Mon. May 10th, 2021

    Science Plays the Long Game. But People Have Mental Health Issues Now.

    I’ve reported on behavior and mental health for 20 years. As I exit, I can’t help but wonder why researchers have placed so little emphasis on helping people in distress today.

    When I joined the Science staff in 2004, reporters in the department had a saying, a reassuring mantra of sorts: “People will always come to the science section, if only to read about progress.”


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    I think about that a lot as I say goodbye to my job, covering psychiatry, psychology, brain biology and big-data social science, as if they were all somehow related. The behavior beat, as it’s known, allowed tremendous freedom: I wrote about the mental upsides of binge drinking, playing the lotto and sports fandom. I covered basic lab research, the science of learning and memory, the experience of recurrent anguish, through the people who had to live with it. And much, much more.

    Like most science reporters, I had wanted to report on something big, to have a present-at-the-creation run that would shake up our understanding of mental health problems. At minimum, I expected research that would help people in distress improve their lives.

    But during my tenure, the science informing mental health care did not proceed smoothly along any trajectory. On the one hand, the field attracted enormous scientific talent, and there were significant discoveries, particularly in elucidating levels of consciousness in brain injury patients who appear unresponsive; and in formulating the first persuasive hypothesis of a cause for schizophrenia, based in brain biology.

    On the other hand, the science did little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health — rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use — went the wrong direction, even as access to services expanded greatly.

    What happened? After 20 years covering the field, here and at The Los Angeles Times, I have a few theories, and some ideas on what might be required to turn things around.

    Early on in my job, I started to field a steady stream of calls and emails, usually from parents asking for advice.

    “My son is suicidal. We’ve tried everything. What do we do?”

    “Our daughter is cutting herself, she’s out of control. Can you recommend a therapist, or someone to talk to?”

    More than a few of these queries came from colleagues at The Times. Others came from friends and family.

    I always provided suggestions and referrals (with a disclaimer), and helped decode the psychiatric jargon, if needed. I also followed up later, to see how things were going. This second conversation was a reminder, every time, that the mental health system, for all its caring professionals, is chaotic and extremely difficult to navigate. There are few systemwide standards, and vast and hidden differences in quality of care. Good luck finding an authoritative guide to navigating the full range of appropriate options.

    In time, those seeking help became the lens through which I saw my job, and their questions became my own. What does a diagnosis of bipolar really mean, in a young child? Is this drug necessary? How trustworthy is the evidence?

    One answer to that last question came in the mid-2000s, when the Food and Drug Administration held a series of hearings on whether antidepressant drugs, like Paxil, Prozac and Zoloft, backfired in a small number of users, causing suicidal thinking and behavior.

    The hearings were hair-raising. Hundreds of family members who had lost a loved one crowded the rooms, their anger and expectation sucking up most of the oxygen; and some of the parents, it was clear, knew at least as much about the drugs as the doctors.

    By 2006, the F.D.A. had concluded that a so-called black-box warning on antidepressant drug labels was warranted, citing the suicide risk for children, adolescents and young adults. Many psychiatrists were dismayed by the decision, insisting it would discourage the use of valuable medications.

    The antidepressant wars, as this debate came to be known (it rages on today), also helped uncover the influence of industry money on academic psychiatry. The pharmaceutical industry paid researchers at brand-name institutions to talk up drugs at seminars and conferences; it paid for “expert panels” to promote their use; and it often had outside firms write up the studies themselves, massaging the data.

    This state of affairs made it virtually impossible to interpret psychiatric drug studies. Some experiments were undoubtedly honest, rigorous efforts to document the diffuse effects of a medication. Others were no more than “infomercials,” in the phrase of the late Dr. Bernard Carroll, one of the most stubborn critics of his own profession — drug ads, in effect, dressed up as research. The infomercials were usually easy to spot, but not always; and without knowing the back story, the money trail, you couldn’t be sure what to believe.

