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UT Southwestern Grand Rounds

• December 12, 2013

Very exciting event last week. I was asked to speak at UT Southwestern Psychiatric Grand Rounds. Engaging event, lots of great questions. I want to post the latest Struck by Living Stay Well list here - as I promised some I would publish this digitally for them. Special thanks to Dr. Madhukar Trivedi for this opportunity!

Struck by Living

Top Ten for Mental Health Brain Protection for Adults– Julie K. Hersh

Mental illness, like many diseases, is prime example of “what comes first?” Do genetics cause mental illness or does the environment breed it? I always answer “both” to this question. How we react to our environment determines our mental health, oftentimes more than the environment itself. We’ve all seen one person devastated by failure or disappointment, while another person uses that same situation as motivation for future success. As Charles Darwin said: "It is not the strongest of the species that survives, nor the most intelligent that survives. It is that one that is the most adaptable to change."

This list has undergone various iterations – showing that a mental health list changes for different phases of life. The first five items are what I would call “brain preservation” tactics; things that I do on a daily basis to maintain health. The rest are more “stress management” techniques, and I have seen these items change as stress in my life changes. The key is to make your own list. No one keeps a list like this perfectly, certainly not me! Try to remember tomorrow is always a new day and a new chance to create good habits.

1. Sleep. Get the right amount. Most depressed people report problems with sleep. Depression, insomnia and anxiety combined are danger signals that (unchecked) can be precursors to suicidal behavior. I need about 7 hours of sleep a night. If I find myself sleeping less, closer to 5 or less a night, this is usually an indication that stress is interfering with my sleep. I cut back on caffeine, and don’t read electronics close to bedtime. If this does not work, I consult with my psychiatrist and use medication to ensure sleep.

2. Exercise. Due to an injury, in all three of my depressive episodes I was unable to run. Now I find an alternate exercise if injured. 150 minutes of brisk walking can reduce—and sometimes eliminate—depression according to research done by Dr. Madhukar Trivedi of UT Southwestern. For more information on exercise and brain function read Spark by John Ratey.

3. Medication: Be aware the Impact of Alcohol/Drugs and take medication if prescribed. Not everyone needs medication for mental health, but everyone needs to understand the impact of alcohol and drugs on brain function. Alcohol is a depressant and impacts brain hormone dopamine. Dopamine controls our ability to experience pleasure. When drinking, alcohol increases dopamine, hence the reason we feel good after a few drinks. Once drinking stops, dopamine levels drop at an escalated rate, leaving a person in a dopamine-deprived state. If you have a tendency to be depressed, alcohol or illegal drugs only compounds the impact of depression. I take an antidepressant (which happens to be dopamine based) on a daily basis. Many people stop their medication as soon as their brains stabilize, only to see their depression reemerge. I did this in 2005. I relapsed and learned the hard way that a small bit of prevention ensures health. Medication (combined with the other actions on this list) creates a preventative buffer against a potentially deadly level of depression.

4. Meditation. I meditate on a daily basis, currently about 30 minutes. For me, mediation is a combination of meditation/prayer, although meditation has a different quality. Prayer is about asking, meditation is about listening and acceptance. While my prayer life has been sporadic and crisis-driven throughout my life, meditation has allowed for a deepening and consistency in both practices. Meditation often surfaces ideas and sources of comfort that I had not been able to obtain in the other areas of my action-packed life.

5. Nutrition. I’m convinced that Seasonal Affect Disorder - SAD (caused by lack of

sunlight and a Vitamin D deficiency) played a part in my depression. All three of my depressive episodes began in January and peaked in the spring. All three occurred in gray weather – one was in South Bend and the other two were two of the rainiest winters on record in Dallas. I try to get 15 minutes of unprotected sunlight every day. SAD lamps and visors can be purchased for gray environments. Supplements can help with Vitamin D efficiency, but make sure to check with your physician to make sure you actually have a deficiency. Excess vitamins can sometimes lead to other unanticipated problems.

6. Friends and Family as a Barometer for Health. My family and friends are often the best people to help keep me honest with regard to my mental health. If they see me not sleeping, committing to too many tasks (more than usual) or withdrawing from social settings, they tell me. Remember, depression is a brain disease. Trying to solve depression with the very organ in your body that is broken is a difficult task.

7. Brain Engagement. A happy brain is a more productive brain. I try to have a day a month where I feed my brain with something I love that is not related to work. I love theater, art, and museums. I dismissed these things as unessential in the past. Today, I see them as critical for my thinking and creativity.

8. Avoid the Age Escalation Trap. Often, at least in the US, people of the same age group tend to socialize and work together, magnifying the problems of that age group. A simple question such as “Where will my child go to college?” or “How can I find a job?” becomes amped with anxiety, fueled by other people agonizing over the same thing. Someone out of the same age group - 10 years or more older (or younger) can act as a sounding board to keep problems in perspective. An older person often has the insight from weathering the same experiences we face. One of my most valued friends today is an 85 year-old man who helps me keep my 53 year-old worries in check. He helps me maintain my sense of humor and perspective.

9. Plan proactively for a health crisis and know the signs of depression. These days I proactively call my psychologist when I am about to approach a major transition point in my life. I know my warning signs of depression (insomnia, lack of appetite, isolation) and together we are watchful during the transition period. If you are unsure what might be a sign of depression, check out this list from the Grant Halliburton Foundation: http://www.granthalliburton.org/knowthesigns.html. Here is a 24-hour number for support: 1-800-873-TALK.

10. Remember that your value is more than what you do. High achievers have a tendency to feel like a failure unless they are constantly productive. That’s just not realistic. Oftentimes the moments we believe to be the worst in our lives become the turning point to a better path we never imagined. Unfortunately we often only see the path in retrospect. In the gray period of uncertainty, try to remember that you have value just in being. This is perhaps the hardest point for me to remember, but when I do, I laugh a lot more. This lesson humbles us, yet frees us to pursue our passions in the same instant.

Here are some other photos from the talk: