Towards A Healthier View of Happiness: Human Fulfillment

By Roberto A. Blanco, M.D. 

I believe that mistaking what one would call pleasure or joy with happiness is causing people a lot of unnecessary pain.  In popular culture and the media, “happiness” is the feeling when you open a brand new bottle of soda, when you have a party with your friends, or when you get a new car.  Consumer culture has subtle but noticeable effects on people’s beliefs to the point where most people buy into these images or ideals consciously or unconsciously to some extent.  

But, this is not the meaning of happiness for which we should be striving.  This is because pleasure, while it may be fun, is superficial and impossible to sustain.  Even for people who live a “charmed life," it is impossible to find pleasure or joy in all events in life.  In fact, unless there is some larger or longer-lasting definition of happiness such as human satisfaction that fills our lives, it is likely that we won’t be able to find joy in anything.  Events that should provide joy will lose their effect eventually without some deeper meaning.

This may be why many people become depressed.  A lot of us put pressure on ourselves to be “happy” all of the time.  Because we confuse pleasure for happiness at times, the fact that we are not “happy” all of the time can lead to more dissatisfaction with life or lack of fulfillment.  If happiness equates with pleasure or joy, how can we be happy and happy with ourselves when we are going through difficult but worthwhile transitions?  What about during periods of grief? 

It is often very difficult to sustain superficial happiness especially when the inevitable thoughts of ‘why am I feeling bad?’ or ‘why am I not happy?’ creep into the mind.  These thoughts often cause people to feel guilt and then as if they are failures.  To be joyful and smiling all of the time is just an unrealistic goal and we should not feel bad about ourselves if we happen to be in a difficult stage of life.  We need to keep in mind that it is all part of a larger plan or goal of development, human fulfillment or self-actualization.

The search for a good definition of happiness is not a new idea and certainly not one that I thought of.  Over 300 years before Christ and in his book entitled NicomacheanEthics, Aristotle proposed his definition of happiness to the ancient Greek people and laid out his arguments for the meaning of happiness.  He argued that having true happiness is the best and final aim for human activity.  Aristotle called true happiness “eudaimonia” which was a type of long-lasting happiness more consistent with human fulfillment or satisfaction.  Aristotle also believed that happiness should be human fulfillment and not confused with joy or pleasure when he wrote:



For one swallow does not make a spring, nor does one sunny day;

similarly, one day or a short time does not make a man blessed and happy.

I agree that human fulfillment is a loftier goal than joy because when someone is having a difficult time or fallen on hard times, they can still be working towards human fulfillment. During these formative or growing experiences, we can still feel as we are fulfilled or fulfilling our own self-actualization even if we aren’t joyous.  When we take into consideration human fulfillment, we no longer need to feel guilty or as failures during difficult times, transitional periods, or episodes of grief.  We begin to see life from the wide angle of human fulfillment rather than from the small picture of pleasure.

Kahlil Gibran, the famous Christian mystic poet from the early 20th century, also believed in eudomainia.  When Almustafa, the all-knowing visitor in the poem The Prophet, answers a woman’s question on pain, he exemplifies this belief in the beauty of human fulfillment and long-lasting satisfaction despite these painful episodes:

And could you keep your heart in wonder at the daily miracles of your life, your pain would not seem less wondrous than your joy;

And you would accept the seasons of your heart, even as you have always accepted the seasons that pass over your fields.

And you would watch with serenity through the winters of your grief.

As people living in a society where mental illness is so common, we must seek to understand happiness and human fulfillment.  In the hopes of making happiness something more meaningful and sustainable, what we should be striving for is an eternal, longer-lasting form of happiness which is known as human fulfillment or as the Greeks called it eudaimonia.  This is because human fulfillment rather than joy or pleasure allows for the different stages of our lives and growth without having to feel guilt or as if something is wrong.  If we make human fulfillment the goal, we will live happier and more satisfying lives.  Now the obvious question becomes, how do we achieve it?

1.  Aristotle (1999).  Nicomachean Ethics. (Martin Ostwald Trans.)  Upper Saddle River, New Jersey: Prentice Hall, Inc.

2. Gibran, Kahlil (1964).  The Prophet .  New York: Alfred A. Knopf.

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Make Mental Health Your Priority Every Month

By Felicia Wong, M.D



As the month of May comes to an end, make a promise to yourself that personal mental wellness will remain a daily priority.  Mental Health America has been working for 100 years to promote well-being for all Americans and recently developed a resource called 10 Tools to Live Your Life Well based on extensive scientific evidence.

