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Complementary Medicine, In the News, Mental Health, Neuroscience, Research

An oasis of peace in “the 500 channel universe”: Research on mindfulness and depression

An oasis of peace in "the 500 channel universe": Research on mindfulness and depression

1135112859_45dc222725_zEarlier this month, the American Psychological Association issued a feature on mindfulness and depression, highlighting research that suggests mindfulness is an effective way to ameliorate and treat mood disorders, particularly recurrent depression. Some of the featured research suggests a strong neurological basis for the association.

Zindel Segal, PhD, a psychologist at the University of Toronto who is quoted in the article and who was on the three-person team that created Mindfulness-Based Cognitive Therapy (MBCT), wonders if all the attention mindfulness is now receiving is part of a backlash against “the 500 channel universe” of distractions in modern society. It’s not a pill that can be taken and done with, though – it’s a restructuring of mental attitude that requires maintenance. Through MBCT, people learn to pay attention to sensations and feelings rather than evaluative thoughts.

The studies in the review suggest that MBCT works at least as well as medication to prevent recurrence, that it is effective for peri-natal depression, and that it may work especially well for people with histories of relapse or depression stemming from childhood. A brief prepared for the Department of Veterans Affairs found that mindfulness approaches were most effective against depression compared to other health conditions.

I found the neuroscience particularly interesting: Part of the reason for MBCT’s effectiveness may be that practicing mindfulness increases connectivity and tissue density in certain areas of the brain. This is a classic example of neuroplasticity – the idea that neurological pathways can adapt and change throughout one’s life.

Norman Farb, PhD, a neuroscientist at the University of Toronto, distinguishes two forms of self-reference that activate different areas of the brain: extended/narrative self-reference, which links experiences across time, and momentary/experiential self-reference, which is centered on the present. Mindfulness exercises emphasize the present, in contrast with destructive narrative patterns of thought common in those suffering from stress, anxiety, and depression. In Farb’s study, fMRI results show that regular mindfulness practice strengthens areas of the brain that focus on the moment. It suggests that although we habitually integrate these two forms of self-reference, they can be neurally dissociated through attentional training.

Neural differences may have effects even when someone is not actively engaging in mindfulness: A study led by Veronique Taylor at the University of Montreal showed that the experienced meditators has less activity in narrative self-referential areas than novice meditators even in a resting state. Another study led by Harvard University neuroscientist Sara Lazar, PhD, showed that over the course of an 8-week mindfulness stress reduction program, the gray matter in participants’ amygdala shrank in density, while density increased in areas related to sustained attention and emotion regulation. The amygdala is implicated in anxiety as well as depression, which correlates with the finding that the participants’ stress levels decreased.

According to the feature, Segal has been impressed with the dramatic rise in popularity of meditation over the past 20 years, which “resonates with people’s desires to find a way of slowing down and returning to an inner psychological reality that is not as easily perturbed,” he says. Perhaps most encouragingly, mindfulness practice has no adverse side-effects or contraindications, so I would expect to see more research into its efficacy, which could be good for all of us in our “500 channel universe.”

Previously: Mindfulness training may ease depression and improve sleep for both caregivers and patients, Using mindfulness-based programs to reduce stress and promote health, Using mindfulness therapies to treat veterans’ PTSD, How mindfulness-based therapies can improve attention and health and Study shows mindfulness may reduce cancer patients’ anxiety and depression.
Photo by ronsho

In the News, Men's Health, Mental Health, Parenting, Pregnancy, Research

Examining how fathers’ postpartum depression affects toddlers

Examining how fathers' postpartum depression affects toddlers

Zoe walking with GilPostpartum depression doesn’t only affect moms, and new research shows that fathers who suffer from it have just as great an effect on their kids as depressed mothers do. As described in a press release from Northwestern University late last week, toddlers who have a depressed parent of either sex can experience emotional turmoil that manifests both internally and externally, through behaviors such as hitting, sadness, anxiety, lying, and jitteriness.

Most previous studies on the consequences of postpartum depression have focused only on women; this study (subscription required), published in Couple and Family Psychology: Research and Practice, is one of the first to examine how toddlers are affected by depression in either parent. It was led by Sheehan Fisher, PhD, professor of psychiatry at Northwestern University’s Feinberg School of Medicine.

As quoted in the release, Fisher states:

Father’s emotions affect their children. New fathers should be screened and treated for postpartum depression, just as we do for mothers… Early intervention is the key. If we can catch parents with depression earlier and treat them, then there won’t be a continuation of symptoms, and, maybe even as importantly, their child won’t be affected by a parent with depression.

