Be Healthy Fall 2015 by Banner Publications Inc.

Fall 2015

Be knowledgeable. Be well. Be healthy.

Mental health

OUR EMOTIONAL WELL BEING

2 Be Healthy | Fall 2015

Publisher Melvin Miller Health Editor Karen Miller Senior Editor Yawu Miller Art Director Daniel Goodwin Production Caleb Olson Proofreaders Rachel Reardon For advertising opportunities Please contact Karen Miller at (617) 936-7800 or kmiller@bannerpub.com

Be Healthy is published by Banner Publications, Inc. 23 Drydock Ave. Boston, MA 02210 Volume 3 â&#x20AC;˘ Number 2 Fall 2015 Be Healthy is printed by Cummings Printing 4 Peters Brook Drive P.O. Box 16495 Hooksett, NH 03106 603-625-6901 COVER PHOTO: THINKSTOCK/ANDS456 PAGE 3 PHOTO: THINKSTOCK/ SIPHOTOGRAPHY

Editorâ&#x20AC;&#x2122;s note: The information presented in Be Healthy is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate for your age, sex, race and risk factors and make timely visits to your primary care physician.

Mental health

Bipolar disorder: Not the normal ups and downs

Recipe: Szechuan stir-fry

Fall 2015 The issue

Mental Health

Focus

Depression Bipolar disorder Suicide Anxiety

10 12 14 17

Healthy steps

Recipe Nutrition Yoga Exercise

19 20 22 23

baystatebanner.com/news/be-healthy | Be Healthy 3

The issue: Mental Health

MENTAL ILLNESS Very common but often goes untreated

THE GENERAL PUBLIC'S PERCEPTION OF MENTAL ILLNESS IS MORE OFTEN INFLUENCED BY ITS PORTRAYAL IN THE MOVIES THAN BY FACT. In reality you sit beside people with mental health disorders on the bus and you work with them. Just as you cannot detect who has diabetes or high blood pressure, for the most part, you cannot detect who has a mental illness. That’s because when diagnosed many mental health conditions can be successfully treated. Mental illness carries an air of mystery. That’s understandable. It’s a disease of the brain, which is a complex, sophisticated organ that controls almost every aspect of the human body. The brain not only enables us to think, remember and breathe but it also controls our emotions and behavior. It makes up only two percent of our body weight but consumes 20 percent of the energy we use — it is constantly working. President Barack Obama in 2013 developed The Brain Initiative to help solve and understand its mysteries. Sometimes the communication system in the brain goes a little awry. Chemicals called neurotransmitters may not function as well as they should and prevent messages from getting through. It is this malfunction that can lead to certain forms of mental illnesses. For instance, as noted by the National Institute of Mental Health, low amounts of the chemical serotonin can lead to depression; an inadequate supply of glutamate, the most common neurotransmitter, is linked to depression, schizophrenia and obsessive compulsive disorder, or OCD. Medications help restore the balance. Mental disorders can also result from trauma or other 4 Be Healthy | Fall 2015

environmental stimuli. Some disorders are genetically linked, particularly schizophrenia and bipolar disorders. When mental health symptoms interfere with daily living it’s advisable to talk with your primary care physician. Chances are they won’t subside on their own. Symptoms vary by the disorder, but Dr. Morgan Medlock, a psychiatrist at McLean Hospital, explained that there are some tell-tale signs regardless of the exact illness. “There’s a social aspect of mental instability,” she said. “A person may no longer interact at school or church and becomes withdrawn. If a person’s social functioning changes, that’s a strong indicator.” The economic impact of mental illness is huge. The April 2015 Medical Expenditure Survey noted that at $51.1 billion, mental disorders were the third most costly medical expenditures for adults between 18 and 64 in the U.S. in 2012.They trailed only traumatic-related disorders and cancer. Almost half the expenditures were due to prescribed medications. These figures correspond to the volume of patients. Approximately 45 million or almost 20 percent of U.S. adults experience a mental illness in a given year, as noted by the National Association of Mental Illness, or NAMI. In comparison only 14 million people are living with cancer and 29 million have diabetes.

The issue: Mental Health

“

The mind is one thing that a person feels able to control. Especially for individuals who feel they have already lost control of many other areas of their lives, losing control of the mind is scary.” — Dr. Morgan Medlock Psychiatrist McLean Hospital

PHOTO: THINKSTOCK/ CHERYL CASEY

Yet, as common as these illnesses are, nearly 60 percent of adults with a mental illness fail to receive treatment in a given year. For many reasons. One is lack of availability of mental health services and providers. A report published by Mental Health America — Parity or Disparity: The State of Mental Health in America 2015 — showed a wide difference among states in prevalence of mental illness as well as access to care. For instance, while Massachusetts has one mental health provider for every 248 residents, Alabama has one provider for every 1,827 residents. Availability of health insurance is another factor. Since the passage of the Affordable Care Act, commonly referred to as Obamacare, only 12 percent of people in this country lack health insurance, according to the most recent Gallup report. The ACA’s impact on coverage for mental health services,

»TYPES OF MENTAL ILLNESSES The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is used by mental health professionals to diagnose and classify mental disorders. It consists of dozens of psychiatric disorders. Some disorders have subcategories, which have subcategories of their own. The list below is a brief summary of common disorders. n Attention deficit hyperactivity disorder (ADHD): Difficulty staying focused and paying attention; more common in childhood, but may continue into adulthood. nA nxiety disorders: Characterized by excessive worry and fear, panic attacks and phobias nA utism: Developmental disorder that disrupts the ability to socialize or interact with others nB ipolar disorder: Characterized by mood swings, shifting from depression to mania or hypomania nB orderline personality: Difficulties in regulating emotions; includes a pattern of unstable relationships, distorted self-image and impulsiveness. nD epression: Persistent feelings of sadness, worthlessness and hopelessness

nD issociative disorders: Characterized by a disconnection between thoughts, identity and memory; can include amnesia and alternate personalities nO bsessive-compulsive disorder: Characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform nP ost traumatic stress disorder: Intrusive memories of a traumatic event; avoidance of activities related to the trauma n S chizophrenia: Serious mental illness that interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others For more detailed information visit the National Institute of Mental Health at www.nimh.gov.

baystatebanner.com/news/be-healthy | Be Healthy 5

The issue: Mental Health

Stigma The stigma of a mental health illness looms large among blacks. There is a fear of being considered “crazy” or hospitalized or reluctance to “air their dirty laundry.” Some are too embarrassed to receive care or think that treatment will not be effective. Or they may not be aware that the symptoms require treatment. Blacks might feel uncomfortable discussing their problems with people of another race for fear they will not be understood or misdiagnosed. NAMI reported that African American men are more likely to receive a misdiagnosis of schizophrenia when expressing symptoms related to mood disorders or PTSD. Medlock agreed. “There’s an overdiagnosis of schizophrenia and psychosis among blacks,” she explained. Loss of control is another fear. “The mind is one thing that a person feels able to control,” Medlock theorized. “Especially for individuals who feel they have already lost control of many other areas of their lives, losing control of the mind is scary.” 6 Be Healthy | Fall 2015

Dr. Morgan M. Medlock can combine two of her skills in treating patients. She is a psychiatrist and has a Master of Divinity degree.

