Meditation: It does a mind-body good

For those of us who meditate, we know it works. It calms the mind, brings clarity and focus, and helps to ease the effects of challenges in our lives. Some folks are skeptical about "all that mind-body" stuff, and they're not going to be swayed by personal opinion. So it's really nice when research backs you up and says, Yep, it's not all in your head. This stuff really works.

Where is this great evidence, you ask? The National Academy of Sciences (which, by the way, is the adviser to the U.S. on science, engineering, and medicine) publishes a weekly rag. In the most recent edition there was a study on meditation. And how it works. And not just for long-time practitioners.

The researchers enrolled 80 Chinese college students into their study. They randomly assigned 40 students to a test group and 40 to a comparison group. They taught the test group a form of meditation known as integrative body-mind training, which incorporates meditation and mindfulness work. The group practiced for 5 days 20 minutes at a time. The comparison group was taught a relaxation technique, which they also practiced for 20 minutes daily over 5 days. Before and after the 5-day training, the students were given a variety of tests to examine their emotional states and concentration abilities.

They found that compared to the relaxation group, the meditation group had less anxiety, fatigue, depression, and anger. They also showed decreases in stress and increases in their immune response. All in 5 days. 100 minutes. With no previous training.

You too can receive the benefits of meditation. There are a host of guided meditation CDs that can get you started (just check out your favorite book store or Amazon). A practice called yoga nidra is one of my favorites. And you don't have to spend a lot of time. Just 20 minutes a day to be on your way to less stress and greater relaxation. Sounds too good to be true, huh? But it isn't.

PMS: You are what you eat - or something like that

Periods are bad enough without adding premenstrual agonies to the front end. You know what I'm talking about - the bloating, breast tenderness, irritability, fatigue, acne, crying spells, anxiety, and food cravings (chocolate, salt, both - do I hear chocolate covered pretzels anyone?) that occur a week or so before your period arrives.

There has been a lot written in the popular media about easing PMS symptoms through changes in diet, such as consuming less caffeine and sodium and increasing vitamin B intake. But a study published in the Journal of Women's Health actually looked at what proportion of the participants' diets consisted of what kinds of foods (e.g., fats, carbs, fiber) and how these proportions related to their premenstrual symptoms. The study consisted of 3,302 ethnically diverse women who participated in SWAN (Study of Women's Health Across the Nation). They did find some relationships between what women ate and how they felt. But you may be surprised by the results (I sure was).

Fat intake was associated with fewer premenstrual cravings and less bloating (potato chips okay). Caffeine was associated with more anxiety and mood changes (pumpkin spice latte from Starbuck's not okay). Alcohol consumption was associated with less anxiety and mood changes (glass of red wine okay), but more headaches (or maybe not okay). Fiber was associated with more breast pain (bran muffin maybe not okay, I'm still not sure about this one - see below).

Perhaps more important than the dietary findings, they found certain subgroups of women experienced PMS differently. Perimenopausal women reported significantly more premenstrual symptoms than premenopausal women. Additionally, women with depression reported more PMS symptoms, especially anxiety and mood changes. Conversely, 0lder women reported less anxiety, mood changes, and back pain. Finally, overweight and obese women reported more cravings and bloating than normal weight women.

Is there a dietary moral here? The authors of the study say no. With the exception of caffeine, most of the dietary relationships were in the opposite direction - that is, fat and alcohol were actually associated with fewer symptoms, not more. Additionally, I would add there are other benefits of fiber intake that may outweigh the monthly nuisance of breast pain (although I'm not someone who experiences breast pain, so I might be convinced otherwise). They also didn't time their study to measure food intake and then track subsequent symptoms in the same 2-week period. Had they done this, they might have identified some different relationships between food and symptoms. Perhaps the more important part of this study is the identification of subgroups of women who are at higher risk for PMS symptoms, namely perimenopausal women, overweight women, and women with depression. If you are in one of these subgroups and you experience PMS, talk to your health care provider about ways to alleviate your symptoms.

