Mental Health for Hockey Professionals. PHATS Meeting. Nashville, TN June 27, Gary Solomon, Ph.D., FACPN

Transcription

1 Mental Health for Hockey Professionals PHATS Meeting Nashville, TN June 27, 2016 Gary Solomon, Ph.D., FACPN Associate Professor, Departments of Neurological Surgery, Orthopaedic Surgery & Rehabilitation, and Psychiatry, Co-Director, Vanderbilt Sports Concussion Center Vanderbilt University Medical Center Team Neuropsychologist, Nashville Predators Team Psychologist, Milwaukee Admirals Consulting Neuropsychologist, Tennessee Titans

2 Employee, Vanderbilt University Medical Center Either Vanderbilt or I receive consulting fees/expense reimbursements from: Nashville Predators, Tennessee Titans, Tennessee Tech Athletics, University of Tennessee Athletics, ImPACT 12.58% of my annual income is derived from sports organizations Honoraria received in past year: American Academy of Neurology, UPMC TEAM Concussion Conference, American Medical Society for Sports Medicine, American Association of Neurological Surgeons Editorial Board: Neurosurgery (Associate Section Editor), American Journal of Sports Medicine, Archives of Clinical Neuropsychology, Concussion Grants: Department of Defense: Consultant, Restoration of standing and walking through Intra-spinal Microstimulation in humans This presentation is not endorsed by any organization with which I am affiliated. Blame me for anything I say; it s all my fault.

3 Let s talk about Mental Health

4 Why do we joke about psychological disorders? We joke about it because we often don t understand them or we are scared of these illnesses. It s mental and it s personal. But mental lives in the brain. These are brain disorders.

5 The Human Brain The average human brain weighs 3 pounds. The average male in the US weighs 196 pounds. The average female in the US weighs 166 pounds. The average person spends 99+% of his/her time conditioning the 193 pounds (163 for women), and < 1% of his/her time working on the 3 pounds that controls everything. At the professional hockey level, the mental game can make the difference between success and failure, both in players and in management.

6 Life is full of stress. Stress is not just what happens to you, but how you respond to the stuff that happens to you. You can t always control what happens to you, but you can always choose how to respond. How you respond often depends on how you see things. How you see things is affected by your mental health. Is mental health a major problem?

7 Mental Health Epidemiology 2009: Average number mentally unhealthy days past month (Adults) Average # mentally unhealthy days per month = 3 for men, 4 for women; 10% of the time life is crappy

8 What percentage of people in the USA seek psychological treatment from psychiatric professionals for mental healthrelated conditions?

9 Mental Health Epidemiology National trends in mental health service utilization (USA) Psychiatrists, Psychologist, Psychiatric Nurse, LCSW Among insured people: Overall, about 10%

10 Mental Health Epidemiology: PCP Visits 2012: In adults 18 years, >30% of PCP office visits were related to mental health Σ crappy days (10%), dedicated mental health (10%) + PCP (30+%)= >50% Life is hard, people struggle, be kind

11 Review: Depression, Anxiety, & Suicide Signs and Symptoms Treatments Resources

12 What is depression? Depression is a disturbance of mood and is very common. Depression is an illness. There are different types of depression. Depression can affect how you feel, think, and act. People with depressive illnesses do not all experience the same symptoms. How severe, how frequent, and how long the symptoms last varies depending on the individual and his or her particular illness.

13 CDC, 2011: Percentage of High School Students who felt sad or hopeless for 2 consecutive weeks Females: 32.7% Males: 19.3% 7% of adults will develop major depression each year Rates are higher in women, ethnic minorities, and people with chronic illness

14 Lifetime Prevalence of Mood Disorders 18.2% for adolescents 21.4% for adults 1 out of 5

15 The most common signs and symptoms of depression include: Persistent sad, anxious, or "empty" feelings Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or helplessness Irritability, restlessness Loss of interest in or lack of pleasure from activities or hobbies once pleasurable, including sex Fatigue and decreased energy

16 Signs and symptoms of depression include: Difficulty concentrating, remembering details, and making decisions Insomnia, early-morning awakening, or excessive sleeping Overeating or appetite loss Thoughts of suicide, suicide attempts Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment There are different types of depressive disorders NOTE: These symptoms can occur in other medical conditions, as well as due to LIFE!

