Is the Mental Health Crisis Deepening? Yes.

 

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A really good piece appeared in the Financial Times on mental health and EAP’s. The need for employee assistance has skyrocketed. But here and in England this has now become a crisis. Especially in the context of getting proper medication and therapy. Here are a few excerpts:

 

  • Employee assistance programs are usually pretty dull affairs. For a few decades now, employers have paid EAP providers to run phone lines their employees can call if they need support with personal problems. The idea is to provide some short-term support — a handful of counselling sessions, say — to help staff deal with mild problems before they get worse. But this year, EAPs have found themselves facing a swelling wave of complex mental health problem.

 

  • A recent report by the Joseph Rowntree Foundation highlighted the striking link between antidepressant use and deprivation: in 2021/22, more than twice as many patients were prescribed antidepressant drugs from practices in the most deprived areas in England than in the least deprived areas. The problem with leaning more on employers to provide mental health support during this time is that not everyone has access to such programs.

 

  •  People on low pay, insecure contracts or no work at all are less likely to have such a safety net. They will need as much help as the money-constrained state can spare. Some interventions don’t have to be very costly, such as integrating talking therapies with debt advice. Other policies that would help are already on the table but need to be implemented, such as government plans to make life in the rental sector less insecure.

 

  •  Leaving people to cope on their own will store up more problems, both for them and the economy as a whole. Already, a rising share of people say they are too ill to work. Although the over-50s are the biggest driver of this trend, there is also a worrying rise in inactive young people. For them, the biggest cause of long-term sickness is mental illness, phobias and nervous disorders, up 24 per cent since 2019. Economic problems are hard for people at the best of times, and these are not the best of times. How well or badly we handle this moment will have ramifications long into the future.

        “The Mental Health Recession is Deepening.” Financial Times (Nov. 22, 2022).





Couples and Depression — How Do You Help your Loved One?

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     Millions of couples are dealing with depression. Specifically, when one is suffering from it. What should the other do to help? A really great article has addressed this issue. Here are some excerpts from that recent article in the New York Times.

  • Millions of Americans are in relationships with partners who are prone to depression.
  • When helping your partner weather a battle with depression, experts say there are ways to be supportive while also caring for yourself.
  • Learning more about what depression is and how it affects people may also help you protect yourself emotionally, respond with more empathy and avoid taking your partner’s behaviors personally.
  • If one partner doesn’t understand that their partner is suffering from depression, they may mistake things like a loss of interest in romance or sex as a personal rejection.
  • To help a loved one get diagnosis and treatment, you can call potential providers and set up appointments, or compile a list of clinicians for them to contact. But experts say it is also important to remember that you cannot force anyone to get help, and that pushing too hard can backfire.
  • You shouldn’t have to be your partner’s sole support, especially in situations where they may be in danger. Keep in mind that depression can increase the risk of self-harm and suicidal thoughts.
  • Romantic partners can affect each other’s health and health-related behaviors in ways good and bad.
  • It is imperative that you support your own mental health. If you are experiencing symptoms of depression, reach out to a health care provider for evaluation. But even if you are not, you may find it helpful to see a therapist or to join a peer-led support group.
  • In addition to connecting with a therapist or support group as needed, it is also important to find other ways to prioritize self-care. It does not have to be time-consuming or complicated,
  • Spend time outside in nature, get involved in some form of advocacy or move your body. Jogging for 15 minutes a day, or doing less strenuous exercise like walking or gardening for an hour, may have a protective effect against depression.
  • And “socialize, socialize, socialize — whatever that looks like for you. You may encourage your partner to join you in your efforts to get out and exercise or connect with others, but keep in mind that loss of interest in normal activities or hobbies is a symptom of depression.

                         Couples and Depression — How to Help?” (Oct. 2022)

Are Unmarried Couples Facing a Wealth Gap? Yes, But …”

   

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   A good piece appeared in the Wall Street Journal discussing the wealth gap facing unmarried couples living together (compared to married couples). My take away is that economic assessment is correct. But I’m really not sure that economic analysis ought to govern a couple’s decision to get married. Nevertheless, here are some excerpts from this article. 