Improve depression with exercise

Exercise produces a lot of benefits. It reduces the risk of stroke and heart disease. It lowers the "bad cholestrol" while increasing the "good cholesterol." It helps to reduce blood pressure and maintain a healthy weight. According to research published online this month in Psychosomatic Medicine, exercise is also an effective treatment for depression.

Researchers tested the effectiveness of 4 types of depression treatments: a led exercise regimen, a home exercise program, an antidepressant known as a selective seritonin reuptake inhibitor (SSRI), and a placebo, or a pill that does not contain any medicine. They sorted 202 adults (153 women) with depression into each of the groups and followed them for 4 months.

They found that 41% of all patients no longer met the criteria for major depressive disorder. When they broke the groups down by treatment group, they saw improvements in all 4 groups. Secifically 45% of the led exercise group, 40% of the home-based exercise program, 47% of the antidepressant group, and 31% of the placebo group saw improvements. Interestingly, the rates of improvement were very similar for those in the led exercise group and those taking antidepressants. Further, although participants in the 3 "active" treatment groups (led exercise, home exercise, and antidepressants) had greater improvements than the placebo group, nearly one-third of those in the placebo group still got better. The investigators noted that improvements in depression may be related to factors other than treatment type, such as attention from mental health care providers and monitoring of symptoms.

Per the investigators, it is important to note that this study does not demonstrate that exercise is better than SSRIs for relieving depression. So if you are taking antidepressants, this is not license to stop your medication without first discussing the pros and cons of such a decision with your doctor. However, the study authors d0 note that exercise can increase positive thoughts, enhance self-concept, and change how the body responds to stress, all of which can lead to fewer depressive symptoms. So if you have depression or are prone to a depressed mood, try some exercise - you might see improvements in your mood, as well as other areas of your life.

It's okay to feel blue

September 11th is a day that was forever changed in 2001. Despite six years having passed and despite your emotional and physical proximity to the events of that day, it is not unusual to feel unsettled on this anniversary.

There has been a fair amount of research on the psychological aftermath of 9/11. One of the most common mental health disorders associated with the terrorist attacks is post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder that develops in response to trauma. Symptoms, which must be present for at least one month, include: being easily startled, losing interest in things you used to enjoy, irritability, aggression and/or violence, difficulty feeling affectionate, feeling emotionally numb with loved ones, flashbacks (reliving the trauma through thoughts and nightmares), and avoiding situations that remind you of the original incident. Symptoms generally develop within three months of the incident, but can emerge years later. The course of PTSD varies with individuals: some will recover within three to six months, while others will develop a chronic condition that lasts several years. Other mental health problems often accompany PTSD, including depression and substance abuse.

A recent review of the research on PTSD after 9/11 identified several groups at higher risk for PTSD. Most obviously, individuals who were directly exposed to the attacks are at high risk for developing PTSD with chronic symptoms. However a number of other groups also are vulnerable to PTSD. These include: people who were geographically close to the attacks, low-income individuals, people with low education, women, Latinos living in New York, and those with poor social supports. Additionally, the researchers noted that repeated exposure to graphic media portrayals of the attacks contribute to PTSD, especially among vulnerable groups.

So if you find yourself feeling low, irritable, or just not yourself today, give yourself a break. Take five minutes several times throughout the day to sit quietly, breathe, mediate, pray - whatever cultivates peace and calmness. The Department of Veterans Affairs also has some good information on self care. In addition, you might want to limit your television viewing and other media coverage this week, so you do not continue to expose yourself to the images of that day - especially if you are among one of the groups identified as more vulnerable to PTSD. Finally, if you think you have undiagnosed PTSD, see your health care provider who can provide the necessary referrals for treatment.

Depression more damaging to daily health than other common conditions

After today's headline about the increase in suicide rates among teen girls, new research on the effects of depression on daily health status should come as no surprise.

In a study published in this week's Lancet, researchers examined the effects of depression on everyday health status for 245,404 people living in 60 countries in all regions of the world who participated in the World Health Organization's World Health Survey. They defined everyday health as encompassing several domains, including general health, vision, mobility, self care, pain/discomfort, sleep/energy, emotional processes, and thinking processes. In addition to studying the effect of depression on health status, the researchers also studied and compared the effects of four chronic health conditions on health status: angina, arthritis, asthma, and diabetes.

