Mental Health Awareness Week: Anxiety/Depression and Women’s Health

If you’re anything like me (and let’s hope for your sakes you’re not), being aware really takes a lot out of you. With ‘aware’ having synonyms like ‘cognizant,’ ‘mindful,’ ‘wide-awake,’ ‘vigilant,’ and ‘wary’ (I took ‘conscious’ alright–I’m pretty sure I’ve got that pegged), expecting me to be ‘aware’ for any length of time seems to be asking a lot.

So I was going through life, not vigilant, for sure, but ‘alert’ (another synonym)-at least most of the time–until I ran into the 2014 Health Observance and Recognition Calendar Days. Look–I already provided you the link–you really must go take a look. Because you may have thought that you were ‘watchful,’ but I bet for years you’ve failed to notice Root Canal Awareness Week (April 5-12), Medical Transcriptionist Week (May 18-24), Health Care Recruiter Recognition Day–anyone?–June 3; I bet few have properly been mindful of School Backpack Awareness Day (September 17) and I’m pretty skeptical that an appropriate number of people have been vigilant when it comes to  a personal favorite in our household, what’s known as Time Out Day, September 1, which–I am not making this up–“emphasizes the importance of surgical teams taking a “time out” to confirm vital patient information before beginning every invasive procedure.”  That’s right–I’m all for a day that encourages surgeons to find out if I’m actually the one who’s supposed to be in surgery or if it is my 87-year-old roommate, to determine if I’m keeping my uterus–or finally throwing in the towel on the thing, to make absolutely certain that it’s the right side that’s problematic–so they should probably do their business there.

Be that all as it may, there were two weeks asking for my attention that I felt I really should summon up mindfulness for, and, if you haven’t spent all your intentness elsewhere, perhaps you’d join me.  It’s a bit of a challenge, because they’re both the same week, May 12-18, but I think we should all give it a try.

National Anxiety and Depression Awareness Week

When it comes to anxiety and depression, there are a few things it’s definitely worth being mindful of.

  • Anxiety disorders are the most common mental illness in the U.S., and they affect nearly 40 million adults in the United States age 18 and older (18% of U.S. population) (Anxiety & Depression Association of America).
  • Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.
  • Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA (The Journal of Clinical Psychiatry,60(7), July 1999).

According to the National Institute of Mental Health:

  • Major depressive disorder is the leading cause of disability in the U.S. for ages 15-44.
  • Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
  • Of course it can develop at any age–but the median age of onset is 32.
  • The National Alliance for the Mentally Ill tells us that depression affects more than 6.5 million of the 35 million Americans aged 65 years or older.
  • The New York Times, which always teaches me something, made me cognizant of the fact that researchers report nearly 60 percent of the people in treatment do not receive adequate care.
  • Breaking down the stats reveals in any given one-year period, 13 million to 14 million people, about 6.6 percent of the nation, experience the illness.
  • I further learned that, although I was quite interested in stats on ECT, no one keeps them.  ECT.org attempts to clarify the situation with this obfuscating information: “Only a handful of US states require reporting, and many other countries either do not collect data at all, or do so partially.” Illuminating.

Note that you won’t find any such lack of knowledge when it comes to Awareness Day # 2  You ready? It really doesn’t take much vigilance at all–I’ll walk you through.

Mental Health Wellness Week

Unlike most of the Awareness Months, Weeks, or Days I cover, Mental Health Awareness Week is a grassroots public education campaign–it wasn’t designated by the Senate, it isn’t supported by an organization that’s been around since the time of King David, raising money since he, in his young shepherd incarnation, picked the jewels off of Goliath–and invested them wisely. It’s just this. . .well, this week, with its focus on promoting mental health around the US.

It lists on its site a whole bunch of goals for the week–all of them worthy (can you really find fault with “promote an understanding of mental health wellness?” Could you argue against “Help individuals find support groups and wellness events in their local communities”?), and I suggest you head on over there–it’s got a lot to offer.

