Feb 07

Fun-filled Day of Womens Heart Health

by Dr. Micaela Wexler

On Friday, February 6, 2015, I had the honor of speaking at a fundraiser for Women’s Heart Health Month. I spoke at the Red Dress Gala held by the Alpha Phi Sorority at Indiana University.
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Full disclosure: my daughter, Sarah Raider-Wexler, is a sophomore at IU, and as VP of Marketing for her sorority, she is in charge of the chapter’s two philanthropic projects. I have no financial ties to pharmaceutical or cardiac treatment device companies. I do not prescribe medications for cardiac medical issues, although I do continue them when patients are admitted to my care in the hospital.
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I am very proud my daughter. It was a beautiful event. Everywhere I looked, there were smiling pairs of mothers and daughters in their red dresses. And, this year they raised several thousand dollars more than last year.

When Sarah asked me if I would be the physician speaker, she said, “Mom, heart disease can be pretty grim: it’s the number one killer of women. So, give them some tips, but please, keep it light.”

Women’s cardiac health is near and dear to my heart not only because I am a physician but because both my parents have heart disease. My father survived a heart attack and my mother survived open heart surgery.

I have learned people are much more likely to engage in healthy behavior if it is fun!

A fun-filled day of cardiac health:

Wake up and take a few deep cleansing breaths while you’re still in bed. Deep breathing decreases blood pressure. Let’s try one right now.

When you get to the bathroom, read the post it note you left on your mirror last night telling you something wonderful about yourself. If all it says is “you’re awesome!” That’s enough.

Then, as you sit on the toilet with your phone in your hand, and I know there are people in this room who do that, read a joke or look at a funny video.

Laughter really is the best medicine. A 2006 study in Maryland showed that laughing 15 minutes a day dilates your vessels 22 percent. This lowers your blood pressure, and putts less strain on your heart.

Now it’s time to crank up your favorite dance song, or two. Something with a beat, and start dancing. Dancing improves heart health. Listening to rhythmic music 30 minutes a day lowers blood pressure and heart rate. I recommend Grenade by Bruno Mars.

Played 10 times in a row.

When you get to work, hug your boss.

Hugs save lives.A study in North Carolina showed that hugs reduce heart disease, and women benefit more than men. And it doesn’t matter if the person is close to you or a casual acquaintance. You still get the benefit. So hug someone every day, several times a day.

If you have to sit for your job, get up and walk around at least once an hour. I take a big container of water and take a huge drink right when I get to work. An hour later, I go to a bathroom far away from the clinic. Fewer people use it, which means fewer germs. And, more movement.

While you’re in the bathroom, think about your beautiful body. This beautiful body that brought you here today. Women, we are COMPLICATED! Women don’t have typical symptoms of heart attacks. If you feel anything funny from your jaw to your pelvis, call your doctor.

Walk during lunch. It doesn’t have to be a long walk. Walking 10 minutes a day twice a day every day significantly reduces heart disease.

Middle of the afternoon: time for some more cleansing breaths. Check out your mood. Are you stressed out? Taking those deep breaths will relax you.

If you find you have trouble relaxing, or that your mood is depressed, think about getting help. Untreated depression carries a high risk of a heart attack, especially for women. You have to be happy: you heart depends on it.

Don’t forget to hug people during the day! Do this every day during Womens Heart Month.

After work, treat yourself to some more dancing while you change out of your work clothes, to get rid of the day’s stress. You earned it!

Then, it’s time for a glass of red wine. Studies have shown that ONE daily glass of red wine is good for your heart.

After dinner, treat yourself to some dark chocolate for dessert. Again, you’re doing this for your heart. Chocolate with 65% cacao is the kind that is good for your heart.

Then just before bed, grab that blank post it, and write something awesome about yourself and put it on your bathroom mirror.

Early diagnosis beneficial in AD
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Appointment information for Dr. Micaela Wexler: wexlerpsych.com

Jan 15

Want to lose weight? SLEEP!

BabySleepBy Dr. Micaela Wexler

Are you overweight? Are you getting enough sleep?