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. 

These "10 Tools" provide proven, healthy ways to cope with stress and boost your overall well-being.  Make a commitment to follow this list and feel more relaxed, fulfilled, and focused long after Mental Heath Month is over. . .  

1) Connect with Others. People who feel connected are happier and healthier--and may even live longer.

2) Stay Positive. People who regularly focus on the positive in their lives are less upset by painful memories.

3) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

4) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Create Joy and Satisfaction. Positive emotions can boost your ability to bounce back from stress.

7) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

8) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

9) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

10) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

So now you know the tools. . . Today is the perfect time to start incorporating this list into your day-to-day routine.  For more information, go to http://www.liveyourlifewell.org/ . 

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Understanding Psychosis

By  Sara Coffey, D.O.



Often patients and family members have a hard time understanding how a person can be psychotic.  Psychosis is defined as grossly impaired reality testing. Psychosis can be present in several mental illnesses including, schizophrenia, schizoaffective disorder, bipolar disorder and even depression.

The stigma or lack of information surrounding these disorders leaves them feeling guilty or ashamed. I often explain to them that the brain is an organ just like the heart, the kidneys or the liver. And just as our heart, kidneys or liver can become diseased, so can our brain.

The brain is a complicated organ with several different functions. It helps regulate our breathing, our heart rate, and our temperature and handles more complex tasks such as vision and hearing, pain sensations as well as processing complex thoughts or emotions. It is easy for us to understand that if the heart becomes damaged it might not pump as effectively, but it is often harder for us to understand what happens if the brain becomes compromised or unwell. A brain with mental illness may start to hear things that are not there, or experience thoughts that cannot be explained and seem irrational.  A person may become excessively anxious for no reason, or depressed without warning or cause.

In the world of mental illness we use terms to describe such experiences like hallucinations and delusions.  A patient with hallucinations might experience voices talking to them when no one is present. When we recall that one function of the brain is to process and interpret sound it is easy to see how auditory hallucinations might occur if that part of the brain is compromised.

Patients can have delusions that people are out to harm them for no reason, and without proof, or delusions that they are famous powerful figures in history. And again, when we look at how the mind works, how complex processes are taking place that help us navigate who we are and what we do, it makes sense that if something wasn’t working normally in the brain that a person could have a belief that was false.

Although these symptoms might make sense when we look at the brain as an organ, or a tool performing a function, it doesn’t lessen the impact mental illness has on families. Often mental illness takes away what we consider the heart or personality of person and this can be extremely difficult to cope with. Furthermore, the simplicity of understanding is not without criticism. For instance although we are learning more and more about the brain every day, there is still no cure for mental illness, only treatment for symptoms, and often times the treatment cannot fully clear the symptoms of certain diseases.

However, it is important to know that psychosis, like other mental illness symptoms, is not the fault of the person with the illness or the family who cares for them. These symptoms are part of a complex illness that affects patients unwillingly every day.

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The Truth About Domestic Violence

By Roberto Blanco, M.D.



In my work with patients across the world, I can´t help but notice how many come to psychiatric clinics as a result of domestic violence. Despite its prevalence in other countries, domestic violence is also quite common in the United States. In the United States alone, 22 percent of women are physically assaulted by an intimate partner during their lifetimes and over 5 million are victims every year. Domestic violence touches all elements of society regardless of age, race, or socioeconomic status.

As a child psychiatrist, I can´t help but think of the smallest victims of domestic violence as I often see them in my clinical work. These are the children who are either involved secondarily by witnessing the abuse or become victims directly themselves. The effects of domestic violence on this population are far ranging and long lasting. As these children develop, they may struggle to deal with conflict. They may also become aggressive or experience severe depression, nightmares and other symptoms of post-traumatic stress, as well as other anxieties or fears.



The effects of domestic violence on children are dependent on the nature and severity of the abuse and on the developmental level of the child. Young babies and infants cannot understand why violence occurs in the home and so violence in this population can cause deep-seated changes in personality, self-esteem, and ways of interacting with others that can last for a lifetime. Often older children have a better understanding of what is going on, but still often blame themselves for the abuse and can have excessive guilt or anger as a result.



