Tag Archives: mental health

motivation for change

14 Sep

Sorry for the blog hiatus; a new semester has begun, and that always means upheaval here at the home of a college teacher! Anyway, I’ve been thinking a lot about motivation lately and trying to figure out what will motivate me to make healthy choices, and I wanted to toss some ideas out there in case any of them help you.

I am not particularly motivated by rewards that I promise myself–mostly because, if it’s something I want to do and it’s feasible, I’m not going to wait until I hit a goal to do it. Instead, I think about giving myself time and care every day to reduce stress and make me more able to commit to healthy choices and maintain them. Time is tight around here, like it is for most people, but I take a long hot bath any night that I want to; it helps me sleep and reduces my stress, which makes it easier for me to say no to junk food and yes to exercise the next day.

When I really struggle, I try to pause and think about why that healthy habit matters. If I’m longing to snack on unhealthy foods, even though I’m not hungry, chances are good that I am not in any frame of mind to contemplate why I want it. If I’m stressed, bored, sad–whatever it is that is making me want to overeat or stop thinking about healthy choices–I’m not going to be in the mood to sit down and think about my inner feelings. (It’s great if you can do that; it’s just that I can’t.)

So, instead, I let myself off the hook on figuring out why, at least right then.

I stop, remind myself that this is emotional eating, not hunger, and then I give my future self the gift of a healthier choice. I imagine me, the next morning, getting up knowing that I did exercise yesterday. I imagine myself knowing that I did eat my vegetables or that I didn’t eat mindlessly. This only works for me if I actually stop and imagine myself in the future, being grateful that I made the healthier decision.

I know how cheesy that is, but hey–it works for me. It works better for me to think about my behavior as the gift, rather than promising myself gifts if I change the behavior.

I also thought you might like this little diagram. Check it out.

follow-up: overeating

15 Aug

My last post discussed eating disorders–a very real issue for a lot of women. Overeating plagues even more of us, though: that is, the tendency to eat more than we need, and to eat for reasons other than hunger (even when it’s not severe enough to warrant the label “eating disorder”).

 

Some doctors believe that this is more often a problem for women with PCOS and insulin resistance, because the levels of insulin in your blood are connected to cravings and hunger. In particular, a lot of insulin-resistant people crave carbohydrates even when they have had plenty of calories.

 

Is this you? Do you find it difficult to stick to your eating plan or to listen to your body and eat mindfully, only when you are really hungry? It definitely describes me. There are some things you can do to minimize this, though. Some of these tips you have heard before, but maybe there’s something here that can help you.

  1. Clear your home of your most difficult-to-resist foods. For those of you who share your home, either with a family or a roommate, this might be hard. If popcorn is your go-to food when you’re bored or upset, and your spouse loves it, what do you do? My recommendation is that you get it out of the house. Ask your spouse to keep it at work or find a replacement that you wouldn’t be inclined to overeat. Talk to your housemates and explain that it’s important to you. If the rest of the household isn’t willing to get rid of something that you find irresistible, try to make it less convenient for you to eat it. Store it high up, or ask your partner to put it away out of sight so that you will be less likely to notice it. If you have roommates, ask them to store it in the bedroom so it’s not in your common space.
  2. Avoid tempting situations. If you always succumb to the siren call of the soft pretzels at the mall, don’t walk past them. Go a different route through the mall or whatever you have to do. If you always overeat when you go out to a certain restaurant with a friend, suggest a different restaurant that has healthier options (especially if you dine together frequently). It may seem extreme to avoid whole places in order to control your eating, but it’s not. Would you expect an alcoholic to resist drinking if there were always a bottle of his/her favorite drink on the kitchen shelf, or if every Thursday night was spent in a bar? Not really. It makes sense to save yourself the difficulty.
  3. Find healthier replacements for the things you usually snack on. This is harder than it sounds, because most of us are not satisfied with carrot sticks when we really want potato chips. But think about things that are similar to the food you overeat. For example, if you do crave potato chips, would you be satisfied with whole-wheat crackers and hummus? Or roasted chickpeas with some kind of seasoning? Or even with homemade sweet potato chips?
  4. Plan. This is hard for me, but it really does help: plan what you are eating for the day. Plan not only your meals, but your snacks. If you have a plan, it is easier to choose to adhere to your decision to eat toasted pita with hummus instead of a cookie from the break room at work. And you know that you will be getting a meal at some point in the future, which can make a difference to the way you feel about snacking. I am much more able to eat healthfully throughout the day and avoid overeating if I know that I am making a satisfying dinner that night.
  5. Prep. This is similar to item 4: get your snacks ready ahead of time so that you don’t have to prepare them when you’re craving something to eat. If you have to stop and peel a carrot and cut it up, it’s much less likely that you’ll eat your planned carrots and dip. If you have to clean a box of strawberries before your snack, it’s that much more tempting to eat chocolate instead. When everything is ready in the refrigerator (you might even box up your day’s snacks the night before), you can just grab it and eat it, and that eliminates the time you might spend thinking “maybe it would be easier to just eat this other snack instead.”
Practical suggestions help, of course, but I think it’s important to understand why we overeat. If you are a normal American overeater, you might get a lot of benefit out of David Kessler’s book,The End of Overeating: Taking Control of the Insatiable American Appetite.

