Welcome to the May edition of Tips and Topics and to all the new subscribers.

In SAVVY, there is preoccupation with medication as the main and most effective treatment in physical and mental health and addiction. But there are a variety of non-medication lifestyle interventions that can be as effective as medication, if not even better.

In SKILLS, engage with clients to embrace an exercise mindset, use the power of placebo to build hope, and work with families to improve relationship time.

In SOUL, Tucker Carlson, previously a ratings star for Fox News, sent a text message to a producer on January 7, 2021 when he was watching a video of people fighting on the street in Washington. In this age of polarization and demonizing those with whom we disagree, Carlson shares some surprisingly good and insightful advice.

David Mee-Lee, M.D.
DML Training and Consulting

SAVVY

Society, psychiatry and addiction medicine are, in my opinion, too focused on medications as the answer to any ailment. Watch any TV show and you will likely see at least one advertisement for a prescription or over-the-counter medication. Rarely do you see anything promoting lifestyle change.

While scientific advancements in neurobiology, brain function and neurotransmitters have given rise to effective pharmacotherapies, they have also seduced too many into seeing medications as the most important intervention in mental health and addiction.

To balance the scale of therapeutic interventions, this month’s edition highlights some recent findings on lifestyle interventions that can be supportive of what medications do and in some cases, are superior to medication.

Tip 1

Exercise and physical activity can improve anxiety, depression, addiction recovery, and other health outcomes. For depression, exercise may be more effective than counseling and leading medications.

Here are the Headlines:

• • The Addition Of Simple Exercises To Treatment May Improve Recovery From Substance-Use Disorders, Study Indicates

The Washington Post (4/26/23, Reynolds) reports a study “found that incorporating simple workouts such as jogging or weight training into treatment improved the likelihood of recovery from a variety of substance-use disorders, including to cocaine, opioids, cannabis and alcohol.” The study was published online April 26, 2023 in PLOS One. The study’s findings “build on other research, some with animals, showing that exercise changes our brains and thinking in ways that can reduce drug cravings and relapse and might even stave off addictions in the first place.”

• • Exercise For Treating Depression As Effective As Standard Drugs, Psychotherapy, Review Suggests

The Washington Post (3/15/23, Reynolds) reports, “Exercise as a treatment for severe depression is at least as effective as standard drugs or psychotherapy and by some measures better, according to the largest study to date of exercise as ‘medicine’ for depression.” The new research “pooled data from 41 studies involving 2,265 people with depression and showed that almost any type of exercise substantially reduces depression symptoms, although some forms of exercise seemed more beneficial than others.” The review findings were published online February 16 in the British Journal of Sports Medicine.

Researchers are calling for exercise to be a mainstay approach for managing depression as a new study shows that physical activity is 1.5 times more effective than counseling or the leading medications.

• • Exercise Appears To Significantly Decrease Suicide Attempts, Systematic Review Suggests

Healio (4/3/23, Bascom) reports, “Exercise significantly decreased suicide attempts,” investigators concluded in the findings of a 17-study, 1,021-participant systematic review and meta-analysis published online ahead of print in the June issue of the Journal of Affective Disorders.

• • Supervised Exercise Programs May Be Tied To Significant Reductions In Symptoms Of Depression Among Children And Teenagers, Systematic Review Concludes

HealthDay (1/6/23, Thompson) reported, “Supervised exercise programs are associated with significant reductions in symptoms of depression among children and teenagers,” investigators concluded in the findings of a 21-study systematic review and meta-analysis “involving more than 2,400” children. The findings were published online Jan. 3 in JAMA Pediatrics. Additionally, the systematic review “revealed a greater benefit from exercise among children who had already been diagnosed with depression or another mental illness.” Anish Dube, MD, MPH, Vice Chair of the American Psychiatric Association’s Council on Children, Adolescents, and Their Families, stated that “‘in a sense, physical activity itself is similar to an intervention that we would call behavioral activation,’ in which patients engage in meaningful activities to subvert...depressive lethargy.”

Tip 2

For children and adolescents consistent and good sleep supports health, happiness and mental well-being.