Data for the study was collected from nearly 200 couples; questionnaires were administered both in the first few months after their child’s birth, and when their child was three years old. The forms were completed by each partner independently. Parents who reported signs of postpartum depression soon after the birth of their child also showed these signs three years later – the symptoms didn’t self-resolve. The questionnaire also asked about fighting between parents, which, interestingly, did not contribute to children’s emotionally troubled behaviors as much as having a depressed mother or father did.

Fisher stated in the release that depressed parents may smile and make eye contact less than parents who are not depressed, and that such emotional disengagement may make it hard for the child to form close attachments and healthy emotions.

Previous studies have shown that fathers are at a greater risk of depression after the birth of a child than at any other time in a typical male’s life.

Previously: A telephone lifeline for moms with postpartum depression, 2020 Mom Project promotes awareness of perinatal mood disorders, In study, health professionals helped prevent postpartum depressionDads get postpartum depression too and A call for depression screening for pregnant women, moms
Photo by Michelle Brandt

Addiction, Media, Medicine and Society, Mental Health, Technology

Patient tells how social media helped her overcome the “shame” of her eating disorder

Patient tells how social media helped her overcome the "shame" of her eating disorder

3375657138_d025fc4092_bMany of us turn to our friends and families for encouragement when times are tough. So it’s no wonder that social media sites have also become important sources of emotional support for people with illnesses.

Recently, a story over on MindBodyGreen highlighted how one woman used Facebook as a tool to help her overcome the shame and deception that hampered her recovery from her eating disorder. As Lindsey Hall explains:

Two months into rehab, I was still struggling with letting go of the games of my eating disorder. Transitioning from in-patient to out, I’d been rapidly finding myself falling backwards instead of forwards.

Here I was, 24 years old, still living some days bagel by bagel, still opening the door to deception, and guilt and shame. I knew on some level that admitting to my eating disorder on social media would be a way for me to stop the show. I knew I needed to own this struggle in order to own all of myself, and to continue on my journey learning the art of self-acceptance.

As Hall describes in the story, her decision to make her eating disorder public on Facebook was a leap of faith with no guarantee that it was the right thing to do:

I’ll never really know what drove me to write that Facebook status, but I posted it anyway to the open arms of nearly 2,500 “friends” and family, to people that had met me once at a bar or sat next to on a plane. Having lived so long behind a smoke screen, I was ready to expose myself. I needed to feel bare, even while broken, in order to be able to clean my slate, and start from scratch in reconstructing my life.

The feedback Hall received from her gutsy post on Facebook and the subsequent blog posts and stories about her eating disorder haven’t always been positive, but as Hall explains, that wasn’t that point. Hall’s eating disorder is public information now, and this new level of accountability has helped her keep her eating habits on track.

Previously: Incorporating the family in helping teens overcome eating disordersA growing consensus for revamping anorexia nervosa treatmentPossible predictors of longer-term recovery from eating disordersGrieving on Facebook: A personal story and How patients use social media to foster support systems, connect with physicians
Photo by .craig

In the News, Medical Education, Mental Health, Surgery

Surgeon offers his perspective on balancing life and work

Surgeon offers his perspective on balancing life and work

5136926303_a3d0bb0767_bMany of us strive to balance our life and work so we can be successful, happy and healthy. Yet, for people with unpredictable work schedules, such as doctors who must treat medical emergencies that have no regard for the nine-to-five work week, it can be hard to achieve this balanced bliss.

Much has been written about this topic, but the candor of this recent blog post from Robert Sewell, MD, a general surgeon at Texas Health Harris Methodist Hospital, caught my eye. In the piece, which originally appeared on the Family Physician blog and was posted on KevinMD yesterday, Sewell gives a brief account of what it’s like to be a surgeon and discusses the challenges and rewards of this career choice. He starts by providing a bit of his own back story:

I got married during medical school, and like every surgeon back in those days I told my wife, “I will always have two wives, you and medicine.” While some spouses accepted that dictum, others, including mine, resented it. Shortly after starting my practice it became clear that our relationship had been strained to the breaking point by my singular focus on achieving my life’s goal.