Several significant findings emerged from this research. First, people who had depression AND one of the four chronic health conditions had significantly worse daily health than people who had depression alone or one of the four conditions alone. Second, people who had angina, arthritis, asthma, or diabetes were significantly more likely to be depressed than people who did not have one of these conditions. Third, women had worse daily health than men. Finally, depression contributed to poor daily health more so than any of the other chronic health conditions. These findings were consistent even across different countries with different demographic characteristics.

This study demonstrates that depression continues to be a public health problem that needs greater attention not only in the United States, but around the world. Unfortunately, much of our lack of attention to this important health issue reflects the stigma associated with mental health problems in our society. If there is an upside to this research, it is that women with chronic health conditions should be aware they are at greater risk for developing depression. If you think you may have symptoms of depression, talk to your health care provider when you see her for your chronic health condition. She should be able to diagnose and treat your depression if necessary, or refer you to someone who can.

Light treatment for postpartum depression

If one good thing came from Tom Cruise's public insult of Brooke Shields - and the cadre of new mothers who have taken antidepressants for postpartum depression (PPD) - it's that people started paying attention to a disorder that is often hidden because of fear and stigma.

Postpartum depression is characterized by any of the following symptoms over a 2-week period or more within the first year after delivery: restlessness, irritability, sadness, hopelessness, feeling overwhelmed, crying a lot, having little energy or motivation, appetite changes, sleep disturbances, difficulty focusing, remembering or making decisions, feeling worthless or guilty, loss of interest in pleasurable activities, withdrawal from friends and family, headaches, chest paints, heart palpitations, hyperventilation, not having interest in the baby, and thoughts of hurting the baby or oneself. There are a number of contributing causes of PPD. These include rapid changes in hormonal levels (specifically progesterone and estrogen) after delivery, low thyroid levels, exhaustion from delivery, broken sleep patterns, feeling overwhelmed by parenting responsibilities, doubting one's ability to be a "good" mother, stress resulting from changes at work and home, feeling a loss of one's pre-pregnancy identity, having less free time, and having less control over time.

The two most common treatments for PPD are talk therapy and antidepressants. Findings from a study released this month, however, show that light therapy may be a promising new treatment, especially for women who refuse medication because they are breastfeeding or simply do not like the idea of taking medicine. Light therapy involves exposure to specific wavelengths of light, or very bright full-spectrum light, for a prescribed amount of time. It has been used successfully to treat a variety of conditions, including acne, seasonal affective disorder, and non-seasonal depression.

Researchers in Canada studied the effects of light therapy on 15 women who had a diagnosis of PPD but who were not taking antidepressants. The women were assigned to one of two treatment groups: 30 minutes of daily light exposure between 7AM and 9AM using a 10,000-lux bright light or 30 minutes of daily light exposure between 7AM and 9AM using a 600-lux red light. After 6 weeks of light therapy, both groups of women showed significant reductions in their depressive symptoms, with an average of 49% improvement. Additionally two women (one in each group) experienced a complete remission, or absence of PPD symptoms.

While these findings are encouraging, this study followed a small number of patients, and the authors acknowledge that more work needs to be done to determine whether this approach is as useful for PPD as it is for seasonal affective disorder. Additionally, none of the patients were suicidal, so nothing can be said about how light therapy might work for women with more severe symptoms. However, the upside is that more treatment options offer women more control over how their depression is managed, which can improve the ability to cope with the disorder.

If you are interested in learning more about light therapy, the Mayo Clinic has a nice piece with information about the risks and benefits. You also can talk to your doctor or mental health care provider about whether light therapy may be worth a try.

What you think about your depression affects how you cope

When you are diagnosed with a mental health problem such as depression, one issue you have to face is how to deal with the diagnosis. Research suggests that women generally use what's called "emotion-focused coping," which includes crying, dwelling on the causes and implications of their depression (aka ruminating), and seeking support from others. (Versus men who cope by distracting themselves with hobbies, sports, alcohol, and drugs.)