17 Symptoms of Depression

18 What s the difference between a crappy day and depression?

19 In a crappy day or week, symptoms are fleeting and transient, and you can usually shake them off. The symptoms rarely interfere significantly with your ability to function at home or at work. As noted, average crappy days per month is 3 for men, 4 for women In depression, the symptoms persist for at least 2 weeks and stay with you. You can t shake them off. The symptoms begin to interfere with your relationships and work performance.

20 Gender differences in depression Depressed women are more likely to have feelings of sadness, worthlessness, and excessive guilt Depressed men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping Men may be more likely than women to turn to alcohol or drugs when they are depressed In depression, women get sad, men get mad

21 What causes depression? Depression is caused by a combination of genetic, biological, social, and psychological factors Depressive illnesses are disorders of the brain, not a sign of personal weakness Theories about depression suggest that: 1) important neurotransmitters chemicals that brain cells use to communicate are out of balance, and 2) that certain thinking styles lead to anxiety and depression.

22 Brain Scan (PET): Depressed vs. Non-Depressed Lighter color means more brain activity

23 Not wanting to admit to depression

24 Treatments for Depression Medications---Antidepressants Counseling---Talk therapy Combinations of medication + counseling In severe depression, Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT) The choice of treatment is based on symptoms, medical condition, family history, and personal preference The sooner we treat it, the better the outcome Overall cure rate is about 85%

25 Medications often prescribed for depression (also used for other conditions) SSRIs: Prozac (fluoxetine) Celexa (citalopram) Paxil (paroxetine) Zoloft (sertraline) Lexapro (escitalopram) Luvox (fluvoxamine) Vortioxetine (Brintellix) Tricyclic Elavil (amitriptyline) Norpramin (desipramine) Anafranil (clomipramine) Sinequan (doxepin) Pamelor (nortriptyline) Vivactyl (protriptyline) SNRIs: Effexor (venlafaxine) Cymbalta (duloxetine) Viibryd (vilazodone) Pristiq (desvenlafaxine) Fetzima (levomilnacipran) Wellbutrin (bupropion)

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28 What is Anxiety? Anxiety is a normal reaction to stress. We experience anxiety physically and mentally: butterflies in the stomach, increased heart rate, thoughts racing, chest pounding, sweating, rapid breathing, tense muscles, inability to focus or concentrate, unexplained aches and pains/physical symptoms, etc. Anxiety is not all bad---anxiety helps one deal with a tense situation at work, study harder for an exam, keep focused on an important meeting, prepare for a game, look both ways before you cross a street In general, anxiety helps one cope But when anxiety becomes an excessive or an irrational dread of everyday situations, it has become a disabling disorder

29 Lifetime Prevalence of Anxiety Disorders 38.3% for adolescents 33.7% for adults 1 out of 3

30 Panic Disorder: sudden fear, sense of loss of control, pounding heart, short of breath, sweating, tingling in hands/feet, racing thoughts GAD: excessive worry about everyday events with inability to control the feelings, easily, startled, unable to relax, trembling/twitching, can t concentrate, tired all the time, unexplained aches & pains OCD: persistent, upsetting thoughts (obsessions) that lead to specific behaviors (compulsions) to relieve the anxiety temporarily Social Anxiety Disorder: overwhelming anxiety and self-consciousness in everyday social situations; fear of being watched and judged Phobia: Fear of a specific thing or situation (flying, snakes, spiders, public speaking, heights) Treatments are similar to those for depression

31 Sigmund Freud, M.D. Be careful about self-diagnosis: Just because you have one or more symptoms doesn t mean you have a disorder And even if you have several of the symptoms, we cross the line and consider making a diagnosis when those symptoms interfere with our ability to do our job or to get along with others

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33 Suicide Worldwide There is one suicide worldwide every 40 seconds Suicide accounts for more deaths annually worldwide than accidents, homicides, and war combined About 1,000,000 people worldwide commit suicide annually Suicide in the USA There are twice as many suicides than homicides In the USA, 41,149 people commit suicide annually = 113 a day (one every 12.8 minutes) The suicide rate is going up.

34 Suicide epidemiology From 2000 through 2014, there was a statistically significant (p<0.05) increase in the total suicide rate and the rates for each method, for both females and males. QuickStats: Age-Adjusted Suicide Rates for Females and Males, by Method National Vital Statistics System, United States, 2000 and MMWR 2016;65:503.