    When it came to judging government-funded research projects — a cleaner enterprise, presumably — I again asked the questions that people in crisis continually asked me. Is this study finding useful for my son, or my sister, in any way? Or, more generously, given the pace of research: Could this work potentially be useful to someone, at some point in their lifetime?

    The answer, almost always, was no. Again, this is not to say that the tools and technical understanding of brain biology didn’t advance. It’s just that those advances didn’t have an impact on mental health care, one way or the other.

    Don’t take my word for it. In his forthcoming book, “Recovery: Healing the Crisis of Care in American Mental Health,” Dr. Thomas Insel, former director of the National Institute of Mental Health, writes: “The scientific progress in our field was stunning, but while we studied the risk factors for suicide, the death rate had climbed 33 percent. While we identified the neuroanatomy of addiction, overdose deaths had increased by threefold. While we mapped the genes for schizophrenia, people with this disease were still chronically unemployed and dying 20 years early.”

    And on it goes, to this day. Government agencies, like the National Institute on Drug Abuse and the National Institute of Mental Health, continue to double down, sinking enormous sums of taxpayer money into biological research aimed at someday finding a neural signature or “blood test” for psychiatric diagnoses that could be, maybe, one day in the future, useful — all while people are in crisis now.

    I have written about some of these studies. For example, the National Institutes of Health is running a $300 million brain-imaging study of more than 10,000 young children with so many interacting variables of experience and development that it’s hard to discern what the study’s primary goals are. The agency also has a $50 million project underway to try to understand the myriad, cascading and partly random processes that occur during neural development, which could underlie some mental problems.

    These kinds of big-science efforts are well-intended, but the payoffs are uncertain indeed. The late Scott Lilienfeld, a psychologist and skeptic of big-money brain research, had his own terminology for these kinds of projects. “They’re either fishing expeditions or Hail Marys,” he’d say. “Take your pick.” When people are drowning, they’re less interested in the genetics of respiration than in a life preserver.

    In 1973, the prominent microbiologist Norton Zinder took over a committee reviewing grants by the National Cancer Institute to investigate viruses. He concluded the program had become a “gravy train” for a small group of favored scientists, and advised slashing their support in half. A hard, Zinder-like review of current behavioral science spending would, I suspect, result in equally heavy cuts.

    How can the fields of behavior and brain science begin to turn the corner, and become relevant in people’s lives? For one, prominent scientists who recognize the urgency will have to speak more candidly about how money, both public and private, can warp research priorities. And funders, for their part, will have to listen, perhaps supporting more small teams working to build the psychological equivalent of a life preserver: treatments and supports and innovations that could be implemented in the near future.

    There’s a reason that so many people use binge drinking, playing the lotto and runaway eating to support their mental health: because the effects are reliable. Because they don’t require a prescription. And because they’re available, right now.

    Published at Thu, 01 Apr 2021 13:53:43 +0000

    Anxiety depression mental health

    We’ve finally reached the point where everyone in the U.S. who’s 16 and older is eligible for a COVID-19 vaccine. Although it’s clear the vaccines offer great protection against COVID-19, you still may have some questions about how they’ll affect your everyday life. Take working out, for instance: Maybe you’re wondering about exercise and the COVID-19 vaccines—and whether your exercise habits can influence your reaction to the shot.

    There are three COVID-19 vaccines authorized for emergency use in the U.S., and all are effective at fighting COVID-19. (Moderna is 94% effective at preventing lab-confirmed COVID-19, Pfizer is 95%, and Johnson & Johnson is 66%—and all have even greater efficacy against serious disease or death. This doesn’t mean the Johnson & Johnson vaccine is automatically a terrible option. You can read more about why it’s difficult to directly compare these numbers here.) But like all medical treatments or drugs, they can come with some side effects. According to the Centers for Disease Control and Prevention, potential side effects of the vaccines include pain, redness, and swelling at the vaccine site, as well as systemic reactions such as fatigue, headache, muscle pain, chills, fever, and nausea.