»TYPES OF MENTAL HEALTH PROVIDERS There’s a common misperception that mental health services fall under the purview of psychiatrists. Not so — and that might be a good thing. According to the most recent report from the U.S. Bureau of Labor Statistics, psychiatrists number roughly 25,000 — too few to tend to all those in need. In comparison, licensed clinical social workers, who provide the bulk of mental health care in some settings, add 200,000 to the pool. There are several other types of mental health professionals, but may differ in the level of services offered or licensure to prescribe and dispense medication. In addition, some providers specialize in treating certain mental health conditions, such as bipolar disorder or schizophrenia. These factors should be considered when choosing a provider. Mental health providers that can prescribe medication: nP sychiatrists are medical doctors (M.D.) nP sychiatric mental health nurse or doctors of osteopathy (D.O.) that practitioners (P.M.H.N.) are registered specialize in the diagnosis and treatnurses with training in mental health. ment of mental health disorders. Some n C ertified physician assistants psychiatrists, however, only prescribe (P.A.-C.) practice medicine under the medication and do not counsel patients. supervision of physicians and can specialize in psychiatry. Mental health providers that cannot prescribe medication: nP sychologists hold a doctoral degree n L icensed professional counselors (L.P.C.) (Ph.D., Psy.D., Ed.D) in psychology are trained to provide diagnoses and psyand are trained to make diagnoses and chotherapy. Training varies by state, but provide individual and group therapy. most have at least a master’s degree. n L icensed clinical social workers n S everal other providers, such as marital (L.C.S.W.) hold a master’s or doctoral and family therapists, certified alcohol degree in social work and are trained to and drug abuse counselors are available. provide assessment and counseling. Credentials may vary by state.

PHOTO: ARAM BEDROSIAN

however, is not universal and can vary from state to state. African Americans and other minorities are less represented in the patient pool of mental health services. Only onethird of African Americans who need such care receive them, according to the American Psychiatric Association. In addition, blacks are more likely to stop treatment early and less likely to receive follow-up care. Yet, the daily challenges of many people of color — poverty, low education, discrimination — can cause undue stress, depression and anxiety. Dr. Chester M. Pearce, a black psychiatrist affiliated with Massachusetts General Hospital, coined the phrase “microaggressions” in 1970 to mean unintended discrimination. These subtle forms of racism can accumulate and result in a toxic stress response. The American Psychiatric Association agrees. In 2006 the organization took the position to recognize that racism and racial discrimination can adversely affect mental health.

The issue: Mental Health

»STIGMA: THE SOUND OF SILENCE

PHOTO: ACTIVE MINDS

Pablo Campos, 27, said he was always an emotional guy. “It’s the Latin culture,” he explained. “We tend to be very passionate.” That emotion eventually led to trouble. In the third grade he was a bully and picked on other kids. He had outbursts if he thought that someone didn’t like him. By the fifth grade he was drinking and by age 12 had experimented with pot. At 15 he was referred to a psychiatrist and diagnosed with chronic depression. The prescribed medication and weekly talk therapy helped, but did not curb his behavior. “My problems escalated,” he said. By sophomore year he was using hard drugs. “That made everything worse,” he confessed. “I was moving backwards in mental health.” By the beginning of his senior year things got very low. He came to the conclusion that he had only one option. “I didn’t want to be around anymore,” he decided. He took 40 pills — anything he could find. He cut his wrists, then hopped into his car and drove over 100 miles an hour. The flashing lights of a patrol car — and a crash barrier — stopped him. He blacked out and woke up in a hospital handcuffed to the bed. That’s when he came face to face with the stigma of mental health. His parents finally confessed that his maternal and paternal grandparents suffered with depression, addiction and anxiety, but no one ever talked about it. The culture of Guatemala — his parents’ birthplace — didn’t allow it. “It’s on the down low,” Campos said. “People won’t go for help and advice. It took my attempted suicide for them [his parents] to acknowledge it.” Since many mental illnesses have a genetic link, this information could have been valuable to him and his therapists. Stigma isn’t limited to older people. Teens and young adults readily seek treatment for substance abuse. To them that’s cool, Campos explained. But treatment for a mental health disorder is a sign of weakness. “There’s no street cred,” he said. At age 20 Campos got on the right track through professional help. He has a strong support system, he got married and he is studying to become a clinical social worker. He exercises regularly and has become a foodie of sort. Campos works with Active Minds, the leading non-profit organization that aims to remove the stigma of mental illnesses and encourage open conversations on college campuses nationwide. Campos wants to help others. “I’m seven years clean,” he said.

Religion and faith have long been the cornerstone of the black community. Medlock, who has a master’s degree in divinity, understands. “We try to pray away mental illness,” she explained. Faith may be able to move mountains, but, when it comes to mental health, it might require a little help from a psychiatrist. Medical and spiritual interventions work together for an individual’s healing. The impact of stigma is unfortunate. Mental illness can be treated with good results. Medications, such as anti-depressants and mood stabilizers are effective. Meds are part of the treatment. Psychotherapy, or talk therapy is the other. “Talk therapy helps you to get to the root of the problem,” Medlock said. “It causes changes in the brain as do meds.” She stressed the impact of lifestyle. A healthy diet, exercise and some supplements, such as omega 3, all play into a healthy mind, she advised.

Consequences Ignoring the problem will not make it go away. There can be dire consequences in addition to unnecessary pain and suffering. A government report found that more than onefourth of all sheltered persons who were homeless had a severe mental illness and more than one-third had chronic substance abuse. In a presentation to the Massachusetts Association for Mental Health, Steven W. Tompkins, the sheriff of Suffolk County, said, “Approximately 42 percent of Suffolk County inmates present with some form of mental illness that ranges from mild personality disorder to major mental illness. Of that number, approximately 26 percent suffer from a major mental illness.” He went on to explain that many inmates have co-occurring mental health and substance abuse disorders. Medlock is encouraging. “Some people can recover fully from a mental illness,” she explained. “If the illness no longer impedes one’s ability to have the life they desire, that is considered a full recovery.” baystatebanner.com/news/be-healthy | Be Healthy 7

»A MENTAL HEALTH CHECKUP: DEPRESSION Over the last 2 weeks, how often have you been bothered by any of the following problems? (Use “√” to indicate your answer)

Not at all

Several days

More than half the days

Nearly every day

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

3. Trouble falling or staying asleep, or sleeping too much

4. Feeling tired or having little energy

5. Poor appetite or overeating

6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down

7. Trouble concentrating on things, such as reading the newspaper or watching television

8. Moving or speaking so slowly that other people could have noticed? Or the opposite — so fidgety or restless that you have been moving around a lot more than usual

9. Thoughts that you would be better off dead or of hurting yourself in some way

+ __

____ +

+ _ _______ =Total Score: ________

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all

Somewhat difficult

Very difficult

Extremely difficult

Scores of 5, 10, 15, and 20 represent cut points for mild, moderate, moderately severe and severe depression, respectively. Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. This tool is for educational purposes only and is not a substitute for diagnosis by a mental health professional.

