Tag:

depression

7 Ways Exercise Improves Mental Health

{Rancho Cucamonga, California}

Not a day goes by where I don’t ask myself the following question: Should I, or shouldn’t I go to the gym today?

You don’t have to be lectured by a doctor to know that exercise is good for you. We all recognize that exercise provides positive benefits on our overall health and mood, yet do we religiously incorporate physical activity into our regular routines? Trust me, even as a physician who preaches the importance of incorporating non-medication alternatives such as exercise into wellness plans, I empathize with the struggle to prioritize physical activity in our busy schedules. Yet, if you’re interested in even more specific ways that exercise can enhance your mental health, I compiled a list of information that I often provide to my patients:

1. Target your mood. Exercise has been shown to be just as effective as antidepressants for the treatment of depression. A study led by Dr. James Blumenthal found that an exercise program provided equal benefits in mood as regular doses of Zoloft (a commonly prescribed antidepressant). Also, a Cochrane review (which is a systematic review of all high quality research relevant to a specific research question) found that exercise is associated with a greater reduction in depression symptoms compared with no treatment.

2. Alleviate anxiety. I can attest to this, for my ability to manage stress (especially when in clinic) declines after missing several workouts, though my coworkers say I mask my anxiety fairly well (which is hard for me to believe!). Aerobic exercise has been shown to be an effective treatment for several anxiety disorders. One study found that exercising at 70-90% of maximum heart rate for 20 minutes 3 times a week has been shown to significantly reduce anxiety sensitivity.

3. Boost concentration. Exercise elevates the brain’s levels of dopamine and norephinephrine, which are important chemicals involved with focus, attention, and our executive functions (planning, analyzing, prioritizing, organizing, initiating, and completing tasks/activities). Some people with ADHD are able to manage their symptoms with exercise alone, though many find the ideal treatment regimen includes medication plus exercise. For more helpful info, I often refer my patients to ADDitudeMag.COM.

4. Sleep better. Though the most common method utilized to treat insomnia is via pharmaceuticals, I am always on the lookout for ways to improve sleep without the risks of dependency and tolerance that many sleep aids have. Regular, physical exercise raises core body temperature, which can benefit the initiation and maintenance of sleep.

5. Improve heart health. People living with mental illness tend to have higher risks of cardiovascular disease. Over 50% of adults with serious mental illness are obese. Among individuals who are overweight, losing 5% of body weight can improve risk significantly and one way to accomplish this is through lifestyle modifications such as increased exercise.

6. Connect with others. Social connectivity has been found to be one of the factors that contributes to happiness and well-being. Whether you have a walking buddy, join an exercise class, or join a meet-up group for hiking, etc, physical activity may provide an opportunity to socialize and engage with others.

7. Sharpen your memory. Studies on exercise and prevention of dementia were mostly limited to studies performed on rats, but I did find one promising study which found that older adults involved in a 6-month aerobic training program positively impacted cognitive functioning.

I often tell my patients that they don’t have to be marathon runners to experience the benefits of exercise. The most important aspect to keep in mind when choosing your preferred form of exercise is sustainability — your chosen form of exercise should be something congruent with your interests, goals, and can be easily incorporated into your routine, whether it’s walking, running, playing basketball, yoga, dancing, etc.

Thought of the Day: Which type of exercise have you found to improve your mental health?

Photo by Marlon Santos

May 28, 2015 10 comments

Psychiatry

May Is For Mental Health

written by freudandfashion

It seems just like yesterday that I wrote about Mental Health Awareness Week (see my post here), and I’m happy that the entire month of May is devoted to educating the public about such a prime aspect of our wellbeing. I hope that communities will continue to grow and strengthen in their understanding of mental health so that nobody ever has to feel isolated in their struggles. For me, each day provides an opportunity to educate about mental health (though my siblings have to constantly remind me to “stop working”/psychoanalyzing on my days off). If you follow me on Instagram, I plan to post daily information related to the field for the remainder of the month of May.

When brainstorming something to write to commemorate this month, I felt that my response to a question that MedDebate asked me during an interview seemed appropriate:

In your opinion, How do we eradicate the stigmas associated with mental health conditions?

