Alternative Prescriptions and Mental Health

I came across this article in Medical News Today, which discusses how exercise can help with depression. None of that is a surprise, of course, and as I type this entry, I’m still gross from having come back from the gym, so yay!

Here’s the interesting part of the study: Individuals who did “prescribed exercise” showed a rise in endocannabinoid levels in their blood – something typically associated with improved mood. This did not occur with people who selected their own exercise.

Wait, what?

Why would that be? Two potential explanations from the article:

One explanation could be the small number of participants and the variation in intensity levels in the preferred-intensity session. Some participants completed the preferred session at a constant, light intensity, while others varied the intensity.

Another explanation for the difference in results between the preferred and prescribed exercise sessions could be that exercising at a level that someone else prescribes has a psychological as well as a biological effect.

It’s that second explanation I want to focus on. We know that anti-depressants often have a powerful placebo effect. Placebos occur, in part, because someone expects a treatment to work. That being said…we know that exercise does, in fact, help with the treatment of depression and other mental health challenges. So that can’t be a complete explanation.

This got me thinking – what if Doctor’s began to “prescribe” other therapies? Go for a damn walk. Meditate. Eat better. And I don’t mean just give it as advice, I mean take out a little prescription pad, write something down and hand it to the patient. Would the patient be more likely to treat that prescription with more care than they would regular advice? Would they actually spend time reducing their stress levels, or just taking ten minutes out of their day to put headphones on and meditate?

I don’t know. But I think that, when you combine aspects of the placebo effect (expecting a therapy to work) with scientifically proven therapy, you’re increasing your chances of success and recovery (again, not a Doctor here, just speculating).

This entire study and line of thought has made me wonder if we shouldn’t try to get Doctors and other health care professionals to look outside of the realm of traditional prescriptions and more into the world of prescribing lifestyle changes.

As you likely know, depression rates are rising across the Western world. We can’t just rely on therapy and medication to get ourselves out of this mess. Something has to change, and I think one aspect of that chance must be revamping the way we look at therapy. Maybe this idea of “alternative prescriptions” can help?

As always, let us know what you think in the comments below!

Does CBD help with depression or anxiety?

In 2018, Donald Trump signed the Farm Bill into law. Among other things, this piece of legislation made legal much of the sale of CBD and hemp, as well as research into this area. – This opens up an array of new potential research, but CBD may have a positive impact on depression and anxiety.

What’s CBD, you ask? First, what it’s not: Marijuana. It is not marijuana. CBD is short for cannabinoid oil, and it became legal to be sold after the 2018 Farm Bill was signed into law.

Specifically, CBD is extracted from hemp plants. It works be manipulating your Endocannibinoid System, a part of your body which regulates a variety of bodily functions, including, potentially, your mood.

Here’s an important point though: While some research has been done, more research is DESPERATELY needed in order to determine CBDs usefulness, effectiveness, proper dosages, long-term impact, etc. At the moment, it is not widely regulated by the FDA, though the FDA has sent out cease and desist letters to some companies which have falsely marketed benefits yet to be proven by research.

Indeed, as of yet, there is no formal regulation when it comes to CBDs marketing or ensuring the quality of ingredients. For example, a 2017 Penn State study surveyed 81 CBD products and found that 70% were mislabeled. As such, if you’re going to purchase CBD, your best bet is to ensure that the label notes it has been independently tested. This means that a product has been evaluated by a 3rd party, and that 3rd party has determined that’s it’s labeling is accurate.

Okay. Enough about the legal disclaimers and warnings. What does the research show?

According to one 2014 study, CBD and Marijuana may show anti-depressant like effects. That finding was replicated in 2018, when a study showed that CBD has “anxiolytic, antipsychotic and neuroprotective properties” and may be useful in fighting a slew of problems, including PTSD and depression.

There’s additional research available, but it does seem clear: There’s opportunity here.

While CBD is not marijuana, and will not get you high like marijuana, some forms of CBD (namely Full Spectrum CBD) do contain trace amounts of marijuana. As such, if you ingest this type of CBD, you may feel some effects. Furthermore, it is possible for Full Spectrum CBD to show up on a drug test – so DON’T TAKE IT if that’s an issue for you.

Furthermore, you should not take any CBD product without consulting with your Doctor or medical professional first. While common side effects of CBD are relatively minor, there can be more problematic impacts for people with Parkinson’s, liver issues, or pregnant/nursing women.