• • Study Highlights Importance Of Good Sleep For Adolescents’ Mental Well-Being

MedPage Today (4/5/23, DePeau-Wilson) reports, “Sleep problems throughout the transition from childhood to early adolescence were associated with psychopathology symptoms, highlighting the importance of good sleep for adolescents’ mental well-being,” investigators concluded in a study revealing that “among over 10,000 kids, those with more severe sleep problem profiles had a higher risk of concurrent internalizing symptoms.” The findings were published online April 5 in JAMA Psychiatry.

• • Consistent sleep may be key factor in supporting children’s health, happiness

CNN (3/16/23, Holcombe) reports, “One of the keys to keeping your child happy and healthy is making sure they get enough sleep consistently,” according to a new study published in JAMA Network Open. For the research, investigators “monitored 100 children ages 8 to 12 living in New Zealand,” and “the children alternated between a week of going to bed one hour earlier and one hour later – with one week at normal time in between the two.” Investigators “covered many aspects of well-being, including an assessment of how the children felt physically, and psychologically, in their relationships with parents and peers, and how they felt about school.”

Tip 3

In anxiety, mindfulness can be better than medication and breathing exercises may even be better than mindfulness.

• • Practicing Mindfulness To Relieve Anxiety May Be Just As Effective As Escitalopram, Research Indicates

The Washington Post (1/23/23, Morris) reports, “Practicing mindfulness to relieve anxiety can be just as effective as medication,” research indicates. The findings of a 276-participant study published online Nov. 9, 2022 in JAMA Psychiatry “showed that people who received eight weeks of mindfulness-based interventions experienced a decrease in anxiety that matched those who were prescribed escitalopram.”

• • Breathing Exercises May Improve Mood, Reduce Anxiety Better Than Mindfulness Meditation, Study Says

The Washington Post (3/16/23, Sima) reports, “A study in Cell Reports Medicine showed that just five minutes of breathwork each day for about a month could improve mood and reduce anxiety – and these benefits may be larger than from mindfulness meditation for the same amount of time.”

SKILLS

Tip 1 

Engage clients in embracing an exercise mindset to improve physical, emotional and social health.

• • Exercise mindset, perception can have impact on health outcomes

The Washington Post (3/22/23, Reynolds) reports that a “new study of mindsets and exercise...shows that learning how much we actually move by tracking our steps could help us start thinking of ourselves as active people, which can pay health dividends, even if we don’t start exercising more.” The research suggests that people who “had been given inflated steps responded almost identically to those receiving accurate counts.” Investigators “suspect this signifies that many of us see little subjective difference between 7,000 and 9,000-ish steps, but plenty of difference between 7,000 and 4,000.” The findings were published in the Journal of Medical Internet Research.

Tip 2

Use the power of placebo to retain patients in treatment and improve their sleep.

• • Use Of Open-Label Placebo Alongside Methadone For OUD Tied To Greater 90-Day Retention Rates, Better Sleep Quality Compared With Use Of Methadone Alone, Small Study Indicates

Harvard Medical School’s News & Research explained placebo medication:

“The researchers found that participants who knowingly received placebo pills in addition to standard-of-care methadone treatment were significantly more likely to remain in treatment than were participants who received methadone treatment alone. Participants who received placebo pills also reported better sleep quality.

"The clinical implications of our intervention have great potential impact, as retention in treatment is a serious challenge for the field of addiction medicine,” said Belcher. “We’ve demonstrated it’s feasible to administer a placebo in addition to standard-of-care methadone in a community-based opioid treatment setting without adding a significant burden to clinic procedures, and the low-cost, low-risk nature of this intervention could provide an appealing strategy to target early methadone treatment adherence.”

It had long been assumed that deception or concealment is necessary for placebo effects to occur — “tricking” a patient to believe an inert pill contains active medication. But, a growing body of evidence from randomized controlled trials with irritable bowel syndrome, chronic low back pain, and other conditions has demonstrated that no such deception is necessary for placebo treatment to alleviate symptoms. Additionally, conditioning study participants to placebos by having them pair the placebo with an active medication — thereby potentially associating the placebo with a relief in symptoms that may be caused by the active drug — has been shown to treat symptoms of insomnia, ADHD, post-surgical pain, and more.”