  • A walk down the aisle can be a route to greater wealth and prosperity for couples in the U.S. Married people have higher net worths than their unmarried counterparts their age.  
  • The mystery, though, is why cohabitating but unmarried couples struggle to build wealth in the same way. As of 2019, the median net worth for cohabiting couples age 25 to 34 was $17,372, a quarter that of the $68,210 for married couples of that same age range is $7,341.
  • While there are legal and tax benefits to marriage, research suggests the financial security and long-term mind-set of those who tie the knot may also be a powerful driver of wealth. More married couples pool their money—such as sharing savings accounts and investing together—to achieve certain goals. Cohabiting couples are less likely to combine finances and investments.
  • Working with two incomes and combining their investments to maximize compound interest can significantly increase a couple’s financial prospects. Simply put, married people may be more likely to be on the same page financially.
  • Married people may be much more likely to have these conversations around what goals they have for their financial future. There seems to be something very special and unique about deciding to share finances.
  • Unmarried couples may be less willing to commingle their money. Our money, our income, represents a huge part of who we are, sharing that can be scary for people, so they tend to be very protective.
  • Both married and unmarried couples who do pool finances also experience greater relationship satisfaction and may even stay together for longer. 
  • Housing is one of the biggest factors in establishing a couple’s wealth. Compared with single people and cohabiting couples, married couples hold a larger concentration of housing wealth. 
  • In the current hypercompetitive housing market, housing affordability declines, single people and cohabiting couples are often at a disadvantage. 
  • Housing prices are so high that you really need pooled resources to be competitive in some of these markets.”
  • Marriage rates are lower among Black and Latino groups, and those same households of similar ages held far less wealth than their white counterparts, whether married or partnered. Family structure also influences the overall net worth of a household. Partnered couples with young children tend to have less wealth than partnered couples without children. 

         “Unmarried Living Together Face Wealth Gap.” (Nov. 2022)

          

JUST SAD OR CLINICALLY DEPRESSED — How to Know the Difference? How to Treat Depression?

      

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   To me one of the great questions of the day is understanding the difference between being sad and clinical depression. A lot has been written on this recently. An excellent article in the Washington Post today discusses this topic and treatment for depression. Here are few of its observations. 

  • To say that we live in stressful times is an understatement. Covid. The climate crisis. A country riven with tension and political discord. What’s clear is that the world we live in has taken a toll on our collective mental health. 
  • But it is never too soon for people to wonder whether they are just stressed and sad — or clinically depressed. 
  • Feeling sad is normal, but depression is not. It’s a critically important distinction. Feeling distressed and sad is a normal and expected response to what we’ve endured these past several years, including the social isolation and loss of human life brought about by the pandemic.
  • But unlike everyday sadness, clinical depression is never a normal response to stress or trauma; it’s a serious medical illness that is associated with significant impairment in our ability to function in major areas of our life — in relationships, at home and at work. 
  • So how can you tell if you are depressed or just plain sad? 
  • To start, depression is a syndrome that involves far more than sadness. Aside from a sad or flat mood, depression typically causes insomnia, loss of libido and appetite, social withdrawal, low energy, feelings of hopelessness and suicidal thoughts, feelings and actions. 
  • Sad people are unhappy about a specific event, while depressed people feel bad about themselves and have a loss of self-confidence. 
  • There is abundant scientific evidence that clinical depression is associated with distinct brain changes in circuits that regulate mood, sleep, energy and appetite.
  •  Brain-imaging studies have identified multiple regions where there is altered activity or structure in people with depression. 
  • The notion that depression results from a chemical imbalance of any neurotransmitter such as serotonin is simplistic and wrong. 
  • Depression isn’t a disease of a single neurotransmitter or brain circuit, but more likely a system-level disorder involving multiple pathways and their related neurotransmitters. 
  • We don’t yet understand what causes the biological abnormalities in depression to come about in the first place, but we think it results from a complex interaction between genes and environmental stress. 
  • Still, we know a lot about how to treat depression. Both psychotherapy and antidepressants are highly effective for depression. 
  • Therapy and antidepressants are most effective. Psychotherapy is a first-line treatment for people with mild to moderate depression, but when depression is severe, meaning either the presence of psychotic symptoms or suicidal thoughts and feelings, then a combination of therapy and antidepressant medication is the safest and most effective approach. 

                    “Stress and Sad.” Washington Post (Oct. 18, 2022).

COUPLES AND MARRIAGE — Do They Change? Yes, But how?