Now that we’ve gotten the warnings out of the way: Is their potential for people with mental illness and CBD? I’d say yes. Anecdotal evidence and some research seems to indicate the potential for relief. Again, more research is needed. Again, don’t do anything without talking to a Doctor or medical professional first. But, yes. More research is now being conducted, this area does prove promising.

 

The biggest reason it’s so hard to find a mental health practitioner

We don’t have enough of them.

As I run around in my real job discussing mental health, I consistently come back to this one central truth: The biggest issue in the area of mental health is that we simply do not have enough people to provide care, or who take Medicare or Medicaid. This means that, when you call a psychologist or psychiatrist, the most likely response is, “I’m sorry, but the Doctor is not accepting patients at this time.”

Consider this: According to a 2016 study, the supply of mental health practitioners by 2025 is expected to be 250,000 short. This disturbing trend is occurring despite the fact that rates of mental illness and suicide continue to increase, and increase alarmingly among the youngest members of our society.

Interestingly, the above article notes that a big part for the rise in demand of mental health practitioners has been a lessening of the stigma which surrounds mental health. As more people become more comfortable with seeking treatment, they put a greater strain on the need for mental health providers.

The problem is particularly bad in rural areas, where, according to this 2018 CNN article, “a majority of non-metropolitan counties (65%) do not have a psychiatrist and almost half of non-metropolitan counties (47%) do not have a psychologist.” This shortage contributes to higher rates of mental illness, addiction, and suicide in rural communities. Indeed, it helps explain why rural areas typically have higher suicide rates than their urban counterparts.

So, what can we do about this?

I’d argue the biggest challenge is the need to increase mental health reimbursement rates, which are historically lower for mental health services. These low rates typically steer prospective doctors away from mental health specialties and into more lucrative practice areas like cardiology and oncology. Increasing these rates would help recruit more practitioners.

Additional funding is also needed for recruitment and loan forgiveness programs. Many states – including Pennsylvania – have begun enacting these programs in an effort to increase access.

Private practitioners and hospital systems also need to step up their game when it comes to this area, but according to the article above, the good news is that they are doing just that. I know that both of the major health networks in my area have said they are looking to expand capacity and recruitment when it comes to psychologists and psychiatrists, and they aren’t the only ones

If you are interested in the interaction between mental health and public policy, you really should pay attention to this space. There will be a lot more in this area in teh next few years.

Your smartphone can tell if you’re depressed

person using phonwYou know how I’ve written about how social media and phones can cause depression? Well, it turns out, your phone can also tell if you are depressed.

The study, from the University of Stanford, shows that face and speech software on your phone can detect depression based on your facial expressions and speech patterns:

The researchers fed video footage of depressed and non-depressed people into a machine-learning model that was trained to learn from a combination of signals: facial expressions, voice tone, and spoken words. The data was collected from interviews in which a patient spoke to an avatar controlled by a physician.

In testing, it was able to detect whether someone was depressed more than 80% of the time. The research was led by Fei-Fei Li, a prominent AI expert who recently returned to Stanford from Google.

The article did caution that, due to the way the study was conducted, the therapeutic applications aren’t clear. According to David Sontag, an assistant professor at MIT:

…that the training data was gathered during an interview with a real clinician, albeit one behind an avatar, so it isn’t clear if the diagnosis could be entirely automated. “The line of work is interesting,” he says,“but it’s not yet clear to me how it’ll be used clinically.”

I have two thoughts about this type of treatment. First, this is fascinating – and this type of technology be helpful in terms of closing the gap between those who have access to treatment and those who don’t. In addition to studies like the one above, Stanford has also developed apps which can be used to treat depression – and which apparently work. I’ve touched on this topic in previous entries as well: Apps which treat depression can work.

In other words, apps and automated programs can help to treat depression. That’s fascinating to me – I never would have believed that depression could be treated without a live, human person, but apparently it can work.

On the other hand, there are some rather frightening potential applications of this sort of treatment. First is privacy: I am sure that any app working right now is operating with the strictest of privacy measures and data safeguards, but as we have seen repeatedly, data hacks and breaches occur with relative consistency. This has some very serious implications for something like text therapy or therapy which occurs over a device, because it begs the question: What data is recorded, and how could it potentially be accessed? I mean, I’m pretty open about the fact that I receive treatment, but even I wouldn’t want the items I discuss with my therapist broadcasted to the whole word. Is that possible with these apps? I don’t know, and it may not be. But there are real privacy and technological concerns which must be addressed when it comes to therapy delivered electronically.