This book is an excellent discussion of why we overeat and how to stop. Kessler, a former FDA commissioner, spent most of his career trying to improve regulation of cigarettes; his book is another contribution to public health, in my opinion, and it was very helpful to me. Kessler talks a lot about how foods are manufactured to produce the craving response that trips up so many of us. I highly recommend the book.

PCOS and Eating Disorders

10 Aug

Aside from the fact that PCOS seems to predispose our bodies to hang onto calories, there is a connection between PCOS and disordered eating (binge eating disorder, bulimia, or compulsive overeating, for example). It’s not clear whether PCOS might cause the eating disorder or whether the eating disorder can change hormones enough to encourage PCOS to develop, as this article by Angela Grassi points out. The only thing that is clear is that the PCOS population has a higher rate of disordered eating than the rest of the female population.

But if you have PCOS and struggle with disordered eating, it doesn’t really matter which problem came first, does it? You just need to find the solution.

So what to do? Your first stop needs to be a counselor or health care professional. This treatment finder from the National Eating Disorder Association has some good resources. You could also go to your primary care doctor and ask for suggestions or a referral, or ask your counselor, psychiatrist, or other mental health care professional, if you have one.

Diagnosis

Your doctor or therapist can help you determine whether you have an eating disorder. In some cases, it’s very clear, and you already know that you have one, but some sufferers don’t realize that their eating is unusual or problematic. Each specific disorder has a separate set of diagnostic criteria, but in general, any of the following behaviors or experiences suggests that you should consult a professional. (I have focused on binge eating disorder and bulimia, as these seem to be the most closely linked to PCOS–anorexia may be the most publicized ED, but it is not the most common among PCOS ladies.)

Symptoms:

* You routinely eat when you are not hungry;

* You overeat large amounts of food, even to the point of making yourself feel ill or uncomfortable (and not just on Thanksgiving!);

* You feel as though your eating is out of control;

* You eat secretly and hide your eating habits from others;

* You feel ashamed or guilty over the things you eat;

* You purge after eating–for example, vomiting, abusing laxatives or diet pills, fasting, or exercising obsessively;

* You eat in response to non-physiological factors: stress, emotion, boredom, etc.

Keep in mind that some of these are behaviors that can be normal and fairly functional if they’re minor. After all, most of us would consider it reasonable for a woman who just broke up with her boyfriend to hunker down on the couch with a pint of Ben & Jerry’s, and most of us eat more than we need to in certain social situations. It’s a matter of degree. It’s a disorder if your eating habits interfere with your life (that is, if they’re harming your health, causing you anguish, interfering with your job or school, or compromising your family life). Ultimately, a trained professional is the person who will be able to help you figure out whether you have an eating disorder or just a few bad habits.

While you’re setting up treatment, check out this page from the PCOS Network–it has good suggestions for curbing binge eating, most of which apply to compulsive overeating or bulimia as well. Don’t assume that you can handle this problem on your own, however. Any eating disorder can wreak havoc on your health over time, and they are very difficult to manage.

