Your Brain Wants You to Be Mellow: New Evidence Shows Chronic Emotional Stress Can Increase the Risk of Mild Cognitive Impairment in Later Life

So you’ve been putting off getting therapy, even though most of the time you feel anxious and upset? Well, a new study suggests that you may be putting your brain in danger.

Researchers at Rush University Medical Center in Chicago, Illinois, followed more than 1200 men and women who were 65 and older, average age of about 76. At the beginning of the study they made sure that none of them had mild cognitive impairment (MCI), and measured their emotional distress using a simple 6 item scale of neuroticism. Items such as 1) “Are you the type of person whose feelings are easily hurt?”; 2) “Are you the type of person who is rather nervous?”; and 3) “Are you the type of person who is a worrier?” make up this scale.

At the beginning of the study the average score was about 15 on this emotional distress scale. Patients were followed up for up to 12 years. About 38% developed MCI during the study. Those in the top 10% of emotional distress at the beginning of the study were about 40% more likely to develop MCI.

What is interesting is this relationship held even after researchers statistically removed the effects of depressive symptoms at the beginning of the study. So the results were from emotional distress, not from depression. The risk for MCI increased by 2% for every 1 point increase on the distress scale. This is a pretty strong correlation.

So what does this mean? I think what it means is that chronic emotional upset is hard on the brain. It makes sense, since emotional stress raises stress hormones such as cortisol, which we know can damage the brain, especially the hippocampus, which controls memory. What we don’t know is whether this study was picking up some early brain changes in the elderly, changes which correlate with both emotional distress AND a tendency to develop MCI. A better study would look at younger people, and see if emotional distress in those aged 40 or 50 leads to the development of MCI in later life.

Since about a third of those with MCI will develop Alzheimer’s Disease, any reductions in the prevalence of MCI would be tremendously beneficial to society. Perhaps psychotherapy should be mandatory for all those over 65!

What can you do to lower your brain risk? First of all, honestly evaluate whether you suffer chronic emotional stress. Ask yourself if most of the time you feel calm and happy, or upset and worried and stressed. Also ask your close friends and/or family what they think. If you are someone who suffers chronic stress, then get help. A cognitive behavioral psychologist can teach you good stress management skills, and may help break lifelong patterns of emotional stress. Another good option is to learn mindfulness meditation and yoga and practice them daily. These are known to reduce psychological distress.

Whatever you do, don’t take it lightly if you are in long term distress. Your brain wants you to be mellow!

Copyright 2007 The Psychology Lounge/TPL Productions

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Can Cognitive Behavioral Therapy Make a Baby? How Psychological and Behavioral Factors Can Reduce Infertility

An article in the May 7 edition of U.S. News and World Report titled “Success at Last: Couples Fighting Infertility Might Have More Control Than They Think” shows how health psychology can impact even something as basic as making a baby. This fascinating article shows that behavioral and psychological factors may play a big and controllable role in producing the infertility that 1 in 8 couples suffer. It turns out, that the body may be smarter than we gave it credit for. Woman’s bodies may recognize certain states as not ideal for childbearing, and therefore prevent or lower fertility. Two examples are being overweight or underweight. Overweight risks pregnancy complications such as diabetes, high blood pressure, so the extra estrogen produced by body fat interferes with ovulation. Underweight women may not have enough body fat to sustain a baby, so the pituitary gland releases less of key ovulation hormones. Other behaviors strongly influence fertility. Take smoking for example. Multiple studies show that smoking can delay getting pregnant by a year or more. And one study at Columbia University found smokers entered menopause 3 years earlier on average. Or diet. Trans fats, a key component in such unhealthy foods as donuts, cakes, etc. may raise testosterone, which suppresses the ovaries. Research shows that as little as 4.5 grams, which is the amount found in one donut, can have this effect. Even positive behaviors can negatively affect fertility. One study found woman who exercised four or more hours a week were 40 percent less likely to conceive after their first IVF (In vitro Fertility) treatment than women who didn’t exercise. Once again, it may be that the body interprets hard exercise as danger and stress, and shuts down the fertility system.

Even pure psychological stress can affect fertility. Here’s the biological mechanism. A few hours before ovulation, the pituitary gland sends out luteinizing hormone (LH), which tells the ovaries to release an egg. But if you are experiencing psychological stress such as a fight with your husband, or a dressing down from your boss, or a kid having a tantrum, then your LH will be suppressed, disrupting ovulation.

Even mild stress may have a big effect. One study of monkeys found that moving monkeys to a new cage, combined with a little less food and 1 hour on treadmill caused 70 percent of the monkeys to have irregular menstruation! So don’t skip that meal and take a long run when stressed, or you’ll greatly lower you odds of getting pregnant.

What’s worse is that IVF treatment itself may lead to large amounts of psychological stress. One fertility expert found that 40 percent of women in infertility treatment had all of the symptoms of an anxiety disorder or depression: sleep disturbances, difficulty concentrating, and irritability. So if stress lowers fertility, and fertility treatment increases stress, then fertility treatment may actually harm fertility!

But cognitive behavioral therapy may improve the situation. Alice Domar and colleagues at Harvard found that a 10 week cognitive behavioral group therapy program improved the success of fertility treatment from 20 percent to 55 percent in the women who participated in the group therapy. So what can we learn from this research?