Second: Can someone be diagnosed against their will? I don’t think so. Not yet, anyway. Later down the line, programs like the one discussed above may also have issues with consent. It seems to me that the Stanford program is not yet ready to be used in a public or even therapeutic setting. But, when it is, will people be able to use it on others without their consent? That…that’s kind of a scary thought.

These are questions which are only somewhat hypothetical. Technology is clearly advancing, and I can only hope privacy and ethical safeguards can advance with it.

Let us know your thoughts in the comments below!

Do mental health apps work?

One of the things I have seen a lot of lately is apps that claim to be able to help you improve your mental health and get treatment. There are a bunch out there – this includes apps like What’s Up, Mood Kit and MY3, among many, many others.

Here’s the important question: Do they work?

I bring this up because there’s been a bit of controversy with one app, BetterHelp. The App says that it will hook users up with licensed therapists. The controversy, however, emerged with many YouTubers who had engaged in sponsored ads with BetterHelp.

As long as the sponsorship is transparent, I don’t personally see an issue, but problems emerged with BetterHelp itself. First, it’s terms of services explicitly couldn’t guarantee placement with a qualified, licensed professional:

We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you. The Counselor Services are not a complete substitute for a face-to-face examination and/or session by a licensed qualified professional.

Umm…..that’s a major, major problem. That’s beyond not acceptable. Any app that claims it will provide mental health professionals to users has a moral obligation (and I hope a legal one!) to ensure that the counselors themselves actually are licensed professionals, or at least disclose in a VERY publicly way when they are not.

This entire incident got me wondering about these apps. How good are they? Do they work? Are they substitutes for seeing a counselor in a face to face setting?

First, the obvious: Answers to the questions I posed above will vary widely. It all depends, of course, on the quality of service offered.

The most comprehensive answer I could find was in this paper, published in March 2018. The answer varies, of course, but in sections, it seems to be yes:

  • Depression: ” A meta-analysis of 18 randomized controlled trials (RCTs) covering 22 mobile apps revealed that using apps to alleviate symptoms and self-manage depression significantly reduced patients’ depressive symptoms compared to control conditions (g=0.38, P<0.001).” However, the apps work best when depression is mild to moderate, not severe.
  • Anxiety: “A meta-analysis of nine RCTs that evaluated the effects of smartphone-delivered interventions on symptoms of subclinical and diagnosed anxiety disorders revealed that users experienced reductions in total anxiety after using anxiety treatment apps (g=0.33, P<0.001). Additionally, anxiety-focused mobile apps delivered the greatest reductions in anxiety symptoms when paired with face-to-face or internet-based therapies. In fact, replacing outpatient patient-therapist sessions with a mobile app resulted in no significant loss of treatment efficacy.”
  • Schizophrenia: “Self-reported patient experience survey results revealed high adherence, positive user experience, and broad-ranging clinical benefits.”

Wow. So, yes, theoretically, these can work!

I have two additional thoughts. First, hey, if it works, it works. The mental health practitioner shortage is, in my opinion, the greatest crisis affecting mental health, and if apps can help close that gap at an affordable rate, it’s worth using.

Second. however, is this: It has to be a real app, with high quality and scientifically based therapies and design. In the digital day and age, it can be all too easy to design a subpar treatment program that can scam users out of money and provide no clinical benefit. I hope, in the long run, that the federal government will step in and better regulate these apps in order to protect users from negative experiences that can damage their mental health and sap their limited resources.

Do you have any experiences with mental health apps that you want to share? Please let us know in the comments below!

Depression and meditation

Ugh, just writing this article makes me a little depressed. Why? Well, cause I can’t stick with this. No matter how hard I try, I absolutely, positively cannot stick with meditation – and that’s despite the evidence I’m about to write about below.

The studies are clear and I have written about the subject before: Meditation helps with depression. According to one study published in The Lancet, meditation may be as useful as anti-depressants at keeping depression at bay (side note: Damnit! I really need to look at this again!). This study noted the benefit of mindfulness meditation, which is a specific type of meditation.

What is mindfulness meditation? Mindful.org describes it simply: “Take a good seat, pay attention to the breath, and when your attention wanders, return. By following these simple steps, you can get to know yourself up close and personal.”

Want to know more? I found a few interesting resources on the subject. First, there’s this, from Headpsace, a meditation app I’ve used before. The article details the struggles of a very depressed man who tries meditation in a desperate attempt to get some relief and how meditation changes the way he thinks. The Washington Post ran a similar story earlier in the year, in which the author discusses how the Headspace app (this isn’t a sponsored post, I swear) helped them relearn their thinking.