As I was getting ready to plan my New Year weight loss strategy, I was thrilled when I entered the words sleep and obesity in Google and found countless articles showing that lack of sleep, as in less than seven hours a night, leads to increase in weight. Sleep has been shown to affect the level of the hunger inducing hormone leptin secretion in children, and there is no reason to believe the same doesn’t happen to adults; sleep deprivation causes the decision making center of our brain to become less active, and leads to junk food cravings; sleep deprivation leads to decreased energy and motivation, which results in decreased exercising; sleep loss has a negative impact on metabolism, increasing the risk of obesity and diabetes.
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So, if people want to lose weight, instead of starving themselves or hitting the gym, why don’t they just SLEEP more?

As a psychiatrist who listens to people complain of insomnia all day long, I can tell you it isn’t that easy. Many of my patients with sleep problems are also overweight.

Sometimes the reasons people aren’t sleeping are obvious: They have a small baby, they are depressed or anxious, they work nights, they are worried about debt or losing their jobs, they don’t have a job, they have a job but work too many hours (that would be me).

Other times, the reasons are obvious to me and not to them: they have relationship conflicts, they are fighting with or attracted to someone at work, they are watching TV right at bedtime, they are sleeping with smart phones next to their heads and texting and posting all through the night. Some people just have bad sleep hygiene (again, that would be me).
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Then there are the people with chronic insomnia who have medical issues preventing sleep, such as chronic pain, restless leg syndrome, obstructive sleep apnea, post traumatic stress disorder, severe mental illness, to name just a few.

So, if you aren’t getting enough sleep, you first need to rule out any medical issues. A medical sleep evaluation includes a physical exam, a medical history, a sleep history and a screening for depression or anxiety.

There are some things you can do in addition to your medical evaluation. Determine what your sleep hygiene is. Sleep hygiene consists of the activities you engage in during the two hours prior to bed time. Do you “work ’til you drop (like I do)? That will keep you up at night. You need to spend those two hours before bed time slowing things down. Don’t expect to fall asleep until at least two hours after you have stopped working. Find relaxing activities to do during that time, such as some stretching exercises followed by a bath. Get your clothes ready for tomorrow, regardless of whether or not you are planning on leaving the house. Plan what your day will be.
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Get yourself moving during the day. You can start with just 10 minutes of walking during lunch. You can also do a simple stretch or yoga routine before bed. Increasing your activity during the day will always lead to better sleep at night.

Anything you didn’t get done today, just put on the list for tomorrow. My feeling is this: if I didn’t get all my tasks done, it’s because I didn’t plan my day properly. Better luck tomorrow. I happen to work as a psychiatrist in a critically under served area, so I’m always going to have too much on my plate. That makes it easy for me to let myself off the hook, which I realize is not true for everyone.

Let’s say you’ve dutifully done your sleep hygiene and you STILL can’t sleep. Something that helps me is to keep a small notebook by my bed and write down the thoughts which are racing through my head. If I forget to put the notebook and pen under the pillow, then my toddler tears my thoughts to shreds the next morning, but, nothing is perfect. That usually means that since I didn’t see her sneak up and get it, then I did get to sleep.

I strongly recommend you use paper and pen rather than your smartphone. You will still be able to read it, even if you write in the dark. (Try it right now: close your eyes and write something with a pen.) And, your mind will be focused only on what you are writing, which is not possible with a smartphone.
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Writing these thoughts down will help you determine why you are not sleeping. You will be able to figure out if you have insomnia because you’re worried about work, or because you are depressed. If you find that you are writing thoughts that reflect hopelessness and doom, or that you are ruminating over the same things over and over again, or you have so many thoughts you can’t get them all written down, then you may need to see a psychiatrist or therapist. Or, both.

If I go too many nights in a row without writing in the dark at night, then I will do get insomnia again. Something that commonly happens to me when I write my thoughts down in the dark is that I dream solutions to my problems. Sometimes I dream that I forgot to put my notebook under my pillow again.
The bottom line is that we have an important weight losing tool at our disposal: sleep. Maybe I’m just lazy by nature, but the way I look at it, before I start starving myself or start killing myself in the gym to lose weight, I think I’m going to start with something a little bit easier: sleep.