  1. A woman’s body is wise. It will respond to behavioral and psychological stressors by lowering fertility. Anything that resembles stress, even hard exercise, will trigger physical responses that lower fertility.
  2. At critical points such as several hours before ovulation, even normal stressors can disrupt the ovulation process. And in stress-prone or perfectionist or angry women, the likelihood of experiencing stress during these critical hours is very high. Thus for women who are experiencing difficulty getting pregnant and who by personality are “stressy” (you know who you are!) cognitive behavioral therapy (CBT) will be helpful in learning to manage and lower stress.
  3. Infertility treatment is by its nature stressful, and this leads to a paradox; infertility treatment may lower fertility if it increases stress. It may be helpful to evaluate stress levels in women undergoing IVF and if stress is high, intervene with CBT group or individual therapy.
  4. The ultimate in infertility treatment may be what I recommended to my friend Jill, who had tried many cycles of IVF to no avail. I told her, “You’re young, why don’t you and your husband stop trying to get pregnant, and just have sex for fun, and enjoy life for a few years. If nothing happens then you can adopt.” She was pregnant within the year, and now has two lovely children. A good long relaxing vacation with no schedule, no hard exercise, healthy food, and no stress may be the best fertility treatment available, and even if it doesn’t work, at least you’ve gotten a great vacation!
  5. Finally, what this research shows us is how linked our minds and bodies are. Changing thoughts and feelings and behaviors changes our bodies, and fertility is just one example of this.

Copyright 2007 The Psychology Lounge/TPL Productions

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Is Your Shrink Being Paid to Give You Drugs? The Secret Link Between Psychiatrists and the Drug Industry

Regular readers of this blog will remember my earlier article on Rebecca Riley, the young girl whose overtreatment with powerful psychiatric drugs may have led to her death.

Now it turns out that some psychiatrists may actually be getting paid by the drug industry to give kids powerful drugs! And this is in spite of an almost complete lack of evidence that these drugs work or are safe for children.

The New York Times has an article called Psychiatrists, Children, and Drug Industry’s Role, and this scary article documents the secretive practice of paying psychiatrists to prescribe certain drugs.

The article documents that more than half a million children are now receiving atypical antipsychotics such as Risperdal, Seroquel, Zyprexa, Abilify, and Geodon. These drugs have never been tested on or approved for use in children!

In Minnesota alone, the only state that requires such reporting, from 2000 to 2005 payments from pharmaceutical companies to psychiatrists soared by six times, to $1.6 million, and the rates of prescribing antipsychotics to children went up by nine times.

And the Times found that the money worked. Those psychiatrists who received more than $5000 from the drug companies wrote 3 times as many prescriptions for atypical antipsychotics than those doctors who got less or no money. Other interesting figures are that the average payment to psychiatrists was $1750, with a maximum of $689,000. (Nice work if you can get it!)

I should point out that atypical antipsychotics are not benign drugs. Side effects can include rapid weight gain that leads to diabetes, and movement disorders such as tics and dystonia, which can lead to a lifelong muscle disorder.

The Times describes one unfortunate girl, Anya Bailey, who was given Risperdal for an eating disorder by her psychiatrist George Realmuto, who had received more than $7000 from Johnson and Johnson, the maker of Risperdal.

Although the drug helped her gain weight, she also developed a painful and permanent dystonia in her neck that now causes her chronic pain and a movement disorder, even after stopping the drug.

And she was never given any counseling for her problems, only drugs!

So what can we learn from this article? First of all, the practice of paying psychiatrists to prescribe certain medications is widespread, but only Minnesota requires full disclosure. We should pressure our legislatures to mandate full disclosure in every state. Write to your state and federal congress and senate and ask them to either ban this practice or to require full disclosure, on the web, by name of doctors, of how much money is given by each drug company.

Secondly, when you take your child to a psychiatrist, you should ask them for a full written disclosure of any money they received in the last few years from drug companies for speaking, or for research. Payments to psychiatrists (and other M.D.’s) are disguised as speaking honorariums or research payments, but when a doctor receives $5000 for giving one or two talks, it is safe to say that they are being paid for something else. If the psychiatrist admits to receiving money, then you should probably find another psychiatrist, as this creates a bias to prescribe that I do not think can be overcome.

Third, you should be dubious about any suggestion to give your child an antipsychotic medication for any diagnosis other than true psychosis. This means that unless your child is actively hallucinating, and delusional, i.e. “crazy” there is no evidence that antipsychotics will help them. For instance, there was only one well-controlled study of the use of atypical antipsychotics in bipolar illness in children, and it found little or no difference between using the antipsychotic and not using it. And most of the children in the group receiving the antipsychotic dropped out of the study due to side effects. A second study by the same researchers found no advantage to using antipsychotics.

Fourth, consider taking your child to a psychologist or counselor rather than a psychiatrist. Psychologists don’t receive money to influence their treatment decisions and use behavioral approaches that don’t have side effects. And there is much more research evidence that supports the use of these behavioral approaches in childhood disorders. Dangerous medications should be reserved for second or third line treatments only. Remember the old saying that to a young boy with a hammer everything becomes a nail, similarly to a doctor whose specialty is giving drugs, all problems become biochemical.

Finally, let’s put pressure on our legislators to outlaw this thinly disguised bribery, which threatens the health of children and adults. Shame on the pharmaceutical industry! And even more shame on psychiatrists, who of all people should be trustworthy and not willing to accept such bribes. I make the perhaps radical suggestion that patients boycott psychiatrists who accept money from drug manufacturers. If doctors can’t earn a decent living without taking payments from drug companies that often have the appearance of bribes, then perhaps they need a new profession. I realize that there are decent, honest psychiatrists who either don’t take drug company money or don’t let it influence them, but I suggest that it may be hard to tell the difference unless psychiatrists employ full disclosure.

Copyright 2007 The Psychology Lounge/TPL Productions

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.