMORPGs can help people become more social, puzzles can help reduce outside distractions and deal with trauma, etc).

Additional useful information is in this Slate article, which discusses what happens to someone’s brain when they play video games:

In the past few years, multiple fMRI studies, including a seminal one conducted at Stanford University, have peered into the brains of gamers. Their results show that when we play video games, two regions of the brain are continually hyperstimulated: the region most associated with motivation and goal-orientation (often referred to as “the reward pathways”) and the region most associated with learning and memory (the hippocampus).

BUT, the article also notes:

These two regions of the brain, the reward pathways and the hippocampus, are the same two regions that get chronicallyunderstimulated, and that even shrink over time, when we’re clinically depressed.

In other words: Video game play is literally the neurological opposite of depression.

The key, according to this article, is to “play games with a purpose” – in other words, a positive goal. Doing so will alter your brain and encourage you to see the world in a whole new light. This, in turn, help rewire your brain so that you can better cope with depression.

There is also ample evidence that video games can help you fight depression. One 2018 study found that action games can help reduce depression. And a 2012 study found that a fantasy game designed specifically to fight depression could be more effective than visiting a counselor.

And all of this, of course, says nothing about the very positive ways which certain games show depression – and show people fighting back. And, after all, I’m a big fan of using media to show how to conquer depression!

On a personal level? I’ve found video games to be a very pleasant distraction at the moments where I am down. They can, however briefly, take me away from my troubles and give my brain space to breathe and recover. I get the temptation to drown yourself in a video game when you are down, but the truth is that this accomplishes nothing. If you use video games as a way to reorient yourself to the real world, it can help get you to where you need to be. Maybe that’s why I tend to like open world games that provide a big escape – games like Skyrim or Grand Theft Auto 5…err, I mean, Mario Kart. Let’s go with that.

As always, I welcome your thoughts below. Have these experiences been yours? What video games do you play when you are down? Let us know in the comments!

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!

Gender differences in depression

This isn’t exactly a revolutionary statement, but men and women experience depression differently. Gender differences and the topic of “toxic masculinity” have received quite a bit of press lately, and this is an area I think is absolutely worth exploring. Do men experience depression differently then women? Do they then show those differently Because of the way we socialize the genders, are men more likely to experience and express depression differently and in ways which we would consider to be more stereotypical?

According to the available research, yes, absolutely.

An October 2013 study found that men experience depression in a manner which is “different than what is included in the current diagnostic criteria.” The results of the study found that men are more likely to experience anger, aggression, substance abuse and risk taking when depressed. These symptoms are not used when diagnosing depression, but are outside of currently accepted diagnostic criteria.

Even more interestingly: When alternative (but accepted) measures are used to diagnose depression, the study found that men and women experience depression in relatively equal proportions.

Other reviews have come to similar conclusions. In this article in VeryWellMind, it was noted that women express depression by becoming more visibly emotional, while men become “more rigid” and less emotional. An article in University Health News noted that symptoms of depression experienced by men often involve “having symptoms that are not usually considered in the diagnosis of depression.”

What does this tell us? Men and women are obviously socialized differently and express emotions in different ways. What I would love to know is the role of this socialization and how it affects depression expression – what men are more likely to experience and express depression in different ways? What women are more likely to express depression in ways which are more similar to men? That would be an interesting study.

But, the conclusions here are pretty clear. Men experience depression different then women, and that means that we have to be more aware of the gender differences between the two in order to ensure that men get the same treatment as women. I’d also argue that it means we have to ensure that we raise men differently. Men need to know it’s okay to experience and express emotions in ways which aren’t stereotypically male. Things seem to be changing in that regards, but that one is on all of us who are parents to ensure that men know there’s nothing wrong with being sad and saying as much.

What is ASMR, and can it help with depression and anxiety?

If you’ve been on the internet long enough, odds are good you’ve heard of or seen ASMR videos. I’ve found them to be a nice, relaxing break, one capable of helping you unwind at the end of the day, similar to relaxing meditation. But, can they help with depression or anxiety? It certainly appears that way.

First, for the uninitiated, let me answer this question: What is ASMR? It stands for “autonomous sensory meridian response.” Per the Google definition, which is pretty accurate as far as I am concerned:

a feeling of well-being combined with a tingling sensation in the scalp and down the back of the neck, as experienced by some people in response to a specific gentle stimulus, often a particular sound.

ASMR recently was seen by hundreds of millions of Americans with this Super Bowl commercial from Michelob:

ASMR can be triggered by a variety of things. For some people, there is nothing that works (like my wife, who wants to throw my iPad out the window when I watch these videos). For others, ASMR triggers include gentle sounds (like tapping or whispering) or demonstrations.

There are a ton of channels and videos on YouTube which are designed to “trigger” ASMR. It’s become an incredibly popular internet trend, one that thousands (if not millions) use to relax and unwind.

From a mental health perspective, here’s a more interesting question: Can ASMR be used to help fight off depression and anxiety?

Well, yeah. Maybe.

ASMR as a formal, intentional genre of videos is relatively new, having only been around since the early 2010s. However, there has been some research done on the subject, and the answer, so far, is yes. According to a study published in 2015, 80% of participants who viewed ASMR said that the viewing had a positive effect on their mood, while another 69% found that their depression symptoms had been improved. Another study showed that ASMR videos can reduce heart-rate and increase skin conductivity, signs of physical and mental relaxation. There are also a slew of internet reports, like this one, of people who have used ASMR to fight depression.

Just to be insanely clear here: ASMR is not a substitution for therapy or medication. Personally, I think it’s a nice distraction, a good way to unwind and temporarily ease the painful symptoms of depression or anxiety. That being said, it’s not a permanent, formal treatment. But, if you’re stressed and looking to relax a bit, ASMR can be helpful. And, even if you’re not – go enjoy it! Millions of people across the world have found themselves finding relaxation and joy with ASMR. Go search for videos and see if there’s anything there you like.