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A new research study was published recently that discusses how marriage transforms couples in their relationships. Very interesting. Here are a few conclusions from that study:

  • Since newlyweds have to find ways to get along on a daily basis, it’s perhaps not surprising that they experience changes in personality as they adapt to partnered life.
  • Wives tended to show decreases in openness to experience, perhaps reflecting their acceptance of the routines of marriage.
  • Husbands increased significantly in conscientiousness, while wives tended to stay about the same. Since women tend to be higher in baseline conscientiousness than men, the increase for men probably reflects their grasping the importance of being more dependable and responsible as a spouse.
  • Husbands also became more introverted over the first year and a half of marriage. Other research has shown that couples tend to shrink their social networks after they wed, so this decline in extraversion reflects that trend.
  • Husbands showed a slight increase in emotional stability, but it was not statistically significant. Wives, however, showed a much greater increase. In general, women tend to report higher levels of neuroticism (emotional instability) than men, so it appears that the commitment of marriage had a positive effect on the wives’ emotional stability.
  • As husbands and wives negotiate life together, the best predictor of whether their marriage will thrive is the personalities of the two individuals as they enter the relationship. Emotionally stable partners make for emotionally satisfying marriages; for others, the journey is much more likely to be bumpy.

                          “How Marriage Transforms Us.” (October 2022).

 

WHY FORGIVE A CHEATING PARTNER — MANY GOOD REASONS, HERE ARE SOME.

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There is a good article in the recent issue of PSYCHOLOGY TODAY. It discusses why people forgive their cheating partners. The following are some excerpts from that article.

  • Infidelity is a relatively common occurrence, estimated to occur in 20–25 percent of marriages and close to 75 percent of dating. In the aftermath, the partner who was cheated on can experience a variety of unfortunate symptoms, including posttraumatic stress symptoms, depression, and anxiety.
  • This is particularly true when attributing responsibility to the partner who was unfaithful.
  • The following are some reasons why infidelity is forgiven. If she/he shows me that she/he has truly regretted it.
  • If infidelity was casual and not recurring.
  • If she/he gives me a sound excuse.
  • If she/he swears that she/he will not do it again.
  • If she/he shows me that he really wants to be with me.
  • If I love her/him.
  • If it was the first time she/he did it.
  • If she/he confess it on her/his own.
  • If she/he did it only once.
  • If she/he persuades me that she/he truly loves me.
  • If it was a frivolous act.
  • If she/he was drunk when she/he did.
  • If we have been many years together.
  • If I believe that I led her/him with my actions to be unfaithful.
  • If we have a good time together.
  • If she/he did at the beginning of our relationship.

“Why Do People Forgive their Cheating Partner? (Oct. 2022).

Economic Stress and Skipping Therapy …. Therapists Need to be More Responsive.

     With rising inflation and economic uncertainty, unfortunately, some couples are skipping therapy to save money. There is a good article in the Wall Street Journal discussing this difficult situation. My bottom line is that therapists need to work with clients that are having a difficult economic time. Economic stress merely compounds so many other issues. Here are a few major points made by this article. 

  • U.S. inflation has been rising at the fastest rate in four decades. Many are putting off therapy sessions or forgoing them altogether. 
  • Nearly a third of American adults in therapy say they have had to cancel a session because they couldn’t afford it and nearly half say they would have to quit if their out-of-pocket costs increased. 
  • Healthcare spending was down 7% in July from September of the year prior. 
  • People are experiencing more stress, there’s an exacerbation of chronic illness, they are having sleeplessness, they’re using more substances. 
  • Many therapy providers say they are largely unaffected by inflation-driven dropouts thanks to wait lists that have amassed throughout the pandemic. 

“Some Americans Skip Therapy to Save Money.” Wall Street Journal (8.25.22).

In Praise of Anxiety — ‘Anxiety May Lead to Excellence.’

A recent article in the Wall Street Journal describes recent research that discusses the benefits of anxiety in the workplace. That it can lead to really good performance and in fact excellence. Here are a few excerpts.

