2 posts tagged “ADHD”

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

Posted January 14th, 2014 by

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 21st 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. 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 GymTM 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 JackpotTM an augmented reality tool that locates pleasant and positive activities, using your GPS location. PTSD CoachTM, an app to help people learn and manage symptoms after a trauma. LiveHappyTM, a happiness boosting app based on the principles of positive psychology. MoodAgentTM, 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.


Overcoming Obstacles – Newsletter Highlight 2010

Posted December 27th, 2010 by

Last week, we posted highlights from our December community newsletter interviews. As we close out 2010, we want to spotlight another question asked this month – one that is relative to all members, all patients (no matter the condition).  What obstacles have you faced and overcome this year?

To review all of our newsletters, you can visit our archives page here.

* * *

2166 (Amy) What obstacles have you overcome this year?
ellie
(ellieGADsufferer – Mood Conditions Community)

First of all, I became well enough to leave my local psychiatric hospital after having been an inpatient for six months. My anxiety means that all new things – even getting on a bus to go somewhere new – make me have severe panic symptoms.

I now make sure I am out of bed by 0700hrs during the week and make myself go out at least three times per week, whether it is meeting friends for coffee or attending appointments. Otherwise I will return to “avoidance,” whereby I cut off all contact with friends and family, including calls and text messages.

kidneygirl (kidneygirl1198and0505 – Transplants Community)

I have had to deal with and overcome the struggles that come with tardive dyskinesia. Reglan has been black-boxed [with a FDA-mandated warning about the risk of tardive dyskinesia] over the past two years, but I took it for three or four years before that. [Read kidneygirl1198and0505’s Reglan treatment evaluation for more details.]

Signs of tardive dyskinesia may include: continuous and repetitive movements of the mouth, tongue, and jaw; facial grimacing; lip smacking, puffing of the cheeks; uncontrollable movements of the arms, legs, fingers, and toes; and swaying motions of the trunk or hips.

Mine has gotten so bad that I have regular grand mal seizures from time to time, and sometimes it’s hard to carry on a conversation without looking weird.

mtnlady (mountain lady – Parkinson’s Disease Community)

One of the biggest obstacles in my life this year was getting over the death of a very close friend.  This person became ill and died within a few months.  Her death made me more aware of how precious life is.

Another obstacle was in the adjustment of my medicine for Parkinson’s.  My doctor wanted me to try a new medicine with fewer long-term side effects.  I tried it for several months but did not do very well.  I am currently back on my original medicine, taking a little more than before, but I have readjusted well.

andrew (andrewn78 – HIV Community)

This year I overcame a hard breakup. It was difficult because I thought we were going to be together for a longer term relationship than we were (only nine months).

It was also difficult to start dating again. I forgot how many people don’t know much about how HIV is contracted and that there are many people who would never date someone who is living with HIV or will date someone living with HIV but the fear of contracting HIV puts too much of a damper on the relationship. It’s a difficult process.

tommymkr (Tommy Maker – ALS Community)

I’ve spent a lot of time this year getting used to the fact that I have become dependent on others.

Prior to diagnosis, I sat on the local council, was involved in the organization of all types of public elections and I was a trade union official. These were voluntary roles which involved helping others. Yet, initially, after diagnosis, I had an enormous difficulty accepting help from others. However, I’ve come to realize that I have a loving family, fantastic friends and very supportive colleagues. I have found that many of them don’t know what to do and are very glad when I am specific as to what they can do for me.

I’ve also learned that no question is too personal. I struggled a lot with questions about personal hygiene and when I found the courage to ask these most intimate questions, I found that the professionals were so familiar with the questions asked that, beyond the initial embarrassment, we quickly went on to find solutions. I have also found that when people ask questions about my condition, they are entitled to an answer, an honest answer.

nates (Nates-Sweetpea – Fibromyalgia/CFS Community)

Oh my, 2010 has been a huge year! I didn’t know how I was going to get through it whole, but here I am knocking on 2011, one step at a time. I had to rejoin the workforce on a part-time basis this year, after years of not working (not being able to work), but I had to as my husband had lost his job about 18 months previously, and we were facing bankruptcy!

So I’ve been working part-time since last February, about 17 to 32 hours a week. We did go through bankruptcy, lost our home, vehicles and our high 700’s credit score with it. But you know what, I survived.  Actually, no, I overcame, with the help of a very supportive Sunday School class, great friends, and a wonderful husband and daughter.

kg
(kg10043 – Epilepsy Community)

I work for the US Forest Service and, as of July, made it to retirement age still working. Two times they tried to force me to take a disability retirement. To keep working I have had to move around to several jobs in four different states because of my health. Not only have I made it to retirement age, but I am still working even though they are trying to get rid of me once again. (What a joke when you consider that the federal government has a quota for disabled employees).

It has meant I have not only had to work in a variety of locations, but doing different kinds of work. Just in the time on this forest I have worked as the Oracle DBA in the computer shop, in GIS, later in Forest Planning, with a crew of five Soil Scientists, a Botanist and myself mapping the soils and ecological types and writing recommendations for management.  And now for the last two years I have been “unfunded” and doing all kinds of random jobs for projects in the office. Just this year that has included supporting the USFS in legal challenges as well as jobs so simple as filing paperwork and addressing envelopes.

cobe (cobebu8 – MS Community)

For me, with multiple sclerosis and ADHD, my main problems have been the concentration to do what I need and want to do and fighting the progression of MS. I have RRMS [relapsing remitting MS] but since I have had it for 25 years, ever so slowly, it is progressing at the same time I get exacerbations. I have a new neurologist too, and he is part of a big group and getting through when I am having problems, is a problem.

Plus, with only SSDI [social security disability insurance] and not being able to find a part-time job, I have had to stop taking some needed meds and not going to necessary doctor’s appointments (e.g. my eye surgeon/doctor to see if the optic nerve is still swollen and I can’t do a necessary MRI because the insurance company won’t pay.) So to get help for my asthma, I am doing a research study to get free care. I haven’t found one for MS or depression yet.


PatientsLikeMe member lscanlon