Domestic violence does not need to be only physical to qualify as a form of abuse. Abuse can also take the form of emotional, financial, or sexual control or disregard. Initially, characteristics of an abusive relationship can often be endearing such as wanting to be with you all of the time. Over time, this can become intense jealousy for no reason, excessive control over relationships and behaviors, and aggression or violence. Options for milder forms of emotional abuse can include family and/or individual therapy. For severe cases, there may be a need to get out of the situation or to a safe house. For more information on domestic violence, please see the American Pyschiatric Association's brochure  Let´s Talk Facts About Domestic Violence.

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Which Medicines and When: Collaborative Process of Finding the Right Medicines

By Claudia L. Reardon, M.D.

Many patients have long and trying journeys on the way to finding medication regimens that work for their psychiatric symptoms. It isn’t always obvious why psychiatrists choose certain medications and avoid others for given patients. In this blog post, I will review the process by which a physician chooses a psychiatric medication. The more the patient knows about how the psychiatrist is thinking through the medication decision-making, the more active a role that patient can play in the process. 

Psychiatrists consider the following issues when prescribing a medication:

1. Target symptoms. A patient might have many different symptoms, for example, depressed mood, anxiety, trouble with concentration, and severe insomnia. It is important to decide which symptoms should be addressed first, since it is likely that one single medicine will not help all of the symptoms. Doctors often prefer not to start multiple medications at the same time, as it otherwise can be difficult to figure out which medicine is helping or which is causing side effects. Thus, in a patient with the above symptoms, the physician might first choose to address the patient’s depressed mood with an antidepressant. Since trouble with concentration and severe insomnia could be caused by depression, it is possible that treatment with an antidepressant will help those symptoms as well. It is important to address the symptoms in the order that makes the most sense.


2. Psychiatric diagnosis. The physician cannot simply treat a target symptom with a medication without knowing the overall psychiatric diagnosis. For example, depressed mood could be due to many different diagnoses, including major depressive disorder, bipolar disorder, schizoaffective disorder, drug or alcohol abuse, or medical problems such as low thyroid. All of these would have different treatments. Major depressive disorder would be treated with antidepressants, while antidepressants can actually sometimes worsen bipolar disorder. Likewise, if a patient’s depression is caused by a medical problem, it is essential that the medical problem be addressed rather than simply “band-aiding” the symptom of depression with an antidepressant.


3. Medical conditions and other medications. It is critical that the physician be aware of all the patients’ medical issues and other medications they are taking. Certain psychiatric medications would be dangerous if prescribed to patients with certain medical problems. For example, some medications can worsen seizure disorders, cause abnormal heart rhythms, or worsen diabetes. Additionally, some psychiatric medications can have dangerous interactions with other medications.


4. Side effects. Psychiatrists must consider how a given medication’s side effects will impact a given patient. For example, a patient who drives heavy machinery for a living should probably not take a medication that causes drowsiness. On the other hand, sometimes physicians can “take advantage” of side effects. For example, if a patient is sleeping and eating poorly, the doctor might prescribe a medication with sleepiness and increased appetite as side effects.


5. History of response. If a patient or his or her family member has had a good response to a medication in the past, that might be a good reason to choose that medicine now.


6. Patient preferences. Finally, and most importantly, the physician must make sure that the patient is willing and able to take the medication being prescribed. If the patient feels that the side effects are intolerable, or simply cannot afford it, it doesn’t matter how reasonable the choice of medication might be since the patient will not take it. The physician should check with patient to ensure they are comfortable with the medication being prescribed. Likewise, patients should not hesitate to speak up if they have concerns about a medication being prescribed for them.

In summary, physicians consider a multitude of factors in choosing a psychiatric medication for a patient. Ultimately, the decision about a medication should be a collaborative one between the psychiatrist and the patient.

What’s the difference between all these medications?

By Sara Coffey, D.O.





This is a question I am often asked by my patients. Several times a day we see commercials for prescription pills to treat a variety of diseases from high cholesterol to heart disease and treatment for mental illness is no different. Today I would like to talk about one of the most common mental illnesses, Depression and its treatment.

Depression affects roughly 15 million Americans adults, and it is an illness that can be readily treated with antidepressant medications, talk therapy or a combination of medication and talk therapy. Antidepressants have been around for decades and include several classes of medications that work on different chemicals in the brain, but today the first line treatment for depression are medications called, SSRI’s or Selective Serotonin Reuptake Inhibitors. For the most part medications in this class are very similar; they work by increasing the amount of serotonin between nerve cells which is thought to play a role in depression. Unlike a pain pill that works right away, antidepressants can take up to 4 to 6 weeks to have an affect.