I believe that eliminating stigma requires empathy, self-awareness, and normalization of mental health discussions. Many still believe that mental illnesses are signs of weakness rather than the fact that they are true neurologic diseases. Educating and raising awareness are important factors for understanding issues in mental health, but education can only go so far without empathy. To be completely honest, even I had my own stigma going into the psychiatric profession and it wasn’t until I acknowledged my own mental health issues that I was able to be more open, relate even more to my patients, and reduce stigma in my mind. The more people are willing to talk about their own mental health, the more people can connect with one another to normalize discussions of mental health-related issues.

May 11, 2015 6 comments

Personal therapy

Grief In Repeat

written by freudandfashion

{Upland, California}

Upon driving into my garage coming home from work this evening, I suddenly burst into tears as the garage door slowly closed behind me. I haven’t felt like myself at all this past week. I tried my hardest to discern the reason for my melancholic mood and pinpointed a series of events that occurred after the subject of death was brought up during my therapy session this past weekend. The subject of terminal illness and inevitable death is never an easy one, even as a physician who had to pronounce deaths in the hospital wards and was educated on how to talk to patients about advance directives (Do Not Resuscitate/DNR), hospice, etc. We all have triggers that may occur randomly during our day that may unleash suppressed feelings that go deeper beyond whatever triggered us in that present moment. A patient once told me that hamburgers made her sad because her deceased father cooked them all the time at family gatherings. For others, something as simple as a hamburger triggering profound emotions may sound ridiculous, but we must be empathetic to each individual because none of us know of the history, context, or meaning that a symbol (such as hamburgers) provided in a person’s life.

My initial trigger was watching the movie Furious 7 last week. Now, I know that millions of devoted Paul Walker fans (including myself) were profoundly impacted by his tragic death, but the uncontrollable amount of tears that I shed was far too disproportionate to the mild attachment I had for the actor. Since everyone I knew who watched the movie admitted to shedding tears, I didn’t think much of my emotional response at the time. But, during my group therapy session, I was extremely angered about an unrelated topic, and again, I couldn’t figure out the reason why. Leaving my therapy session in a pissed off mood, I contemplated quitting group because I didn’t want to be a part of anything that made me feel angry and unsupported. I looked at my phone and started scrolling Instagram to distract myself from my emotions, and stopped incessantly scrolling once I came across the picture below, which my sister posted for National Siblings Day with the following caption:

It was always the four of us. Although we’re all grown up with separate lives, we will always have the same love for each other, and share the same values that our Lola and Lolo (Grandma & Grandpa) taught us. My latepost In honor of ‪‎siblings Day 4/10 and my lolo’s birthday 4/7. I love you all. I miss you Lolo & Lola.

Last week was my grandfather’s birthday. The theme of losing such a devoted and integral part of a family is the theme that resonated most with me about the movie. And watching the ending somehow re-opened the wound in my heart that I experienced when I first received news that my grandfather passed away from cancer thirteen years ago. I continue to re-experience feelings of grief each year around his birthday and this year is no exception. I wrote about my grandfather’s influence and my difficulties coping with losing him in previous blogposts (here, here & here). Last week, a few of my patients discussed their own grief, which is always a hard subject to process. I always do my best to provide them with as much support as possible because I know what it’s like to feel isolated, angered, and confused by a complex mixture of emotions.

I used to want to believe that “time heals all wounds,” but one of my inspiring readers modified my perspective of the statement to make it more accurate: time may help make the grief a bit more tolerable. Grief never goes away, but rather is re-experienced in different, sometimes confusing ways. But, just like the goal of the movie, I try to shift my focus from sadness to embracing my grandfather’s strength and legacy. I can already feel the wound close a tiny bit as it starts to repair itself yet again.

April 15, 2015 16 comments

Personal

Drift Away

written by freudandfashion

{San Diego, CA}

My whole week was a bit of a blur. I sometimes wish that I could take a vacation for a few months and have no responsibilities whatsoever. Where would I go? I have no idea. What would I do? No clue. Come to think about it, having no responsibilities for an extended period of time might be depressing. After all, my entire life has been devoted to my career, which is a huge part of my identity. Without my work, I’d lose my sense of purpose especially since being a physician makes up a large percentage of who I am. Perhaps that’s why retiring can be so hard (I have several retirees who present with depression). With that in mind, I suppose the better alternative to an extended vacation would be to continue working, but at a comfortable pace with firm limits and boundaries in place. It sounds so simple. After all, I know my limits and the workload I can handle before getting overwhelmed…but it’s my job to reinforce it. I guess reinforcing it is sometimes harder than the job itself.

