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Category Archives: Mental Health


The Onion spoofs big pharma’s approach to mental health, here.

In an effort to alleviate the vague, passing sensation of restlessness and unease that inexplicably afflicts thousands of people each day…


The link between depression and heart disease in women

As we’ve stated over and over again in our book and blog – it’s crucial to treat mental health problems. I quite frequently encounter patients who are told by unsupportive and/or ignorant family or friends that depression or anxiety are “all in the head.”


Unfortunately, nothing could be further from the truth. Being depressed or stressed most of the time results in actual physiologic changes in the body which cause real damage. Women particularly seem to be hard hit by the effects of untreated depression.

A new study published in the Journal of the American Heart Association followed over 3,000 people with known or suspected heart disease over 3 years. Women younger than 55 who suffered from moderate to severe depression had over TWICE the risk of developing a heart attack or dying.

So if you are depressed, please seek help. Not just for your quality of life, which in and of itself is a good reason, but to potentially save your life.

– Tamir

(Image links to source, under this license.)


Mental Health Issues Are Serious Medical Issues

Let’s start this post with a multiple choice question. Which of the patients below needs to seek medical attention?

a) A 25 year old male who finds himself constantly stressed out and anxious.

b) A 14 year old female who just fell off of her bike and broke her wrist.

c) A 36 year old female who feels sad most of the time and doesn’t really have any pleasure from doing things that used to be fun.

d) All of the above.

Poor mental health

It isn’t all in your head

If you said #4, then kudos, you’re spot on. Unfortunately, due to ignorance, misinformation, and in some cases cultural beliefs, many people fail to see mental health as a legitimate part of a person’s overall health. Sure, most people believe that people with very serious mental illnesses such as schizophrenia or those with suicidal thoughts need to see a psychiatrist. However, for the “run of the mill” common problems that many of us face in life such as feeling stressed out, anxious, or mildly depressed, there are a large number of people that sigh and think that it’s “all in the head.”

They fail to see why a person suffering from these conditions can’t just “be happy” or “chill out.” That person is often looked down upon. This is very unfortunate as today, there are very effective treatments such as therapy, exercise, relaxation techniques, and medication, all of which can make anxious and depressed people feel much better. Sadly enough, what often happens is that people delay seeking treatment for their mental health problems because they have unsupportive family, partners, or friends with absurd viewpoints.

Someone who is depressed or anxious can’t just be happy or calm in the same way as someone with a broken leg can’t just get up and walk or someone with a bad infection can’t just wish it away. Even when people do seek help, years of conditioning against the different mental health modalities often skews their perception and makes it more difficult to treat them. For example, when I suggest therapy to patients, they many times have this image from pop culture about someone lying on a couch blaming their mother for their neuroses while a psychiatrist is scribbling in a pad and charging them hundreds of dollars an hour!

The bottom line is that if you or someone you know is frequently depressed, anxious, or otherwise mentally ill, then encourage them to seek help. Not only will their quality of life increase, their physical health will improve as well. Untreated depression and anxiety is bad for the heart and otherwise destroys the body. When a body is under stress, it releases stress hormones that weaken the immune system and increase the risk of many different diseases.

Allow me to end with a clarification. I am not suggesting that if you feel down or stressed out for a day, you have to run to the doctor (although exercising and learning relaxation techniques are definitely good for everyone to try in such situations). What I am saying is that if most of the time you are depressed or anxious, then it’s time to seek help.

– Tamir

(Image links to source, under this license.)


Quitting smoking when you have mental health issues: New research

As we discuss in our book and blog, there’s a widespread misconception that smoking helps people deal with mental health problems such as anxiety. In many cases, smokers who have psychiatric/psychological illnesses or problems with drug or alcohol abuse are treated for the disorder or substance abuse, but the doctor will often hold off on smoking cessation due to the mistaken notion that patients need to deal with their more serious issues first.


Well, a new study published in Psychological Medicine adds more evidence that not only is it not necessary to hold off on smoking cessation, but continuing to smoke actually makes people more likely to continue suffering from mental health problems as well as drug or alcohol abuse.

The authors of the study analyzed data from over 4,800 smokers who participated in 2 surveys spaced 3 years apart. They found that those who initially reported mood/anxiety disorders, or drug or alcohol abuse in the first survey were much less likely to report those problems in the second survey if they quit in the interim. The numbers were quite impressive.

64% of the people in the initial survey reported mood/anxiety disorders, 33% had problems with alcohol, and 23% with drugs. At the follow up survey, those who had quit smoking were 40% less likely to suffer from anxiety, 30% less likely to have a problem with alcohol, and 70% less likely to have issues with drug abuse!

Although this study doesn’t definitively prove that smoking cessation improve mental health, the drastic results are quite suggestive. The take home message is that if you currently smoke and suffer from mood/anxiety disorders, alcohol abuse, and or drug abuse, it seems that by quitting, you could increase your chances of successful outcomes with your other problems. Don’t buy into the assumption that cigarettes will help you deal with stress or anxiety.

– Tamir


Taking responsibility and combating common excuses

Many people who engage in self-destructive behaviors such as smoking, eating a poor diet, and not exercising, or even worse, abusing drugs or alcohol, are often so entrenched in their unhealthy lifestyles that they seem resigned to the idea that things will never change for the better.

For example, many people will blame their lack of exercise on long work schedules. Some will blame their continued smoking on stress. Others will overeat because they feel depressed. This may sound a bit harsh, but in most cases, these are all poor excuses. These circumstances don’t have to condemn you to an unhealthy life. And ultimately, the changes need to come from you.

Let’s look at some examples:

“I work long hours so I have no time to exercise”

On the surface, this seems legitimate. After all, if you wake up early, work a very long day, then come home at night exhausted (and perhaps do chores, spend time with your family, etc.) then how or when will you work out?

However, if you break down your day, you’ll see that you can quite readily fit exercise into almost every day. You can wake up 10 minutes earlier (which won’t significantly cut into your sleep) and do some calisthenics (push-ups, squats, jumping jacks), shadowboxing, or, if you have a treadmill do a quick intense workout (sprinting or fast walking). Take a quick shower, and just like that, you’ll probably feel energized, happy, and ready to take on the day.

During lunch, go on a brisk walk, or, if it isn’t feasible to walk outside, then perhaps walk up and down the stairs, do some isometrics at your desk, etc.

When you come home, either do another quick workout such as the morning one, or, incorporate physical activity into your family time. Shoot some hoops with your kids. Run around. Kick a soccer ball. Go on a brisk walk with your spouse. Anything besides plopping on the couch to watch television. On the weekends, when you have more time, do a longer workout of 45 minutes to an hour. Before you know it, in spite of your long work schedule, you somehow managed to fit in plenty of exercise.

“I’m smoking because I’m stressed out”

This is, in a way, a lame excuse. If you have a lot of stress, then do something about it.

Maybe you’re stuck in a situation in which the stress is constantly there (a mean boss, a sick loved one). Even in those situations, learn how to deal with the stress in a healthier manner. Exercise. Meditate. Try deep breathing exercises. Seek professional help from a therapist or psychiatrist. Continuing to smoke won’t make your stress go away or improve. In some ways, it may worsen it, since the nicotine withdrawal you feel between cigarettes will actually make you more agitated.

Also, passivity often keeps us from changing our lives positively. For example, if you have a horrible job, then perhaps look for a new one. Sometimes a pay cut may be worth having a less stressful job. If you’re stuck in an unhappy marriage, then seek professional help, or, if unfortunately things are absolutely awful then consider ending the relationship. Do what you can to change your life for the better. Your life is worth the effort.

“I’m binging out of depression”

This too is a very common scenario which unfortunately is misguided. I’ve personally had patients who’ve gained a tremendous amount of weight due to “comfort eating.” The same advice that applies to people who smoke out of stress applies here. Seek professional help. Depression is treatable. It’s a shame that people will spend years suffering and ruining their health instead of treating their depression.

The bottom line is that we’re often stuck in less-than-ideal situations in life. The easy thing to do is to engage in self-destructive behavior and put all the blame on your circumstances. However, though it takes more effort and planning, stepping up to the plate and taking responsibility for yourself is ultimately the way to go.

– Tamir


Physical Activity and the Future Risk of Depression

In our book, as well as in several blog posts, we emphasize over and over again the benefits of regular exercise in order to prevent many different diseases, including heart disease, diabetes, strokes, and certain cancers. There’s also evidence showing that being physically active can help with certain mental health disorders such as depression and anxiety.