Which SSRI a doctor chooses will depend on each individual patient. Just like every other medication, antidepressants can have side effects and interact with the body or other medications in a way that may be dangerous or uncomfortable for patients. Some SSRI’s may be more likely to make a person tired or sedated, while others may have a tendency to give a patient more energy. Depending on an individual’s depressive symptoms, your doctor might prescribe a medicine that would be more likely to help you fall asleep or feel more alert and energetic. Furthermore, certain SSRI’s have been studied more in patients with a particular medical disease, like heart disease for instance and this might leave a physician to try a medication that has research data to show that the medication is safe for their patient. Certainly, some medications work better in some patients than others, and after a period of 4-6 weeks of adequate dosages if no improvement in symptoms occurs your doctor will likely recommend increasing your dose or switching to another antidepressant to treat your depression. In some instances a physician might recommend augmenting your medication by adding another medication that works in a different way to treat your Depression.



Even if the first anti-depressant doesn’t seem to work for you, there are still other options for treatment. Newer medications that work on norepinephrine and dopamine in the brain are also used quite frequently to treat depression, and older medications to treat depression, although they often have more side effects are still effective in treating depression and can be used in refractory cases.



As a patient it is important for your prescribing doctor to know about your symptoms, side effects, and other medical history and current medications that you are taking. And, as always if you have any questions about the medications you are being prescribed don’t hesitate to ask your doctor about your concerns.

National Family Caregivers Month: Self-Care for Caregivers

By Felicia Wong, MD

I love helping others. That is why I became a doctor, and why I love my job as a psychiatrist. But when I was a pre-medical student in college, my mom shared the following words of wisdom with me:  “In order to take care of others, you need to take care of yourself first.”

It took me a moment to understand the importance of the point she was making. I had taken a break from my community service projects due to a sports injury, and was eager to return to them. However, at that time, I was not fully recovered and was often in pain, and would tire easily. My mom encouraged me to take some more time off in order to focus on my own recovery and healing. Initially, I felt guilty taking the time out for myself. But in the end, I realized mom was right. Once I became strong and well again, I had so much more to offer to others.

Caregivers tend to be selfless, and expect a lot of themselves without recognizing their own need for self-care. Studies have found that caregivers have higher levels of depression and stress than non-caregivers. Sometimes caregivers are so committed to helping others that they forget to take care of themselves. They fail to recognize that if they drive themselves to exhaustion or sickness, they may not be able to help at all.

Warning signs of caregiver burnout from the non-profit Helpguide.org include:

• You have much less energy than you used to


• It seems like you catch every cold or flu that’s going around


• You’re constantly exhausted, even after sleeping or taking a break


• You neglect your own needs, either because you’re too busy or you don’t care anymore


• Your life revolves around caregiving, but it gives you little satisfaction


• You have trouble relaxing, even when help is available


• You’re increasingly impatient and irritable with the person you’re caring for


• You feel overwhelmed, helpless, and hopeless

Key strategies to prevent burnout include getting the help you need, seeking emotional support, and taking time out to care for yourself.

• Learn and use stress-reduction techniques.


• Attend to your own healthcare needs.


• Get proper rest and nutrition.


• Exercise regularly.


• Take time off without feeling guilty.


• Participate in pleasant, nurturing activities.


• Seek and accept the support of others.


• Seek supportive counseling when you need it, or talk to a trusted counselor or friend.


• Identify and acknowledge your feelings.


• Change the negative ways you view situations.


• Set goals.

For additional strategies for self-care for caregivers, visit the Family Caregiver Alliance, and watch for my next post on caring for someone with Alzheimer's. 

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Anger: A Complicated Emotion

Anger is a normal emotion that can be useful in coping with the world. But anger expressed in excess or suppressed can cause problems. Healthy Minds blogger Molly McVoy, M.D., talks about anger, how to recognize inappropriate anger and what to do about it.

Athletes Suffer from Depression Too

By Claudia L. Reardon, M.D.

Athletes don’t get depressed, right? After all, they are so physically fit and healthy that they must be equally emotionally healthy. Unfortunately, this is not true. Just like the rest of us, athletes can be at risk for depression. This is the case all the way from the school-aged child playing on a recreational team, up to the professional athlete who makes a living playing his or her sport.