Providing whole-person care for children and adults under one roof.

Improving lives, together. Providing a full continuum of psychiatric care for all ages.

Belmont, Mass. 800.333.0338 www.mcleanhospital.org

8 Be Healthy | Fall 2015

Integrated services include: - Primary Care & Preventative Medical Care - Behavioral Health Care - Substance Use Concerns - Women’s Health & Prenatal Care

We’re working as a team for you! Staff includes: - Physicians & Nurses - Psychiatrists & Social Workers - Case Managers - Nutritionists - Pharmacists - Medical Assistants and much more!

Evening and weekend appointments available. Call: 617-442-8800 - 45 Dimock St. Roxbury, MA www.dimock.org

Focus:Mental health A closer look » Depression 10 » Bipolar disorder 12 » Suicide 14 » Anxiety 17

Jordan Burnham talks to students about getting help for mental illnesses. PHOTO: ACTIVE MINDS

“

It’s okay to ask for help. Don’t worry about stigma.” — Jordan Burnham Suicide survivor

14 baystatebanner.com/news/be-healthy | Be Healthy 9

FOCUS: Depression

Major depressive disorder PEOPLE TEND TO USE THE WORD "DEPRESSED" RATHER LOOSELY. They often mistake depression for grief or sadness. Although the conditions share some traits, they are actually quite different. It is normal to experience grief or sadness in response to a loss or something unpleasant in life. Sadness, however, is not constant and is interspersed by lighter moods. It also tends not to affect a person’s functioning. Sadness and grief eventually subside. Depression does not.

Albert S. Yeung, M.D. Director of Primary Care Studies Depression Clinical and Research Program Massachusetts General Hospital

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The disorder can affect anyone. It knows no bounds. Both genders, all ages and all races are targets. Celebrities are not exempt. Halle Berry, Alicia Keys and Kanye West have all been victims. Even Serena Williams, who is ranked number one in women's singles tennis, admitted that she at one time had been afflicted. The medical term is major depressive disorder. Its diagnosis involves a detailed examination of symptoms that have interfered with one’s normal functioning at work and at home for at least two weeks. The DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) is the standard classification of mental disorders and the bible of mental health practitioners. It serves as a universal authority for psychiatric diagnosis. According to the DSM-V, there are nine distinct symptoms of major depressive disorder — changes in appetite and sleeping, loss of energy and difficulty in making decisions, for example. An individual who experiences at least five of the nine symptoms is diagnosed with depression, according to Dr. Albert S. Yeung, a psychiatrist at Massachusetts General Hospital. In addition, according to Yeung, one of the five symptoms must be depressed mood or loss of interest in activities one usually enjoyed. Depression is one of the most common types of mental illness. The National Institute of Mental Health reports that approximately 15 million people suffer the condition every year. It takes a toll on the

economy. In a study published recently in the Journal of Clinical Psychiatry, depression costs $211 billion a year, which comprises direct costs, reduced productivity (workplace) costs and suicide-related costs, which include loss of earning. It can occur at any age. Women are 70 percent more likely than men to experience depression, but it’s possible that men — less eager to seek help — are undercounted. The incidence in minorities is comparable to that in whites. Depression is common among older people, and is largely precipitated by chronic medical illnesses, financial difficulties and isolation. Depression is caused by a combination of genetic, biological, environmental and psychological factors. Some types run in families. Other cases may stem from trauma or a very stressful situation. An imbalance in the brain of certain chemicals, such as serotonin, that controls mood may also be a factor. MRIs have shown that the parts of the brain that effect mood, sleep, thinking, appetite and behavior appear to be different from those without depression. It’s challenging enough to cope with depression alone, but many times it pairs up with other mental health disorders. “It does not protect you from other conditions,” explained Yeung. People can also suffer from PTSD or substance abuse. Anxiety often goes hand-in-hand with depression. “They’re like siblings,” he explained. Other medical conditions are linked to depression as well. Low levels of thyroid hormone can lead to depression symptoms. Up to 27 percent of people with diabetes have depression, and it’s a two-way street. Diabetes increases

PHOTO: ALBERT YEUNG, M.D.

You don’t just ‘snap out of it’

FOCUS: Depression

» COULD YOUR SADNESS BE DEPRESSION? Major depressive disorder, or depression, is a common and serious medical illness that negatively affects how a person feels, thinks and acts. It can decrease one's ability to function at work and at home. Fortunately, it is also treatable. Depression is diagnosed if a person demonstrates at least five of the symptoms listed below. One of the symptoms must be depressed mood or loss of interest. Symptoms must last at least two weeks. Depression symptoms can vary from mild to severe and can include: n Feeling sad or having a depressed mood n Loss of interest or pleasure in activities once enjoyed n Changes in appetite — weight loss or gain unrelated to dieting n Trouble sleeping or sleeping too much

n Loss of energy or increased fatigue n Restlessness or slowed movements and speech n Feeling worthless or guilty n Difficulty thinking, concentrating or making decisions n Thoughts of death or suicide SOURCE: AMERICAN PSYCHIATRIC ASSOCIATION

the risk of depression and depression may lead to unhealthy lifestyles which increases the risk of diabetes. Scientists also now theorize that depression is actually a risk factor for Alzheimer’s disease. The good news is that treatments are available and major advances have been made in medications over the years. “There is a new generation of medicines for depression,” Yeung explained. “And they are safer.” If a person does not respond to the initial course of treatment, there are many alternative medicines available. Transcranial magnetic stimulation is a new approach which has been approved by the Food and Drug Administration for treatment of resistant depression. Research studies have shown favorable outcomes, according to Yeung, but so far insurance does not cover the cost, which can be expensive. In addition to medications, talk therapy or psychotherapy is recommended. Talk therapy is “getting to the meat of the matter.” It involves problem-solving and finding the trigger that precipitated depression. People learn coping skills and how to handle challenges. Talk therapy alone may be adequate treatment for those with milder forms of depression.

In spite of the advances in diagnosis and treatment a high percentage of blacks do not receive treatment for depression. For several reasons. The stigma of mental health remains high in the black community. Some people do not have access to care or lack coverage for services in their health plan. A recent report published in General Hospital Psychiatry found that only 19 percent of Black Americans with major depression received treatment recommended by American Psychiatric Association guidelines. Those with a concomitant medical condition often fared worse; treatment was focused primarily on the medical illness only. Lack of treatment has serious results. Not only do people suffer unnecessarily, depression is the leading cause of suicide. Yeung emphasized that successful treatment also includes self-management. “There’s a new wave of mindfulness that helps alleviate symptoms,” he said. Yoga, tai chi and meditation are an effective complement to treatment of depression. Depression is curable. A person can have only one episode that is successfully treated. People who have learned good coping skills or know their trig-