Treatments

There are no shortcuts on this one: you have to do the hard work of figuring out why you eat the way you do and how to achieve healthier habits. Some of the things you might try, in the treatment process, include:

  • Cognitive-behavioral therapy (or other psychotherapy). In many cases, therapy can help. CBT is most often suggested, because it concentrates on revising your own self-talk–the things that you say to yourself inside your own head–and that can be very effective at changing behavior. But really, any kind of therapy that can help you be more conscious and mindful in your eating choices will help.
  • Group therapy. You can consider a group run by a mental health professional and/or something like Overeaters Anonymous.
  • Medication. Sometimes certain antidepressants can help. Your doctor can help you make decisions about this.
  • Nutritional counseling. While this is not really a problem that can be solved by a nutritionist–it’s a mental health issue, not a lack of education about nutrition–sometimes a good nutritionist can help you figure out what is reasonable, what kinds of things you will find satisfying that would also be good for you, and what you might do to avoid foods that trigger your binge behavior.
  • Treating your PCOS symptoms. This is only my opinion, and I haven’t seen it said anywhere, but if there is a link between the two problems, it would seem likely that treating the PCOS may also help.  Some researchers feel that the prevalence of binge eating disorder among PCOS patients may be due to the body’s response to insulin, and if so, treatments for insulin resistance–such as Metformin–could also help.
Summing Up
If you have an eating disorder, it will be very hard for you to treat your other health issues until it is under control. And it is very difficult indeed to manage it alone. While I think that self-care is often a good option for some problems (mild depression, for example), an eating disorder always requires treatment. If you need it, get it; if you can’t figure out where to find help or how to pay for it, ask your primary care doctor for suggestions.

body image resources

1 Jul

A lot of PCOS patients struggle with their weight, which can cause difficulties with self-image or self-esteem. It is common for overweight women, in particular, to suffer from low self-esteem, especially if they have tried unsuccessfully to lose weight.

Our culture is not very accepting of different body types. But there are some organizations and blogs that are working to push back against idealized, unrealistic, or narrow views of beauty.

Here are a few places you might want to visit:
Adios Barbie
This site fights unrealistic and judgmental views of women’s bodies–as exemplified by Barbie.

Health at Every Size
The HAES community focuses on healthy living without fixating on weight loss. It’s based on the belief that “the best way to improve health is to honor your body.” It’s based on the research and writings of researcher and nutritionist Linda Bacon.

BodyPositive
This site has some good stuff, though you’ll have to overlook the bright yellow, eye-popping design.

Why is this important? The fact is, as a PCOS patient, you will have much better luck if you can think about your exercise plan, your diet, and your lifestyle in general as an approach to health, not just a weight-loss plan. By far the most common piece of advice for women with PCOS is “lose weight”–but your lifestyle choices will accomplish a lot more if you can think instead about accepting your body and taking care of it.

Straight talk about antidepressants

19 Apr

Women with PCOS have a higher rate of depression than the rest of the population. (And, according to the National Institute of Mental Health, 6.7% of adults suffer depression in a given year–that’s a huge proportion!) I have talked about how to identify depression and how to manage it, but I haven’t talked about antidepressants specifically.

Most people who suffer depression over a long period of time will consider antidepressants, even though some people still feel uncomfortable about taking these kinds of drugs. They can help a lot. But it’s important to know what you’re getting; there can be side effects and withdrawal problems, too.

Personally, I’ve tried a number of different antidepressants. Some were awful for me; some worked well. I’m not going to discuss which ones might be best for you, beyond a couple of general statements, because one of the biggest challenges for doctors who treat depression is that every sufferer responds to these drugs differently.

I am discussing newer types of antidepressants–SSRIs, NDRIs, and SNRIs–because these are the drugs of choice today. There are some others, but chances are that your doctor will consider these first. Most of the drugs you hear about (Prozac, Zoloft, Paxil, Effexor, Wellbutrin, Lexapro, etc.) fall into these categories. Tricyclic antidepressants and MAOIs are not used very often because of the higher likelihood of serious or dangerous side effects.

TIPS AND HINTS
1. These drugs are life-saving and medically useful. If you are resisting trying them, even though you’re miserable, because you think you should be able to “just snap out of it,” or because you think that antidepressants are for wimps, rethink it. At least consider it. There are good reasons that some people may not want to take them, but this particular reason is silly.