March 28, 2015 6 comments

Psychiatry

Antidepressant Awareness

written by freudandfashion

I have a love/hate relationship with antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Basically, I love them when they actually help my patients, but hate the intolerable withdrawal that may occur when taking patients off of them. If you’ve ever contemplated abrupt discontinuation of an antidepressant, consult your doctor before stopping them altogether, particularly if you’ve taken them for at least six weeks.

In my practice, I never hesitate to prescribe antidepressants when indicated, however, I always warn my patients of potential withdrawal effects that may occur if the medication was to be discontinued in the future. Informed consent and patient education should be given before a physician prescribes any new medication. Over the course of my training and practice in psychiatry, my observations of the negative impact of weaning off antidepressants shocked me, mostly because I never learned about the phenomena in textbooks the way that I learned about other withdrawal syndromes (such as alcohol, opioid, methamphetamine, etc). From flu-like symptoms to acute somatic pain symptoms — I witnessed a full range of issues (see below for a more extensive list). The unfortunate thing is that patients often internalize the symptoms and believe there’s something wrong with them, though typically the only factor that changed since the last visit was lowering the antidepressant dose.

A telling statement was hearing a patient say that getting off an antidepressant was worse than getting off heroin. Antidepressant discontinuation is no joke. And the unfortunate thing is that many people aren’t aware of the negative withdrawal effects that may occur from lowering the dose or discontinuing the antidepressant. I was fortunate to have an amazing mentor during residency training, who taught me that “slower is better” when it came to lowering the dose of antidepressants. A literature search for any research articles regarding weaning off antidepressants yields little results, therefore, guidance on how to take patients off of them is minimal.

I am NOT writing this post to bash antidepressants especially since they have improved the quality of life of many. However, I AM writing this post to raise awareness because I see this issue OFTEN. And if this information encourages one person to advocate for him/herself and the symptoms they experience, then mission accomplished!

Possible Antidepressant Withdrawal Symptoms:

insomnia
agitation
worsened anxiety
resumption of depressive symptoms
headache, “brain zaps”
stomach upset
flu-like symptoms
increased pain
tiredness
nightmares
dizziness
suicidal thoughts

March 20, 2015 21 comments

Psychiatry therapy

Shock and Denial

written by freudandfashion

I review the 5 Stages of Grief with my patients all the time. Yet, no matter how many times I review them, nor how many patients or people I lose in my life, experiencing these stages never gets easier nor avoidable.

Stages of Grief:

Shock/Denial
Depression/Sadness
Anger
Bargaining
Acceptance

The following was written last week:

Today, I shall focus on shock/denial. Why focus on the shock/denial stage? I received a call from the medical examiner (aka coroner) today. I hold my breath each time I answer my office phone in fear that the medical examiner’s office is on the other line. The worst sentence to hear upon answering the phone is “Hi doctor, this is (insert name here) from the medical examiner’s office.”

My biggest fear became a reality today, yet again.

Currently, I am in the shock/denial phase and I’m coping by intellectualizing (a defense mechanism that many of my colleagues employ to deal with difficult news; mostly because I’m more comfortable processing the loss clinically rather than emotionally at this point, hence, the reason I am focusing on writing a blog post that teaches the stages of grief), carrying on with work, and going about my day, with the occasional few tears and blank stares when I have downtime. These moments of sadness are periods that I try to avoid, especially after glancing at my fully-booked patient schedule. According to the medical examiner, “cause of death is not known, the toxicology results are still pending.”

Each and every one of us go through this phase when we experience loss. I blogged about the subject of grief recently when I lost a patient to suicide two months ago. I am aware that my demeanor is currently “off” because I’m quite tense and impatient right now as well. I might be going through the motions of a regular day, but in no way am I taking this loss lightly. I know the anger stage will approach soon. For me, the worst stage is sadness/depression because I generally want to isolate and hide.

The following was written today:

One week has passed since hearing the tragic news about my patient. I enter the clinic, greet my usual “good morning” as I observe everyone going about their busy day as normal. I enter my office and suddenly have a desire to punch my computer as it takes forever to reboot. I settle for slamming my palm against the keyboard instead. Note that this is my usual morning routine, minus the angry/”I wanna punch something” part. The anger stage is here.