» TYPES OF DEPRESSION Major depressive disorder: This disorder, often just referred to as depression, is marked by severe symptoms that interfere with your daily life. The symptoms must be at least two weeks in duration. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes. Persistent depressive disorder: This form of depression has less severe symptoms than major depressive disorder and lasts usually two years or more. It also can interfere with normal functioning. Bipolar disorder: Also called manic-depression, bipolar disorder is characterized by mood changes that cycle from extreme highs (mania) to extreme lows (depression). DEPRESSIONS THAT DEVELOP UNDER UNIQUE CIRCUMSTANCES: nP sychotic depression: Occurs when a person has severe depression plus some form of psychosis, such as having delusions or hallucinations. nP ostpartum depression: Occurs in 10 to 15 percent of women after giving birth. n S easonal affective disorder (SAD): Characterized by the onset of depression during the winter months, when there is less natural sunlight.

gers fall into that category. Others may require longer care, however, especially if they have a history of recurrence or poor response to the initial recommended medication. Yeung remains optimistic. “People need to understand that depression is a medical disease. It can be overcome,” he said. “Most people with depression get better with treatment.” baystatebanner.com/news/be-healthy | Be Healthy 11

FOCUS: Bipolar disorder

Not the normal ups and downs HAKEEM RAHIM, 34, WAS A STUDIOUS LITTLE KID. He would sit quietly in class, his shirt buttoned up and glasses perched on his nose. “You look like someone you’d take your taxes to” was a comment once made about him. That little kid grew up to be a 6-foot-oneinch 200-pound wrestler and soccer player in his high school in New York. He had aspirations of being a doctor. He was on his way as a pre-med student at Harvard University when his life suddenly took an unexpected turn. At the age of 17 he had his first panic attack. He attributed it to stress from being away from home in a new environment. He retreated to his dorm and the safety of his bed in a darkened room. “I thought I was sick,” he explained. After about an hour he felt better. Rahim said he had mood swings during his freshman year but explained them away. “I didn’t think it was out of the norm,” he said. “College does that.” At the end of his freshman year he had his first episode of mania. Rahim explained he felt overly confident and certain. He talked … a lot. When he returned home to New York, his feeling of empowerment grew. He 12 Be Healthy | Fall 2015

was convinced that he had insights to the universe. He walked up and down the streets imparting wisdom — so he thought — to total strangers. This manic phase lasted for one to two weeks. His parents thought he was stressed and sent him to stay with relatives in Grenada to unwind. After about five days he plummeted into depression. He fared better his sophomore year, but still experienced highs and lows and social anxiety. He slept a lot, but that’s what Harvard does to you, he reasoned. At the end of sophomore year Rahim had another episode of mania. This time he finally got the care he needed. He was hospitalized in New York for two weeks. There he got his diagnosis — schizoaffective disorder and bipolar I disorder. As is often the case, Rahim’s illness coexisted with anxiety and psychosis. He began medication and talk therapy. That didn’t mean, however, that it was clear sailing. In his junior year the meds caused him to gain weight and sleep too much. He didn’t make it through the second semester. Nor did he succeed when he tried to return the next fall. “I crashed,” he explained.

Hakeem Rahim, Ed. M, M.A. founded Live Breathe, LLC, which focuses on mental health advocacy and educational consulting.

He took another year off and worked at a bank. He had his meds adjusted. The adjustment and time off did the trick. He returned to Harvard, but it took great effort, he said. “It was like learning to ride a bike again.” His mind had slowed and it took him a while to catch up. He survived with tutoring, which also included counseling services. That’s when he turned things around. “That was 100 percent helpful,” he explained. Rahim is not alone in his struggles. It is estimated that 6 million people in this country suffer from bipolar disorder (formerly called manic depression), according to the National Institute of Mental Health. As in Rahim’s case, it often starts in the late teens or early adult years, but children and older adults are not exempt. Often the symptoms are overlooked or not recognized. Rahim’s mood swings were attributed to the rigors of college life rather than a mental illness. The cause of bipolar disorder is not always clear. There is a genetic link. It can run in families. Roughly 80 to 90 percent of those diagnosed have a relative with either depression or bipolar disorder, according to the American Psychiatric Association.

PHOTO: PETROLNELLA PHOTOGRAPHY

Bipolar disorder

FOCUS: Bipolar disorder

The disorder is marked by two distinct phases — depression, or periods of deep sadness, and mania, periods of extreme agitation. Some people experience hypomania instead of mania. Hypomania is characterized by less severe symptoms than mania, lasts at least four days and does not interfere with daily functioning. There’s more than one type of bipolar disorder. Bipolar I is characterized by mood swings from major depressive disorder to mania. Bipolar II disorder occurs when a person has at least one major depressive episode and at least one hypomanic episode. Cyclothymic disorder is characterized by frequently occurring mood swings of hypomania and depression. The symptoms, however, are less severe than the other two forms of the disorder.

“

This disease might change your mind, but it does not change you. I am more than medication. I am still Hakeem Rahim.”

The phases can be dangerous. A person can attempt suicide during the depressive phase, or engage in reckless activities, such as spending sprees or careless sex when manic. Bipolar disorder can coexist with other mental health disorders. Psychoses, anxiety and substance abuse are often concomitant with the disorder. Bipolar disorder does not go away. It’s lifelong. However, it is very treatable.

»SYMPTOMS OF BIPOLAR DISORDER Below are examples of symptoms that might occur with bipolar disorder. If symptoms persist and interfere with your day-to-day activities, it is advisable to seek consultation with your medical advisor. Symptoms of mania or hypomania may include: n A long period of feeling "high" n Sleeping little or not being or being overly happy or outtired going n Having an unrealistic belief in n Talking more than usual and one's abilities talking fast, having racing n Behaving impulsively, e.g. unthoughts restrained buying sprees, sexual n Extreme irritability indiscretions or foolish business n Being easily distracted investments n Being overly restless n Racing thoughts Symptoms of depression may include: n An overly long period of feeln Insomnia or sleeping too much ing sad or hopeless n Thinking of death or suicide or n Loss of interest in activities attempting suicide once enjoyed, including sex n Having problems concentratn Feeling tired or "slowed down" ing, remembering and making n Being restless or irritable decisions

» MAJOR TYPES OF BIPOLAR DISORDER n Bipolar I Disorder — defined by at least one episode of mania. The mania may require hospitalization or trigger a psychosis, which is a break from reality. n Bipolar II Disorder — defined by a pattern of depression and hypomania, but not mania. n Cyclothymic Disorder, or Cyclothymia — a mild form of bipolar disorder. Characterized by episodes of hypomania as well as mild depression for at least two years.