35 Suicide epidemiology The rate of suicide is increasing in: Civilians: Sullivan EM, Annest JL, Luo F, et al. Suicide among adults aged years United States, MMWR. 2013;62: Military: Center AFHS. Deaths by suicide while on active duty, active and reserve components, US Armed Forces, Med Surveil Monthly Rep. 2012;19:7 10. The rates of suicide in both men and women have increased significantly from : Sullivan EM, Annest JL, Luo F, et al. Suicide among adults aged years United States, MMWR. 2013;62: People in the US are now more likely to die from suicide than MVCs: Rockett IR, Regier MD, Kapusta ND, et al. Leading causes of unintentional and intentional injury mortality: United States, Am J Public Health. 2012;102:e

36 Suicides in Canada Average of 3,650 suicides per year; average is 10 daily Men commit suicide 3x > women but women attempt suicide 3-4x > men There were 26% more suicides than traffic deaths 23,000 people are hospitalized annually for suicide attempts Suicide is the leading cause of death for men ages and The suicide rate in Canada is slightly higher than the US

37 Suicidal Thoughts and Behaviors Among Adults Aged 18 Years United States,

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39 Men complete suicide primarily by firearms and strangulation Women complete suicide primarily by poisoning (OD) Strangulation method is increasing

40 No one is immune from suicide According to the American Foundation for Suicide Prevention (2014), about how many physicians commit suicide annually in the US?

41 Warning signs of suicide The strongest and most disturbing signs are verbal "I can t go on," "Nothing matters any more, I m a burden, Unbearable pain, Feel trapped, or even "I m thinking of ending it all." Talking about wanting to die. Looking for a way to kill oneself. Talking about feeling hopeless or having no purpose. Talking about being a burden to others. Increasing the use of alcohol or drugs. Acting anxious, agitated, or recklessly. Sleeping too little or too much. Withdrawing or feeling isolated. Showing rage or talking about seeking revenge. Displaying extreme mood swings. Suffering a major loss or life change. Giving away possessions

42 The Why of Suicide In my experience, people commit suicide because of a sequence of thoughts that they truly believe: Life (or this situation) sucks, it will always suck, and there is nothing I or anyone else can do about it. This problem is unsolvable and cannot be fixed. Things will never change. This is the best solution for me and everyone else. This is hopeless. This is how a suicidal person sees things. Depression affects how you think, not just how you feel. Suicide is a permanent solution to what is usually a temporary problem

43 What if someone I know is in crisis? If someone you know exhibits warning signs of suicide do not leave the person alone. Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt. Take the person to an emergency room or seek help from a medical or mental health professional. The National Suicide Prevention Lifeline: TALK (8255)

44 Don t assume someone will reach out. Only 1 in 5 seeks help. You can encourage them to make that critical first step. 1. Ask if you can talk in private. 2. Ask questions to open up the conversation. How are you doing? You haven t seemed yourself lately. Is everything okay? Is anything bothering you? 3. Listen to their story, and express concern and caring. 4. Ask if they have thought about hurting themselves or ending their life. 5. Encourage them to seek mental health services. Tell them seeking help can take courage, but it s the smart thing to do.

45 Do: Listen. Express concern and caring. Take the person seriously. Ask open-ended questions. Talk about suicide openly and directly. Avoid: Avoid minimizing feelings. Avoid advice to fix it. Avoid debating the value of life. Avoid offering clichés. Avoid being judgmental.

46 Summary Mood and anxiety disorders are commonplace in all aspects of society Most people are uncomfortable talking about mental health problems These are brain disorders/illnesses, not character flaws or signs of weakness These disorders can be inherited and based on biochemical factors There is a % chance that any of you will have a mental health disorder during your lifetime These disorders are treatable with counseling and medication Left untreated, these disorders carry a risk of suicide, especially when alcohol and/or drugs are a factor Suicide causes more deaths than homicide or traffic accidents You can make a difference and help save a life MIND MATTERS!

47 Take a few minutes and get to know the mental health professional affiliated with your team (Or if you don t have one, get one) = Spare Tire

48 Thanks to: Andy Hosler for inviting me, PHATS for having me, the Nashville and Milwaukee boys for all that you have taught me, and to all of you for your attention.