Whenever we see a news story about a famous athlete with depression or an athlete who has committed suicide, it tends to come as a big surprise since athletes tend to be glamorized and admired in our society. However, here are some things we know about the reality of depression in athletes:



1. Athletes seem to be at least as likely as the general population to suffer from depression.

2. Athletes who suffer multiple concussions are up to four times as likely as other athletes to suffer depression. Athletes in some sports, including football, hockey, and soccer, are especially likely to suffer concussions.



3. Overtraining syndrome can occur in athletes who are seriously training for an event and do so beyond the body’s ability to recover. Overtraining can look very similar to depression and can actually lead to full-blown depression. Like depression, overtraining can include fatigue, insomnia, appetite change, weight loss, difficulties with motivation, and poor concentration. Overtrained athletes usually notice that their sports performance worsens. They may develop more injuries; experience muscle and joint pain, and lose enthusiasm for their sport. If an athlete is overtrained, the treatment is usually to cut back on physical activity or do cross training at a lower intensity until the symptoms start to improve. If overtraining leads to full-blown depression, medication and/or talk therapy may also be helpful.



4. Besides concussions and overtraining, other common factors that can lead to depression in athletes include injuries, competitive failure, aging, retirement from sport, and the same daily stressors that can lead to depression in the general population.



5. In recent years, athletes across several sports have started to open up about their struggles with depression. Hopefully this will help athletes with depression to feel better about seeking help for this disorder.

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Could My Child Be Depressed?

By Gariane Phillips Gunter, M.D

Most of us know someone who has suffered from depression at some point in their lives. However, did you know that depression is not just something that affects adults? Depression is a serious illness that can affect anyone, at any age, including children and adolescents. When a youth is depressed nearly every part of the young person's life is impacted as well as the lives of their family. If left untreated, pediatric depression can lead to problems in school and with friends, to accidents, to substance abuse, and, in its most extreme cases, to suicide. It can disrupt relationships among family members and friends, harm school performance and limit other educational opportunities. It can lead to other health problems through its effects on eating, sleeping, and physical activity. Because it has so many consequences, it is important that depression is recognized and treated successfully. When it is, most children can get back on track with their lives.

Children suffering from depression may not have the same symptoms as adults with the same diagnosis. While adults may appear down or tearful to those around them, children may appear more irritable or complain about physical symptoms such as stomach aches or headaches. Below are differences in symptoms that may be seen in adults versus children.

Youth living with depression need a thorough evaluation and comprehensive treatment from an appropriately trained professional. Each treatment must be tailored to the individual child or adolescent. Cognitive-behavioral therapy (CBT), a form of talk therapy, has been demonstrated to significantly contribute to recovery. In addition some antidepressant medications, when monitored, can be an effective part of the treatment for pediatric depression. If you think that someone you know may be suffering from depression, please encourage them to see their doctor.

The American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association released a revised and expanded version of The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families, part of the ParentsMedGuide series of publications to help parents understand depression and treatment options.

Getting Help Gets a Good Customer Review

By Molly McVoy, M.D.



A recent survey published in Consumer Reports, found that respondents reported the highest satisfaction for the combination of medication and talk therapy, when compared to talk therapy or medication alone.



The survey reported on over 1500 people treated for anxiety, depression or both. They also found that readers reported a higher satisfaction with treatment by a psychiatrist than by other mental health professionals (psychologists, social workers, and licensed professional counselors).

 

This is good news for psychiatrists and the mental health community in general. This is one indicator that the public feels treatment works and that psychiatrists help.





In addition, this consumer report supports the scientific evidence we already have – depression and anxiety treatment does work! In study after study, approximately 2/3 of patients respond to treatment for depression with an even higher percentage responding to treatment for anxiety disorders.



The bottom line is, treatment works and, it appears, most of the public knows it!

Dads Get Postpartum Depression Too

By Gariane Phillips Gunter, M.D.



Over the past several years, with great help from Brooke Shields and others sharing their stories, postpartum depression in new moms has become well known. However, recent evidence suggests that new dads may be suffering too. A recent study in the May 19th issue of the Journal of the American Medical Association reports that “14% of American men develop depression, either during their partner’s pregnancies or in the first year after delivery”.