Medication alone or medication with psychotherapy is typically used. The disorder might be treatable, but it is not always easy to diagnose, according to the National Institute of Mental Health. That’s partly because it may seem like several different problems. Patients may be initially diagnosed with schizophrenia or depression alone. A few years ago Rahim decided to “come out,” so to speak and share his

experience with others. “I felt I was hiding and lying to myself,” he explained. He went on the speaking circuit and works closely with NAMI in Queens/ Nassau as a presenter for Let’s Talk Mental Illness program. His message is clear. “This disease might change your mind, but it does not change you,” he explained. “I am more than medication. I am still Hakeem Rahim.” baystatebanner.com/news/be-healthy | Be Healthy 13

FOCUS: Suicide

A tragic decision With treatment suicide is often preventable IT TOOK JORDAN BURNHAM, 26, JUST 2½ SECONDS TO REACH THE PAVEMENT FROM HIS NINTH FLOOR BEDROOM WINDOW. But he does not remember one second of the fall. Perhaps that’s a good thing. It must be frightening to see the world pass by at rapid speed. He remembers the ambulance and the lights at the football stadium as they passed by. But those few seconds are completely erased. Burnham landed on his left side and fractured the bones in his leg, thigh, pelvis, wrist and jaw. He was hospitalized for five months and just recently had his last surgery — seven years after the event. The jump from his bedroom window was a culmination of events and problems that could be traced back to the third grade. Burnham said he would smile and joke and make people laugh. That allowed him to fit in but it also allowed him to hide the depression lurking within. He noticed that he would still be upset about

something that happened months ago. “I shouldn’t still feel this way,” he thought. Looking back, he realizes he had no coping skills. High school was a challenge. He was the only black person and felt the pressure that he had to be better than most — almost perfect. “I felt I had the weight of the African American community on my shoulders,” he explained. He began to drink. In hindsight he said it served as a coping mechanism. Back then, he thought it was just the culture of high school. The tipping point came at the age of 16 when he failed his driving test. When a stop sign tripped him up, he flew into a rage, which resulted in a referral to a therapist. It was then that Burnham was diagnosed with depression, but he did not take the sessions with the therapist seriously. “I thought I would go two times and move on,” he said. “I did not see treatment as a process.” He was prescribed

With a combination of talk therapy, medication and a wide support network, Jordan Burnham is able to cope with his depression.

medications, but took them haphazardly. Junior year was not a good one for Burnham. Things really began to spiral downward. He drank and partied more than he should. Images of college were slowly retreating. Thoughts of suicide began to creep in. When he verbalized these thoughts his family called the police who transported him to a psychiatric hospital. “I did not know what to expect,”

n Depression or other mental health disorders n Substance abuse n Family history of mental disorder or substance abuse n Family violence, including physical or sexual abuse

n Firearms in the home n Family history of suicide n Exposure to suicide of family members, peers or celebrities n Chronic illness or pain n Gender — occurs in almost four times as many males as females

n Age — more common in people under the age of 24 and 65 and older n Being the victim of bullying n Previous attempts n Race — more common in American Indians and whites, but the number is increasing among blacks

Suicide is not a normal response to these risks and can often be prevented by appropriate treatment for the mental or substance abuse disorder. 14 Be Healthy | Fall 2015

PHOTO: ACTIVE MINDS

» WHAT PUTS A PERSON AT RISK FOR SUICIDE?

FOCUS: Suicide Suicide in African Americans

Joseph D. Feaster Jr. talks openly about the suicide of his son in hopes of bringing mental illness to the forefront in the African American community.

Burnham said. But life in the hospital was easier than on the outside. It was a safe environment, he explained. After discharge he continued to drink — even though he was on antidepressants. The low point came during his senior year when the party he gave was busted by the police. His friends who attended were suspended from school athletic teams. Burnham said he felt he let them down. He let his parents down. When his father discovered the stash of alcohol in the trunk of his car, his thoughts changed from “why am I here?” to “I don’t want to be here anymore.” He called his girlfriend and said “I have to go.”

There’s a perception that African Americans do not commit suicide. It has always been considered a white person’s affliction. To a certain extent, that is true. In figures from the 2013 National Vital Statistics System, suicide is the 10th leading cause of death in whites, but does not show up in even the top 15 causes of deaths in blacks. When you break the figures down by age, however, another picture emerges. In all age groups the number and percentage of deaths from suicide is greater in whites, but between the ages of 10 and 14, it is the third leading cause of death in both groups. After that the trends differ. Suicide jumps to the number 2 killer in whites from age 15 to 34, and remains in the number 3 position in blacks up to the age of 24. The difference is the age at which suicide hits the hardest. In blacks, it is more common between the ages of 20 and 44 — the peak earning years. In whites it is more common in the fifth decade. These numbers, however, may change. In a May 2015 study published in the May JAMA Pediatrics, researchers found that suicide rates among elementary-aged children between five and eleven increased significantly in blacks from 1993 to 2012, while the rates fell in whites. There are many possible causes for the uptick in suicides among black youth. Easy access to firearms and exposure to trauma have an impact. Most importantly, however, is failure to receive treatment for depression, anxiety and other mental illnesses. Almost 100

percent of suicides occur among people with a history of mental illness.

A closer look at suicide Homicides pervade the daily news and top the headlines of many local newspapers while suicides — unless they involve celebrities — do not make the news. This lopsided reporting gives the impression that the number of homicides far outweighs the number of suicides. Not so. In Massachusetts suicides are almost five times more common than homicides. In the most recent data from Massachusetts’ Injury Surveillance Program, in 2012 the Commonwealth experienced 624 suicides and 135 homicides. The number pales beside attempted suicides. In fiscal year 2013 there were over 4,200 hospital discharges for self-inflicted injuries and almost 7,200 emergency department visits. The majority of suicides are committed by males, but females make more attempts. The most common age for suicide in the Commonwealth is 45 to 64. While males use firearms and hanging, females resort to hanging and overdoses. If Burnham could take that leap back he would. He said he gets it now. “Learn to cope and deal with problems,” he advised. Jordan is now a mental health advocate. He works with Active Minds, the leading non-profit organization that aims to remove the stigma of mental illnesses and encourage open conversations on college campuses nationwide. Burnham offers advice. “It’s okay to ask for help. Don’t worry about stigma,” he said.

» PAY ATTENTION TO THE WARNING SIGNS!

PHOTO: JOE FEASTER

n Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself n Looking for ways to kill oneself by seeking access to firearms, available pills or other means n Talking or writing about death, dying or suicide n Feeling hopeless

n Feeling rage or uncontrolled anger or n Feeling anxious, agitated or unable to seeking revenge sleep or sleeping all the time n Acting reckless or engaging in risky acn Experiencing dramatic mood changes tivities — seemingly without thinking n Giving away belongings or getting n Feeling trapped — like there’s no way affairs in order out n Seeing no reason for living or having no n Increasing alcohol or drug use sense of purpose in life n Withdrawing from friends, family and society SOURCE: SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA). baystatebanner.com/news/be-healthy | Be Healthy 15

FOCUS: Suicide The families that remain Some people feel ashamed or embarrassed when a mental illness strikes their family. They sweep it under the rug. It’s best not to talk about it, they rationalize. Not Joseph Feaster Jr. “This is my ministry,” the 65-year-old lawyer explained. When his only son took his life five years ago, Feaster came out fighting. “There’s not one scintilla of stigma associated with this,” he explained. Joseph E. Feaster III was a smart and likeable kid. He excelled in school — both in grades and sports. As far as his father could tell, there was no tell-tale sign that a serious mental disorder was about to erupt. He headed off to the University of Pittsburgh to study film. All seemed well until the summer after his freshman year. Feaster III had his first “episode”

when he started rambling incoherently, then lunged at his father. That resulted in a short stay in the hospital to stabilize him. The father evoked Section 12, which allows involuntary hospitalization of a person who is a danger to him or herself or others. Upon discharge, Feaster III denied he had a problem and refused to take his meds. Oddly, even without prescription medication, he seemed fine for several years, according to his father. Actually, his family later discovered that he was self-medicating with alcohol and gingko, an herb often used to treat depression. Feaster III eventually completed his education at UMass Boston and was accepted into the master’s degree program in the school of Business and Entrepreneurship at Northeastern University. While on a conference call with his class

mates, one fellow student, a trained EMT, was concerned about Feaster’s erratic conversation. He called 911. Feaster jumped out of a third-story window brandishing a Samurai sword. He was tackled by the police and readmitted to the hospital. It was at this point that Feaster III acknowledged he had a problem and promised to take his meds. That proved to be an idle promise. Seven months after his discharge, he jumped from the same window but did not survive. He was 27 years old. Although his life was over, in his death he gave life to others. The family donated several of his organs. Feaster Jr. is pragmatic. “This is a disease of the brain,” he explained. “Why would you treat a person with mental illness any differently from anyone else? It’s nothing that I did or Joseph did.”