2. Be aware that the first one you try may not help you. Finding the right medication for you takes trial and error. Work with your doctor and be prepared for the possibility that it will take time.

3. In a related vein, don’t expect these medications to help overnight. It can take up to six or even eight weeks to feel better, in some cases. (Some people do see a lot of improvement very quickly. It varies.)

4. Take them conscientiously. These are not drugs that you want to take “when you need them” or forget to take. A missed dose now and then is not a crisis, but they really do work best–and have the fewest side effects–when you take them every day, exactly as directed.

5. Antidepressants can also be extremely helpful for anxiety problems or make anxiety worse. Again, it varies. Be aware that if you suffer anxiety as well, you may have to adjust your medication based on that.

6. Tell your doctor about ANYTHING else that you take–other prescription drugs, over-the-counter drugs, supplements.

SIDE EFFECTS
Some common side effects of antidepressants include:
* drowsiness
* dry mouth
* nervousness, anxiety
* insomnia or hypersomnia (that is, too much or too little sleeping)
* decreased or increased appetite
* weight gain (this is long-term–not immediate–but it’s a big problem for some women and something to remember if you already struggle with your weight because of PCOS symptoms)
* sexual dysfunction, including anorgasmia (aka the inability to have an orgasm)

WHAT TO DO ABOUT SIDE EFFECTS
In some cases, if you can ride it out for a week or two, the side effects will go away. In other cases, not. In particular, weight gain and sexual dysfunction tend to be the ones that cause long-term problems. If the side effects are untenable, don’t give up. A different drug might be better for you. Wellbutrin might be something to ask about; for most people, it actually produces a small increase in libido, and it doesn’t contribute to weight gain (indeed, some people find it easier to control their weight or lose weight while they’re taking Wellbutrin). Some people also take Wellbutrin with their other antidepressant to help ameliorate the side effects.

DISCONTINUATION SYNDROME
When you stop taking an antidepressant, you can suffer symptoms. (People sometimes call these “withdrawals” but the technical term is “discontinuation”–that’s because these drugs are not addictive in the sense that animals–or people–given free access to them are not driven to take them. They do, however, cause symptoms when you stop taking them.)

These symptoms can be very, very unpleasant, although not everyone experiences them. The most notorious antidepressant for causing these symptoms is Effexor (and I can attest that it can be extremely unpleasant indeed to stop taking it!), but any of them can cause these problems:
* depression
* irritability or agitation
* aggressiveness
* dizziness
* sensory disturbances (e.g., paresthesias such as electric shock sensations–a lot of sufferers call these “brain zaps,” and all I can say is, if you experience them, you’ll recognize the description)
* anxiety
* confusion
* headache
* lethargy
* nausea
* vertigo
* bizarre and vivid dreams
* seizures (rare)

Some of the specifics here depend on your specific drug. The half-life of your medication (that is, how long it stays in your body) affects the severity and duration of the symptoms. If you are on a med that has a short half-life, you may see these more quickly and they may be worse. (Effexor, which has a very short half-life, can produce these symptoms even if you miss a dose.) It is a good idea to cut your dose down gradually, as your doctor directs. Some doctors also prescribe Prozac, which has a long half-life, while you are discontinuing your other medication. Sometimes taking a short course of Prozac can make the symptoms less severe.

BOTTOM LINE
Antidepressants may be very useful to you. While the big lists of scary side effects can be intimidating, these drugs have changed the lives of a lot of depression sufferers. The most important thing is that you have a good care provider: one who listens to you, will help you tweak your regimen, and has a lot of experience dealing with antidepressants. I recommend, if you can, that you visit a psychiatrist. They do nothing but psychiatric medication management (mostly–a few of them also provide therapy), and they’re very good at it. If you can find a doctor who knows a lot about these drugs, it will make the process a lot easier and you might see some excellent results.

THREE MORE NOTES
1. If you are pregnant, breastfeeding, or planning to get pregnant, be sure to discuss this with your doctor. There is considerable evidence that the advantage of treating depression in a pregnant or nursing mother may outweigh the risks, but it should be an educated decision–and there are some drugs that are much better-tested in pregnancy than others.