Healio (4/19/23, Rhoades) reports, “The use of open-label placebo alongside methadone for opioid use disorder” (OUD) “was associated with greater 90-day treatment retention rates and better sleep quality compared with the use of methadone alone,” researchers concluded in a 131-participant randomized clinical trial, the findings of which were published online April 12 in JAMA Network Open.

Tip 3

Provide family counseling to improve parent-child relationships and encourage longer family mealtimes.

• • Longer family mealtimes tied to healthier meals for children

MedPage Today (4/3/23, Monaco) reports, “Longer family mealtimes may be one strategy to get kids to eat healthier, according to a randomized clinical trial that found an improvement in the balance of foods eaten at the table.” Results show that “on average, longer family meals induced kids to eat 3.32 more pieces of fruits and 3.66 more pieces of vegetables than those who ate during their regular mealtime duration, the researchers explained in JAMA Network Open.”

• • Teens with closer relationships to parents have lower chance of substance abuse

HealthDay (3/23/23) reports, “Teens who report better relationships with their moms and dads are healthier both mentally and physically and less likely to abuse drugs or alcohol as young adults, according to researchers.” The study also reveals that these teens “reported lower levels of stress and depression, as well as lower use of nicotine, alcohol, cannabis and other drugs.” The findings were published in JAMA Network Open.

SOUL

I don’t watch cable news shows much at all. They usually thrive on berating anyone on the “other side”; and building viewer ratings by whipping up polarizing points of view that demonize and dehumanize people.

Tucker Carlson had a huge following on Fox News before he was let go recently. Reportedly, he “made an inflammatory, racist comment in a text message to a producer about a video that showed a group of "Trump guys" attacking "an Antifa kid," writing in the message that "it's not how white men fight," according to the New York Times.”

The message was sent on January 7, 2021, and Carlson wrote:

"A couple of weeks ago, I was watching video of people fighting on the street in Washington. A group of Trump guys surrounded an Antifa kid and started pounding the living s**t out of him. It was three against one, at least. Jumping a guy like that is dishonorable obviously. It's not how white men fight. Yet suddenly I found myself rooting for the mob against the man, hoping they'd hit him harder, kill him. I really wanted them to hurt the kid. I could taste it."

He continued: "Then somewhere deep in my brain, an alarm went off: this isn't good for me. I'm becoming something I don't want to be. The Antifa creep is a human being. Much as I despise what he says and does, much as I'm sure I'd hate him personally if I knew him, I shouldn't gloat over his suffering. I should be bothered by it. I should remember that somewhere somebody probably loves this kid, and would be crushed if he was killed. If I don't care about those things, if I reduce people to their politics, how am I better than he is?"

I was impressed with the insightful wisdom that arose from Tucker’s text. Here’s what I gleaned from his text that is a good start to decreasing our country’s polarization:

• • “.....this isn't good for me. I'm becoming something I don't want to be.” - The importance of self-reflection to take stock of whether hate, violence and lack of compassion and empathy are taking us over.

• • “Much as I despise what he says and does, much as I'm sure I'd hate him personally if I knew him, I shouldn't gloat over his suffering.” – Certainly we may disagree vehemently with another’s beliefs and priorities. But violence and causing pain and suffering to those with whom we disagree is never justifiable.

• • “I should be bothered by it. I should remember that somewhere somebody probably loves this kid, and would be crushed if he was killed.” - Dehumanizing others is the start of a slippery slope of lack of empathy that can lead to violence and death.

• • “If I don't care about those things, if I reduce people to their politics, how am I better than he is?" – Righteous indignation, demonizing others for their differing opinions pushes us apart.

Self-reflection and concern about what we are becoming; causing no harm; remembering others’ humanity; and empathy can start to bring us back together again. Who would have thought that Tucker Carlson’s texts could spark some healing.

UNTIL NEXT TIME

Thanks for joining us this month. See you in late June.

David