Unfortunately, dad’s depression may be overlooked as the symptoms may not present as sadness but as irritability, anger or isolation from their loved ones. Without identification and treatment of dad’s depression, negative outcomes for the new baby and family can occur.



New babies need secure, healthy attachments for their physical and emotional development and these attachments are strained when either parent is suffering from their own depression. If you are a new mom or dad and feel you may be suffering from depression, please talk to your doctor and ask for help.

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For Mental Health Month, Join a Former First Lady In Bringing Down Barriers to Mental Health Treatment.

By Roberto Blanco, M.D.



I was seeing a very depressed patient the other day and we were discussing how far he had fallen in his functioning since he had gotten ill. He said, “I used to be strong. I used to be able to provide for my family.” And yes, there was no doubt that he was unable to provide for his family now. Despite being relatively healthy physically, mental illness had made it so that he could not work, had difficulty leaving the house, or finding enjoyment in anything.



I try not to read too much into simple statements. But the phrase “I used to be strong” resonated with me because I think that it had something to do with why he waited until it was almost too late to seek treatment. While I think that he was trying to express the depths of his feelings of helplessness and need, his statement implied that he was now weak. Fatigue, lack of energy, and poor sleep from depression could make anybody weak. However, I don’t think that this is what he meant.



I often hear people stigmatizing mental illnesses like depression by saying that it only happens to “the weak”. One thing that I’ve learned from my experience practicing psychiatry is that it can affect anyone from CEOs to valedictorians to world-class athletes. Just like this patient indicated, it doesn’t matter how strong you are or think you are, mental illness can affect you if life and genetic predisposition put you in the wrong circumstances.



One of my main concerns with the stigmatization of mental illness is that if it is seen as a weakness, then the solution is often seen as needing to “be stronger”, deny a physiologic problem, and not seek help. As many mental illnesses are quite treatable with medications, psychosocial interventions, and therapy, this can often have tragic and unintended consequences such as loss of close relationships, occupations and careers, or even death.



The other concern is that if mental illness is seen as a fault of character and not as a group of illnesses, then appropriate and necessary resources and medical services won’t be available. In North Carolina, where I work, acknowledging that you need help is not the biggest barrier to treatment. Actually, it is trying to find a provider or an inpatient bed.



With the demand for inpatient psychiatric services skyrocketing in North Carolina, the number of psychiatric beds available has decreased and the outpatient mental health system, which was once a model nationally, has crumbled. It’s hard to imagine that with greatly increasing rates of kidney disease in this country that dialysis clinics or transplant services would be closing down. However, this is exactly what is happening to psychiatric services in North Carolina. It is a complex issue but is due to the national trend of closing state psychiatric hospitals as well as to the privatization and decentralization of outpatient mental health services.



Some people are taking notice of this disturbing trend, including the former First Lady of the United States, Rosalynn Carter. She has written a book on the mental health crisis in the United States and is encouraging people to be vigilant in taking care of their mental health, to overcome challenges, and to get involved.



May is Mental Health Month. So, please take this opportunity to join our former First Lady in advocating for mental illness treatment. Go to your local legislatures or call your congressional representatives and ask that they support funding for mental health services.

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A Happy Heart may be a Healthier Heart

By Felicia K. Wong, M.D.



Heart disease is the leading cause of death in the United States. The month of February, “American Heart Month”, is dedicated to raising awareness about heart disease and increasing knowledge about prevention. In this post, I will discuss the connection between mental health and heart disease.





Depression is a risk factor for heart disease



Many studies have shown that negative emotions such as depression, anger and stress are risk factors for heart disease. The February 2006 issue of the Harvard Mental Health Letter notes that, “the recurrence of cardiovascular events is more closely linked to depression than to high cholesterol, smoking, high blood pressure or diabetes”. Antidepressant treatment may benefit depressed heart patients and possibly reduce their risk for future heart problems. Cardiac rehabilitation programs that provide patients with stress reduction and wellness strategies may also help reduce the impact that depression has on heart disease.



Happiness may protect against heart disease



People with a tendency to experience positive emotions, such happiness, enthusiasm and contentment, are less likely to develop heart disease than those who tend not to experience it, suggests a new study published in the February 17 advance online issue of the European Heart Journal, led by Karina Davidson, Ph.D. of Columbia University Medical Center. Dr. Davidson’s research team followed 1739 healthy adults living in Nova Scotia for 10 years and examined the impact of positive personality traits on heart disease risk. They found that the people in the study with the most negative emotions had the highest risk for heart disease, whereas those who scored highest for happiness had the lowest risk for heart disease.



