The Mental Health First-Aid That You’ll Hopefully Never Need
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Take Your Mental Health As Seriously As General Health!
Sometimes, health and productivity means excelling—sometimes, it means avoiding illness and unproductivity. Both are essential, and today we’re going to tackle some ground-up stuff. If you don’t need it right now, great; we suggest to read it for when and if you do. But how likely is it that you will?
- One in four of us are affected by serious mental health issues in any given year.
- One in five of us have suicidal thoughts at some point in our lifetime.
- One in six of us are affected to at least some extent by the most commonly-reported mental health issues, anxiety and depression, in any given week.
…and that’s just what’s reported, of course. These stats are from a UK-based source but can be considered indicative generally. Jokes aside, the UK is not a special case and is not measurably worse for people’s mental health than, say, the US or Canada.
While this is not an inherently cheery topic, we think it’s an important one.
Depression, which we’re going to focus on today, is very very much a killer to both health and productivity, after all.
One of the most commonly-used measures of depression is known by the snappy name of “PHQ9”. It stands for “Patient Health Questionnaire Nine”, and you can take it anonymously online for free (without signing up for anything; it’s right there on the page already):
Take The PHQ9 Test Here! (under 2 minutes, immediate results)
There’s a chance you took that test and your score was, well, depressing. There’s also a chance you’re doing just peachy, or maybe somewhere in between. PHQ9 scores can fluctuate over time (because they focus on the past two weeks, and also rely on self-reports in the moment), so you might want to bookmark it to test again periodically. It can be interesting to track over time.
In the event that you’re struggling (or: in case one day you find yourself struggling, or want to be able to support a loved one who is struggling), some top tips that are useful:
Accept that it’s a medical condition like any other
Which means some important things:
- You/they are not lazy or otherwise being a bad person by being depressed
- You/they will probably get better at some point, especially if help is available
- You/they cannot, however, “just snap out of it”; illness doesn’t work that way
- Medication might help (it also might not)
Do what you can, how you can, when you can
Everyone knows the advice to exercise as a remedy for depression, and indeed, exercise helps many. Unfortunately, it’s not always that easy.
Did you ever see the 80s kids’ movie “The Neverending Story”? There’s a scene in which the young hero Atreyu must traverse the “Swamp of Sadness”, and while he has a magical talisman that protects him, his beloved horse Artax is not so lucky; he slows down, and eventually stops still, sinking slowly into the swamp. Atreyu pulls at him and begs him to keep going, but—despite being many times bigger and stronger than Atreyu, the horse just sinks into the swamp, literally drowning in despair.
See the scene: The Neverending Story movie clip – Artax and the Swamp of Sadness (1984)
Wow, they really don’t make kids’ movies like they used to, do they?
But, depression is very much like that, and advice “exercise to feel less depressed!” falls short of actually being helpful, when one is too depressed to do it.
If you’re in the position of supporting someone who’s depressed, the best tool in your toolbox will be not “here’s why you should do this” (they don’t care; not because they’re an uncaring person by nature, but because they are physiologically impeded from caring about themself at this time), but rather:
“please do this with me”
The reason this has a better chance of working is because the depressed person will in all likelihood be unable to care enough to raise and/or maintain an objection, and while they can’t remember why they should care about themself, they’re more likely to remember that they should care about you, and so will go with your want/need more easily than with their own. It’s not a magic bullet, but it’s worth a shot.
What if I’m the depressed person, though?
Honestly, the same, if there’s someone around you that you do care about; do what you can to look after you, for them, if that means you can find some extra motivation.
But I’m all alone… what now?
Firstly, you don’t have to be alone. There are free services that you can access, for example:
- US: https://nami.org/help
- Canada: https://www.wellnesstogether.ca/en-CA
- UK: https://www.samaritans.org/
…which varyingly offer advice, free phone services, webchats, and the like.
But also, there are ways you can look after yourself a little bit; do the things you’d advise someone else to do, even if you’re sure they won’t work:
- Take a little walk around the block
- Put the lights on when you’re not sleeping
- For that matter, get out of bed when you’re not sleeping. Literally lie on the floor if necessary, but change your location.
- Change your bedding, or at least your clothes
- If changing the bedding is too much, change just the pillowcase
- If changing your clothes is too much, change just one item of clothing
- Drink some water; it won’t magically cure you, but you’ll be in slightly better order
- On the topic of water, splash some on your face, if showering/bathing is too much right now
- Do something creative (that’s not self-harm). You may scoff at the notion of “art therapy” helping, but this is a way to get at least some of the lights on in areas of your brain that are a little dark right now. Worst case scenario is it’ll be a distraction from your problems, so give it a try.