Dr. Micaela Wexler also blogs on child psychiatry topics at kidpsychdoc.com.

Nov 14

Is your depression keeping you from losing weight?

By Dr. Micaela Wexler
If you are having trouble losing weight, it could be due to depression. As a family psychiatrist, this link is very obvious to me, but not to my patients. Studies show that depression and obesity are linked to each other. A meta analysis study published in JAMA in March 2010 shows a that depression can lead to obesity and obesity can lead to depression. (1) A study of Dutch teenagers, published in Obesity in March 2010, showed a clear association between weight status and suicidal behavior in obese adolescents. (2) The same link was found in a later study done on Korean teenagers. (3)
Depression causes physical changes which affect interest, sleep, appetite, sexual drive, and thought processes. Some types of depression cause people to eat and sleep more than normal. If you are having trouble finding the willpower to exercise it might be due to decreased motivation, which might be due to depression.

Are you finding it hard to lose weight even though you are exercising and sticking to your diet? This could also be due to depression because depression makes the body’s metabolism change. When a person is depressed chemical changes take place that make it harder to lose weight. Some of these changes can cause weight gain and fatigue.

Depression can also cause a change in eating patterns. The chemical imbalances caused by depression make it harder for people to connect hunger with food intake, which is why some depressed people eat even when they are not hungry. Or, they are hungry even after eating.

It is easy to blame your weight on lack of willpower. But, if you are having trouble losing weight, it is important to make sure you are not depressed. Besides causing weight gain, untreated depression can cause more serious problems like diabetes, heart disease, and suicide. And, studies show that treating depression leads to weight loss.

Do you feel sad or hopeless? Are you having trouble sleeping? Have you lost interest in things like hobbies or TV shows or fun activities? Do you have trouble motivating yourself to do things? Are you short-tempered? Do you have negative thoughts about yourself? All of these are signs that you might be depressed.

If you’re having any of these signs, go see a therapist or a doctor or call your local mental health center. Start treating your depression so it doesn’t keep you from losing weight.

1) Overweight, Obesity, and Depression
A Systematic Review and Meta-analysis of Longitudinal Studies FREE
Floriana S. Luppino, MD; Leonore M. de Wit, MS; Paul F. Bouvy, MD, PhD; Theo Stijnen, PhD; Pim Cuijpers, PhD; Brenda W. J. H. Penninx, PhD; Frans G. Zitman, MD, PhD

2) Weight status, psychological health, suicidal thoughts, and suicide attempts in Dutch adolescents: results from the 2003 E-MOVO project.
van Wijnen LG, Boluijt PR, Hoeven-Mulder HB, Bemelmans WJ, Wendel-Vos GC.

3) The relationship of weight-related attitudes with suicidal behaviors in Korean adolescents. Kim JS, Lee K. Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.

4) Pagoto S, Schneider KL, Whited MC, et al. Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: the Be Active Trial. Int J Obes (Lond). 2013 Mar 5. [Epub ahead of print]