2. If your medication tells you not to drink alcohol, don’t. Talk to your doctor if you want more information. I have a glass of wine often even though I take Wellbutrin, but I would not drink more than one drink while I’m taking it. It’s very important because alcohol can affect you more when you’re on an antidepressant, which means both that you may end up more intoxicated than you had planned or expected, and that any side effects of your medication may get worse. Plus, in a more general sense, alcohol is a depressant, which is not what you want if you suffer from depression!

3. Sometimes, an antidepressant that works well for you might stop working. This just happens occasionally. For example, I found that after my pregnancy, when I went back to my old antidepressant, it no longer worked well for me. That can happen even if you don’t stop taking it or have an obvious physical change such as pregnancy and birth. If it happens to you, don’t panic–talk to your doctor, and try something else.

politics: size discrimination

5 Feb

Since many women–perhaps even most women–with PCOS struggle with their weight, I thought this might be a good forum to talk about a kind of discrimination that is getting worse over time, not better: the judgment of “fat” people.

Despite the “fat acceptance” movement and the increasing awareness that many people who are considered overweight can still be healthy, I don’t think our culture has gotten very far in this particular arena. (See the Health at Every Size page for more information about the movement–I’m not involved in it, so I won’t presume to summarize the tenets here. It is an intriguing project, though, because it accepts and celebrates the pursuit of health–not the pursuit of a particular body shape.)

It’s a complicated thing. Yes, I think most people who are extremely heavy would be healthier if they lost some weight. And yes, I group myself in that category! However, it is neither reasonable nor fair to assume that you know anything about a person’s health, lifestyle, or personality from his or her size. A thin person may be sedentary and eat poorly; a fat person may eat fairly well and get more exercise.

Here is my list of destructive beliefs about fat people–ideas that are floating around in American society (and in many other parts of the world!):

1. Fat people are lazy.

2. Fat people are sloppy.

3. Fat people are stupid. (After all, why would you be fat when it’s so clear how to avoid it?)

4. Fat people are ugly/unattractive/not sexy.

Obviously, I do not agree with any of these statements. You might want to think about how you would respond if the “fat people” part of that sentence were replaced with, say, “black people”–part of the reason this is so troubling is that people ARE born with a certain predisposition to be heavy or thin, even if it’s not completely set in stone.

Certainly, you have plenty of control over your health and the state of your body. But you may not reasonably, or healthfully, be able to adhere to a cultural idea that supports a body type that is unhealthy for many women. And the fact is, you don’t have to. No one is even telling you that you have to be healthy, although of course I hope that you are and that you want to be. But these assumptions are not made about thin people who don’t eat their vegetables, or about people who smoke (although smoking has become less socially acceptable over time), or about people who never exercise and sit behind a desk all day long. There is no denying it: this is about the way a person looks.

If you are overweight or obese, you probably recognize these ideas. They’re destructive and hurtful, as well as false. Some of these are more flexible than others (for example, if you are tidy, well-groomed, and well-dressed, you’re less likely to be thought sloppy; however, if two women show up in yoga pants and messy ponytails, it is the overweight woman who will be considered a slob).

It is your job to oppose these beliefs, right now, and forever–in thought, in word, and in deed. If you are working on your health, if you eat well, if you exercise, if you are educating yourself about PCOS and taking control of your genetic and medical inheritance, of course you are not lazy. If you are reading about these issues, integrating what you learn in books, in research, in blogs like this one, of course you are not stupid.

I do not suggest that it doesn’t matter what sort of condition your body is in (although I do think it is an egregious mistake for any of us to judge others based on any visible evidence of that condition). I am suggesting the following things:

1. Your body is yours. You can treat it as well or as poorly as you want. It does not reflect on your moral or intellectual status to eat a cookie.

2. A healthy body can look a lot of different ways. There is plenty of evidence that women can be healthy at many sizes.

3. You (maybe in consultation with a trusted doctor) are the proper judge of what weight is healthiest for you. Screw the weight charts, screw the BMI charts–if you are eating right, you’re fit, and your medical statistics are all in range, you’re healthy. That’s that. It doesn’t matter whether you wear a size 2 or a size 22 or whatever.