- Find a connection to community—whatever that means to you—even if you don’t feel you can join it right now. Discover that there are people out there who would welcome you if you were able to go join them. Maybe one day you will!
- Hiding from the world? That’s probably not healthy, but while you’re hiding, take the time to read those books (write those books, if you’re so inclined), learn that new language, take up chess, take up baking, whatever. If you can find something that means anything to you, go with that for now, ride that wave. Motivation’s hard to come by during depression and you might let many things slide; you might as well get something out of this period if you can.
If you’re not depressed right now but you know you’re predisposed to such / can slip that way?
Write yourself instructions now. Copy the above list if you like.
Most of all: have a “things to do when I don’t feel like doing anything” list.
If you only take one piece of advice from today’s newsletter, let that one be it!
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How To Reduce Or Quit Alcohol
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Rethinking Drinking
When we’re looking at certain health risks, there are often five key lifestyle factors that have a big impact; they are:
- Have a good diet
- Get good exercise
- Get good sleep
- Reduce (or eliminate) alcohol
- Don’t smoke
Today, we’re focussing the alcohol bit. Maybe you’d like to quit, maybe just cut down, maybe the topic just interests you… So, here’s a quick rundown of some things that will help make that a lot easier:
With a big enough “why”, you can overcome any “how”
Research and understand the harm done by drinking, including:
And especially as we get older, memory problems:
Alcohol-related dementia: an update of the evidence
And as for fear of missing out, or perhaps even of no longer being relaxed/fun… Did you ever, while sober, have a very drunk person try to converse with you, and you thought “I wish that were me”?
Probably not
Know your triggers
Why do you drink? If your knee-jerk response is “because I like it”, dig deeper. What events prompt you to have a drink?
- Some will be pure habit born of convention—perhaps with a meal, for example
- Others may be stress-management—after work, perhaps
- Others may be pseudo-medicinal—a nightcap for better* sleep, for instance
*this will not work. Alcohol may make us sleepy but it will then proceed to disrupt that very sleep and make it less restorative
Become mindful
Now that you know why you’d like to drink less (or quit entirely), and you know what triggers you to drink, you can circumvent that a little, by making deals with yourself, for example
- “I can drink alcohol, if and only if I have consumed a large glass of water first” (cuts out being thirsty as a trigger to drink)
- “I can drink alcohol, if and only if I meditate for at least 5 minutes first” (reduces likelihood of stress-drinking)
- “I can drink alcohol, if and only if it is with the largest meal of the day” (minimizes total alcohol consumption)
Note that these things also work around any FOMO, “Fear Of Missing Out”. It’s easier to say “no” when you know you can have it later if you still want it.
Get a good replacement drink
There are a lot of alcohol-free alcohol-like drinks around these days, and many of them are very good. Experiment and see. But!
It doesn’t even have to be that. Sometimes what we need is not even an alcohol-like drink, but rather, drinkable culinary entertainment.
If you like “punch-in-the-face” flavors (as this writer does), maybe strong black coffee is the answer. If you like “crisp and clear refreshment” (again, same), maybe your favorite herbal tea will do it for you. Or maybe for you it’ll be lemon-water. Or homemade ginger ale.
Whatever it is… make it fun, and make it yours!
Bonus item: find replacement coping strategies
This one goes if you’ve been using alcohol to cope with something. Stress, depression, anxiety, whatever it may be for you.
The thing is, it feels like it helps briefly in the moment, but it makes each of those things progressively worse in the long-run, so it’s not sustainable.
Consider instead things like therapy, exercise, and/or a new hobby to get immersed in; whatever works for you!
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The Five Pillars Of Longevity
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The Five Pillars Of Longevity
This is Dr. Mark Hyman. He’s a medical doctor, and he’s the board president of clinical affairs of the Institute for Functional Medicine. He’s also the founder and medical director of the UltraWellness Center!
What he’d like you to know about is what he calls the “Five Pillars of Longevity”.
Now, here at 10almonds, we often talk about certain things that science finds to be good for almost any health condition, and have made a habit of referencing what we call “The Usual Five Things™” (not really a trademark, by the way—just a figure of speech), which are:
- Have a good diet
- Get good exercise
- Get good sleep
- Reduce (or eliminate) alcohol consumption
- Don’t smoke
…and when we’re talking about a specific health consideration, we usually provide sources as to why each of them are particularly relevant, and pointers as to the what/how associated with them (ie what diet is good, how to get good sleep, etc).