    Side effects aren’t the same for everyone across the board, though. Carl Fichtenbaum, M.D. an infectious disease specialist at the University of Cincinnati College of Medicine, tells SELF that individual reactions to the vaccine can be as disparate as a symphony is from a grunge festival, ranging from no reaction at all to being stuck in bed with flu-like symptoms for a few days as your body builds up protection to this dangerous virus.

    These potential reactions are simply a byproduct of how vaccines work: Vaccines contain foreign substances called antigens specific to the infection you’re trying to prevent, Dr. Fichtenbaum explains. In an attempt to banish the antigen “invaders,” your immune system springs into action, releasing white blood cells and other tools. It’s this immune response that can make you feel a little icky in the hours or days following your vaccine.

    Eventually your body will develop memory cells known as T-lymphocytes, a type of white blood cell that protects you from future infection. Say, for instance, you come in contact with SARS-CoV-2, the virus that causes COVID-19, after you’re fully vaccinated: Thanks to the vaccine, those memory cells should mobilize at the first sign of infection and quickly produce antibodies to fight the virus.

    But what does this whole process mean for your exercise routine? Can working out impact this all-important vaccination? And then, what about what comes after? Here’s what you need to know about exercising and your COVID-19 vaccination.

    Anxiety depression mental health 1. Moderate exercise shouldn’t harm your vaccine response—and experts are even looking into whether it may help it.

    While there are no actual quick “immune boosters,” moderate exercise does help your immune system function properly, as SELF has reported previously. So it’s only logical that scientists have wondered how an exercise session affects vaccine response in general. Because the COVID-19 vaccines are so new, however, there’s not much data on how exercise may affect the immune response to those vaccines specifically—and even existing data on other vaccines is not exactly conclusive. Still, there’s also no data showing that moderate exercise hurts your immune response. (While the CDC doesn’t offer explicit guidance on exercise and the COVID-19 vaccines, they do state that medical exercise tolerance tests are fine before or after.)

    The more pertinent question, then, is whether moderate exercise can help your immune response. There has been prior research on earlier vaccines that suggest a potential benefit to exercise. A 2014 review published in Brain, Behavior, and Immunity analyzed 20 studies (including a bunch that examined vaccines for conditions ranging from influenza to pneumonia to tetanus) and concluded that both chronic and acute exercise may boost vaccine effectiveness. And more recently, when a 2020 study from the same journal compared 45 elite athletes to 25 age-matched controls (who exercised no more than twice a week), it found that the athletes had a stronger immune response to their influenza vaccine.

    But if your workout motivation has waned during the pandemic—whose hasn’t?—don’t stress. The authors of a 2021 paper in Brain, Behavior, and Immunity exploring exercise’s effect on vaccine efficacy stated that, as we mentioned before, not only is the current data inconclusive, but much of it may not be applicable to the COVID-19 vaccine. There are still too many unknowns with this still-novel virus.

    According to Hilary Babcock, M.D., MPH, an infectious disease specialist with BJC HealthCare and Washington University School of Medicine, the relationship between exercise and vaccination effectiveness is not necessarily causal. That means it might not be the exercise causing the improved response. Instead, it may be that younger, healthier people—who are more likely to have a good immune response to vaccines in general—may also be more likely to exercise, Dr. Babcock tells SELF.

    Besides, while some research suggests a potential benefit, it’s also important to recognize that not exercising regularly didn’t show any harm to the  immune response. After all, in the 2020 study mentioned above, even the control group showed a robust immune response to the vaccine.

    So there’s no need to push yourself into exercise you don’t want to do in the hopes that you’re improving your immune system response for the shot. In fact, in a nod to your upcoming vaccine, it might actually be helpful to ease up a little before getting vaccinated.

    Anxiety depression mental health 2. You may want to go easier in your workouts prior to your vaccine.

    Because it’s hard to predict whether or how intensely you’ll experience side effects, you may want to dial back the intensity of your workouts during the 48-hour period before you get your shot, Nanci Guest, Ph.D., R.D., CSCS, a certified personal trainer and athletic performance coach in Toronto, tells SELF—and definitely don’t make your early-morning workout the time you decide to try something new if your appointment is scheduled for that afternoon.