Unfortunately, it seems that depression, anxiety, and stress are becoming more prevalent. Many people begin to become depressed as they age. Mental health can suffer for a variety of reasons such as chronic illness, inability to participate in activities enjoyed at a younger age, and in some cases, feelings of worthlessness.

Obviously, taking care of yourself when you’re younger can help prevent many chronic illnesses and other personal factors that can affect your ability to enjoy life. Smoking cessation is probably one of the most important lifestyle changes to make, along with adopting a healthy diet and regular exercise.

A recent paper published in the American Journal of Preventive Medicine adds more evidence to the importance of physical activity before we hit old age. The paper reviewed 30 studies assessing the risk of developing depression later in life, covering 26 years worth of data. The vast majority of the studies (25 out of 30) showed a significantly reduced risk of developing depression later in life in people who were physically active when younger.

These days, people are generally living longer, and so quality of life becomes a big issue. Why spend your golden years depressed and riddled with chronic illnesses when a little effort now can pay such large dividends later on?

– Tamir


The connection between poor diet and depression

It’s well-known that an unhealthy diet high in processed food and junk food increases one’s chances of developing several different health problems, including heart disease, diabetes, and certain cancers. It seems that the same holds true for mental illness.

A recent article in Brain, Behavior, and Immunity followed over 43,000 women from the ages of 50 to 77 without any depression at baseline for 12 years. Compared to the women with the best diets, those with the worst diets (high in soda, cakes, cookies, fried foods, sugar, etc.) had an over 40% higher risk of becoming depressed.

The authors of the study suspect that the underlying cause is that poor diets increase inflammation in the body. Inflammation is known to lead to heart disease, cancer, and many other chronic diseases. In addition, it’s now known to increase one’s risk of depression as well. This additional evidence helps us dispel the erroneous notion that anxiety, depression, and other mental health conditions are “all in your head.” It seems that whatever isn’t good for the body (e.g. a poor diet, lack of exercise), also isn’t good for the mind (in fact, there’s a lot of evidence showing that regular exercise helps with symptoms of depression and anxiety).

The bottom line is that if you eat a poor diet, you aren’t only messing up your physical health; you’re hurting your mental health too.



More evidence that excess stress kills

It’s been known for a while that excess stress isn’t good for the body. Stress is NOT “all in your head.” When your body is under chronic stress, stress hormones are released which cause real physiological changes in the body. Our bodies are very well equipped to deal with short term intermittent stresses, but when someone is under constant stress, it does indeed take a toll on the body. The sad thing is that many people, due to the erroneous belief that stress is only a mental problem, neglect to seek treatment. They’re under the mistaken notion that seeking help for chronic stress and its associated problems, depression and anxiety, somehow makes them weak people, or even worse, makes them feel as if they are crazy.

Stress kills; don't repress emotions

This is absolutely absurd. Much in the same way that a person with a serious infection or someone suffering a heart attack seeks help and needs treatment, so does someone suffering from chronic stress. Just as antibiotics can kill the infection, and different interventions can save the heart, there are many effective strategies to deal with stress. These include psychotherapy, medication, exercise, and relaxation techniques.

Unfortunately, many people will continue to bottle in all of their emotions – blind to the damage that all of that pent up stress is doing to their bodies. Well, a new article published in the Journal of Psychosomatic Research reveals just how harmful stress is. The authors of the study handed out an “emotion suppression scale” to over 700 people. The scale, based on different questions, measured how much a person suppresses his or her emotions. The people were subsequently followed for 12 years, during which over 100 had died.

Compared to the group that suppressed their emotions the least (i.e. they were the most open about expressing how they were feeling), the group that suppressed their emotions the most fared much worse. They had a 35% higher risk of dying from any cause during the duration of the study. Furthermore, their risk of dying from cancer was 70% higher, while the risk of dying from cardiovascular disease was 47% higher!

The study wasn’t designed to tease out differences between the groups which would shed light as to why suppressing one’s emotions is so damaging. However, the authors speculated that perhaps people who bottle up their emotions use more harmful coping techniques such as smoking, overeating junk, or drinking alcohol. Or, perhaps, just having no outlet for a lot of stress over many years results in damage to the body.

The bottom line is that if you are under a lot of stress, seek help. It’s there. Many times it’s incredibly difficult to deal with emotional baggage by yourself. Just as it would be idiotic to try to fight a lung infection without antibiotics, so to, bottling up emotions instead of dealing with them destroys one’s body. And no, chain-smoking, hitting the bottle, or binging on potato chips and ice cream doesn’t really count as dealing.

