I see a lot of depression in my practice. My experience treating it has been similar to what is discussed in medical literature. In about 70% of patients there has been some improvement with antidepressants, but a full remission has occurred in only 40 to 50%. In the interest of boosting this disappointing remission rate, I have been searching for something that will either augment antidepressants or that could be used alone.

I have found a supplement considered to be medicinal food. It is safe, and it really does work. It is a vitamin that is a form of folic acid known as L-methylfolate.

Folic acid is an essential B vitamin. It is found in green leafy vegetables, eggs, cereals and fortified foods (to name a few). When you take in folate or folic acid in your diet it is absorbed by the small intestine where it is converted by an enzyme into L-methylfolate. This metabolite is used to make serotonin, norepinephrine and dopamine, which are all important for mood regulation.

Scientists have identified 40 mutations on the gene responsible for making the enzyme that converts folic acid into L-methylfolate. The most common genotype is known as C677T. If there is one mutation on this gene your ability to convert folic acid is reduced by 34%. If you have two mutations, it is reduced by 71%. Now you probably are seeing where I am going with this.

If you have a defective enzyme then you cannot convert folic acid to L-methylfolate properly and you will have lower serotonin, norepinephrine and dopamine levels. These gene mutations are extremely common. The treatment is simple. It is a prescription of L-methylfolate, a vitamin. If given in the proper amounts (7.5 to 15 mgs) it can improve mild depression relatively quickly. In a study of elderly depressed patients, the response rate at 6 weeks was 81%. Results are often seen in just two weeks.

A recent study of those with major depression found that adding L-methylfolate improved depression from 7% for those on an antidepressant alone to 18.5% with the addition of L-methylfolate over a period of 60 days.

It is well tolerated with no more side effects than placebo. It does not interact with other medications. In my experience, if an antidepressant has produced a positive response but the patient is still somewhat depressed L-methylfolate can help.

The results I have seen are impressive. When I treat those with MTHFR mutations (with or without mild depression) with L-methylfolate their mood improves and often they sleep better. Related problems such as irritable bowel will often get better as well.

If you are depressed and/or on medication for depression, I recommend you ask your doctor to see if you have the genetic abnormality that I mentioned. The blood test is called MTHFR. It just makes sense. If serotonin levels are genetically low then why not find a healthy way to boost them?

I recently traveled to Argentina where there is a species of butterfly that lives for only 24 hours. Watching these pretty little beings and trying to come to grips with the recent shootings around the country makes me wonder: What if we all had only one day to live? Would we do things differently?

There are waterfalls where the butterflies live that are 250 million years old. In the scheme of things, comparing our longevity to the age of the falls, isn’t our life just a blink in time, or the comparative equivalent of 24 hours or less? None of us knows how long we have on this earth. That is painfully apparent. Maybe it is time to change our perspective.

These times we live in are difficult because many of us feel that our jobs, family and children should be happy, healthy and perfect. It would be wonderful if our lives turned out like a Hallmark movie. Unfortunately, that is not the way it usually works. Sometimes frustrating, irritating, painful and hurtful things happen. How we deal with these things can determine how we go on and ultimately, how healthy we are. There is a simple way to cope, survive, thrive and heal.

Simply put, it can be done with gratitude.

Finding things to be grateful for can help us feel better emotionally and physically. There is a fair amount of research available through Dr. Robert Emmons at the University of California at Davis. In one study, he divided his study subjects into three groups. As a daily activity, one group was asked to write five things that they were grateful for, another described five things that stressed them and the third group was asked to list any five events that affected them. After 10 weeks, those in the gratitude group felt better about their lives, exercised more and had fewer doctor visits compared to the other two groups.

In another study, people with neuromuscular disease such as post-polio syndrome were asked to write in a daily gratitude journal. After doing so, they were more optimistic about their lives and slept better when compared to the control group.

A study done in Connecticut found that people who had a heart attack and looked at it as a blessing (because it helped them to appreciate life more) had a lower risk of having a second heart attack compared to those who did not see it that way.

All that research supports the life-saving advice I follow myself: When things gets stressful and frustrating, take a moment and count your blessings. Think about those little butterflies that have only one day to live. It makes no sense to waste time with anger, grudges or regret. Identifying things that we are grateful for or expressing gratitude to people in our life who we appreciate makes a lot more sense. It costs nothing and the payoff is huge.

I have an idea for the coming year. Before fulfilling the rest of your resolutions, you might want to try this: Think positively!

There is always a lot of talk about the power of positive thinking. Is there any basis to it? Research suggests that there is.

A recent study done in England followed 166 senior citizens for six years to see how attitude affected their health. The researchers administered a questionnaire to see how people approached health problems. They also took saliva and blood tests that measured cortisol levels and C-reactive protein, markers for stress and inflammation.

