Michael Craig Miller, M.D.
Posts by Michael Craig Miller, M.D.
One treatment that can help relieve depression and other mental or emotional problems is cognitive behavioral therapy. It guides individuals to change what they think. A related approach, called metacognitive therapy, helps individuals change how they think. Some preliminary but promising research suggests that metacognitive therapy may be useful for people with attention deficit hyperactivity disorder (ADHD). One study of 88 adults with ADHD found that metacognitive therapy led to significant reduction in ADHD symptoms in 42% of participants, compared to 12% who received supportive therapy. Keep in mind that metacognitive therapy is not yet a proven therapy. More research is needed on its effectiveness in different settings. But that means it doesn’t yet stack up to its elder cousin, cognitive behavioral therapy. And metacognitive therapy can’t be considered as a first line treatment for ADHD.
A friend once asked me about his son, who was about to turn 20. As a teenager, the boy had a quick temper. But now, on the brink of adulthood, the young man seemed to be getting worse. When a teen gets angrier as time goes by, it is a cause for concern. A 19-year-old is no longer a child, but neither is he or she a fully-fledged adult. This in-between state can extend well into the twenties. Some human development researchers have begun to call it “emerging adulthood.” No matter this stage is called, it presents a tricky time for parents and their children. Emerging adults must decide how much help they want or are willing to accept from their parents or anyone else. At the same time, parents must decide how much help it is reasonable to give.
For some people with depression that isn’t alleviated by medication or talk therapy, a relatively new option that uses magnetic fields to stimulate part of the brain may help. Called repetitive transcranial magnetic stimulation (rTMS), it was approved by the FDA in 2008. Although more and more centers are beginning to use transcranial magnetic stimulation, it still isn’t widely available. Transcranial magnetic stimulation directs a series of strong magnetic pulses into the brain. These pulses create a weak electrical current that can increase or decrease activity in specific parts of the brain. In two large studies, rTMS improved depression in 14% of people who underwent it, compared to 5% who underwent sham, treatment. The cost can range from $6,000 to $10,000, depending on the clinic and how many sessions are needed. Insurance may not cover the cost of treatment.
It is normal for children at some points in their development to be concerned about sameness and symmetry and having things perfect. But when such beliefs or behaviors become all-consuming and start interfering with school, home life, or recreational activities, the problem may be obsessive-compulsive disorder (OCD). Obsessions are irrational thoughts, images, and impulses that a person feels as unrealistic, intrusive, and unwanted. To relieve the anxiety caused by these obsessions, a youth may engage in compulsive rituals. Two main types of treatment are used to help youths better manage OCD: a form of talk therapy known as cognitive behavioral therapy, and medication. The ideal approach is to try cognitive behavioral therapy before turning to medication.
A new study involving 1.2 million children and young adults provided reassuring evidence that the drugs used to treat ADHD do not increase the risk of death from heart disease. Researchers analyzed medical records from a nationwide private insurance plan along with health plans based in Tennessee, California, and Washington State. They compared children taking stimulant drugs (like Ritalin and Adderall) that are commonly used to treat ADHD to children not taking these drugs. Cardiac problems were no more common among children using a stimulant as among those not taking one.
Many people try to tune out stress. A healthier approach may be to tune in to it. Paying more attention to what is going on around you, not less, is the first step toward cultivating mindfulness, an excellent technique to help you cope with a range of mental and physical problems, including stress. Mindfulness teaches people to be present in each moment. The idea is to focus attention on what is happening now and accepting it without judgment. Mindfulness techniques have been shown to ease stress, prevent major depression from reappearing, alleviate anxiety, and even reduce physical symptoms such as pain or hot flashes.
One way I procrastinate is to read articles on procrastination. There is quite a good, short, helpful one in this week’s issue of Nature. The authors, who consult to academics in Adelaide, Australia, point out that motivation rarely leads to action. Paradoxically, action leads to motivation. Their concise article is “Waiting for the motivation fairy.” […]
Confused about how to extend analog parenting into the digital world? New guidelines from the American Academy of Pediatrics offers practical advice to pediatricians (and parents) to help children use social media tools safely and in ways that encourage them grow socially and emotionally. Michael Miller, M.D., editor of the Harvard Mental Health Letter, says the guidelines are “anchored in what we know about child and adolescent development rather than any perceived special influences of the social network.”
Artificial food coloring has been blamed for causing hyperactivity in children. For most kids, there is no connection between food coloring and hyperactivity, an FDA panel has concluded. But it also noted that certain children with attention deficit hyperactivity disorder (ADHD) may be uniquely vulnerable, not just to food colorings, but to any number of food additives. The panel said that food additives themselves are not inherently toxic to the nervous system, but that some children have a unique intolerance to these substances.
• LINK TO VIDEO • In early March, I had the privilege of participating in a seminar on stress at Harvard Medical School. The talk was part of a free series called the Longwood Seminars which covers common medical topics. Although I was asked to talk about stress and the heart, I devoted most of […]