Sewell acknowledges that it’s desirable to balance the amount of time you devote to your work and personal life, but that as a surgeon it’s not always possible to do so:

Perhaps the most important lesson I learned is that a successful life and marriage requires balance. Too much emphasis on any one aspect throws both you, and those around you, out of balance. This should have been obvious, but as a surgeon, it was an extremely difficult lesson to learn, largely because of the nature of what we do. A kid with acute appendicitis, or an accident victim who is bleeding out from a ruptured spleen, simply can’t wait for a recital or soccer game to be over.

In the last two decades I’ve witnessed a significant effort by many young physicians to push back against those career pressures, as they seek more balance in their lives. While that is certainly a good ideal, being a surgeon is simply not a nine to five job. It’s a calling, and if you are truly called to the profession it’s in your blood.

Previously: Helping those in academic medicine to both “work and live well”Program for residents reflects “massive change” in surgeon mentalityNew surgeons take time out for mental healthUsing mindfulness interventions to help reduce physician burnout and A closer look at depression and distress among medical students
Photo by Colin Harris

Mental Health, Nutrition, Pediatrics

Incorporating the family in helping teens overcome eating disorders

Incorporating the family in helping teens overcome eating disorders

Apple on plateLearning that your teen has an eating disorder is baffling and deeply troubling news for parents. Our instincts are to protect and try to help our children out of the morass, but for decades, families were kept out of the treatment loop for teens with conditions like anorexia and bulimia.

The team at the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital Stanford, led by psychiatrist James Lock, MD, PhD, is integrating the family into helping teens overcome their eating disorders. Lock recently sat down with the Stanford Medicine Newsletter for an informative Q&A about teen eating disorders.  He spoke about the historic reasoning for cutting parents out of treatment plans:

For most of the early 20th century, parents were erroneously blamed for mental illnesses in their offspring: So-called refrigerator mothers (those lacking warmth) caused autism, and overcontrolling parents caused anorexia nervosa, experts claimed. These ideas about causation are without foundation.

Research at Stanford and elsewhere has shown that parents can play a big role in helping their teens recover from eating disorders. For example, we have demonstrated that a specific family-based therapy is twice as effective as individual psychotherapy for treating anorexia nervosa.

And what to watch for in teens:

Warning signs include changes in eating patterns, skipping meals, increased driven exercise or discussion about weight, avoidance of desirable but calorically dense foods, refusing to eat with the family, vomiting, large amounts of food missing from the refrigerator and increased irritability and emotionality. If a parent sees these signs, it would be a good idea to make an appointment for an evaluation and consultation.

The full Q&A is worth a read.

Previously: Families can help their teens recover from anorexia, new study showsA growing consensus for revamping anorexia nervosa treatmentPossible predictors of longer-term recovery from eating disordersWhat a teenager wishes her parents knew about eating disorders and Research links bulimia to disordered impulse control
Photo by daniellehelm

Health Costs, In the News, Mental Health, Research, Stanford News

Exploring the costs and deaths associated with workplace stress

Exploring the costs and deaths associated with workplace stress

6273248505_43d0b56424_oMany of us know that a stressful job or work environment can be hard on our physical and mental health. But what is less known – and less studied – is how work-related stress translates into deaths and dollars spent on health care. According to new research, work-related stress may be linked to more than 120,000 deaths per year and about $190 billion in health-care costs in the United States alone.

In a study submitted to Management Science, former Stanford doctoral student Joel Goh, PhD, and Stanford professors Jeffrey Pfeffer, PhD, and Stefanos A. Zenios, PhD, reviewed 228 studies to explore the relationships between ten common sources of workplace stress, mortality and healthcare expenses in the U.S.

The researchers found that a lack of health insurance and job insecurity were among the top stressors linked to poor physical and emotional health. From a recent Stanford Business story:

Job insecurity increased the odds of reporting poor health by 50%, while long work hours increased mortality by almost 20%. Additionally, highly demanding jobs raised the odds of a physician-diagnosed illness by 35%.

“The deaths are comparable to the fourth- and fifth-largest causes of death in the country — heart disease and accidents,” says Zenios, a professor of operations, information, and technology. “It’s more than deaths from diabetes, Alzheimer’s, or influenza.”

Perhaps the most surprising result, the researchers explain, was the strong effect of psychological stressors on overall health:

Employees who reported that their work demands prevented them from meeting their family obligations or vice versa were 90% more likely to self-report poor physical health, the researchers note. And employees who perceive their workplaces as being unfair are about 50% more likely to develop a physician-diagnosed condition.