Jul 28

It’s not enough to just get up and move

By Dr. Micaela Wexler
Last month (June 2013) the American Medical Association voted to classify obesity as a disease, a decision which will hopefully lead to a more comprehensive view of this public health issue which affects one third of all Americans, instead of our current narrow focus. As a psychiatrist, it is difficult for me to stand by while the link between obesity and depression is ignored. In recent years, solutions have been focused almost exclusively on diet. Our simplistic view of obesity is evidenced by the widespread support for Michelle Obama’s “Let’s Move” campaign. This campaign, and others like it are, at best, short sighted, and at worst, cruel and harmful, especially with regards to children and adolescents. While there is nothing wrong with promoting exercise and healthy eating, especially among young people, focusing solely on diet and exercise ignores other issues which need to be addressed in order to successfully treat this growing health crisis.
The most harmful aspect of these campaign is that it adds to the view that obesity is a moral failing, which contributes to an unhealthy treatment of people with weight issues. At the Building a Healthier Future Summit, this past March, Obama charmed her audience with the following, “We can’t lie around on the couch eating French fries and candy bars, and expect our kids to eat carrots and run around the block. But, too often, that’s exactly what we’re doing.”
This view of people with obesity is not only demeaning, but flies in the face of research which shows obesity has many causes: genetics, hormonal influences, mental health status in addition to poor diet and exercise. Multiple studies have shown a correlation between maternal obesity and obesity in offspring. Children born to obese mothers start to have weight problems as early as toddlerhood. Once obesity has set in, hormonal and metabolic conditions in the body make weight loss challenging. Limiting focus to diet and exercise doesn’t take into account the many people who are getting up and moving, like families whose children are involved in sports, but who still find themselves battling obesity. Ignoring these various causes leads to ignoring potential solutions.
As a rural psychiatrist, I am confronted with the challenge of obesity, which is more widespread. A study done by Christie Befort, PhD, published in the fall 2012 issue of the Journal of Rural Health, shows that obesity is significantly higher for adults from rural areas of the United States. The study compared 7,325 urban adults with 1,490 rural adults, and found that after controlling for factors such as demographic, diet and physical activity variables, the obesity prevalence among rural adults was 39.6% versus 33.4% among urban adults.
Studies have established that obesity tends to cluster in families, in part due to genetics. For example, in 1990, a study published in the NEJM comparing the body mass index of identical and fraternal twins reared apart and reared together showed that genetic influences on body mass index are substantial. Although no single gene can account for obesity, as many as 50 genes have been found that are associated with obesity, affecting things such as metabolism, food cravings, fat accumulation and fat storage, to name a few.
The link between depression and obesity is well known in psychiatry. Ignoring this link is especially dangerous when it comes to children and adolescents. A meta analysis study published in JAMA in March 2010 shows a reciprocal link between obesity and depression, ie, depression can lead to obesity and vice versa. (1) A study of Dutch teenagers, published in Obesity in March 2010, showed a clear association between weight status and suicidal behavior in obese adolescents. (2) The same link was found in a later study done on Korean teenagers. (3)
A person who is depressed undergoes physiological changes which affect interest, sleep, appetite sexual drive and thought process. They most likely do not possess the motivation to “get up and move.” Changes in eating patterns, along with a disconnect between food intake and hunger are common in people with depression. Depression itself has been shown to cause weight gain and fatigue; metabolic changes that occur during depression make the body less responsive to diet and exercise. People with depression tend to lose their perspective when dealing with problems in their life. They tend to carry a great deal of shame, as do people with obesity.
As with obesity, the incidence of depression is significantly higher among rural residents than among urban residents. (4). This difference becomes more pronounced with regards to suicide, especially teen suicide. (5) Currently, in the rural setting, the stigma for mental illness is a major challenge in addressing the issue of depression. The same is true for obesity, with many obese people having internalized society’s view that people are that way because they are lazy. Perhaps with the AMA classification, people with obesity will feel more empowered to reach out for help. As the veil of shame is lifted on obesity, so may it also lift when it comes to depression. Addressing the link between depression and obesity will go a long way in decreasing morbidity and mortality among our youth. Then maybe it won’t be so hard for people to get up and move.

1) Overweight, Obesity, and Depression
A Systematic Review and Meta-analysis of Longitudinal Studies FREE
Floriana S. Luppino, MD; Leonore M. de Wit, MS; Paul F. Bouvy, MD, PhD; Theo Stijnen, PhD; Pim Cuijpers, PhD; Brenda W. J. H. Penninx, PhD; Frans G. Zitman, MD, PhD

2) Weight status, psychological health, suicidal thoughts, and suicide attempts in Dutch adolescents: results from the 2003 E-MOVO project.
van Wijnen LG, Boluijt PR, Hoeven-Mulder HB, Bemelmans WJ, Wendel-Vos GC.

3) The relationship of weight-related attitudes with suicidal behaviors in Korean adolescents. Kim JS, Lee K. Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.

4) Rural-urban differences in depression prevalence: implications for family medicine.
Probst JC, Laditka SB, Moore CG, Harun N, Powell MP, Baxley EG.
South Carolina Rural Health Research Center, University of South Carolina, 220 Stoneridge Drive, Columbia, SC 29210, USA. jprobst@gwm.sc.edu
Fam Med. 2006 Oct;38(9):653-60.

5) A review of the literature on rural suicide