I find myself not in sync with the program, wondering: So many people think they know about mental illness and really don’t need to spend more time learning about it.  More power to them.  But, I wondered, did they know the following facts?

Mental Health Stats You Just Might Have Missed

  • There are more people with mental health problems than there are with cancer and heart  disease– COMBINED.
  • And about half of all those mental disorders begin before the age of 14.
  • 46% of Americans will experience mental illness in their lifetime, and 26% will experience some form of mental disorder every year.
  • Every year, there are at least 8 million people in the United States who have a mental disorder but do not seek proper help.
  • Those with mental illness are three times more likely to be in the criminal justice system than in hospitals in the US.
  • More than 50% of adults and 70% of children in America are NOT receiving treatment for their mental illness.
  • Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used drug by persons people aged 18–44 years.
  •  From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States (among all ages) increased almost 400%.
  • The average length of inpatient stay in a psychiatric hospital is 7.2 days.
  • The number of prescriptions for antipsychotics given to children and adolescents has increased by 8-fold since the early 90s.
  • Worldwide, someone suicides every 40 seconds.
  • Most low- and middle-income countries have only one child psychiatrist for every 1 to 4 million people.
  • The hands-down, single largest cause of disability world-wide is depression.  But, wait, there’s more. On the list of the “Top-10″ you will also find: bipolar disorder (#6), schizophrenia (#9), alcohol abuse (#4), and self-inflicted injuries (#5).
  •  Older Caucasian males commit suicide at the highest rate of any population group.
  • The five countries with the highest suicide rates are, in order (close your eyes and guess before you read): Greenland, South Korea, Lithuania, Guyana, and Kazakhstan (did you get any right?).
  • BUT. . .the vast majority of people with mental health problems are no more likely to be violent than anyone else. A mere 3%-5% of violent acts can be attributed to the mentally ill.

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I want to call special attention to the following stat–maybe you should even read it twice:

  • By being proactive and seeking help for their mental illness, between 70 and 90 percent of people experience tremendous reduction of their symptoms and live a better life.

In fact, your life might just be better enough that you can . . . .

donate to the Mental Health Wellness Week organization.

Wouldn’t that have worked out well for everyone?

 

October is “Talk About Prescriptions” Month

When seeing the “Talk About Prescriptions” title of the month, some people (translation: almost anyone who knows me) get a little nervous. Talking about MY prescriptions with me could be a rather lengthy and uninteresting conversation.

However, having to listen to your treatment-resistant mood – disordered spouse’s or sibling’s cocktails is not at all what this month is about.  Breathe easy.

Rather, it’s about bringing to the fore the knowledge required for safe use of prescription medication.

It may seem perfectly obvious. You’ve got a sinus infection. Your doctor writes you a script for amoxicillin. You (in theory) complete the course of the med–viola, all’s well. (Well, that’s not exactly the truth. Usually it’s ‘viola–you’ve still got your sinus infection,’ but let’s just stipulate so we can move on.)

If your sole experience with prescription meds is some infection every five to ten years–you’re really on the outs.

Because Americans like prescription medication.  They like it a whole lot. Enough to spend $234.1 billion per year on it (and that was as of 2008).

A Mayo Clinic study published just this year found that almost 70% of Americans takes at least 1 prescription drug, and over 50% takes two. And one in (brace yourself) five takes five or more prescription medications.

Spending on prescription drugs climbed to $250 billion in 2009, accounting for 12 percent of total personal health care expenditures.

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But here’s the thing–while we as Americans clearly like our prescription meds a lot–we may not like this corollary:  after spending the first hundreds of billions to purchase the meds, Americans then spend an additional $177 billion a year on medications to fix the problems caused by that first batch.

American HealthCare points out that there are over 700,000 ER visits each year due to incorrect use of prescription medication, 120,000 of which will end up resulting in admissions. Hospital costs alone are $3.5 billion per year.

Shocking as these numbers are, for a real shakeup, let us move from misuse to abuse. The Centers for Disease Control note that overdose from prescription painkillers quadrupled in the US from 1999 (4,030 deaths) to 16,651 in 2010.  In the first decade of this century, according to Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, 125,000 lives were lost to legal drugs, like Vicodin, OxyContin and methadone.