The researchers acknowledge that the study has some limitations. For example, they were unable to make strong causal links between work-related stress, mortality and health-care expenses; and they only examined 10 sources of stress. The importance of the study, Pfeffer explains, is that it draws attention to the need to create positive work environments where people feel good about themselves and their work.

Previously: How the stress of our “always on” culture can impact performance, health and happinessStudy finds happy employees are 12 percent more productiveWorkplace stress and how it influences health and How work stress affects wellness, health-care costs
Photo by Bernard Goldbach

Mental Health, Parenting, Pregnancy, Women's Health

A telephone lifeline for moms with postpartum depression

A telephone lifeline for moms with postpartum depression

Van_Gogh_-_Madame_Augustine_Roulin_mit_BabyI’m currently pregnant and due in less than two weeks. It’s my second child, so I’m not as worried about caring for a newborn as I was the first time around. But one nagging worry I have is the risk of postpartum depression, sometimes called postnatal depression. I have a family history of depression and that puts me at higher risk. Luckily, it wasn’t a problem with my firstborn, but it can crop up in later pregnancies – and scientists don’t entirely understand the reasons for it.

Postpartum depression usually hits four to six weeks after delivery—though it can show up months later. It’s characterized by feeling overwhelmed, trapped, guilty or inadequate, along with crying, irritability, problems concentrating, loss of appetite or libido, or sleep problems. An estimated 9 to 16 percent of new mothers are affected by postpartum depression. Even men are known to suffer from it sometimes. PPD affects not just the mother (or father), but can have lasting effects on the child as well, so helping these parents through a difficult and isolating time is critical

Now, a study published in Journal of Advanced Nursing shows that providing a social network for new moms, via phone calls from other mothers who had recovered from PPD, could alleviate symptoms for moms in the study for up to two years after delivery. A news release summarized the findings:

For the present quasi-experimental study, researchers recruited 64 mothers with depression up to two years after delivery who were living in New Brunswick. Peer volunteers who recovered from postnatal depression were trained as peer support and provided an average of nine support calls. The average age of mothers was 26 years, with 77% reporting depressive symptoms prior to pregnancy and 57% having pregnancy complications. There were 16 women (35%) who were taking medication for depression since the birth.

I find the idea that this insidious problem could be tackled with a phone version of the ubiquitous and valuable moms’ groups an uplifting one. Compared to drug treatments, regular phone calls from a peer who’s gone through something similar is a relatively cheap treatment. Further studies are needed, but I’ll be watching to see whether this approach takes hold as a standard intervention for PPD.

Previously: “2020 Mom Project” promotes awareness of perinatal mood disorders,  Is postpartum depression more of an urban problem?, Helping moms emerge from the darkness of postpartum depression, Breastfeeding difficulties may lead to depression in new moms, and Dads get postpartum depression, too
Image by Van Gogh

Mental Health, NIH, Pregnancy, Research, Women's Health

Women who have a stillbirth are more likely to experience long-term depression, study shows

Women who have a stillbirth are more likely to experience long-term depression, study shows

5614885964_e75f4261b2_zAny serious loss requires grieving time, and the birth of stillborn child is no exception. However, a recent study suggests that women who have experienced a stillbirth should be monitored for depressive symptoms well after the standard six-month grieving period – up to three years, in fact. Among women who have given birth and who have no history of depression, women who have had a stillbirth are at significantly higher risk of developing long-term depression.

The research was conducted by the NIH’s Stillbirth Collaborate Research Network (SCRN), which defines stillbirth as the death of a baby at or after the 20th week of pregnancy. It occurs in 1 out of 160 pregnancies in the United States, a surprisingly high ratio.

This study is the first to show definitively that women who have no history of depression may face a risk for it many months after a stillbirth

From 2006-2008, the researchers enrolled nearly 800 women from 59 hospitals across the U.S., around a third of whom had delivered a stillbirth (with the other two-thirds having had delivered a healthy baby). In 2009, the women were asked to complete a questionnaire designed to gauge whether they were experiencing symptoms of depression.

After accounting for other factors related to depression and stillbirth among the more than 76 percent of women who did not have a history of depression, the researchers found that women who had a stillbirth were twice as likely to have a high depression score compared to women who had a live birth. This difference was even greater among those responding to the questionnaire 2-3 years after they had delivered, at nearly nine times as likely.