– Tamir

(Image links to source: Wikihow.)


As old as you feel

Throughout our book and in several blog posts, we’ve stressed the importance of a positive outlook on life. A fascinating recent study conducted by Krystal Warmoth of the University of Exeter in England sheds some insight as to how important such an attitude is. The study consisted of interviewing 29 older people of varying degrees of health and asking them their perceptions of aging and frailty. People who perceived themselves as old and frail were more likely to withdraw from activities that promote good physical and mental health, such as engaging in regular exercise and interacting socially with others. This in turn completed the self-fulfilling prophecy that they were indeed old and frail, since abstaining from healthy things ultimately leads to physical and mental decline.

Our own worst enemies

Many times in life, we’re our own worst enemies. Our attitude towards what we can or can’t do often makes the difference in terms of our overall physical and mental health.

I can tell you that from my own experience as a physician I’ve seen this many times. I have a patient in his 80s who only came to see me a couple of years ago at the urging of his family since he had “never” seen a doctor. Except for a couple of minor issues, he’s quite fit and healthy. One may attribute this to his having good genes, but I can tell you that in his case, his parents didn’t die at an especially old age. Furthermore, he’d been a smoker for many decades.

What I believe is a big driving force behind his health is his attitude towards life. As soon as I walked into the room for our first meeting, he didn’t look like someone in his 80s. He looked at least 10-15 years younger. He walked well without the use of a cane, with an erect posture. He had a smile on his face and immediately started to crack some jokes. I usually go through what’s called a “review of systems” with patients in which I ask them from head to toe whether or not anything is bothering them (headaches, neck pain, chest pain, etc. etc.). Almost every question I asked him was followed by a no. No headaches. No dizziness. No hearing problems. He did have some cataracts which were taken care of. No difficulty swallowing. No shortness of breath. No chest pain or discomfort. Halfway through, he said, “I told you, Doc, I’m fine. No complaints. I feel good.” He had retired from his job as an auto mechanic a year before, but was bored being home so went back to work “part time” – close to 40 hours a week. He didn’t view himself as “old and frail.” I similarly have had other such role model patients.

Old and frail at heart; old and frail in body

On the flip side, I’ve had “old and frail” patients in their teens. Unfortunately I’ve seen several teenagers who are overweight, with poor posture, bad backs, neck pain, elevated cholesterol, elevated blood pressure, elevated sugars, and who are always tired. They find it hard to exercise. They have multiple somatic complaints. Many of them are pessimistic and anxious, always living life waiting for some disease or other misfortune to befall them.

If you are such a person, then it’s important that you to try to change your mental outlook. If part of the problem is that you suffer from depression, anxiety, or another mental illness, then by all means seek professional help. You’ll notice that the new you will be much happier, fitter, and ready to take on the challenges of life, no longer “old and frail.”

– Tamir


Use it or lose it

Keep your mind active

Our bodies have a “use it or lose it” mentality; for example, someone who doesn’t regularly exercise will have weaker, atrophied muscles. It seems that our brains follow the same rules. Today, people are for the most part living longer lives. With old age often comes Alzheimer’s disease and other forms of dementia. There’s a lot of active research being conducted on how to prevent as well as how to treat Alzheimer’s. It’s known that people who have a lot of the risk factors for heart disease and strokes, such as smoking, diabetes, high blood pressure, and elevated cholesterol are at a higher risk for developing dementia as well; so if any of the above apply to you then by all means address them.

However, what if anything else can you do to keep the mind sharp? A large recent study published in the Canadian Medical Association Journal looked at various factors that contributed to halting cognitive decline and found that while many of the herbs and supplements that are commonly sold for Alzheimer’s didn’t make much of a difference, engaging the mind through crossword puzzles, cognitive training, etc did.

This makes a lot of sense. Use it or lose it. I’ve seen in my own life people who retire, veg on the couch for hours on end watching TV, and end up senile quite fast (declining physically as well). So if you’re approaching your golden years, whether or not you still work, keep your mind active. Read, learn new things, do sudoku, crossword puzzles, help your grandchildren with their homework and of course, exercise, follow a healthy diet, and if you smoke, quit.

– Tamir

(Image links to source.)