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Mental Health at the Forefront of Cardiovascular Health Discussions at AHA21

Mental health was a big topic of conversation at AHA21, a fitting topic when pandemic related stress, clinician burn out, and depression seem to be at an all-time high. As a graduate student myself, I was interested in attending sessions that touched on depression, wellness, and work-life balance topics. A Health and Tech panel session titled, “Mental Health and Cardiovascular Disease,” addressed how depression and languishing mental health can heighten the risk of cardiovascular diseases and cardiovascular events. This is because chronic stress activates our sympathetic nervous system and promotes changes in heart rate, blood pressure, and stress hormone levels. While there is a diverse array of known factors that influence depression, clinicians are now taking on the challenging task to measure how mental health contributes and modulates cardiovascular health outcomes.

Clinicians often connect patients with resources and educate patients about chronic disease self-management. However, when patients are coping with chronic physical conditions, mental health conditions can go unrecognized and may further impact health outcomes. As stated in the panel conversation, an astonishing 22% of people with heart disease struggle with depression as well. Properly identifying patients with depression is particularly important as mental health challenges that accompany traumatic health crises can interfere with cardiovascular disease treatments, often managed with lifestyle changes and adherence to strict medication regiments. Clinicians who are willing to attain mental health training to recognize mental health symptoms may provide more useful resources to patients. For example, routine mental health screening during visits were discussed to be a powerful tool that can help clinicians assess depression and anxiety symptoms and facilitate patients getting comprehensive assessment and specific resources that may improve overall health outcomes.

Digital solutions may also be effective tools for managing mental health and heart-healthy behaviors in the future. There is biotechnology in the works that may help patients track physiological reactions to daily stressful experiences, and individual step count and heart rate variability data may one day help clinicians make better informed decisions. One digital intervention program in the works in the works is Happify Heart and Mind, tailored to address lifestyle changes that would benefit individuals with heart disease risk factors. Clinical trial data presented at this session showed that depression, anxiety, and overall wellbeing was improved in patients who used Happify compared to traditional psychoeducation. The take-away question to walk away with after this session is to reflect on who would benefit the most from digital solutions. While scientists can leverage technology to touch on the complex relationship between mental health and cardiovascular health, these solutions need to be adapted to cross the digital literacy divide. Patients who face social inequities would stand to benefit most from personalized and adaptable comprehensive interventions, and clinicians can help connect the most underserved patients with digital resources and support programs.

Resources:

https://www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing/how-does-depression-affect-the-heart

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Wellness Amid a Pandemic

I think about wellness often and the unique aspects of being a physician that make preserving our wellbeing even more important. Of course, this COVID-19 pandemic has tested all of us and the things we turn to for wellness and our escape from medicine, may not be available to us right now. After work dinner and drinks, early morning group fitness classes, and young professional networking events have been replaced by Netlfix© and dine-in, home workouts, and Zoom “wine” downs. We all had to dig down deep inside to find new venues for wellness and if we were lucky, our institutions provided resources to help us during this crazy time. What this pandemic taught me was that there are things I still needed to work on to build my resilience even further- and I am totally okay with that. Working on ourselves to better ourselves should be a continuous goal- everyone has room for improvement.

As a single woman living in the city, my nights and weekends were always filled with social events. I felt very isolated and realized how much of my free time was being occupied by my friends and the events I attended as part of my wellness routines. I miss my morning classes at bootcamp and will never complain again when my alarm wakes me up at 4:25am to get to class- whenever that may be. Some of the things that have helped me are FaceTime and Houseparty dates with friends and family, walking outside on the few sunny days Boston has graced us with, trying to eat healthy when I can, in-home workouts which I am not a fan of to be completely honest, but most important, was being vulnerable with friends, family, colleagues, and even patients who asked how I was doing during our virtual visits. I met with a Wellness Coach provided through my institution and the lightbulb moment for me was when he reminded me to be kind to myself. I remember seeing posts all over social media about how we should be building businesses, getting in shape, writing grants, or checking off any other number of “goals” because we have “so much time” and feeling bad, but I got over that. In the middle of this crisis, all our lives have been disrupted, some much more so than others, and we are all doing the absolute best we can. I remind myself to be grateful and I started writing specific things down that I am grateful for each day.