    So if you typically go for a brisk 30-minute walk, don’t try a new bootcamp class; if you’re training for a half-marathon, trade hill repeats for an easy run. That’s because trying new workouts, or exercising more intensely than usual, can lead to delayed-onset muscle soreness, or DOMS. (So can eccentric-based training, which is a focus on the lowering portion of an exercise, where the muscle is lengthened under load, as SELF reported previously.) This soreness can make you feel worse if it’s compounded by flu-like side effects from the COVID-19 vaccine, says Dr. Fichtenbaum.

    You may also want to switch some workouts around, too. If you know you have an upper-body strength-training routine planned for the evening before your vaccine—even if it’s one you’ve done before—you may want to swap it for a lower-body day. That’s because pain at the injection site (your upper arm) is the most common side effect of COVID-19 vaccine shots—83% of first-dose Pfizer participants reported experiencing it, according to the CDC. Couple that with routine DOMS, and you may feel extra uncomfortable after. (It’s important to remember, though, that these side effects are fleeting—but your COVID-19 protection will last for much longer!)

    Anxiety depression mental health 3. Gentle movement after your shot may help ward off soreness.

    The CDC recommends you “use or exercise your arm” to minimize post-vaccine soreness. Unfortunately, there’s no real research out there on specific frequency, duration, or type of exercise to help you feel better, but Dr. Babcock does advise moving your arm more than usual.

    This movement can involve upper-body strength training, as long as it isn’t making your pain any worse. A light workout for your arms and shoulders can help get your blood circulating, which may help arm soreness, says Dr. Fichtenbaum. (Just make sure you’re using an amount of weight that’s not causing you more discomfort—it may be significantly less than what you’re used to lifting, and that’s totally okay!) What it doesn’t include? Going for a P.R. on strength-training moves like shoulder presses, lateral raises, or dips—targeting your deltoids or triceps in particular with too much weight can exacerbate discomfort from the shot, says Dr. Fichtenbaum.

    If you’re way too uncomfortable to even think about picking up a dumbbell or trying a push-up, intermittent, gentle arm movements can help with pain and swelling by stimulating blood flow. Dr. Fichtenbaum suggests shoulder circles, flexing and extending your elbow, or even gently rubbing your arm. Also, try to keep using your arm as you normally would, which can promote circulation. While this likely won’t prevent soreness, it might make it a little more manageable—which can be good news for your future workouts.

    Anxiety depression mental health 4. Easy workouts afterward may be key.

    Plan for easy workouts during the 48 hours after your vaccination, even if you think you feel fine, says Guest. Same reasoning applies here as with workouts prior to your vaccine: You don’t want to trigger any kind of reactions, like muscle soreness, that can compound any possible side effects that may develop after your vaccine. After all, many of these can appear up to three days after receiving your shot, so while you may feel fine at first—and ready to work out—some effects may rear up after that may make that not such a great idea.

    This is especially true after your second shot of Pfizer or Moderna, which tends to trigger more flu-like symptoms than the first. Fatigue, low-grade fever, and muscle aches are more common after that second jab, says Dr. Babock. (There’s no evidence that working out afterward affects the vaccine’s effectiveness, but remember, your immune system is working after a vaccine and after a workout to repair your muscles, so it’s possible you’d also take longer to recover after exercising, too.)

    If you don’t feel 100%, there’s no reason to push through a hard workout—or even to work out at all. If you’re really wiped out, give yourself a break.

    If you’re worried about “losing” fitness by taking it easy after getting your shot, that can actually be a good sign you’re overdue for a rest day, says Dr. Guest. If you’re overly focused on never missing a workout—even if your body is telling you otherwise—you’re much more likely to be at risk for overtraining, she explains. (And no, you’re not going to “lose” your fitness by missing a workout, or even a week of workouts.) She suggests taking advantage of the opportunity to trade your HIIT class for a brisk walk, an easy run, stretching, or even catching up on phone calls or reading.