The CDC also point out that drug overdoses now kill more Americans than do car crashes.  Drug overdoses killed over 38,000 people in 2010, totalling 105 deaths per day.  Of these, prescription pain killers accounted for 165,000 deaths, or 45 a day.

And (I’m a statistic sucker in general-I know you could never tell–but this one, behind its dreadfulness, kind of tickled me:) there were enough painkillers prescribed in 2010 to medicate every single American adult every four hours for one month.

The CDC was not amused by the misuse OxyContin, Opana, Vicodin and the like, saying in 2011, “Overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined.”

And then, as if accidental misuse and downright abuse wasn’t enough, there’s. . .sharing.  For real.

This one’s truly hard for me to envision.  I try to picture it: I see a friend come in, I hang up her coat, offer her a glass of water–no; perhaps a cup of tea? No, not a tea-drinker; would she rather sit on the sofa in the dining room or on the straight-backed chairs in the living room? Oh–need to sit up straight due to back trouble? Fine, fine, ok–Cookie? Yes? Great–and would you like a 300 mg dose of lithium to go with that?

I mean, really.

But crazy and awkward as I may think it is, according to research published in the Journal of Women’s Health, 28.8% of women and 26.5% of men said they had shared or borrowed someone else’s prescription medication during their lifetime.

Just to satisfy your curiosity (if you had any), women were guilty of this far more than men, with the highest offenders aged 18-44, and the most commonly borrowed medications for that group were for: allergies (43.8%), pain (42.6%), and antibiotics (32.3%).

And just to make things more complicated, Medscape found a number of patients follow the (not totally illogical) thought process to its conclusion, thinking, “If 1 pill is good, then 2 pills should be twice as good.” (Apparently it isn’t Medscape alone who’s run into these folks. They showed up as well in “Medication Adherence in America: A National Report Card,” which I particularly enjoyed reading; it shared the illuminating reason–according to survey–for the vast amount of medical non-adherence to medication regimes in this country (this fascinating information is coming up–hang in there): People forget.

So. . . that’s how we get to ourselves to the 28th national “Talk About Prescriptions” Month (TAP Month). (Don’t worry–the other 27 passed me by, as well.)

Anyway, each one has a theme.  This year’s is “Be Medicine Smart,” which sounds like something I’d be all for, if I could figure out what in the world it meant.  Fortunately we get a little help over here in that the “focus” of the month (and I do not know how that differs from the “theme,” you will have to ask someone else) is improving medication adherence.

NOW you’re talking. I’d love to impress you with my extensive knowledge on this topic, but I think there’s a word for it (what comes to mind is self-plagiarism), since, in my Clark-Kent blogging job I published a piece entitled “The ‘Other’ Drug Problem,” where I discuss precisely this.

I believe no discussion of medication adherence is complete without the profound words of C. Everett Koop, U.S. Surgeon General under President Reagan, who was, as Salon pointed out it, the only Surgeon General to become a household name.

Dr. Koop had something worth saying when it came to medication.  While up to now we’ve addressed over-taking medication, taking the wrong medication, or taking your friend’s medication–mis-use of medication includes not taking your prescribed medication.  And, said Dr. Koop:

Drugs don’t work in patients who don’t take them.”

It’s hard to argue the point.

Just a quick look at the scope of the problem:

Among patients with chronic illness, approximately 50% do not take medications as prescribed.  Let’s look at the most commonly prescribed meds.

As many as 50% to 80% of those being treated for hypertension fail to adhere to their medication regimens.

How about statins (which can have a great impact on preventing a heart attack)?  Within 6-12 months after receiving the script, 25-50% had discontinued them–and at the end of 2 years, nonadherance is as high as 75%.

Prescriptions for mental illness?  Magura et al found that, for major depressive disorder, nonadherence is between 28-52% (granted a rather large range), 20-50% for bipolar disorder, and 20-72% for schizophrenia (and I’m really skeptical about that 20%).

