Mental Health

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.

Stephanie Watson

Silent strokes can jeopardize memory

The symptoms of a stroke are sometimes obvious, like numbness or weakness on one side of the face, trouble speaking, difficulty walking, and vision problems. Some strokes, though, pass completely unnoticed—at least right away. But as reported in the June issue of the Harvard Women’s Health Watch, the damage these so-called silent strokes cause to fragile brain tissue can have significant and lasting effects on memory. Although silent strokes don’t cause any obvious symptoms, the interruption in blood flow to the brain can harm the processes needed to form or recall memories, especially if several of them occur over time. You can help prevent silent strokes the same way you others, by controlling blood pressure and cholesterol, not smoking, eating a healthy diet, and exercising.

Patrick J. Skerrett

Memorial Day: Honor the dead by helping the living

Every Memorial Day we remember the men and women who died while serving in the United States Armed Forces. We do this with parades, church services, and placing flags on graves. Another way to honor the fallen is by paying attention to the physical and mental health of those who served and returned. A three-month […]

Nancy Ferrari

iPad apps and screen time for kids: learning or babysitting?

The other day I saw a mother hand an iPhone to a young baby in a stroller. I cringed because it made me think of how much time my young kids spend on the iPad and in front of the TV. It’s a dilemma for parents. Is it okay to let your daughter play with your phone so you can get five minutes of quiet in a restaurant, or will that permanently scuttle her attention span? Ann Densmore, Ed.D., an expert in speech and language development and co-author of Your Successful Preschooler, offers some practical advice for parents. “Screen time is here to stay for young children and we can’t stop it,” she told me. “The world is now inescapably online and digital. Even schools are replacing textbooks with iPads and digital texts. So moms and dads really need to figure out what’s right for their families.”

Martha Herbert, M.D.

New book, The Autism Revolution, offers hope, help for families

For decades, the word “autism” meant an immutable brain disorder, one determined solely by genes and that was only marginally responsive to therapies. Today it is coming to mean something different and more manageable. A growing body of research is dramatically changing the face and future of autism. In The Autism Revolution, a new book from Harvard Health Publications that I wrote with Karen Weintraub, I explain this evolution in autism science and offer strategies for families to help their children right now. One practical finding is that autism is not just a brain disorder but a whole-body condition. Treating digestive and immune system problems can make a profound difference in the family’s life, and even in the autism itself. Another finding is that autism may not necessarily be fixed for life, and that some kids improve with time and treatment.

Guest Blogger

Can grief morph into depression?

Grief can look a lot like depression. Both can make people cry, feel down, have trouble sleeping or eating, and may not feel like doing anything or take pleasure in anything. One key difference is that individuals with major depression tend to be isolated and feel disconnected from others, and may shun support and assistance from others. Some people who are grieving find that an antidepressant helps restore sleep and appetite. Others find it inhibits the grieving process. In general, the grieving process should be allowed to naturally run its course unless a person experiences thoughts of suicide, serious weight loss, or is unable to perform daily functions such as getting out of bed or going to work for more than a day here or there.