» WHAT SHOULD YOU DO IF YOU THINK SOMEONE IS THINKING OF SUICIDE?

n Take the threat seriously n Let the person know you care n Ask questions such as: » Are you thinking about killing yourself? » Do you think you might hurt yourself today? » Have you thought of ways that you might hurt yourself?

» Do you have pills or weapons in the house? n Do not leave him or her alone n Remove potential tools for suicide n Tell him or her that you will get help n Call 911 or go to the nearest emergency room n Call 800-273-TALK — the National Suicide Prevention Lifeline

By the numbers

41.4%

of individuals with any mental illness report receving treatment

8.1

million 16 Be Healthy | Fall 2015

(3.9%) of adults in America have a mental illness and are uninsured

42.5

million

8.8

million

(18.19%) of adults in America suffer from any mental illness (3.77%) report serious thoughts of suicide

SOURCE: MENTAL HEALTH AMERICA, PARITY OR DISPARITY: THE STATE OF MENTAL HEALTH IN AMERICA 2015

FOCUS: Anxiety

Anxiety: When worry or panic takes over More than ‘fight or flight’ EVERYONE EXPERIENCES ANXIETY NOW AND THEN. Actually that’s a normal reaction to life’s stresses. The “fight or flight” response enables us to act quickly when faced with danger. But when the feeling does not go away or appears in response to common everyday events, an anxiety disorder may be the cause.

PHOTO: ACTIVE MINDS

Anxiety disorders are the most common type of mental illness, affecting roughly 18 percent of Americans 18 or older each year, according to the Anxiety and Depression Association of America. The most common age of occurrence is 30 to 44, but it frequently strikes teens and young adults. It is more common in females. Although the exact cause is unknown, there appears to be a genetic link. There are several types of anxiety. Panic disorders are characterized by sudden and repeated attacks of fear. The symptoms are often mistaken for a heart attack — pounding heart, sweating, dizziness and even chest pain. Sufferers begin to avoid places where panic attacks have occurred in the past. Extreme cases can result in social isolation. When the condition progresses to that degree, it is called agoraphobia, or fear of public places. People with generalized anxiety disorder, or GAD, are worry-warts. They think things will always go badly. They worry about things even when there is no need. For instance, it is not unusual to be concerned about health, but people with GAD may imagine things are worse than they really are. The stomach ache must be an ulcer; the headache, brain cancer. At times, worrying keeps people with GAD from doing everyday tasks. Social phobia, or social anxiety disorder, is not a case of extreme shyness, as some people think. Rather, it is an irrational fear of being judged by others and of being humiliated. They worry

about “saying something stupid,” or “not knowing what to say.” This fear can be so strong that it prevents people from going to work or school or doing other everyday things. The good news is that anxiety disorders are treatable. Medication, psychotherapy or both are the typical course of treatment. However, although treatment is available, only about one-third of those diagnosed with the disorder receive minimally adequate treatment, as noted by the National Institute of Mental Health. Kai Roberts, 23, entered Carnegie Mellon University in 2010. During the summer following his sophomore year he began to experience panic attacks that were so severe, he took a semester off. “Prior to taking my leave of absence, the anxiety had me believing that I was on the brink of insanity and that I would never get better. Through a three-week period, I experienced everything that extreme anxiety had to offer — obsessions, compulsions, fears, suicidal thoughts and depression,” Roberts wrote on his website. His time off was well spent. He added a unique form of treatment to his therapy. Roberts has been a music aficionado since he was a kid, and drew on that background to help him heal. He said it gave him a sense of focus. “I used music as my medication,” he said. His therapy resulted in the production of an album, Carnegie Café, which Roberts claims allowed him to put his

Kai Roberts uses meditation and music to help him cope with anxiety.

thoughts and frustrations dealing with his anxiety in the form of poetry. The project helped him, he said, but more than that, he wants it to help others who experience similar situations. Roberts returned to college and recently graduated. He joined the speakers’ bureau of Active Minds, a mental health advocacy group for college students. His alliance with Active Minds will allow him to perform at colleges nationwide. More importantly, he wants to help and empower others facing a mental illness. "It was a straight-up battle dealing with my anxiety,” Roberts said. But with cognitive behavioral therapy, meditation and his music, he’s come a long way. “I’m much calmer now,” he said. baystatebanner.com/news/be-healthy | Be Healthy 17

Healthy Steps Eat right, stay active, live well » Recipe 19 » Nutrition 20 » Yoga 22 » Exercise 23

Healthy body; healthy mind It is well known that healthy lifestyles, such as diet and exercise, can prevent or ameliorate several chronic conditions, including high blood pressure, diabetes, stroke and several cancers. Healthy eating and regular physical activity can also benefit those with mental illness. In some circumstances, exercise can even prevent depression in certain people.

PHOTO: THINKSTOCK/MOODBOARD

18 Be Healthy | Fall 2015

Yoga:

Inner peace may improve mental health (left)

HEALTHY STEPS: Recipe

Szechuan stir-fry THIS IS A SIMPLE HEALTHY RECIPE THAT’S LOW IN UNHEALTHY FATS AND HIGH IN FIBER, PROTEIN AND POTASSIUM. Foods high in low-fat protein, like chicken, and complex carbohydrates, like brown rice, are not only healthier, they are more filling and keep you feeling full longer. They are also important for your mental health. Source: The American Heart Association’s Simple Cooking with Heart Program. For more recipes, visit heart.org/simplecooking.