4. Dieting is unhealthy. A healthy, sustainable diet–in the sense of “what you eat,” not in the sense of “what will help you lose weight”–is a major step toward a healthy lifestyle, but the array of special diets that many overweight or obese people try are more likely to harm than help. In particular, the yo-yo dieting lifestyle is bad for you–not just physically, but also emotionally.

5. You cannot expect other people to stop judging you for your weight until you stop judging yourself. I know this is hard. I know you have probably heard about weight loss for your entire life. I know that you’re going to keep hearing about it. But until you can accept your body for what it is and decide that you are going to stop being ashamed of it, angry at it, or mean to it, you will suffer. And in my view, the best way to change societal pressures is to be clear about the fact that you like yourself and your body. You can work very hard for increased fitness and health without defining your current body as “wrong” or “bad.”


In conclusion:

Our culture expects women to look a certain way. More accurately, it expects women to WANT to look a certain way; I think most of us are accustomed to seeing women who look–well–average. Normal. But it’s expected that every woman wants to wear a size 4. This is patently absurd. Healthy bodies come in many sizes; sexy or beautiful bodies, too. There are a lot of reasons to stop judging your body based on its size, but one of the most important is this: it’s the body you have, right now. No matter what your goals may be, no matter how you may want it to look and feel, right now, it’s what you have. Do you really want to postpone your happiness until your body meets your standard? Especially if you’re drawing that standard from an unrealistic cultural expectation, that’s a bad deal.

START with the happiness. Start with the knowledge that you are already ahead of the game because you are invested in your own health. Start with the knowledge that the people who love you, love you in your current body. Start with the knowledge that your essential self would not change if you could magically eliminate whatever physical “flaws” you dislike. If you can do those things (and trust me–I know they’re difficult), you might have a shot at enjoying the process of improving your fitness and health.

For me, I think of it this way: if I can live a long, healthy, productive life, does it matter what size my jeans are? If I know that every doctor I visit is shocked to find that my blood pressure and lipid panels are what they expect to see in a visibly fit patient, does it matter that I don’t look like an athlete? No. It doesn’t. And while I wish that everyone I met could accept that truth, just as I accept it, I cannot control what other people think. I can only control what I think.

depression, revisited

25 Sep

Autumn is here (officially, as of Wednesday), and with it, for some of us, its unwelcome pal–seasonal affective disorder, or SAD. For some sufferers, the spring and summer are fine and the fall and winter are plagued by depression; for others, depression is a year-round struggle that intensifies as the days shorten.

As you start thinking about preparing for the holidays and planning your Halloween costume, if you are prone to autumn and winter depression, you might want to think about preparing for that, too. Things you can do right now to improve your mood all year:

* Exercise. I’ve said it before, and I’ll say it again: exercise is the #1 most effective antidepressant I’ve ever heard of or experienced. It works for almost everyone, almost every time. The reason it’s not the first-line treatment is that it’s hard! And when you’re depressed, it’s much harder than usual. I know, firsthand, how hard it is to get into an exercise routine and how easy it is to slip back out of it. So let this serve as your reminder to get out there and take a walk, hit the gym, do some yoga or push-ups or whatever. (I’ll even try to join you–my dissertation has taken over my exercise regime and I am ready to recommit!)

* Get your sunshine and vitamin D. Yes, I said “and”–although I’m no doctor and I’m not going to tell YOU what to do, I am taking vitamin D supplements as well as trying to get out in the sunshine every day even if I only have ten minutes. One bonus for the fair-skinned among us: as winter approaches, it’s harder to get sunburned because the angle of the light changes.

* Be vigilant about tracking your mood. Be prepared for a slide by keeping yourself aware of your own mood. It is distressingly easy not to even realize that depression is affecting you, until it’s really bad. If you keep a journal, jot down how you felt each day; if not, consider doing a daily “check-in” to ask yourself how you’re doing. No one else is going to care about you as much as you do (except maybe your spouse), so you need to keep track of your own mood status.

* Enjoy the things that are great about fall. Even though I find it difficult when the days get shorter and the sunlight gets scarce, there are some definite high points about the autumn. Crisp air, beautiful trees, Honeycrisp apples–appreciate them while they’re here!