A study published this month shows that people's emotional reactions to their depression diagnosis affect how they cope. Researchers interviewed 189 patients (133 women) in a primary care clinic who were taking antidepressants. They found women who believed their depression would have a greater negative impact on their lives used more maladaptive coping strategies, such as blaming themselves, ruminating about their illness, and disengaging from others. On the other hand, women who perceived they had some control over their depression and who believed their depression was caused by an identifiable stressor (such as relationship or job difficulties) used more active coping strategies, such as planning, acceptance, problem-solving, reframing the illness positively, and religious/spiritual supports.

Why do coping strategies matter? The researchers suggest that maladaptive coping may actually worsen depressive symptoms, while active coping may help to lessen them. Further, women in particular may benefit from strategies that increase their active coping skills and improve their sense of control over their disorder.

If you have been diagnosed with depression, it may be helpful to talk to your mental health care provider about how the diagnosis has affected you emotionally. You also may ask your provider to give you more detailed information about your depression, such as: how long you can expect to have symptoms, whether the symptoms will wax and wane or decrease gradually over time, how the symptoms will affect you in the short- and long-term, how the treatment will affect you short-term and over time, and how long your provider expects you will need treatment. The answers to these questions will vary for different people, and also can vary for the same person for different depressive episodes, depending on the severity of the episode. Having open and clear communication with your provider can assist you in developing a sense of control over your depression and help you to manage your illness constructively as you heal.

Cod Liver Oil for Depression

Omega-3 fatty acids have been shown to protect against disease, including coronary heart disease and cancer. A new study shows that omega-3s also may be useful for depression.

Researchers examined a community-based sample of nearly 22,000 people in Norway. They found that people who took daily cod liver oil, which is rich in omega-3s, were significantly less likely to have high depression symptoms than people who did not consume daily cod liver oil. These calculations were adjusted for other factors associated with depression, including age, smoking habits, alcohol use, exercise habits and use of antidepressants and lithium. Additionally, these researchers found that the longer individuals used cod liver oil, the lower their risk for depressive symptoms.

The dose of cod liver oil that was studied was 0.7 - 1.2 grams of omega-3 fatty acids. Of this, 0.3-0.6 was DHA, which can reduce blood triglycerides, and 0.3-0.6 was EPA., which is thought to lower inflammation. Additionally, the cod liver oil supplements contained vitamins A, D, and E.

Based on this study, cod liver oil or another omega-3 fatty acid supplement might be a useful addition to your diet, especially if you have a family or personal history of depression. In addition to supplements, fish such as wild salmon, herring, mackerel, anchovies, and sardines are great sources of omega-3s. Do be mindful, however, that omega-3 supplementation isn't for everyone. There are some risks, including increased bleeding in patients taking aspirin or coumadin, reduced glycemic control in diabetics, and increased susceptibility to bacterial infection due to a suppressed immune system. Be sure to talk to your doctor to weigh the risks and benefits before you add supplements. Meantime, a little extra fish in the diet never hurt anyone.

Depression screening and a note about next week

I had a request for "as much information as I could provide" on women and depression. Next week I'll be doing a 5-part series on recent research on depression, including some new findings on treatment.

If you have requests for future topics, please feel free to send them to me at leighann [at] uky [dot] edu. Meantime, here's an online depression screening tool sponsored by the Department of Psychiatry at New York University's School of Medicine. If you have had a history of depression, or think you might be prone to a depressed mood, you may want to periodically check in with yourself using this tool. It may give you an idea of whether you have symptoms that warrant seeking help from a mental health professional.

If you decide to use this tool, please note the disclaimer on its use, taken from the NYU website [ODST=Online Depression Screening Test]:

"ODST is a preliminary screening test for depressive symptoms that does not replace in any way a formal psychiatric evaluation. It is designed to give a preliminary idea about the presence of mild to moderate depressive symptoms that indicate the need for an evaluation by a psychiatrist."

Is work getting you down?

My colleague and I have done a bit of research on job quality and mental health, so this study caught my attention - especially since it's a study of folks born around the same time I was.