Want more info on the research behind meditation? Check out this article on Mindfulness-Based Cognitive Therapy, which is a specific type of meditation designed to help those with depression.

If you’re interested in more information on how meditation may help people with anxiety and depression, look at this pretty fascinating article from Harvard, which details specifically how depression can physically change your brain.

I will say this: As I’ve bitterly noted repeatedly, there have been many instances where I have actually meditated with some regularity, only to stop after some period of time. But, during those times, I did notice some changes about the way I was thinking. Specifically, I found myself focusing less often on anger, frustration and bitterness. I found myself better able to let things go, and it felt great. Sadly, inevitably, a busy life caught up with me, and I let the practice fall away.

Time to try again!

As always, I conclude with a question: What has been your experience with meditation? Have you practiced it – or do you practice it – on a regular basis? Notice any changes that you want to share with us? Please tell us your story in the comments below!

Finding light in the darkness

I’m going to write about two things that personally motivated me to deal with my own demons in a very public way. The short-term inspiration for this is me rereading the acknowledgements section of Redemption. The longer-term inspiration for this is a public tragedy and a low period in my life.

Okay, first, here’s a small section of the acknowledgements in Redemption:

To Robin Williams. Yours was a life well lived, and I hope to be part of a positive story of those influenced by how it ended.

Let me go backwards. Robin Williams completed suicide on August 11, 2014. He had long suffered from a slew of mental health challenges, including depression and substance abuse. However, Williams was suffering from “diffuse Lewy body dementia,” which ultimately contributed heavily to his suicide.

William’s suicide ultimately inspired me to go public with my story. That started when some idiot on Facebook decided to spout off shortly after Williams’ death by saying something along the lines of, “So sad Robin Williams committed suicide. He just needed to pray to Jesus more!”

No, you schmuck, that’s not how it works, and that ignorant comment got me so damn fired up that I wrote an op-ed in my local paper, detailing my own struggles with depression, anxiety and suicidal ideation. That, in turn, set my career in motion in a very different way, making me become much louder about mental health issues. I’ve spoken at events detailing my own struggles, cofounded a mental health caucus, appeared in PSAs and introduced legislation designed to help those who are suffering from mental health challenges. I know that the work I’ve done in this realm has helped people – and I know I have a lot more to do to help more.

It also inspired this speech, the most difficult one I have ever made:

Fast forward about seven or eight months, and I’m struggling, in the midst of one of the most depressed periods of my life. I’m struggling at work, my wife is struggling at work, and life just generally sucks at the moment. I go back to see my therapist. I increase my medication. And then I realize something else: I desperately need an outlet. Something to help get me through everything I am suffering from. I decide to start writing again – I wrote fiction as a kid and had published the non-fiction book I wrote, Tweets and Consequences.

And I remember this goofy plot idea I had as a kid, twenty years ago, about kids getting trapped on a spaceship. And I realize something: That’s not a bad plot. But what if I could make it more? What if I could fold in a mental health message as well?

And thus, Redemption is born.

For what it’s worth: I have a character named Robin in Redemption. In all fairness though, that’s also my daughter’s middle name, so let’s call that character’s naming a 50% tribute to Williams and 50% tribute to my daughter.

The death of Robin Williams helped me and countless others find their voice and seek help. I know that this may be cold comfort to those he loved and those who loved him. But I sincerely hope that they can take some solace in knowing that Williams’ life and death helped so many, including me. His was a life well lived – and, as I said above, I hope to be a small part of that story.

You can always find light in the darkness. Pain makes us great, and with time and therapy, you can turn the most agonizing periods of your own life into something incredible.

As long as you breathe, there is hope. The trick is just finding it sometimes.

Transcranial Magnetic Stimulation?

You know, you first hear about something like this, and you think it sounds like some sort of witchcraft nonsense. Magnets? To help depression?

Apparently. And it’s scientific based.

I write about this now because I had an appointment last week to explore this as a treatment possibility, and it is likely something I’m going to pursue. Here are the basics, per the Mayo Clinic:

During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. And it may activate regions of the brain that have decreased activity in people with depression.

 Though the biology of why rTMS works isn’t completely understood, the stimulation appears to affect how this part of the brain is working, which in turn seems to ease depression symptoms and improve mood.

The most important question, of course, is this: Does it work? According to the evidence I have seen, yes, and that’s in tests involving a placebo. More research is needed, but this appears to work.

Thankfully, the side effects are very mild, per the Mayo clinic.

Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:

  • Headache

  • Scalp discomfort at the site of stimulation

  • Tingling, spasms or twitching of facial muscles

  • Light headedness

The biggest drawback, as best I can tell? The Doctor I spoke with told me its most effective to do it every single day, for 4-6 weeks. Session, I think, are 30-45 minutes. That’s a heck of a time commitment. That being said, sucks for me. It’s not the Doctor’s fault that this is the way the brain works, but it’s certainly a challenge with my schedule – going to Harrisburg and vacation means I won’t have that kind of time until August.

So, let me conclude by asking you for your experiences. Have any of you out there had TMS? Any experiences to share? I’d love to hear them!

College and mental health

A friend of mine was kind enough to share with me this article in Time, an extremely eye-opening look at the massive spike in college students seeking mental health services – and college’s struggles to keep up with the demand. For those of you who are interested in this topic, I highly recommend that you read the entire article, because its a very comprehensive look at the issue.

The summary is this: More college students are in need of counseling services, but many colleges do not have the capacity to deal with these students mental health challenges. This shouldn’t be surprising: 75% of all mental health issues onset by age 24, and college is a time of transition where young adults are cut loose from all their previous moorings and experiences – thus shaking loose a good deal of mental illness, sadly.

Unfortunately, suicides in the United States have been on the rise since 1999, cutting across all demographics, and college is no exception. Even worse is that, many colleges do not actually track suicides, creating a major problem for dealing with this issue.

I will say that this is a deeply personal one for me. In the course of my mental health journey, I think I always suffered, even from the time that I was a little kid. It was my freshman year, however, when all hell broke loose. It was the first time I was away from home, from my family, my girlfriend and everything that I had previously known. I wasn’t ready for college and the experience of basically restarting my life, and I REALLY wasn’t ready for the “party” culture of college. I didn’t party – just the opposite – I was intimidated by everyone who did and didn’t know how to deal. As a result, my depression and anxiety exploded. Freshman year became the turning point for me – it’s the year I first started to suffer, but thanks to the counseling center at Muhlenberg, I had access to a great therapist who helped save my life by helping me develop strategies to deal with my depression and referring me to a psychiatrist who put me on the medication I still take to this day.

This issue is one of the reasons that, in my legislative career, I introduced legislation which would require colleges to develop and disseminate plans on dealing with mental health and suicide prevention. It’s a small step, but one that I think is desperately necessary to deal with this issue.

This is a major issue from a mental health perspective in this country, and one that we desperately need to deal with. The good news is that people are paying attention – and hopefully will continue to do so.

Coping Strategy: Do Something

I was down a few weeks ago when this particular memory bounced into my head.  I was sitting in my therapists office, discussing something – what, I don’t remember.  I think I mentioned to him how I had gone to the gym (unrelated, but hey, exercise can really help depression), despite the fact that I had been really depressed at that moment and didn’t feel like it at all.  And I remember he said that was good, because that moment when you are most down is exactly when you should get up and do something.

It wasn’t meant to be particularly profound.  But it’s one of those things that REALLY stuck with me.  My wife calls it faking it till you make it.  I referred to it as “pushing through,” but that struck me as simplistic, as if you can just willpower your way through depression (sometimes you can; often you can’t).

Imagine yourself as depressed as you have been.  What do you want to do?  The answer there is obvious: Absolutely, positively nothing, aside from this:

depressed on couch

That, as far as I am concerned, is the worst thing you can do.

Please keep in mind I’m only speaking from my personal experience and this isn’t medical advise, but I’ve always found that lying down and swimming in depression leads to one thing and one thing only: More depression.  And guilt.  “I SHOULD be doing my chores.  I SHOULD be hanging out with my kids.”

Is that guilt warranted?  Of course not.  Everyone deserves time to lounge around and do nothing – yes, you too, depressed person. But – and again, this is just my personal experience talking here – sitting around when depressed just leads to feelings of self-loathing and guilt.

This would be my advice to you, dear reader: Just…try doing something.  Anything that’s actually active and engages your mind, body or both.  It may be reading a book.  It may be going for a walk or heading to the gym.  Write.  Play a game.  Do jumping jacks.  Hell, I really don’t care.

What I do know is that, based on my own experience, is that sitting there, doing nothing, in the long-term, can equal a surrender. As best you are capable, get up, get moving. Will it make you feel better? Hopefully.  Maybe.  But doing nothing will certainly continue to sap your hope away, and anything is better than that.

Any specific strategies you want to share? Leave them below!