    According to Garrett Stangel, M.A., a master trainer for the American Council on Exercise and a health and performance coach who owns Balance Fitness in Milwaukee, if you have a fever or “feel like you need to be horizontal,” take a total rest day.

    Anxiety depression mental health 5. Adjust your workout expectations for the week following your vaccine.

    For the week following your vaccination, Dr. Guest suggests dialing back the intensity of your workouts by about 20% and reducing the volume (say, fewer reps, sets, or exercises overall if you’re strength training, or a slower pace or shorter duration if you’re running or doing cardio) according to how you’re feeling. If you’re preparing for a race or an event, the week after your vaccine is a great time to build in a deload week (i.e., an easier week where you reduce your volume or intensity in order to recover and come back stronger). “It’s really important to listen to your body, and let your body tell you what it feels like doing,” says Dr. Guest.

    If you feel fine, there’s no reason to avoid your regular routine, including longer or more intense workouts. But it’s also important to remain flexible, and consider changing up your workouts if you feel good enough to get moving but are not quite up to your regular routine. For instance, if your arm still feels too sore for an upper body workout but you have the energy, Dr. Guest says running, cycling, walking, and core work are great options to get your blood flowing without exacerbating your arm pain. (Of course, if any workout is making your arm pain worse, back off the intensity or call it quits, she says.)

    Regardless of which modality you choose in the week post-vaccine, it’s important to temper your expectations: Don’t be surprised if you can’t hold the pace or lift the weights you normally would. After your shot, “you probably won’t see a P.R. that week,” says Stangel. Don’t beat yourself about it; your body is working hard even if you can’t feel it.

    Anxiety depression mental health 6. You still need to take precautions at the gym after getting your vaccine.

    You’re fully vaccinated two weeks after your second shot (or your only shot if you received the Johnson & Johnson vaccine). That doesn’t mean you should go back to business as usual—meaning, no mask—at your gym or yoga studio even if the location does not require a face covering.

    “You still need to wear a mask and take precautions,” Saskia Popescu, Ph.D., MPH, an infectious disease epidemiologist and assistant professor at George Mason University, tells SELF. In other words, you can develop COVID-19 without even knowing you have it. Plus, while getting the vaccine offers significant protection, it can’t guarantee with 100% certainty that you won’t catch or spread COVID-19 if you are exposed.

    So when you’re exercising in public, whether it’s in the gym or at your yoga studio, the CDC guidelines we’ve been following since last year still apply. Dr. Popescu reminds people to focus on staying six feet apart whenever possible (ideally farther if you’re breathing hard), masking, hand washing, cleaning and disinfecting surfaces and equipment, and being especially cautious in indoor spaces with poor ventilation. “It’s not just one thing,” she explains. “Risk reduction is very additive.” No single precaution on its own works as well as taking multiple precautions together.

    As for outdoor exercise? The CDC now says fully vaccinated people can now safely spend time outdoors in uncrowded outdoor settings with others without a mask, whether or not the others are vaccinated. If you’re not fully vaccinated, though, it’s a good idea to keep your mask handy for times when your regular trails or other workout spaces get too crowded to keep that proper distance.

    And important note: Whether or not you’re fully vaccinated, if you feel under the weather, you should avoid exercising in public spaces, says Dr. Popescu. While you obviously don’t want to spread illness (whether it’s COVID-19 or just a cold), showing up at the gym with the sniffles can also spike anxiety among the people around you. That’s why Dr. Popescu suggests staying home even if you know your sniffles are just seasonal allergies. “Be mindful that this is a stressful time for everybody,” she says. “We’re living in a pandemic, and it does make people uncomfortable.”

    Avoiding public gyms while you’re coughing or sniffling is one thing we hope continues as the pandemic begins to (hopefully) wane. Otherwise, we’re looking forward to the normalcy a session at the gym can bring—all made possible by that all-important vaccination, of course.


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