The researchers’ speculations about how positive emotions might confer long-term protection against heart disease include:



Happy people may have a healthier lifestyle that decreases cardiac risk - eating and sleeping better, exercising more, and smoking less.



Happiness may promote a host of positive physical and chemical changes - such a reduction in stress hormones -- that are good for the heart.



There may be a genetic component - people who are predisposed to happiness might also be predisposed to have fewer heart attacks.



Davidson’s findings suggest that preventive strategies may be enhanced not only by reducing depressive symptoms but also by increasing positive affect. However, she states that the findings should be confirmed via clinical trials before making any clinical recommendations.



In the meantime, those interested in these preliminary findings can begin to take some simple steps to increase their positive affect. Dr. Davidson recommends, "If you enjoy reading novels, but never get around to it, commit to getting 15 minutes or so of [daily] reading in. If walking or listening to music improves your mood, get those activities in your schedule. Essentially, spending some few minutes each day truly relaxed and enjoying yourself is certainly good for your mental health, and may improve your physical health as well."



For more on the study, including theories on how happiness may protect the heart, as well as tips on how naturally negative people can become happy, please see the following article.

Are You Shocked?

By Gariane Phillips Gunter, M.D.



I recently came across an interesting article in the Marie Claire magazine entitled, I Had Shock Therapy… And I’d Do It Again and thought we could talk about this type of therapy a bit. A special thank you to this woman for sharing her story with the world.



What is it? Electroconvulsive therapy also known as ECT, is a well-established psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe major depression which has not responded to other treatment, and an estimated 1 million people worldwide receive ECT every year, usually in a course of 6–12 treatments administered 2 or 3 times a week.



Is ECT Effective? The 1999 U.S. Surgeon General's Report on Mental Health summarized psychiatric opinion at the time about the effectiveness of ECT. It stated that both clinical experience and published studies had determined ECT to be effective (with an average 60 to 70 percent remission rate) in the treatment of severe depression, some acute psychotic states, and mania. The report stated that ECT does not have a long-term protective effect against suicide and should be regarded as a short-term treatment for an acute episode of illness, to be followed by continuation therapy in the form of drug treatment or further ECT at weekly to monthly intervals.



What are the side effects? Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment the most common effects are confusion and memory loss which usually disappears after a few hours.



Famous people who have undergone ECT



Kitty Dukakis, wife of former Massachusetts governor and 1988 Democratic presidential nominee Michael Dukakis and author of Shock, a book chronicling her experiences with ECT.



Carrie Fisher, American actress and novelist. Fisher speaks at length of her experiences with ECT in her autobiography Wishful Drinking.



In my experience, I have come across many people who feel that ECT saved their lives as well as others who did not feel that it was effective. Careful discussion with a mental health professional can help you make the decision that is best for you. I wish you all a healthy and happy 2010.











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RELAX: Feel the stress melt away

By Felicia K. Wong, M.D.



The winter snow may still be months away from melting, but now that the hubbub of the holiday season has passed, it’s time to rest, relax and de-stress!



Easier said than done right? For many of us, finishing one project just means we can start the next. We live in a fast-paced society where there is a lot of pressure (both external and internal) to “go-go-go”. In other words, we live in a world that is full of stressors and stress.



Our body responds to stress by producing stress hormones. These hormones help you respond to “fight or flight” situations and historically helped our ancestors run to safety from lions. However, these days there are (usually) no lions to run from and instead, when the body is chronically stressed, these hormones can take a toll on physical and mental health. People who are under a lot of stress are often emotional – anxious, irritable and depressed.



Ideally, you can try to change the situation that is causing your stress. But if the situation is fixed, there are relaxation methods that can be useful strategies to cope with stress.



Relaxation is a skill. It is something that we are not necessarily born knowing how to do. Good news! Relaxing techniques can be learned and practiced.



I’d like to share with you a relaxation technique called Progressive Muscle Relaxation (PMR). This is a great way to reduce overall body tension. Here is a video to introduce the practice and help you get started:





Each person will find for themselves unique ways to relax – be it through exercise, yoga, music or meditation. PMR is just one strategy. There is no right or wrong way to relax, and no one technique that will work for everyone. So, find out which ones work the best for you and get started!