INGREDIENTS n Cooking spray n 1 pound boneless, skinless chicken breasts or tenderloins, visible fat removed, cut into 1-inch cubes (can substitute lean pork or beef) n 2 tsp. cornstarch n 1 tbsp. low-sodium soy sauce

DIRECTIONS 1. S pray a medium skillet with cooking spray. In a medium skillet, toss chicken, corn starch, soy sauce, ginger, garlic and red pepper flakes. 2. Cook chicken over medium-high heat for

n 1 tsp. minced garlic from jar n ¼ tsp. red pepper flakes n ¼ tsp. ground ginger n 1 16-ounce bag frozen stir-fry vegetables n ¼ cup low-sodium chicken broth n 2 tbsp. chopped unsalted peanuts n 1½ cups brown rice, prepared to package instructions five (5) minutes until no longer pink. 3. A dd vegetables and broth to skillet, reduce heat to medium, cover and cook 20 minutes, stirring occasionally. 4. Top with peanuts and serve over brown rice. * Makes 4 Servings. Price Per Serving: $2.40

PHOTO: AMERICAN HEART ASSOCIATION

NUTRITIONAL ANALYSIS (PER SERVING): n Calories: 455 n Total Fat: 7.0 g n Saturated Fat: 1.5 g n Trans Fat: 0.0 g n Polyunsaturated Fat: 2.0 g

n Monounsaturated Fat: 2.5 g n Cholesterol: 73 mg n Sodium: 265 mg n Carbohydrates: 64 g n Fiber: 7 g

n Added Sugars: 0 g n Protein: 34 g n Potassium: 777 mg n Calcium: 61 mg baystatebanner.com/news/be-healthy | Be Healthy 19

HEALTHY STEPS: Nutrition

BY: KATHY

CUNNINGHAM, M.ED., R.D., L.D.

The link between healthy eating and mental health Eating smarter could lead to improved mood and wellbeing IT MIGHT BE SURPRISING TO KNOW THAT THERE IS A CONNECTION BETWEEN MENTAL HEALTH AND NUTRITION. Research linking the two is growing at a rapid pace. In one survey, almost two-thirds of those interviewed who did not report daily mental health concerns said that they ate fresh fruit or drank fruit juice every day, compared with fewer than half of those who did report daily mental health problems. The findings were similar for fresh vegetables and salad. In addition, participants who complained of mental health issues were more likely to consume unhealthy foods, such as sugar-sweetened beverages, processed foods, snacks, and high-fat fast foods from take-out restaurants. While professional treatment of mental illness is essential, making dietary changes which can improve mood should be an integral part of the treatment plan. A balanced mood and feeling of wellbeing depend on a diet that provides adequate amounts of complex carbohydrates, healthy fats, proteins, vitamins and minerals and water. There should also be a limited consumption of foods and beverages containing high sugar content.

How nutrients in foods can affect mental health n Carbohydrates: The primary source of energy for the brain is glucose, which comes from carbohydrates. There are two types of carbohydrates — simple and complex. Simple carbohydrates, such as sugar-sweetened beverages and white bread 20 Be Healthy | Fall 2015

and rice, provide a quick jolt of energy causing a spike in sugar in the blood. They offer little in the way of nutrients but also exacerbate low mood. The effect of an excessive intake of sugary beverages and foods on the brain has been shown to be similar to that of drug abuse. People who consume too much sugar may experience fatigue, irritability, dizziness, insomnia, poor concentration and forgetfulness. Depression and crying spells are also common. By contrast, complex carbohydrates release glucose slowly providing a steady source of fuel for the brain and B vitamins for the body. Examples of healthy complex carbohydrates include whole-wheat products, oats, wild rice, barley, beans and soy. Some complex carbohydrates from leafy greens — spinach, romaine, turnip and mustard greens, and broccoli, for example — are also high in folic acid. Folic acid, or folate, is a B vitamin that supports the function of the nervous system. It aids in the production of neurotransmitters or chemicals that are used by nerves to send signals throughout the body. Deficiencies in folate as well as other B vitamins have been linked

HEALTHY STEPS: Nutrition

to higher rates of depression, fatigue and insomnia. Broccoli also contains selenium, a trace mineral that plays an important role in the immune system functioning, reproduction and thyroid hormone metabolism. Some studies suggest that low levels of selenium contribute to depression. n Protein: Proteins help maintain our skin, organ, muscle and immune function. Next to carbohydrates, protein is the most abundant substance in the body. The amino acid tryptophan, a building block of protein, influences mood by producing the neurotransmitter serotonin, which is sometimes called nature’s Prozac. Low levels of serotonin is associated with depression. Lean protein sources, including fish, turkey, chicken, eggs and beans, or a meat substitute such as textured vegetable protein, help keep serotonin levels balanced. Protein and carbohydrates team up to improve mental health. To increase the effectiveness of protein, complex carbohydrates can actually facilitate the entry of tryptophan into the brain, thus reducing the symptoms of depression and anxiety and improving overall cognitive function.

n Fluid intake: Here’s another reason to drink plenty of water every day. We think of the brain as billions of white cells and gray cells, but brain tissue is also 85 percent water. Not drinking enough fluid has significant implications for mental health. Dehydration reduces the generation of energy in the brain. The early effects of even mild dehydration can affect our feelings and behavior. Some studies link depression to dehydration. Other studies show that water is a great “anxiety quencher.” Dehydration can actually induce anxiety and nervousness. The key to rebalance this deficit of fluids is to drink eight glasses of fresh water a day. Water alone may not cure anxiety and other related disorders, but it can sure calm nerves and reduce headaches. n Simple healthy eating steps toward a better mood: For overall mental health remember the basics of good nutrition — plenty of fruits and vegetables, whole grains, lean meats and healthy oils. Eat a wide variety of foods to keep your diet interesting and to ensure you obtain all the micronutrients you need.

PHOTOS: THINKSTOCK/OLGNA

n Fish and healthy oils: There is growing evidence to support the saying “fish is brain food.” Studies have found that foods high in omega-3 fatty acids, such as wild cold water fish (e.g., salmon, herring, sardines and mackerel), seaweed and walnuts, have been shown to reduce symptoms of schizophrenia, depression, attention deficit hyperactivity disorder and other mental disorders. This is likely due to the effect omega-3 has on the production of brain chemicals such as dopamine and serotonin. Both these chemicals are responsible for mood. Omega-3 also boosts learning and memory. New evidence published in the Journal of the American Medical Association Internal Medicine shows that balancing carbohydrates, protein, fish and healthy oils in a Mediterranean-style diet can help to protect the brain and improve cognitive function. baystatebanner.com/news/be-healthy | Be Healthy 21

Yoga: Take a deep breath Inner peace may improve mental health SOME PEOPLE WHO PRACTICE YOGA CAN STAND ON THEIR HEAD. Others can contort their bodies into pretzel-like forms. But physical prowess is not the major focus of this ancient discipline. Rather, the purpose of yoga is to combine physical postures called asanas with proper breathing to attain meditation and inner peace. Yoga dates back to 500 B.C., and in the Eastern culture it is closely linked to spirituality. Once the practice crossed the ocean to the West, the religion part tended to fall by the wayside, but the exercise and mindfulness remained. It is estimated that over 20 million people in this country practice some form of yoga. There are at least 20 different types ranging from gentle to physically strenuous. Regardless of its intensity, it is yoga’s intent to help unclutter the mind to get a person more focused. It is considered an integral part of complementary and alternative medicine. Through the years it was discovered that yoga can strengthen muscles, improve posture, reduce back pain and lower blood 22 Be Healthy | Fall 2015