Over the years, people who looked at their health problems in a more positive light had lower cortisol and C-reactive protein levels. The positive thinkers handled stress better and had less inflammation than their more pessimistic counterparts.

Another study done at Yale followed 598 people who were at least 70 years of age (and initially without disability) for 11 years. As some became ill or disabled, those with a positive attitude were 44 more more likely to fully recover than those with a negative attitude.

In addition, a review of 84 studies found a strong relationship between optimism and physical outcomes. Regardless of the severity of disease, the effect held. This included cancer outcomes, heart disease, pregnancy outcomes and immune strength.

Cultivate Positive Thinking
There are some people who look at the glass as half empty others who see it as half full. And then there is another group that sees it as always totally full (with liquid and air). How can you become the latter? Here are five ways to start.

1. Hang out with positive people. Negativity can be contagious and conversely, so can positivity.

2. In a stressful situation, try to find the silver lining. As an example, if you get lost driving with your husband because he refuses to ask for directions, start paying attention to where you are and enjoy the different scenery.

3. Give positive feedback to those around you. There is always something positive you can say even when it might be tough. In the above scenario you can thank your husband for driving safely.

4. Give positive feedback to yourself. We are often harder on ourselves than anyone else. Cut yourself some slack. As an example, you can be proud of yourself for not losing your temper with your husband who is getting you hopelessly lost!

5. Keep a gratitude journal. If you can find several things a day to be grateful for, your attitude will change and you will find that you feel better physically.

It is important to your emotional and physical well-being that you find a way to be optimistic. It is all in how you look at things. In the words of Abraham Lincoln, “Most folks are about as happy as they make up their minds to be.”

I wrote this blog a year ago, and I think it warrants repeating. Here goes!

We are living in tumultuous times. We have so many things that tend to pop up and cause worry. Finances, health, emotional and family problems are all common issues. Many people start to get a sense of helplessness and hopelessness. This impacts their health causing pain, disease, fatigue and depression. I care for many patients where this is the case.

In trying to help them, I have found something that works. That thing is becoming a helper. It costs no money and it improves their health by boosting the immune system and improving brain function. Doing something for others is the key to feeling better.

Studies have found that those who give of themselves experience joy and happiness. It can be something as simple as volunteering for the SMART program and reading to children or working at a food bank. The hospitals and many clinics welcome volunteers. For those who want to donate money there are infinite worthy causes.

People who help others have been studied. Researchers have found that they experience a surge in their endorphins similar to the high that runners experience. Giving to others in need decreases the intensity and awareness of pain, relieves stress, and activates positive emotions. All these things help to improve health. The results of a study done in 2700 men in Michigan found that those men who worked as regular volunteers had a two and a half times lower death rate than those who did not.

Amazing things happen when one goes from being the one who is helped to being the helper. It is nothing short of a miracle. Over and over I see people heal and feel good about themselves and what they are doing. It is easy to get wrapped up in our lives and ourselves, but stepping out of it and realizing that we each have something valuable to give can be good for us as well as others.

The election is over. Some of us are happy. However, it is clear watching the Sunday news talk shows that there are others who are very angry. If I am describing you, it is important to turn that around quickly so that it does not start to eat away at you. Anger especially if it is hostile can cause serious illness.

A recent study of over 5600 people in Italy found that those who scored highest on the anger and hostility scale had a 40% increase in thickening of their artery walls than those with the lowest score. Thickened arteries increase the chance of having a stroke or heart attack. Another study found that those with hostile anger and no evidence of heart disease initially were 19% more likely to develop heart disease later on than their mellower counterparts.

We know that longstanding anger can increase the risk of coronary disease, but what about a single bout of intense anger that can occur with road rage or when your candidate loses the election? A study done in Israel found that those who experienced intense anger had a 14-fold increase in stroke within two hours of the emotional incident. In a Missouri emergency room study of 2500 patients, 500 patients had an episode of severe anger prior to their injuries; the worse the anger, the more severe the injury.

If you are finding yourself angry all of the time, what can you do?
You can get out and exercise. That is a great stress reducer. Meditation can also be helpful. If you find that it is difficult to relax and let your feelings go, it may be time to see a therapist or look into anger management classes.

One of the more successful forms of therapy for anger is cognitive behavioral therapy. It is a structured therapy with a limited number of sessions that can help patients to take negative thoughts and emotions and act in a more positive way.

Anger can destroy you if you let it. Ask yourself this; is it worth dying for something you cannot change that is causing you to be irritated, upset and angry? If the answer is “No,” it is time to go and get some help today.

I love to walk, but now that the weather is getting cold and wet, I just want to stay inside under a blanket. Fortunately, I have someone who will not let me do that. She is relentless and she pesters me until I get off the couch. Her name is Lucy. She is a German shepherd basset hound mix (I know it sounds impossible and a bit strange but it is true).