I see my first few patients and notice a decline in my usual empathetic statements, my mind drifts more frequently, however, I remain fully aware of my thoughts and am able to re-focus. The 20 minutes that I have with each of them is their designated time and I must not let my grief impact any medical decision. I take my lunch break and run into one of the therapists, who was also involved in my deceased patient’s care. I decide to open up about the struggle I’m having today, in hopes that we can provide comfort and support each other during this difficult time. Instead, I get a remark that pisses me the hell off, or at least that’s how I interpreted her curt comment. I essentially wanted to tell her she was an insensitive idiot and to f*** off, but I held my composure. I normally wouldn’t be bothered by such a comment, but I’m clearly more irritable than usual. I let it go and tried to have compassion for her especially since she might be grieving as well, or thought that perhaps she’s a cold witch and doesn’t care, then thought that perhaps I misinterpreted her comment. Perhaps I feel that nobody understands, and maybe no words can make me feel better at this moment anyway.

February 5, 2015 23 comments

Psychiatry therapy

Mind Over Meds

written by freudandfashion

{Claremont, California}

Some of you may have noticed that although I am a psychiatrist, I rarely comment nor write about my thoughts on psychiatric medications in my blog. I did write a post as a resident physician-in-training in 2010 titled Pill Pusher, which briefly describes my general approach to simplify, minimize, and streamline medication regimens to the least amount of meds needed to provide symptom relief. In some cases, I have successfully worked with my patients to wean off and discontinue all of their psychiatric medications, though the process requires much patience, toleration of uncomfortable withdrawal symptoms, and numerous non-medication approaches to maintain stability off of meds. And most importantly, I believe a trusting doctor-patient relationship is needed to provide education of potential withdrawal symptoms, encouragement to push forward, and processing fears that may arise from being off medications for the first time in years.

Now, please do not mistake me for a protester against pharmaceuticals — I witness the positive impact that medications can have on enhancing the quality of life of my patients on a daily basis. However, I do not attribute the improvements primarily to medications. My treatment plans generally promote the development of insight and self-awareness of mood patterns, anxiety triggers, etc, and oftentimes explore how past suppressed emotions may contribute to current symptoms, all of which are topics I aim to emphasize in my blog. Medications may stop working or provide temporary relief, but knowledge of one’s self can last a lifetime.

Photos by Marlon Santos

December 20, 2014 2 comments

Psychiatry

Happy, Crappy Holidays!

written by freudandfashion

{Photo with my sister in Fairfield, CA}

While skimming research articles for scholarly information to include in a blog post on Seasonal Affective Disorder (SAD), I put the information aside for a bit in order to write about my own observations and experience dealing with seasonal mood changes.

Long story short…basically, A LOT of people get depressed during the holidays, fall, and winter seasons. But not everyone meets enough criteria to be formally diagnosed and treated for SAD . Yet, a lot of people feel BAD (no acronym…just “bad”) and guilty that they’re not as happy as expected to be during the joyous holiday season. Several of my patients say they feel down, need to force themselves out of bed, and lack motivation. Many also attribute feeling depressed due to missing family members and loved ones, especially since holiday celebrations tend to make their absence even more apparent.

I read quotes that spread throughout social media with phrases along the lines of “December is the last month of 2014…get off your butt and make it count!” Honestly, I myself would be content if I made it through December 2014 by accomplishing the bare minimum of my daily tasks.

And don’t get me wrong — the holiday seasons are a joyful time for many, and I love when people go all out with their decor, gift-giving, and traditions. But I want to acknowledge that there’s a range of how people feel this time of year and that it’s okay if you don’t feel peppy, super motivated, holiday cheery, and overjoyed because there are a lot of people who feel the same way. With my patients, I try to normalize and validate their feelings, focus on the general progress they’re making, and if their mood declines this season, we try to to work on ways to get through this difficult time of year and hopefully move forward once the holidays are over.

