Mental Health

Patrick J. Skerrett

New concussion guidelines say “When in doubt, sit it out”

New guidelines for recognizing and managing sports-related concussions could help protect the brains of millions of athletes at all levels of play, from professional football to youth soccer. The guidelines, released today by the American Academy of Neurology (AAN), replace a now-outdated set published in 1997. The guidelines step away from trying to “grade” concussions or diagnose them on the field or sidelines. Instead, they focus on immediately removing from play athletes who are suspected of having a concussion until they can be evaluated. “When in doubt, sit it out.” The AAN estimates that concussions cause between 1.6 million and 3.8 million mild brain injuries each year. Many athletes don’t get medical attention for these injuries, often because they or their coaches don’t recognize the warning signs or take them seriously. The new guidelines should help better identify athletes who have suffered concussions and improve how concussions are managed and treated.

Heidi Godman

Your well-being: more than just a state of mind

Americans are a diverse lot, so it’s no surprise they give different answers when asked about their well-being. But it seems that well-being differs from state to state, too. In the latest Gallup-Healthways Well-Being Index, which gauges the physical and emotional health of people in all 50 states, residents of Hawaii reported the best sense of overall well-being while West Virginia residents reported the worst. The index calculates overall well-being based on six quality of life categories, each of which is made up of several components. Poll respondents in Hawaii had the highest scores in the emotional health and work environment indexes, and were most likely to say they were thriving. People in West Virginia were most likely to say they were not thriving, and had the worst emotional health, the worst health habits, the most diagnoses of depression, and high rates of obesity. People in the other 50 states fell in between. It’s possible to change both emotional and physical well-being, and improve happiness.

Howard LeWine, M.D.

Shared genes link depression, schizophrenia, and three other mental illnesses

Five seemingly different mental health disorders—major depression, bipolar disorder, schizophrenia, autism, and attention-deficit hyperactivity disorder—may be more alike than we think. A ground-breaking new study has identified four regions of the genetic code that carry same variations in people with these disorders. Two of the affected genes help control the movement of calcium in and out of brain cells. That might not sound like much, but this movement provides a key way that brain cells communicate. Subtle differences in calcium flow could cause problems that, depending on other genes or environmental factors, could eventually lead to a full-blown mental illness. But this work offers tantalizing hints that bipolar disorder, major depression, and schizophrenia—and possibly autism and attention-deficit hyperactivity disorder—may not be so distinct after all, but could be different manifestations of the same underlying disorder. This could change the way we view mental illness and open the door to more effective therapies.

Patrick J. Skerrett

Mini-relaxations to ease holiday stress

With Black Friday upon us, the holiday season is now officially underway. Although the next month or so provides many opportunities to see family and friends, be generous, and spread good cheer, it can also be a difficult time. In a stressed-out heartbeat, the holiday season can morph into the hell-iday season. Deep breathing, meditation, progressive muscle relaxation, and visualization can evoke a state of rest and release. Doing them can slow your heartbeat, calm your breathing, lower your blood pressure, and help you chill out. You can’t necessarily eliminate the seasonal stressors. But you can counter them using mini-relaxation exercises, whether you have 10 minutes to spare or just one minute.

Michael Craig Miller, M.D.

In praise of gratitude

The Thanksgiving holiday began, as its name implies, when the colonists gave thanks for surviving their first year in the New World and for a good harvest. Nearly 400 years later, we’re learning that the simple act of giving thanks is not just good for the community but may also be good for the brain and body. Gratitude helps people refocus on what they have instead of what they lack. By acknowledging the goodness in their lives, expressing gratitude often helps people recognize that the source of that goodness lies at least partially outside themselves. This can connect them to something larger—other people, nature, or a higher power. In the relatively new field of positive psychology research, gratitude is strongly and consistently linked to greater happiness. Although some people may be born with a gift for expressing gratitude, anyone can learn how to do it. And this mental state grows stronger with use and practice. Here are some ways to cultivate gratitude.

Michael Craig Miller, M.D.

Metacognitive therapy: a possible new approach for ADHD?

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.

Patrick J. Skerrett

Suicide often not preceded by warnings

A close friend of one of my colleagues committed suicide last week. It happened as so many suicides do—out of the blue. A few days earlier, my colleague had spent the day hanging out with her friend, who was relaxed, upbeat, and normal. Sadly, that’s not uncommon. Many people who commit suicide don’t have an identifiable mental health problem, or give any hints that they are thinking about taking their lives. Every suicide, like every person, is different. Many are sparked by intense feelings of anger, despair, hopelessness, or panic. Suicide almost always raises anguished questions among family members and friends left behind: What did I miss? What could I have done? In my friend’s case, the answers are nothing and nothing. When individuals suddenly take their own lives with no warning, all we can do is look to each other for support. It may be natural to ask, “What did I miss?” But we should remind ourselves what experts say: This kind of death defies prediction.

Robert Shmerling, M.D.

Brain disease deaths high in pro football players

How’s this for a mind-bender: Lou Gehrig may not have had Lou Gehrig’s disease. Instead, the disease that ended his life may have been chronic traumatic encephalopathy (CTE). This brain disease is caused by repeated concussions—Gehrig sustained at least four during his baseball career—or other head injuries. It can cause symptoms very similar to those of amyotrophic lateral sclerosis (ALS), now commonly called Lou Gehrig’s disease. More evidence of a connection between CTE and ALS comes from a new study of almost 3,500 retired professional football players, all of whom had played for at least five years in the National Football League. Among the 334 who died during the course of the study, the risk of death from Alzheimer’s disease or ALS was nearly four times higher than expected. Players who manned a “speed” position (such as quarterbacks or receivers) had a risk of dying from Alzheimer’s disease or ALS that was more than three times higher than those playing “non-speed” positions (such as linemen).

Michael Craig Miller, M.D.

Magnetic stimulation: a new approach to treating depression?

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.

Holly Strawbridge

Heart attack can trigger PTSD

We usually think of post-traumatic stress disorder (PTSD) as an aftermath of military combat or terrible trauma. It can also strike heart attack survivors. By the latest account, 1 in 8 people who live through a heart attack experiences a PTSD-like reaction that might be called post-traumatic stress disorder (PTSD). They experience the same key symptoms: flashbacks that occur as nightmares or intrusive thoughts. They try to avoid being reminded of the event and become hypervigilant worrying that it will happen again. As treatments for heart attack continue to improve, 1.4 million people a year are now surviving the event long enough to be discharged home. If the study is correct, 168,000 of them will be diagnosed with PTSD every year. It’s a grim reminder that as we get better at fixing the body, we must recognize the need to treat the mind.