Her front legs are shorter than her back legs so she hops. At times walking for her is not easy, but nonetheless she gets me out there every day, twice or three times a day.
How can I beg off the walk when she needs it to keep her joints agile and it is such an obvious struggle for her at times? To top it off with all her doggy disabilities, she is always happy, and she makes me laugh. I have no excuse.

Lucy keeps me in shape. She also helps me to stay calm and control my stress. These benefits are among many reported by the CDC (Centers for Disease Control and Prevention) and the NIH (National Institutes for Health). Pets can lower blood pressure, cholesterol and triglyceride levels, reduce stress, help maintain social engagement and prevent loneliness.

Not too long ago, there was a national meeting hosted by the NIH where data was presented from large, well-designed studies of people and their pets. One of the studies found that of those people who suffered a heart attack, dog owners were more likely to be alive a year later regardless of the severity of their heart attack compared to those without dogs. Another study looking at married couples found that pet owners had lower heart rates and blood pressures than those without pets even in times of great stress.

Of more than 2000 dog owners, those who regularly walked their dogs were more physically active and less likely to be overweight than those who did not own or walk a dog. Older dog owners had better mobility in as well as outside their homes.

Dogs are great for helping people to be more social. They provide companionship, and people are always stopping dog owners to pet their animals and chat. Those who feel connected and engaged live longer.

If you are having trouble finding reasons to go outside when it is cold, wet or snowy and/or you are feeling a bit lonely and out of sorts then I suggest you go to your local humane society and find your Lucy. There are so many dogs that need a home. They can be a great comfort and motivation to become fit.

And if I haven’t given you enough good reasons to adopt a dog here is one more,

“You can say any fool thing to a dog and the dog will just give you this look that says, ‘My GOSH, you’re RIGHT! I NEVER would’ve thought of that!”
― Dave Barry

Trauma is more common than you may think. Sixty percent of men and 50% of women have experienced at least one traumatic event in their lifetime. It can be due to sexual assault, suffering an injury, witnessing violence, and fighting in the military (just to give a few examples). Post-traumatic stress disorder (PTSD) occurs in a certain percentage of those who experience trauma. When it comes to our soldiers returning from Iraq and Afghanistan 11-20% are affected. Thirty percent of Vietnam veterans suffer from PTSD.

I have many patients who have this potentially crippling disorder. Symptoms can include nightmares; insomnia, anxiety and depression, headaches, joint and belly pain just to name a few. Most experience emotional pain and suffering on a daily basis.

Fortunately, I have found a treatment that has worked on ALL of those who are willing to do it. It is called EMDR or eye movement desensitization reprocessing. It is quick, safe and effective. Most of my patients only need a total of four treatments. It is remarkable. What is this treatment? Read on.

In 1987, Dr Francine Shapiro, a psychologist realized that eye movements can diminish the intensity of disturbing thoughts. She found that utilizing this observation she could treat PTSD with a specific protocol involving eye movements and or tapping.

EMDR is able to change the way that we process painful and traumatic memories. Subjects will still remember the events but without the emotional attachment. I have a great therapist to whom I refer the majority of my patients. The way she explains it is as if you are driving a flat bed truck. All your emotional baggage is in the back of that truck. You leave the bed down and start to drive. Watching in the rearview mirror you can see the stuff flying out the back. You just keep on driving and leave it there.

I have seen remarkable changes. I know it sounds like voodoo. But it is a very effective therapy. There have been at least 20 controlled studies done on EMDR. A study done at Kaiser Permanente found that 100% of those suffering a single trauma and 77% with a history of multiple traumas no longer had PTSD. They were treated for only six 50- minute sessions. In another study, 77% of combat veterans no longer suffered from PTSD after 12 sessions.

EMDR is now an established therapy that is done by psychologists, psychiatrists and therapists who have received special training. The biggest challenge I have had is convincing my patients to try it. Once they do it, the results are nothing short of a miracle.

If you or someone you know is suffering with PTSD you might want to look into finding a therapist who does EMDR. There is an EMDR network (http://www.emdrnetwork.org/) that can help you to find a therapist in your area. Your primary care provider may also be able to help your search.

A common complaint for many of my female patients is hair loss. Here is a repeat of a blog I posted two years ago that is still relevant.

If you have been experiencing excessive hair loss and you are female, you are not alone. Approximately 37% of women experience hair loss after menopause. The most common cause is female pattern baldness.

What Is It?

Female pattern baldness is hair loss from the top of the head, the hairline and general thinning over the entire head. It is normal to lose about 100 to 125 hairs a day. More than this can result in female pattern baldness.

What causes it?

