Achieving wellness: An interview on mental health with Dr. Murali Doraiswamy

Murali Doraiswamy is a Professor of Psychiatry and Behavioral Sciences at Duke University where he is also a member of the Duke Institute for Brain Sciences. He also serves as an advisor to government agencies and businesses. Dr Doraiswamy is the brain health advisor for Men’s Health magazine and serves on the World Economic Forum’s Global Agenda Council for Neuroscience and Behavior.

What’s his take on PatientsLikeMe? What does he see as emerging mental health treatments? And what does he wish more people knew about mental illness? We recently had the chance to chat with him about all that and more. Check out what he had to say in our interview.

 

What interests you about studying and learning more about mental illness?

To me it’s one of the most important public health challenges for the 21^st century – the mind affects every aspect of our body, our physical wellbeing and our family and social relationships.

According to the World Health Organization (WHO), a staggering 450 million people currently suffer from mental health conditions, making them one of the leading causes of poor health and loss of productivity worldwide (some 175 million years lost to disability). Mental illnesses, such as depression, also shorten one’s lifespan.

Rates of conditions, such as ADHD and PTSD are skyrocketing in the US and many newer conditions such as “Internet Gaming Disorder” are emerging. Many of these conditions have their roots in childhood or teenage years.

I am also interested in how culture, environment and brain interact in shaping our behavior. In particular, I am interested in how we may be able to apply insights from behavioral and neuroscience studies to tackle some of the major problems in society.

There is a huge upside to society if we can prioritize and implement low cost scalable public health strategies to treat and prevent these conditions.

As a doctor, what is something you wish more people knew about mental illnesses? 

Clearly drug therapy helps many people but it’s not a cure and may not work at all for many people. We need to do a better job integrating psychological and social interventions into our care models – to truly help people thrive and enjoy a full life. Better resources for those suffering from marijuana addiction (and who are looking for treatment), for example, would help people who are more likely to look for drug and treatment related information online.

The manifestation of mental health conditions is often dependent on the environment. For example, it would be a lot easier for someone to quit smoking if they lived today in New York city, which has banned all public smoking, than if they lived in New York fifty years ago when smoking was seen as trendy and acceptable even in hospitals. Emerging studies show that people living in densely packaged cities have higher arousal response to a given stimulus than people living in rural areas or those who have recently gone for a walk in nature. That’s why Central Park in New York may have a bigger effect on mental health than all of the hospitals in Manhattan.

Our diagnostic criteria are subjective and may not be accurate. The same person can often be given different diagnoses by different doctors and treated differently. Psychiatry is not immune to fads. For example, there has been a 40-fold rise in the rates of childhood bipolar disorder in the US over the past two decades – but is this real?

Mental illness can raise the risk for new medical problems, such as obesity and memory loss, and worsen the outcomes for pre-existing heart disease, diabetes, or cancer.

Any thoughts on what’s ahead in terms of new treatment advances?

Here are my top five.

1. 1. 1. Protect the developing brain. The biggest mental health gains will come from simple public health preventive measures applied during pregnancy and childhood to protect the developing brains (such as childhood nutrition, supportive and secure family environment, reducing neglect, better education, reducing poverty, minimizing  exposure to war and conflict) as well as increasing access to basic physical and mental health care for the poor.
      2. Creating a Nurturing Environment.  A supportive social network makes us view stressors less as a threat. For example, a hug or the presence of a loved one not only reduces our perception of pain but it does so even at the nerve cell level! A lifelong study of 268 Harvard sophomores showed that the single most important predictor of physical and mental wellbeing fifty years later was not any of the things a doctor measures routinely such as cholesterol – it was close relationships. Likewise new studies are showing that spending time in nature (what I call as vitamin N) rejuvenates the brain’s memory centers and lowers our stress response – the reverse of what happens when you live in dense cities.
      3. Positive Psychology. We underestimate the effects that practicing positive activities (such as being grateful and optimistic, counting one’s blessings and performing acts of kindness) has on mood and well-being. But consider this – if a person gets 20 minutes of positive emotions from one act of kindness, he may get energized to go to the gym or to a poetry workshop where in turn he may make a good friend – a positive upwards cycle. For those seeking more information I recommend my favorite weekly blog Positive Prescription by Dr Samantha Boardman. I learn more from it than from all medical journals combined!
      4. Physical activity. A series of studies done at Duke has demonstrated that aerobic exercise is as effective as a prescription antidepressant for treating mild depression. Also in a review of over 100 studies of yoga, we found it to be promising for a range of mental symptoms including issues with sleep, anxiety, attention and mood. Exercise affects more than 20 chemicals in the brain in a positive way and may stimulate the release of endorphins and also nerve growth factors (which are like fertilizers for the brain). It may also protect your brain against age-related memory loss. It’s an old stand-by but new information coming out every day reinforces it’s effectiveness.
      5. Wellness enhancing technologies. Mobile apps, sensors, and online programs will increasingly fill in the gaps that a doctor may not be able to fill. Mood Gym^TM an online interactive web program – based on cognitive behavior therapy – helps people prevent depression and handle stressful situations such as relationship break-ups. It also teaches relaxation and meditation techniques. Positive Activity Jackpot^TM an augmented reality tool that locates pleasant and positive activities, using your GPS location. PTSD Coach^TM, an app to help people learn and manage symptoms after a trauma. LiveHappy^TM, a happiness boosting app based on the principles of positive psychology. MoodAgent^TM, an app that seems to know what kind of music you are in the mood for – often better than you. And last but not least, sites such as PatientsLikeMe and, for those suffering from prescription drug addiction, StopOverdoseIL.org, are going to play an increasing role in empowering those with illnesses.

I am not suggesting these recommendations are necessarily suitable for everyone and you may need to consult your doctor.

How do you think online communities like PatientsLikeMe can positively impact people living with a mental illness? 

PatientsLikeMe, while not being a substitute for medical care, brings the power of the internet to help such individuals better manage their own illness – education, greater insight into their own condition, online community, reduction of stigma, a sense of community – which can lead to positive benefits even when they are not online. For those looking specifically for prescription drugs addiction treatment services, we recommend StopOverdoseIL.org’s guide.

Often peer advice – tips from another patient – may feel more real than advice given by a doctor (since the other person has actually gone through the same condition).

As more people sign up for communities like PatientsLikeMe, this data will become a major tool for research and gaining early insights into which treatments work and which don’t.

Obviously these pros have to be balanced with the need for patient privacy and ensuring patients who reveal their stories don’t suffer any discrimination. But if used wisely PatientsLikeMe can be a powerful tool to achieve wellness.