Dr. Hyman’s “Five Pillars of Longevity” are based on observations from the world’s “Blue Zones”, the popular name for areas with an unusually high concentration of supercentenarians—Sardinia and Okinawa being famous examples, with a particular village in each being especially exemplary.
These Five Pillars of Longevity partially overlap with ours for three out of five, and they are:
- Good nutrition
- Optimized workouts
- Reduce stress
- Get quality sleep
- Find (and live) your purpose
We won’t argue against those! But what does he have to say, for each of them?
Good nutrition
Dr. Hyman advocates for a diet he calls “pegan”, which he considers to combine the paleo and vegan diets. Here at 10almonds, we generally advocate for the Mediterranean Diet because of the mountains of evidence for it, but his approach may be similar in some ways, since it looks to consume a majority plant diet, with some unprocessed meats/fish, limited dairy, and no grains.
By the science, honestly, we stand by the Mediterranean (which includes whole grains), but if for example your body may have issues of some kind with grains, his approach may be a worthy consideration.
Optimized workouts
For Dr. Hyman, this means getting in three kinds of exercise regularly:
- Aerobic/cardio, to look after your heart health
- Resistance training (e.g. weights or bodyweight strength-training) to look after your skeletal and muscular health
- Yoga or similar suppleness training, to look after your joint health
Can’t argue with that, and it can be all too easy to fall into the trap of thinking “I’m healthy because I do x” while forgetting y and/or z! Thus, a three-pronged approach definitely has its merits.
Reduce stress
Acute stress (say, a cold shower) is can confer some health benefits, but chronic stress is ruinous to our health and it ages us. So, reducing this is critical. Dr. Hyman advocates for the practice of mindfulness and meditation, as well as journaling.
Get quality sleep
Quality here, not just quantity. As well as the usual “sleep hygiene” advices, he has some more unorthodox methods, such as the use of binaural beats to increase theta-wave activity in the brain (and thus induce more restful sleep), and the practice of turning off Wi-Fi, on the grounds that Wi-Fi signals interfere with our sleep.
We were curious about these recommendations, so we checked out what the science had to say! Here’s what we found:
- Minimal Effects of Binaural Auditory Beats for Subclinical Insomnia: A Randomized Double-Blind Controlled Study
- Spending the night next to a router – Results from the first human experimental study investigating the impact of Wi-Fi exposure on sleep
In short: probably not too much to worry about in those regards. On the other hand, worrying less, unlike those two things, is a well-established way improve sleep!
(Surprised we disagreed with our featured expert on a piece of advice? Please know: you can always rely on us to stand by what the science says; we pride ourselves on being as reliable as possible!)
Find (and live!) your purpose
This one’s an ikigai thing, to borrow a word from Japanese, or finding one’s raison d’être, as we say in English using French, because English is like that. It’s about having purpose.
Dr. Hyman’s advice here is consistent with what many write on the subject, and it’d be an interesting to have more science on, but meanwhile, it definitely seems consistent with commonalities in the Blue Zone longevity hotspots, where people foster community, have a sense of belonging, know what they are doing for others and keep doing it because they want to, and trying to make the world—or even just their little part of it—better for those who will follow.
Being bitter, resentful, and self-absorbed is not, it seems a path to longevity. But a life of purpose, or even just random acts of kindness, may well be.
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Ikigai – by Héctor García and Francesc Miralles
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Ikigai is the Japanese term for what in English we often call “raison d’être”… in French, because English is like that.
But in other words: ikigai is one’s purpose in life, one’s reason for living.
The authors of this work spend some chapters extolling the virtues of finding one’s ikigai, and the health benefits that doing so can convey. It is, quite clearly, an important and relevant factor.
The rest of the book goes beyond that, though, and takes a holistic look at why (and how) healthy longevity is enjoyed by:
- Japanese people in general,
- Okinawans in particular,
- Residents of Okinawa’s “blue zone” village with the highest percentage of supercentenarians, most of all.
Covering considerations from ikigai to diet to small daily habits to attitudes to life, we’re essentially looking at a blueprint for healthy longevity.
For a book whose title and cover suggests a philosophy-heavy content, there’s a lot of science in here too, by the way! From microbiology to psychiatry to nutrition science to cancer research, this book covers all bases.
In short: this book gives a lot of good science-based suggestions for adjustments we can make to our lives, without moving to an Okinawan village!