Of course there is no easy answer. There are many things that contribute to this including genetics, aging, and changing hormone levels. In particular dropping estrogen levels in relationship to testosterone levels can contribute (resulting in a higher ratio of testosterone to estrogen). The myth of women inheriting their baldness from their fathers is just that, a myth! Thank goodness! (My dad started losing his hair in his 30’s!).

Are there treatable causes?

The most common cause of hair loss that I see is thyroid disease. It can happen with hypo or hyperthyroidism. It also can occur with diabetes and autoimmune diseases such as lupus.

Is there a treatment for female pattern baldness?

There is one approved treatment for women and that is minoxidil or Rogaine. It helps hair growth in 20 to 25 % of women. It can stop or slow down hair loss. It only works as long as it is being used. Once stopped, hair loss continues. Hair transplants can be effective for reducing the appearance of hair loss.

Final Words

If you are losing hair, it is important to find out if there is an underlying cause. If it is due to female pattern baldness, you can consider Rogaine. In the future there may be hormone creams for the scalp. They are in the process of being studied.

Seasonal Affective Disorder or SAD is something that is talked about quite a bit around wintertime, but you will see why I think it is important to talk about it now. SAD is a type of depression that happens as a result of the light changes that occur with the onset of fall and winter. Those with the condition start to feel sad or moody, lose interest in regular activities, crave carbohydrates and have sleeping problems. Typically these symptoms resolve in the spring when the weather gets nice.

If this has happened to you two or more years in a row then you probably have SAD. There are a combination of treatments that may help. Antidepressants and cognitive behavioral therapy are usually recommended. A more recent therapy has been found to be quite effective in addition to these two. It can often be used alone as well; light therapy.

Light therapy can simulate the sun and restore balance to our circadian or body rhythm. It is easy to use and can be extremely helpful. The key is to find the right kind of light and to use it at the correct time of day. The lights for SAD are available commercially and on the Internet. They are usually fluorescent or incandescent and emit little to no UV light.

Generally, you would want to turn the light on first thing in the morning and have it within 2 feet of you for about 30 minutes. There are light boxes specifically designed for SAD. Unfortunately the FDA does not regulate them so it is important to do your homework regarding their safety and effectiveness.

I never thought that I had SAD. However, I found a deal on a light box last year at Costco and decided to do an experiment on myself. Every morning starting in September and ending in May, I used it for 30 minutes. I would turn it on the minute I got up and kept it on while I did my daily email check-in. I noticed that I was happier last winter, with fewer mood swings and was able to keep to my healthy eating plan. My husband noticed that I was easier to live with (the real acid test!).

The key I have discovered with my patients (and myself) is to start with the light box NOW. I noticed the light changing last week and fired it up again. You want to stay on top of this and it will help you to make a smooth mood transition to fall and winter.

I have a very good friend who is a therapist in Portland. He likens the treatment of SAD to that of physical pain. It is much easier to treat if you catch it early and stay in front of it. If you get behind it you are always chasing your tail.

If you think you have SAD you might want to check out light boxes and talk to your doctor. It can make for a much more pleasant winter season!

When I was in junior high school, my mother signed me up for ballroom dance classes. The classes took place in the school gym once a week. The girls had to wear dresses and white gloves and the boys had to wear dress up clothes. I remember feeling like I was being tortured. That was my impression of ballroom dance until several years ago when I tried it again.

Not only do I enjoy it, I found that it makes me really happy. Since I have been dancing I feel stronger, more flexible, and I have great endurance and energy. No matter what is going on in my life, after I go dancing I feel good.

I have a patient who is crazy about tennis. I asked her what it is about tennis that she likes so much. She said that it is all about that focus on that little yellow ball. When she is playing, that is the only thing that matters. That is how I feel about the ballroom. For the moments of the dance I am in 100%.

What does ballroom dancing do physically? It boosts endorphins; those feel good hormones we keep hearing about. It also builds muscles. It strengthens legs muscles but also requires core strength. It is great aerobic exercise that builds endurance.

Probably the best benefit is what it does for the brain. Many of us are looking at ways to keep our minds intact and prevent dementia. Partner dancing is the best way to do that. A 21 year long study of seniors over 75 found that bicycling, swimming and playing golf did nothing for preventing dementia. However, partner dancing done frequently decreased the risk of developing Alzheimer’s disease by 76%. Partner dance included waltz, Latin dances such as tango and salsa and swing.

I have a fondness for Argentine tango and West Coast Swing. Both dances are fun, challenging, allow for continued improvement (an understatement) and they have helped my brain to become sharper while helping me to be happy.

If you are looking for something that will help you to be healthier (both physically and mentally) while promoting happiness and a sense of well being that is fun and doesn’t feel like exercise; get out there and start dancing!