American Teenagers: Depression is our biggest problem

This Pew study. Wow.

PSDT_02.20.19_teens-00-00

According to a new study by the Pew Research Center, a whopping 96% of teens view depression and anxiety as a major or minor problem among their peers, far outpacing literally every other societal problem, including bullying, alcohol, poverty, teen pregnancy and more. And the numbers aren’t even close.

Per the story, it’s even worse than just the graph above:

  • Teens feel this way regardless of whether or not they personally suffer from depression – this means that they are hugely aware of the problem in others, which obviously shows it has a high degree of preeminence.
  • The trend is specific to all teenagers, regardless of “gender, racial and socio-economic lines, with roughly equal shares of teens across demographic groups saying it is a significant issue in their community.”

This makes perfect sense, sadly. As we know from empirical data, rates of mental illness are increasing across the board, but the trend is most visible among American teenagers.

If teenagers across the board are seeing increases in mental illness, what doe that tell us?

I’d argue a broader point, using the graph above: The rise in the first line is a direct result of the rise in every other line.

Again, we know that mental illness is increasing. We also know that mental health isn’t like some contagious virus – you don’t “catch” depression the way you catch a common cold. So, what is it? What is leading to the massive spikes we are seeing in mental illness? My argument is this: It’s not just one thing, but many things. As the graph above and corresponding story makes clear, American teenagers are facing major societal challenges. They are scared, worried and anxious, as a result of a variety of factors, including a more complex society, increasing reliance on technology (at the expense of regular relationships) and the pressures of a rapidly changing and interconnected world.

A problem like this cannot simply be addressed at an individual level. It goes without saying that access to mental health care is incredibly important, and fighting mental health stigma (my favorite issue!) is vital, but we aren’t going to really get at a reduction in mental illness unless we address the societal and cultural problems which have resulted in its increase.

What does that look like? I don’t know all of the answers. But, if you’ve read this blog before, none of what I’m going to say is particularly new. Teenagers – well, hell, and the rest of us – are too addicted to technology. They are spending more times with their phones and less time with each other. This has devastating psychological impacts. The answer is not that simple, of course. But we know that teenagers are spending less time with each other in a variety of ways – less time at parties and social gathers, less time away from adults and less time simply interacting with one another. At the same time, world events and pressures are more available and accessible than they ever have been – thanks, in part, to our lovely phones.

What’s the end result? A generation that is more depressed, more brittle and less resilient.

This isn’t an effort to place blame, but it’s something all of us are responsible for addressing. Teenagers become adults…and, as someone who has suffered from depression and anxiety for my entire life, I don’t want an entire generation of teenagers and young adults to feel that pain. We have to deal with this. Now.

Five ways YOU – yes, you – can help beat mental health stigma

One of the things I am most passionate about when it comes to mental health is trying to beat the stigma surrounding it. I was asked a very interesting question yesterday: What does that look like? What is a stigma free world?

The best answer I have for that very valid question is this: We treat and view physical and mental illness in the same light. And we don’t view mental illness as being anything other than what it is: A serious, dehabilitating and potentially deadly category of diseases which require time, resources and care to heal.

Unfortunately, we don’t live in a society where that is currently the case. We know that nearly one out of five American adults have some sort of mental illness, but only 30-40% seek treatment.  Stigma continues to play a role in this disconnect and in people’s assumptions of what it’s like to live with a mental illness.

So, rather than asking a broader question about what we can do, as a society, let me put the question to you in a more direct, personal terms: What can you do to help end mental health stigma?

Here are five suggestions. They are all relatively simple. You may have thought about them already. But I think it’s important that all of us realize we have a role to play in terms of ending mental health stigma.

1) You have to talk about it: One of the most difficult things which people can do in terms of mental health is also one of the simplest: You have to talk about it. If you are depressed, say it. If you are anxious, say it. According to research, anti-stigma campaigns which are most effective are those which feature real, “normal,” identifiable people discussing their mental illness. This means that the most effective person to attack mental health stigma is…well, you.
2) Encourage people to seek help: If you are one of the lucky ones who has avoided mental illness, that’s wonderful. You still have an important role to play: If someone you know is in pain and needs help, encourage them to get it. Be supportive and non-judgmental, but help them get the help that they need and deserve.
3) Encourage an equal perspective between physical & mental illness: I might be off here, but I believe ending stigma means that we take mental illness the same way we take physical illness. That, I believe, is important, because most people aren’t going to look at a broken arm and think, “Gee, I can just tough it out!” When someone gets physically sick, we usually don’t think twice about helping them get the help they need. I think this is a good model for breaking mental health stigma.
4) Watch your language: Here’s one that I must confess I sometimes violate, and I need to stop. Expressions like, “I’m crazy” or “You’re nuts” don’t help anything. All that does is reinforce a negative stigma about mental health. There has been an awesome campaign in the past couple of decades to eliminate use of the word “retard” as a negative description, and it’s fantastic. The campaign operates on the principle that we are a better society if we are more inclusive. This has to extend to how we discuss mental health as well.
5) Don’t just talk about failures and pain – talk about successes and joy. I think part of the problem with the way we discuss mental health is we discuss it. We talk about failures, about challenges, about struggles. When you discuss mental health, don’t just concentrate on the negatives. Talk about joys and victories. Talk about beating struggles, about thriving. Mental illness can, of course, be extraordinarily painful, but that makes our victories sweeter. Talk about thriving, not just the pain.
As always, I’d love to hear from you! Anything you want to add? Let us know in the comments below!