Before practicing PMR, consult with your physician if you have a history of serious injuries, muscle spasms, or back problems, because the deliberate muscle tensing of the PMR procedure could exacerbate these pre-existing conditions.

Am I Alone?

by Gariane Phillips Gunter, M.D.

















Am I Alone? by Megan Hance



I get a funny feeling, it comes from deep inside.



I get all mad and angry, wanting to go and hide.



My doctor calls it depression, my dad says it's just me.



But the thoughts and feelings, no one will ever be able to see.



Some say I'm psycho, some say I'm just weird.



It's like I'm a different person, and the old me just disappeared.



I get really edgy, I want to commit suicide real bad.



Then I get a headache, followed by feeling sad.



I wish I could get help, I wish it would go away.



Maybe if I keep praying real hard, it will some day.





I came across this poem and think that the author does a beautiful job of describing the stigma often experienced by those with mental illnesses. The holiday season can be a particularly difficult time as symptoms of depression and anxiety may flare, and feelings of hopelessness creep in.



If you feel yourself slipping away, please contact your doctor or a friend and get help right away. Receive the gift of treatment that everyone deserves. I wish you all a safe and Merry Christmas.

Exercise - An effective treatment for mild to moderate depression

By Felicia K. Wong



We’ve all heard it before - “Exercise is good for you”. As holiday eating can lead to unwanted pounds, “Getting more exercise” will be a common New Year’s resolution. However, did you know that exercise has the potential to do wonders for your mental health?



Studies have found that regular exercise can be just as important as medication and therapy for the treatment of mild to moderate depression.



Exercise causes the body to release endorphins, natural chemicals that can reduce your perception of pain. Endorphins can trigger positive feelings and improve your mood quickly.



Regular exercise has been shown to relieve the symptoms of depression by:



- reducing stress



- increasing your energy level



- improving your sleep



- improving your physical fitness, which can improve your self esteem



- providing a distraction from anxiety and feelings of depression



- increasing your sense of mastery and control over your life



It can be difficult to motivate yourself to start moving when you’re feeling down. The goal is to exercise at least 20-30 minutes, three times a week to reap the maximum benefits of exercise for depression. But even a few minutes a day can help boost your mood! Here are some tips to help you get started:



Keep it simple! Set simple and realistic goals. You can start by getting outside and walking around the block. Increase the duration of exercise a little bit each day.



Choose an activity that you enjoy. Walking, biking, yoga – find something that appeals to you.



Keep it interesting. Vary the exercise so you don’t get bored.



Keep it cheap. Unless you plan to use them regularly, avoid buying a health club memberships or expensive equipment. Go outside, get active and enjoy the fresh air!



Make it social. Find friends to exercise with - talking to people will keep it fun and help you stay motivated.



Stick with it! If you exercise regularly, it will become part of your lifestyle and help reduce your depression.



Seeing your doctor is an important step in dealing with depression, and you should discuss treatment options including medication and therapy. However, exercise can be an important additional tool that can provide you with immediate and long-term relief from depression.

Are Depression Symptoms the Same Across Cultures?

By Gabriella Corá , M.D., MBA



Although, as psychiatrists, we make a diagnosis of depression given a specific set of signs and symptoms, the way in which depression manifests may be different across cultures.



In addition to stigma, many Latinos struggle with acculturation issues, lack of insurance coverage and difficulty communicating with healthcare professionals who are not culturally proficient.



Barriers to care also affect African American communities. The diversity of the Latino, African American as well as the Asian communities is often minimized. Many believe that because someone has the same skin color or speaks the same language they have a similar set of needs. In fact, Spanish-speaking African Americans need tailored interventions to address Latino as well as African American cultural needs in order to effectively treat depression or other mental health disorders.



What to do?



1. Learn about depression: look for good sources of information.



2. Seek for help: Tell your doctor you or your loved one may be experiencing depression. If you don’t have a doctor, go to a community mental health clinic and let staff know you need help.



3. Become familiar with cultural differences in the diagnosis and treatment of depression: ask your doctor if his/her office has culturally-competent or culturally-proficient staff to help you. Cultural proficiency goes beyond speaking the language.



4. Be open to staff: Although the doctor’s office may not have culturally-competent staff, healthcare professionals may be very familiar with working across cultures. The “I can only be treated by someone who looks or talks like me” is a myth. Although this may help in the beginning, we know caring and empathic staff will be able to help you beyond gender, color, ethnicity or language.