  • Over the past decade, research has also shown something that many scientists didn’t expect: higher levels of dopamine, the “feel good” hormone, when we’re anxious. 
  • Individuals who learned to reframe their anxiety as an advantage, compared with those who didn’t, performed better under pressure, were more confident and showed biological signs—steadier heart rates, lower blood pressure—of being focused and engaged. The study showed that when we believe anxiety is a benefit rather than a burden, our bodies follow suit and better prepare us to meet the challenges ahead.
  • A sense of purpose doesn’t mean some grand vision or a burning life mission. Purpose refers to the values and priorities that make us who we are and give our life meaning. 
  • That’s why it’s crucial to channel the benefits of anxiety, like persistence and hope, toward purpose. 
  • People who tended to pursue excellence over perfection in these exercises made mistakes, but they came up with more—and more original—answers.

“In Praise of Anxiety.” Wall Street Journal (May 7, 2022).

When Depression Drugs Stop Working — Why and What to Do.

 

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The problem of antidepressants when they stop working is a significant issue. A recent article discusses this critical situation. The following are excerpts from that article Depression Drugs Often Suddenly Fail to Work” that appeared in the Wall Street Journal recently (February 17, 2022).

  • You’ve been on the same antidepressants for years. Then suddenly, the medication seems to stop working. The problem can hit people even when a drug has worked well for a decade or more. Symptoms such as persistent sadness and a loss of interest in favorite activities resurge. Identifying the right solution can be difficult and largely trial-and-error: Some patients may need a higher dose of the same medication, while others may need to try a new drug or a new combination of drugs, doctors say. 
  • There are no statistics on how frequently antidepressants seem to suddenly fail in people who had been doing well on them. But psychiatrists say they see it fairly regularly. 
  • Scientists aren’t certain exactly why psychiatric drugs appear to lose effectiveness for some patients. There’s some evidence that long-term antidepressant treatment may reduce the number of serotonin receptors in the brain, says Dr. Nemeroff. Serotonin is a neurotransmitter, a chemical that transmits messages between neurons, that is important for mood.    
  • People who have lingering symptoms of depression while undergoing treatment, such as continuing sleep problems, are also more likely to experience a relapse or what may seem like a failure of their antidepressants.
  • Alcohol and drugs can destabilize mood and bring on symptoms, as can a change in sleep schedule. Other medications can interfere with antidepressants’ efficacy. And sometimes what a patient thinks is the medication failing is actually a side effect that can occur with long-term antidepressant use: emotional numbing or apathy.
  • The easiest move is to raise the dose of the drug the patient is currently on, says Maurizio Fava, psychiatrist-in-chief at Massachusetts General Hospital. 
  • Some psychiatrists prefer switching patients to a different class of medication. The most common switch is between an SSRI and a serotonin and norepinephrine reuptake inhibitor (or SNRI) like Effexor. SNRIs affect the action of serotonin and the chemical norepinephrine, which is involved in alertness and arousal. Dr. Schwartz says there is some evidence that SNRIs may be more effective at treating depression symptoms.
  • There are potential pitfalls to switching. Besides the possibility of new side effects, people may have withdrawal symptoms from their current medication. It can take several weeks before patients feel the beneficial effects of the new drugs. The biggest danger is that the patient won’t respond to the new medication—and that the old drug was actually helping more than perceived. Patients should work closely with their doctors and monitor their symptoms to continue making adjustments to their treatment until they improve.  

Couples Change — Often Hard to Adjust — But Often Possible.

     

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 There’s a good article in today’s New York Times discussing how all couples change. Here are a few of its observations that I believe are very helpful — especially during the current pandemic.

  • We don’t marry one person as much as we marry one version of a person, a snapshot of who we (and our partner) are individually and to one another at the moment when we say “I do.” Who we are five, 10 or 40 years later is anybody’s guess.
  • People change. As a result, relationships change, too.
  • Not only do relationships change with time, but people change, which can affect the relationship dynamics as well.
  • Personalities are more malleable than we may think. Most of us change, though often gradually.
  • But the pandemic and the disruption it brought have resulted in a period of far more rapid, intense and often negative change for many people the world over.
  • Communication has and will always be the key to mitigate negative feelings around change in your relationship,
  • Sometimes change is precisely what the love doctor ordered in order for two people to realize they are right for one another.
  • Accepting changes that you can live with not only leads to more self-fulfillment but can also lead to a stronger relationship. Change brings back some of that ‘newness’ and can add new passion and interest to the relationship. 

          “Watching a Partner Change is Hard.” New York Times (January 10, 2022).