May is Mental Health Awareness Month and as physicians, we shy away from talking about such things. It may be that we are supposed to be superheroes who are invincible, or it may be that if we did seek help and received a diagnosis we would have to declare it on some medical state licensing applications, or we may just be afraid. Mental health is one of the many aspects of overall wellbeing and there are many ways to reach out for help for those who need it. COVID-19 has had many casualties and we must guard our mental health during this pandemic. Find what works for you and do it. Reach out when you need to and remember that it is totally okay to not be okay. Protect your mind, body, and soul as these are key aspects of our overall wellbeing. I feel optimistic about our future. When we come out on the other side of this let us take all the lessons we learned and remember to never take things such as human contact for granted again.

Stay safe and stay healthy.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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“Run, Forrest, Run!” – Effects of Cardiovascular Exercising on Mental Health

running

Source:pixabay

If life gave me a box of chocolates, I am pretty sure I would eat them all. As a basic science researcher, I am all too familiar with burn-outs and stress, and more recently to the effects of stress-induced anxiety. So, I started running. I ran when my worries got too overwhelming, I ran when I had a bad day in the lab. Next thing I knew, I was running for pleasure. And this is something I did not see coming, especially because I hated running before!

Long before medications were available or even prescribed for mental or emotional disorders, exercising remained the only prescription for tacking problems of mental health by doctors.1 The AHA recommends 150 minutes of moderate-high intensity aerobic exercising a week for adults. Researchers have found this to improve balance of neurotransmitters and show effects as early as the first thirty minutes.

Here are some evidence-based effects of exercising on mental health –

  1. Stress and anxiety – Chronic stress can shrivel parts of the brain. Exercises have found to reverse this effect and even induce growth of neurons and improve synaptic plasticity in the brain.1,2
  2. Depression – Regular aerobic exercising can improve blood circulation to the brain and it is known to positively influence hypothalamus-pituitary-adrenal axis of the brain. All of this bounce back the balance of neurotransmitters, elevate mood, attenuate stress and fight back fear.3
  3. Addiction – While dealing with addiction, exercising has been shown to give a sense of control. Individuals with a tendency to be obsessive, need to fill a void quickly and exercising has shown to be effective in this regard.
  4. Hormonal fluctuations in women – Hormones estrogen and progesterone play an important role for neurotransmitter in the brain, by providing receptors for them to bind. In some women, this complex pathway can behave in a way that increases aggressive behavior which is found to be dramatically reduced by exercise. Exercising is certainly known to increase levels of tryptophan, the precursor to the happy chemical serotonin. This helps in dealing with the constant fluctuations of hormones during a cycle.1
  5. Attention deficits – Aerobic exercising has been successful with disorders of distractions, improving focus, concentration and memory of a task.

As with any given task, starting it – is always a challenge. If you are someone like me who is a novice at running, or the thought of running itself induces fear and anxiety – then start with small steps. Take a walk, slowly increase that to brisk walking and when you feel comfortable start jogging. It doesn’t necessarily even need to be running – jumping rope, biking, throwing ball – any activity that spikes your heart rate are good.

So, will you run away from your problems?

 

References:

  1. John Ratey, Spark: The Revolutionary New Science of Exercise and the Brain, ISBN:0316028355
  2. Carek PJ, Laibstain SE, Carek SM, Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41(1):15-28.
  3. Toups M, Carmody T, Greer T, Rethorst C, Grannemann B, and Trivedi MH. Exercise is an effective treatment for positive valence symptoms in major depression. J Affect Disord 2017; 209: pp. 188-194