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Could ADHD drugs reduce the risk of early death? Unpacking the findings from a new Swedish study
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Attention-deficit hyperactivity disorder (ADHD) can have a considerable impact on the day-to-day functioning and overall wellbeing of people affected. It causes a variety of symptoms including difficulty focusing, impulsivity and hyperactivity.
For many, a diagnosis of ADHD, whether in childhood or adulthood, is life changing. It means finally having an explanation for these challenges, and opens up the opportunity for treatment, including medication.
Although ADHD medications can cause side effects, they generally improve symptoms for people with the disorder, and thereby can significantly boost quality of life.
Now a new study has found being treated for ADHD with medication reduces the risk of early death for people with the disorder. But what can we make of these findings?
A large study from Sweden
The study, published this week in JAMA (the prestigious journal of the American Medical Association), was a large cohort study of 148,578 people diagnosed with ADHD in Sweden. It included both adults and children.
In a cohort study, a group of people who share a common characteristic (in this case a diagnosis of ADHD) are followed over time to see how many develop a particular health outcome of interest (in this case the outcome was death).
For this study the researchers calculated the mortality rate over a two-year follow up period for those whose ADHD was treated with medication (a group of around 84,000 people) alongside those whose ADHD was not treated with medication (around 64,000 people). The team then determined if there were any differences between the two groups.
What did the results show?
The study found people who were diagnosed and treated for ADHD had a 19% reduced risk of death from any cause over the two years they were tracked, compared with those who were diagnosed but not treated.
In understanding this result, it’s important – and interesting – to look at the causes of death. The authors separately analysed deaths due to natural causes (physical medical conditions) and deaths due to unnatural causes (for example, unintentional injuries, suicide, or accidental poisonings).
The key result is that while no significant difference was seen between the two groups when examining natural causes of death, the authors found a significant difference for deaths due to unnatural causes.
So what’s going on?
Previous studies have suggested ADHD is associated with an increased risk of premature death from unnatural causes, such as injury and poisoning.
On a related note, earlier studies have also suggested taking ADHD medicines may reduce premature deaths. So while this is not the first study to suggest this association, the authors note previous studies addressing this link have generated mixed results and have had significant limitations.
In this new study, the authors suggest the reduction in deaths from unnatural causes could be because taking medication alleviates some of the ADHD symptoms responsible for poor outcomes – for example, improving impulse control and decision-making. They note this could reduce fatal accidents.
The authors cite a number of studies that support this hypothesis, including research showing ADHD medications may prevent the onset of mood, anxiety and substance use disorders, and lower the risk of accidents and criminality. All this could reasonably be expected to lower the rate of unnatural deaths.
Strengths and limitations
Scandinavian countries have well-maintained national registries that collect information on various aspects of citizens’ lives, including their health. This allows researchers to conduct excellent population-based studies.
Along with its robust study design and high-quality data, another strength of this study is its size. The large number of participants – almost 150,000 – gives us confidence the findings were not due to chance.
The fact this study examined both children and adults is another strength. Previous research relating to ADHD has often focused primarily on children.
One of the important limitations of this study acknowledged by the authors is that it was observational. Observational studies are where the researchers observe and analyse naturally occurring phenomena without intervening in the lives of the study participants (unlike randomised controlled trials).
The limitation in all observational research is the issue of confounding. This means we cannot be completely sure the differences between the two groups observed were not either partially or entirely due to some other factor apart from taking medication.
Specifically, it’s possible lifestyle factors or other ADHD treatments such as psychological counselling or social support may have influenced the mortality rates in the groups studied.
Another possible limitation is the relatively short follow-up period. What the results would show if participants were followed up for longer is an interesting question, and could be addressed in future research.
What are the implications?
Despite some limitations, this study adds to the evidence that diagnosis and treatment for ADHD can make a profound difference to people’s lives. As well as alleviating symptoms of the disorder, this study supports the idea ADHD medication reduces the risk of premature death.
Ultimately, this highlights the importance of diagnosing ADHD early so the appropriate treatment can be given. It also contributes to the body of evidence indicating the need to improve access to mental health care and support more broadly.
Hassan Vally, Associate Professor, Epidemiology, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Resistance Beyond Weights
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Resistance, Your Way
We’ve talked before about the importance of resistance training:
Resistance Is Useful! (Especially As We Get Older)
And we’ve even talked about how to make resistance training more effective:
(High Intensity Interval Training, but make it High Intensity Resistance Training)
Which resistance training exercises are best?