Researchers studied over 800 employed men and women born between 1972 and 1973 in New Zealand. They looked at the stress these folks experienced at work, including psychological job demands (e.g., work load and time pressures), physical job demands (e.g., heavy lifting and work hazards), control over what work gets done and when, and social support from colleagues and supervisors. They also examined their mental health - specifically anxiety and depression.

After adjusting their calculations for income level, a history of a mental health disorder in adolescence, having a generally negative personality, and other job stressors, they found that women who reported having high psychological job demands were 75% more likely to have depression or anxiety than female workers with low psychological job demands. In fact, when they analyzed the data over time, they found that high demand jobs were linked to new cases of depression and anxiety in workers without any history of either disorder prior to entering the labor force.

Most people who work experience job stress at one point or another. However, it's clear from this study that strategies for reducing stress are in order. Yoga, meditation, and breath work are great tools that I use. And anything that gets your heart pumping and gives your head a rest is always good. You also may want to talk to your supervisor about ways to minimize job stress, such as getting more help with job responsibilities or adjusting deadlines if possible. This can help to reduce your risk for depression and anxiety and improve your quality of life and well-being.

Om Sweet Om

As a long-time yoga practitioner and instructor, I am always interested in new research on the benefits of yoga practice. Two recent studies suggest that yoga can both boost your mood and improve your migraines.

In one recent study, researchers compared the effects of one hour of reading to one hour of practicing yoga on brain functioning. They found the yoga practitioners had a 27% increase in GABA levels, while the readers experienced no change. GABA is the primary inhibitory neurotransmitter in the central nervous system, and low levels of GABA are associated with mood disorders, including depression, anxiety, and manic-depression (bipolar).

In a randomized controlled trial of yoga versus self-care for migraine sufferers, the patients who were randomly assigned to yoga showed significant improvements over those assigned to self-care in headache intensity, frequency, and pain levels. The yoga practitioners also had significant reductions in symptoms of anxiety and depression and use of migraine medications compared to those in the self-care group.

Other research suggests that yoga can improve quality of life in breast cancer patients, decrease seizure activity in individuals with drug-resistant epilepsy, improve gastrointestinal symptoms in adolescents with irritable bowel syndrome, and improve chronic lower back pain. Sound too good to be true? Learn more and judge for yourself. Meanwhile I'll keep doing my sun salutations. Namaste.

STIGMA: Keeping Mental Health Problems on the QT

When I used to practice therapy in an outpatient psychiatric unit of an inner city hospital I co-managed patients with a psychiatrist who would further evaluate and medicate clients as needed. Most of my clients were very distressed when the physician side of the team recommended an antidepressant, anti-anxiolytic, or other medication in conjunction with talk therapy. I would have the same conversation with different patients every time:

ME: If you had diabetes would you feel embarrassed about taking insulin?
CLIENT: No.
ME: Well think of (fill in disorder here) as if it were diabetes. Both conditions have biologic origins that can be helped by medication.

Despite my best attempts, this conversation made very few patients feel better about their diagnosis or its treatment.

It's been over 10 years since I first entered the mental health field, and I'm amazed that little has changed when it comes to the stigma associated with mental health problems, despite the educational campaigns of the federal government and NAMI. This is especially true in rural areas and smaller communities where mental health professionals are scarce and residents so tight knit that folks are afraid if someone sees their car parked in front of the mental health clinic, everyone will know they have a mental health problem before day's end. Unfortunately, this means that rather than seek proper treatment for mental health problems, people self-medicate through the use of alcohol and drugs.

My colleague and I recently published a paper in the Journal of Affective Disorders looking at the percentage of folks who have both a mental (e.g., depression, anxiety, bipolar) and substance use (drug and alcohol abuse and dependence) disorder. While we found no differences between rural and urban folks in terms of the prevalence rates of these disorders, we did find that rural residents were less likely to seek treatment for their disorders than urban folks. We wondered: Is anonymity the key to seeking mental health treatment?

This may be why there is a burgeoning of online communities for folks with mental health problems. This is great in the sense that folks can readily access information and "talk" to people with similar disorders. However, I wonder how stigma is perpetuated by communities who don't share experiences face-to-face. Are we encouraging people with mental health problems to seek support behind a screen name?