Now, here are some bullet points on SAD:

to meet criteria for SAD, one must experience at least 2 yearly consecutive episodes of depression (with a seasonal pattern), which causes significant impairment in daily functioning (for example: calling in sick for work, negatively impacting relationships, feeling suicidal, etc). For more details, please click here for a good summary on the NAMI website.
About 5% of the U.S. population experiences SAD, with symptoms lasting approximately 40% of the year
Cause may be due to a combination of factors, both biological and psychological which may include the following:
- One of the chief biological causes found in the literature is due to changes in our sleep/wake cycle (circadian rhythm) which tend to occur with seasonal changes (Anyone else struggle with winter daylight savings time? I definitely do). For more details, check out this research article by Dr. Alfred Lewy.
- more vulnerabilities to stress this time of year (as I mentioned above)
There are treatments that have been researched to help: light therapy, psychiatric medications, psychotherapy (specifically cognitive behavioral therapy)

If you are struggling with symptoms, you shouldn’t have to go through this alone. Please seek help by reaching out to your doctor, who can discuss possible treatments or even refer you to a psychiatrist or therapist.

And if you know someone who might be struggling with symptoms, you can help by showing them your support and encouraging them to seek help.

References:

Seasonal Affective Disorder

Rohan KJ, Roecklein KA, Haaga DA. Biological and psychological mechanisms of seasonal affective disorder:
a review and integration. Curr Psychiatry Rev. 2009;5(1):37-47.

December 8, 2014 8 comments

therapy

Fight the Blues

written by freudandfashion

{Emerald Bay, South Lake Tahoe}

I’ve written about the subject of laziness several times in my blog (here, here, and here), and this week has been exceptionally rough to get through. I attribute my dysphoria to a combination of factors: mental exhaustion (struggling with recent loss that I wrote about here, weekly sessions with my therapist exploring the origins of my overwhelmingly self-critical tendencies), the weather changes (hello, hibernation mode), and the upcoming holidays. Rather than writing a deeply emotional post, I felt it would be appropriate given my current mood to instead write about 3 things I did this week to combat the seasonal blues. I may be a psychiatrist who inherently gives advice, but I seriously learn a lot from my patients and others. Would love to hear about any techniques you apply to prevent from feeling down this time of year as well!

1. Write a simple to-do list. I used to be overly-ambitious with my lists, but that just left me feeling worse and unaccomplished if I couldn’t get everything done. This week, I listed 3 mandatory responsibilities plus a few smaller, easier tasks (yes, I even listed getting the mail as a task and felt great when I checked it off my list!).

2. Get moving. Though the couch and Netflix seem far more appealing than going to the gym, I struck a balance by going out for a quick jog. Even a 15 minute run helped provide some exercise and made me feel less isolated.

3. Schedule an activity with a friend..and don’t flake! When I have something planned, I hold myself more accountable and am less likely to cancel, especially if it’s with a friend. Even something as simple as putting on makeup for an outing made me feel more like my usual self again.

Thought of the Day: What different techniques do you utilize and find helpful?

November 20, 2014 8 comments

Psychiatry

Friday Reflection

written by freudandfashion

{My dad’s USAF retirement ceremony}

Though I enjoyed looking at all of the thoughtful, commemorative posts to acknowledge Veterans Day (I also posted a happy photo on instagram of me and my dad, who served in the Air Force), I felt a sense of suppressed, sad emotions as well. It was hard to pinpoint because I believe a part of me did not want to acknowledge the fact that behind several of the smiling faces could be a lot of pain, especially with the harsh statistic that 22 veterans commit suicide every day.

One of the most difficult patient cases I ever participated in was as a medical student doing psychiatric consultations on the medical floor. I was paged to see a man in the Intensive Care Unit (ICU), who was on a ventilator for over a week after he survived a suicide attempt jumping off of a highway bridge. He would likely never recover from the damage of his injuries and would stay in a hospital on a ventilator for the remainder of his life. I reviewed his history: he served in the Army, fought in the Vietnam War, was diagnosed with Post-Traumatic Stress Disorder (PTSD) and alcohol addiction, and never had psychiatric issues until he returned home from Vietnam. And there he lay in the ICU — he could not talk, move, nor write. He was essentially a vegetable. Family never came — I don’t think he had any. Yet, I sat there next to him and dedicated at least 10 minutes per day, whether he knew I was there or not, because I felt he deserved to be acknowledged and cared for, at the very least for his service and sacrifice for his country.

Reflecting on that moment, I realize how much our system needs to prioritize support services for the men and women who protect our country. I currently see patients who have served in the military and are diagnosed with PTSD, but I can’t help but think of the majority of veterans who are limited in resources or ashamed to seek help due to the stigma attached to such diagnoses. I hope that some day soon all of our veterans will be able to receive the psychological services they rightfully deserve and need.

Image credit: www.army.mil

November 14, 2014 7 comments

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