There are two reasonable correct answers here:
- The resistance training exercises that you will actually do (because it’s no good knowing the best exercise ever if you’re not going to do it because it is in some way offputting to you)
- The resistance training exercises that will prevent you from getting a broken bone in the event of some accident or incident
This latter is interesting, because when people think resistance training, the usually immediate go-to exercises are often things like the bench press, or the chest machine in the gym.
But ask yourself: how often do we hear about some friend or relative who in their old age has broken their humerus?
It can happen, for sure, but it’s not as often as breaking a hip, a tarsal (ankle bones), or a carpal (wrist bones).
So, how can we train to make those bones strong?
Strong bones grow under strong muscles
When archaeologists dig up a skeleton from a thousand years ago, one of the occupations that’s easy to recognize is an archer. Why?
An archer has an unusual frequent exercise: pushing with their left arm while pulling with their right arm. This will strengthen different muscles on each side, and thus, increase bone density in different places on each arm. The left first metacarpal and right first and second metacarpals and phalanges are also a giveaway.
This is because: one cannot grow strong muscles on weak bones (or else the muscles would just break the bones), so training muscles will force the body to strengthen the relevant bones.
So: if you want strong bones, train the muscles attached to those bones
This answers the question of “how am I supposed to exercise my hips” etc.
Weights, bodyweight, resistance bands
If you go to the gym, there’s a machine for everything, and a member of gym staff will be able to advise which of their machines will strengthen which muscles.
If you train with free weights at home:
- Wrist curls (forearm supported and stationary, lifting a dumbbell in your hand, palm-upwards) will strengthen the wrist
- The farmer’s walk (carrying a heavy weight in each hand) will also strengthen your wrist
- A modified version of this involves holding the weight with just your fingertips, and then raising and lowering it by curling and uncurling your fingers)
- Lateral leg raises (you will need ankle-weights for this) will strengthen your ankles and your hips, as will hip abductions (as in today’s featured video), especially with a weight attached.
- Ankle raises (going up on your tip-toes and down again, repeat) while holding weights in your hands will strengthen your ankles
If you don’t like weights:
- Press-ups will strengthen your wrists
- Fingertip press-ups are even better: to do these, do your press-ups as normal, except that the only parts of your hands in contact with the ground are your fingertips
- This same exercise can be done the other way around, by doing pull-ups
- And that same “even better” works by doing pull-ups, but holding the bar only with one’s fingertips, and curling one’s fingers to raise oneself up
- Lateral leg raises and hip abductions can be done with a resistance band instead of with weights. The great thing about these is that whereas weights are a fixed weight, resistance bands will always provide the right amount of resistance (because if it’s too easy, you just raise your leg further until it becomes difficult again, since the resistance offered is proportional to how much tension the band is under).
Remember, resistance training is still resistance training even if “all” you’re resisting is gravity!
If it fells like work, then it’s working
As for the rest of preparing to get older?
Check out:
Training Mobility Ready For Later Life
Take care!
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The New Menopause – by Dr. Mary Claire Haver
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The author is most famous for “The Galveston Diet”, which book is astonishingly similar in its content, chapters, format, etc to Nikki Williams’ “It’s Not You, It’s Your Hormones” which came out a few years previously but didn’t get the same marketing.
Nonetheless, this time Dr. Haver has something new to add, and we think it’s worth a read.
The general theme of this book is a comprehensive overview of the menopause, experientially (subjective to the person going through it) and empirically (by science), from start to finish and beyond. This book’s more about human physiology, and less about diet than the previous.
Dr. Haver also discusses in-depth how estrogen is thought of as a sex hormone (and it is), to the point that people consider it perhaps expendable, and forget (or are simply unaware) that we have estrogen receptors throughout our bodies and estrogen is vital for maintaining many other bodily functions, including your heart, cognitive function, bone integrity, blood sugar balance, and more.
(in case you’re wondering “why don’t men fall to bits, then?”, don’t worry, their testosterone does these things for them. Testosterone is orders of magnitude less potent than estrogen, mg for mg, so they need a lot more of it, but under good conditions they produce plenty so it’s fine)
But, the amount of testosterone available to peri/postmenopausal women is simply not enough to do that job (and it’d also result in a transition of secondary sex characteristics, which for most people would be very unwanted), so, something else needs to be done.
Dr. Haver also discusses in detail the benefits and risks of HRT and how to get/manage them, respectively, with the latest up-to-date research (at time of going to print; the book was published in April 2024).
Bottom line: if you want to know what’s going on with your peri- or post-menopausal body and how it could be better (or if you want to know what’s going on with someone else approaching/experiencing menopause), then this is a top-tier book.
Click here to check out The New Menopause, and know what’s going on and what to do about it!
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