In an NIH article, author Carol Hogue, PhD, director of the Women’s and Children’s Center at Emory University’s Rollins School of Public Health in Atlanta and first author of the study, said, “Earlier studies have found that women with a history of depression are especially vulnerable to persistent depression after a stillbirth, even after the subsequent birth of a healthy child,” but this study is the first to show definitively that women who have no history of depression may face a risk for depression many months after a stillbirth.

The study appears in the March issue of the journal Paediatric and Perinatal Epidemiology.

Previously: 2020 Mom Project promotes awareness of perinatal mood disordersLosing Jules: Breaking the silence around stillbirth, A call to break the silence of stillbirth and Pregnancy loss puts parents’ relationship at risk
Photo by Gates Foundation

Aging, Genetics, In the News, Mental Health, Neuroscience, Research, Women's Health

Are women at greater risk for Alzheimer’s? Stanford expert to discuss on today’s Science Friday

Are women at greater risk for Alzheimer’s? Stanford expert to discuss on today's Science Friday

2187905205_158290644d_zConfession: I named my parents’ cat (who died recently) Watson after listening to Ira Flatow interview James Watson, PhD, while driving cross country with my dad in 2000. Both before and after the all-critical cat-name-inspiring program, Science Friday has been a part of my Friday as often as I can squeeze it in.

So I was happy to hear that today’s program (which airs locally from 11 a.m. to 1 p.m. on KQED) will feature Stanford’s Michael Greicius, MD, MPH. He’ll be talking about Alzheimer’s disease and why the disease affects men and women differently.

Greicius, medical director of the Stanford Center for Memory Disorders, has worked with the gene variant known as ApoE4 – the largest single genetic risk factor for Alzheimer’s, particularly for women. Last spring, he published a study showing that healthy ApoE4-positive women were twice as likely to contract the disease as their ApoE4-negative counterparts.

Greicius is expected to be on in the second hour, from 12 to 1 p.m. Pacific time.

Previously: Blocking a receptor on brain’s immune cells counters Alzheimer’s in mice, Examining the potential of creating new synapses in old or damaged brains, The state of Alzheimer’s research: A conversation with Stanford neurologist Michael Greicius and Having a copy of ApoE4 gene variant doubles Alzheimer’s risk for women but not for men
Photo by *Ann Gordon

Mental Health, Parenting, Pediatrics, Pregnancy, Women's Health

“2020 Mom Project” promotes awareness of perinatal mood disorders

"2020 Mom Project" promotes awareness of perinatal mood disorders

3505373098_0c1961a29a_zHaving a baby is a huge life alteration – who wouldn’t be at least a bit anxious? The vast majority of women experience mood shifts surrounding pregnancy: Around 80 percent experience “baby blues,” and in up to 20 percent this develops into something more serious. But most of these women go untreated, and many undiagnosed.

The California Maternal Mental Health Collaborative (which is changing its name to “The 2020 Mom Project” as they expand outside California) is spearheading efforts to get the word out about perinatal mood disorders. Last Friday, they hosted a seminar on emerging considerations in maternal mental health. As a birth doula, I was particularly happy to listen in. The keynote speakers approached the issue from a pointedly broad perspective, considering the social, economic, and cultural factors that influence health problems and care provision. The take-home message was that to address perinatal mood disorders, we need to address the context in which they happen, including protecting tomorrow’s moms while they are children today.

Vincent Felitti, MD, professor of medicine at UC San Diego and founder of the California Institutes of Preventive Medicine, has done extensive research on how “adverse childhood experiences” affect health by correlating an “ACE score” of self-reported negative experiences such as abuse, neglect, or household dysfunction with incidence of disease. The top-10 causes of death in the U.S. are strongly correlated with high ACE scores. Moreover, so are their risk factors! Much abuse of alcohol, drugs, and food is a coping mechanism for prior traumas. “What we see as the problem turns out to be somebody’s solution to problems we know nothing about,” Feletti said. “Depression is considered a disease, but what if it was a normal response to adverse life experiences? ACE score statistics support this.”

In a similar vein, Calvin Hobel, MD, an obstetrician-gynecologist at Cedars Sinai Medical Center in Los Angeles, spoke about how maternal stress surrounding pregnancy causes complications and adverse child outcomes, including premature birth. Stress causes uterine irritability, which causes cervical changes that favor pre-term delivery. It signals to the placenta that things aren’t going well, and the baby better get out early. Just as soldiers with stressful backgrounds are more at risk for PTSD, moms who’ve had a rough life are more stress-reactive and less prepared to cope with the demands of motherhood.

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