So. . . what to do?  Frankly, I was shocked by what the National Council on Patient Information and Education (the group that spearheads this month) recommended to become “medicine smart.” I mean, do we as a group really need to be told among 9 important things you can do to make you “Medicine Smart” to:

  • Recognize that all medicines have risks?
  • Make a list of the meds we’re on–and actually share that with the doctor who is about to prescribe something new?
  • Store our medicine in a safe place–where children can’t get to it?

However, they seemed to offer an excellent resource on the Talk About Prescriptions Month site:  a link whereby you could take your pack of pills which (does this happen to other people?) wind up all jumbled together in the wrong container, and actually identify which pill you should take for your gall bladder and which is meant to treat your toe fungus.

 

Maybe by the time this goes out that link will actually work, but right now it seems to have the same illness as all the government health sites.

So. . .I don’t want to leave you hanging with your antibiotics and your mood stabilizers confounded.  Take the whole passel to Drugs.com, click on Pill Identifier, type in the imprint on your pill, then the pill’s shape and color–and you can separate your antihypertensives from your metformin.

I wish you the best of luck with that–and, remember, if you have anything to say about your Prozac or your Miralax, well, come right out and say it. This is the month–but your days are numbered.

A Lotus, A Triangle: Yoga and Cancer

I’m a yoga junkie. I practice every day, and never miss my class on Wednesday nights–ever. Had one of my children chosen a Wednesday night for their wedding, I just would have begged off from 7-8:30, manipulated my body into odd configurations, and, returned, none the worse for wear.

I even love the Sanskrit names for the poses (known to the cognoscenti as “asanas”), and, although this certainly must make me look like a first-class show-off, when I practice lotus pose at home I announce, ‘I will now be doing Padmasana,’ and there’s no utilitarian ‘down-dog’ for me. Oh no. It’s (are you paying attention?) Adho Mukha Savasana.

In my advanced years I’ve perfected the headstand and am working on the handstand, despite eye-rolling from certain family members who shall remain unnamed–for the minute.

And I intuitively know that yoga is truly good for your body–more healing than jogging, more peaceful than the stairmaster, more complex than schlepping barbels up and down. I’ve recommended it to my cancer patients.

But I didn’t have proof of yoga’s healing effects on cancer patients and survivors until recently–and now there’ll really be no stopping me.

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Actually, there have been a few studies on yoga’s impact on cancer, but very few of them  have been (have I taught you anything? What’s the phrase in scientific research? Quick guess. . . ) randomized controlled trials (RCT) (please tell me you knew that).

Lucky for us scientists took it into their heads to do things the right way. Of course, it started in a place far, far away, where they really know how to appreciate yoga (if maybe not always RCTs).

Not surprisingly, one of the early studies came out of (three guesses here. . . .) India.

Not to let anyone miss their scientific rigor in utilizing a RCT, they threw it in the title, “Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial” (did you get that?). They bit off a serious amount in this study, which may in fact undercut it a bit. They looked at cancer-related pain, depression, and fatigue–all areas they felt were being under-managed by the standard medical treatment team.

The study looked at 88 recently diagnosed women with stage II and III breast cancer. All had undergone surgery  and were receiving radiotherapy as adjuvant treatment.

As promised by the title, the patients were randomized to receive yoga or supportive talk therapy.

The yoga group did asanas, breathing exercises, and relaxation, while the other group had one-on-one sessions with a therapist.

And results were good. Researchers found:

A significant reduction was observed in psychological distress, physical distress, a significant increase in the activity level . . .and a significant reduction in fatigue, pain, insomnia, nausea and vomiting . . .following yoga intervention as compared to controls.

But there still didn’t seem to be a significant number of papers in mainstream cancer journals. There was one with the winning title, “Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma” in the journal Cancer, which was indeed randomized–but not controlled. So close. [Interestingly, it did find that it improves sleep quality, but found no significance in affective issues, despite the Indian study’s findings].