Laura Malloy, LICSW Director of Yoga Programs Benson-Henry Institute for Mind Body Medicine Massachusetts General Hospital

pressure and heart rate. More recent studies suggest that yoga is beneficial for people with mental illness. Laura Malloy, the director of yoga programs at the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, is not surprised. Malloy practices and teaches Kripalu yoga, a gentle form of Hatha yoga, and is certified at the 500-hour level. Malloy is also a licensed independent clinical social worker. In other words she helps soothe the mind as well as the body of her clients. Kripalu is called the yoga of consciousness with an emphasis on meditation

and physical healing. Practitioners hold postures and develop inner awareness followed by meditation while moving spontaneously from one posture to another. That’s why Kripalu is called ‘meditation in motion,’ explained Malloy. There is emerging evidence that yoga is beneficial for the treatment of several types of mental illnesses. Studies have suggested that yoga increases levels of a chemical in the brain called GABA. Low levels of GABA are associated with anxiety and depression. One particular study found that yoga was more effective than walking in modifying the concentration of the chemical. At the Anxiety and Depression Association of America Conference 2015 researchers presented a study on the impact of yoga on stress, depression and anxiety. The study included a small sample of women who had mildly elevated anxiety as well as moderate depression and high stress levels. Those who received two 90-minute yoga classes a week showed improvement in all three conditions. An interesting finding of the study was that yoga’s effects on stress and depression were somewhat greater for African American women. The sample size, however, was too small to draw any definite conclusions. Some poses are particularly beneficial to alleviate depression. Depressed patients may suffer poor body image and assume a posture of rounded shoulders, bowed head and curved back. The bridge pose causes you to roll your shoulders back and straighten your spine while concentrating on deep breathing. Yoga instructors say it “opens the chest.” It’s not exactly clear why yoga works. But Malloy is convinced it does. “It helps in emotional release,” she explained. She referred to the saying “the issues are in the tissues,” which means that we tend to store emotions in our bodies. “If a person has not processed grief, for example, feelings can bubble up during the practice.” Other forms of exercise, such as t’ai chi and aerobic exercises like running and walking, are recommended for those with mental disorders. Yoga and t’ai chi share some characteristics, such as deep breathing and slow controlled movements. Some aerobics, however, may not include mindfulness. “You could be watching TV while on the treadmill,” Malloy explained. “You’re paying attention to the TV and not yourself.” Malloy has only one regret about yoga. “I wish it could last longer,” she said.

PHOTOS: (TOP) THINKSTOCK/MOODBOARD; (BOTTOM) COURTESY LAURA MALLOY

HEALTHY STEPS: Yoga

HEALTHY STEPS: Exercise

Exercise for mental health

» PHYSICAL ACTIVITY GUIDELINES FOR ADULTS n 1 50 minutes* per week of mod-

Good for the body; good for the mind IT'S WELL KNOWN THAT EXERCISE CAN STAVE OFF OR REDUCE THE RISK OF HEART DISEASE, STROKE, DIABETES AND SOME CANCERS. YOU CAN ADD DEPRESSION TO THAT LIST. Exercise engorges the brain with blood, which provides nutrients and oxygen for energy. It also stimulates the release of chemicals.

PHOTO: THINKSTOCK/ COMSTOCK

The “runner’s high” is attributed to endorphins that reduce stimulus to pain and may produce a feeling of euphoria. In addition, aerobic exercise can increase the production and release of serotonin, a naturally-occurring chemical that impacts mood. An imbalance of serotonin may be a contributing factor to depression. Researchers at Duke University compared the impact of exercise to medications on depression. A small group of adult volunteers with major depression were randomly assigned to one of three groups: aerobic exercise, antidepressants or a combination of both. After four months, patients in all three groups showed similar improvements in mood. Roughly two-thirds of all participants could no longer be classified as having major depression. A 10-month follow-up to the study, however, found that the effect of exercise lasted longer than that of the antidepressants. Participants who continued to exercise regularly were less likely to relapse into depression. The results of the study suggest that exercise serves as a complement to treatment for depression, and in some cases, may be the only treatment necessary. Another study published recently in Medicine and Science in Sports and Exercise suggests that exercise can actually prevent depression. A group of roughly 3,000 women between the ages of 42 and 52 were followed for 10 years to evaluate the relation between physical activity and symptoms of major depression across time. The goal was to

examine whether being physically active diminishes the risk of depression in midlife women. The researchers found that women who exercised at least 30 minutes a day for five days a week showed fewer signs of depression in comparison to the women who did not exercise. This finding is significant given the fact that the prevalence of depression is highest in women in the age group 40 to 59, according to the Centers for Disease Control and Prevention. These results indicate that regular moderate-intensity exercise, such as walking or jogging, may be protective against depression. Exercise can also reduce stress and anxiety, sharpen the memory and prevent cognitive decline. Some counselors — literally “walk the talk” — and combine “walk therapy” and “talk therapy.” That is, they provide psychotherapy while strolling with their patients. This is especially effective if hiking paths, parks or forests are available. For some, busy city streets work as well. This style of therapy has several benefits. Not only does it cause a person to be more physically active, thus improving mood, it provides a more relaxed environment that encourages people to open up more. For some it is easier to walk and talk when side-by-side instead of the traditional seated, face-to-face interaction. If exercise is so good for you, then why hasn’t everyone jumped on the band wagon? The CDC noted that less than 50 percent of the adult population

erate-intensity aerobic activity, e.g. brisk walking OR n 7 5 minutes* per week of vigorous-intensity aerobic activity, e.g. jogging or running OR n A combination of both. As a rule of thumb, one minute of vigorous activity equals two minutes of moderate activity. nM uscle-strengthening activities two or more times a week. * Aerobic exercise can be broken into 10-minute intervals. SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION

in this country gets the recommended physical activity. Therapists are experts in behavioral change and some now see their role is to help people become motivated to exercise. Michael Otto, Ph.D., a professor of psychology at Boston University, put it well in an interview published by the American Psychological Association. "Many people skip the workout at the very time it has the greatest payoff. That prevents you from noticing just how much better you feel when you exercise," he said. "Failing to exercise when you feel bad is like explicitly not taking an aspirin when your head hurts. That's the time you get the payoff." Think of exercise as medicine. It has no side effects and it’s free. baystatebanner.com/news/be-healthy | Be Healthy 23

FROM STIGMA

TO STRENGTH.

More than one in three people will experience a psychiatric disease in their lifetimes. The need for help has never been greater, yet behavioral and mental health services nationwide are underfunded and many providers are cutting back on care. In contrast, Partners HealthCare continues to expand its psychiatric services, to ensure that our patients receive the essential care they deserve. This investment in the complete well-being of our patients is driven by a fundamental belief that is central to our mission: without mental health, there is no health. Led by our world-class clinicians at McLean, Massachusetts General, and Brigham and Women’s Hospitals, we are delivering new models of care that integrate mental-health services into primary-care practices. We absorb annual losses of more than $50 million providing these vital services, but believe it’s critical to improve behavioral health care and access as we pave the way for prevention and cures. Our long-term commitment to top-quality psychiatric care, research, and education reflects our dedication to help reduce the suffering and end the stigma associated with mental illness. We will continue to provide hope for our patients and their families while strengthening the communities that we serve — throughout Massachusetts and beyond. See how we’re tackling health care’s toughest challenges at connectwithpartners.org