For it, 128 patients ethnically diverse patients from a Bronx cancer care center were assigned to either 12 weeks of once-a-week yoga, or a 12-week-long waitlist for the yoga. Only half were actually receiving medical treatment.
And another was published in 2007 in the Journal of Clinical Oncology, again touting its RCT credentials in its title, “Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life.” That was an interesting study, as it was the first to confirm that results found inCaucasian women applied to minorities, as well.

Turns out that attendance wasn’t too good to the yoga program, so that’s one of this study’s serious limitations. That may explain why the results were somewhat tepid. the upshot: More women from the non-yoga group “experienced a worsening of social well-being” in contrast to the yoga-intervention group (13% vs. 2%). However, the researchers did not find that yoga improves social well-being. Not exactly earth-shattering.

And then recently came a really large RCT in a major journal that got more compelling results.

According to researchers from the University of Rochester School of Medicine, cancer-related fatigue is the single most common side effect for cancer patients both during and after treatment (see Mustian 2009). It can come from the cancer itself, the treatment, and/or the treatment side effects. The fatigue frequently goes on long after treatment is completed.

Karen Mustian, Ph.D., director of the University of Rochester Cancer Center Community Clinical Oncology Program, and her colleagues, assert that 80% of cancer patients report trouble sleeping while in treatment, and a staggering 65% continue to struggle after treatment ends.

And then in a double-whammy–there’s sleep disturbance. Just when the patient craves–and needs–sleep like never before, there he is, desperately counting sheep, exhausted, as the minutes–and then hours–tick by.

It’s really not a satisfactory scenario.

Sleep can be chased away by any variety of cancer-related events: tumor growth, the treatments, staying overnight in the hospital (where I have never once slept a reasonable night’s sleep, and where the nurses like to come visit me at 11pm and 6am shift changes, just to wake me up to ask me if I’m sleeping), pain, GI distress, fever–really, you name it.

Doctors can give you more pills to pop, but it’s a short-term solution, and certainly doesn’t address the fatigue.

Here’s where knowing your Warrior Poses really pays off.

Mustian and her colleagues decided to do something about the sleep and fatigue problems that didn’t involve pushing more pills–and they  got on the yoga program.

Now I’m a Mustian fan, even if she titled her study one of the more dull and inscrutable titles I’ve come across in at least a few days: “Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors.” I mean–seriously?

(Translation for the alphabet soup impaired: YOCAS (this took a while) = Yoga for Cancer Survivors, URCC = University of Rochester Cancer Center (of course!), and CCOP = Community Clinical Oncology Program. There, now that’s better.)

Mustian’s study moved research out of the realm of individual cancers, was a completely randomized, controlled trial–the largest done to date, and was published in a more established medical journal, so her results have gotten a significant amount of play recently. And they’re pretty positive.

The study looked at non-metastatic cancer survivors who’d had sleep disruption for 2-24 months–and had not participated in yoga in the previous three months to the study. Then they randomized (of course) two groups–1 group just received standard care, the second had 75-minute yoga sessions 2 times per week, incorporating asanas, breathing exercises, and meditation.

The yoga group had a 42 per cent reduction in fatigue, versus only 12 per cent in the control group (that’s significant), and, comparing their pre- and post-yoga scores, the groups had more improvement in the quality of their sleep  (22 versus 12 per cent) and felt sleepy less during the day (29 versus 5 per cent) compared with the non-yoga group–and all that was accomplished while reducing use of sleep medication.

Bring on the Mountain Pose. (Ok–I can’t help it–it’s Tadasana.)

REFERENCES

Cohen L, et al. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 2004; 100(10):2253-60.

Hosakote VS, et al. Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial. International Journal of Yoga 2009; 2:73-9

Moadel AB, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. Journal of Clinical Oncology 2007; 25(28):4387-95.

Mustian KM, et al. Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. Journal of Clinical Oncology 2010; 28(15suppl):9013.

Mustian KM, et al. Exercise and cancer-related fatigue. US Oncology 2009; 5(2):20–23.