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Depression

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Jeffrey Sanzel in a scene from 'Every Brilliant Thing.' Photo by Steve Ayle/Showbizshots.com

By Heidi Sutton

You’re seven years old. Your mother is in the hospital. Your father said she’s “done something stupid.”

Thus begins the remarkable one-man play, Every Brilliant Thing. Written by Duncan MacMillan with Jonny Donahoe, the story starts in 1973 as a young boy finds out his mother has attempted suicide. In response, he begins to make a list of everything brilliant about the world, everything worth living for — 1. Ice cream, 2. Water fights, 3. Staying up past your bedtime and being allowed to watch TV, 4. The color yellow, 5. Things with stripes. When his mother returns from the hospital, he leaves the list on her pillow in hopes it will help her heal. She corrects his spelling and gives it back to him. 

Jeffrey Sanzel in a scene from ‘Every Brilliant Thing.’ Photo by Steve Ayle/Showbizshots.com

After his mother’s second suicide attempt ten years later, he brings the list out again and continues to add to it until it takes a life of its own. He leaves post-its all over the house in another attempt to reach out to her, to show her that life is truly worth living. When he falls in love with his future wife Sam, the list becomes a gift for her. When he struggles with his own depression, he rediscovers the list one final time until it reaches one million and helps him heal.

Now, in association with Response Crisis Center, the show heads to Theatre Three’s Ronald F. Peierls Theatre on the Second Stage for its Long Island premiere. Under the direction of Linda May, the show stars Theatre Three’s Executive Artistic Director Jeffrey Sanzel in an incredible performance.

The cabaret-style show recruits members of the audience to join Sanzel on stage to tell the story — the veterinarian who put his childhood dog Bark Twain to sleep — the character’s first experience with death; the father who prefers music over talking; and girlfriend Sam, who he meets in college.

Others participate from their seats  — his guidance counselor Mrs. Patterson, his favorite college professor — people who have made a profound difference in his life. Still others, when prompted, call out brilliant things from his growing list — 23. Mighty Mouse, 24. Spaghetti with meatballs, 25. Wearing a cape, 317. Stars Wars, 319. Laughing so hard you shoot milk out of your nose, 731. hammocks, 993. Having dessert as your main course.

Jeffrey Sanzel in a scene from ‘Every Brilliant Thing.’ Photo by Steve Ayle/Showbizshots.com

Sanzel’s performance is, for lack of a more fitting word, brilliant. His ability to improvise is impressive and his presentation is flawless. The audience, which he draws into the story, hangs on his every word from start to finish. The result is an intimate, funny, sad, emotional, heart-warming and cathartic experience that ends much too soon. 

While he works the room, Sanzel pauses often to addresses the audience about suicide prevention and depression:

“It’s important to talk about things — particulary things that are hardest to talk about.”

“It is common for children of suicides to blame themselves. It’s natural.”

“In order to live in the present we have to imagine a future that’s better than our past — because that’s what hope is.” 

And the final — “I have some advice for anyone contemplating suicide. It’s really simple advice. Don’t do it — things get better. They might not always get brilliant, but they get better.”

1092. Conversation, 2000. Coffee, 2005. Vinyl records, 9995. Falling in love, One Million. Listening to a record for the first time, turning it over in your hands, placing the needle down … and then sitting and listening while reading through the sleeve notes.

The list (and show) will change the way you see the world. Don’t miss this one.

Photo from Response Crisis Center

Theatre Three, 412 Main St., Port Jefferson presents Every Brilliant Thing every Sunday at 3 p.m. through Aug. 28. Running time is one hour with no intermission. All seats are $20 with 50% of the proceeds benefitting the Response Crisis Center. Staff members from the Center will be at each performance to answer questions and provide information. Audiences are encouraged to fill out their own “brilliant things” on provided Post-It notes in the lobby, which will be on display throughout the show’s run. For more information or to order, call 631-928-9100 or visit www.theatrethree.com.

CONTENT WARNING: Although the play balances the struggles of life while celebrating all that is “truly brilliant” in living each day, Every Brilliant Thing contains descriptions of depression, self-harm, and suicide. It is recommended that only audience members 14 and older attend. If you or somebody you know is struggling, call Response 24/7 at 631-751-7500 or the National Lifeline at 1-800-273-8255.

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Pixabay photo

Across the TBR News Media coverage area, on the minds of many board of education candidates running for trustee this election cycle has been the need for greater access to mental health services for students.

In general, the topic of mental health continues to come up more and more as the number of people suffering from this affliction increases. Americans are feeling the impact of COVID-19 shutdowns and of the isolation and loss of control that have followed. The news of more shootings nationwide has brought the issue and its repercussions to the forefront.

The mission of providing mental health assistance or increasing that aid to children and adolescents makes sense and the reasons to do so are countless. According to the Centers for Disease Control and Prevention, one in six U.S. children aged 2–8 years has been diagnosed with a mental, behavioral or developmental disorder. During the period of 2018-19, among adolescents aged 12-17 responding to a study, approximately 15% had a major depressive episode and nearly 37% had persistent feelings of sadness and hopelessness. 

Adolescents today are also having more violent thoughts than they had in the past. It’s now increasingly vital to sit down with young people and get to the root causes of violent ideation. What is triggering such thoughts and how can we address them adequately?

Before the pandemic, mental health problems were already rising, exacerbated by people, especially young ones, sitting in front of computer screens and smartphones, comparing their lives to others. For many, COVID-19 shutdowns only compounded their miseries with more quiet time to sit with their feelings yet without opportunities to express their thoughts in a safe place.

While many therapists offer virtual appointments through Zoom and other platforms, sometimes a patient, especially an adolescent, can feel even more isolated in such a forum as it can be difficult for some to connect with another through a screen.

This general disconnect from society can be detrimental to anyone, especially a child who is just starting to figure out what life is all about and the part he or she plays in it.

Our nation is in the midst of Mental Health Awareness Month, which has been observed in the U.S. since 1949. Now more than ever, it’s important to educate ourselves on the signs of mental health problems and how we can all help. Sometimes it’s as simple as letting those whom we love and who look to us for guidance know they are not alone. People who are struggling need to know they have someone to talk to so that they don’t feel alone and desperate.

At other times, we need to identify the proper balance between keeping one’s secrets and asking for help, even if it means reaching out to a parent, teacher or professional.

Discussions on how to provide our children the best mental health services need to continue past budget votes and BOE elections. Reach out to your board of ed, attend school board meetings and ensure that providing students the help they need is not a talking point but a priority.

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Above, DeLorenzo (in blue) at a Multiple Sclerosis benefit in which she and a group of friends climbed the stairs at Rockefeller Center. Photo from C. DeLorenzo

By Daniel Dunaief

Her colleagues highlight the joy, passion and optimism she brings to her work, which can be the opposite of the way people she is eager to help feel. 

Dr. Christine DeLorenzo, Professor of Psychiatry and Biomedical Engineering at Stony Brook University, studies depression.

A disease with numerous symptoms that likely has a wide range of causes, depression presents an opportunity for Dr. DeLorenzo to bring not only a relentless energy to her work, but also an engineer’s perspective.

“Engineering is all about examining a complex problem and thinking, ‘I bet we can fix that,’” explained Dr. DeLorenzo in an email. “Biomedical engineering takes it to a new level.”

Indeed, Dr. DeLorenzo specializes in brain imaging, using positron emission tomography, among other techniques, to understand and differentiate the factors that might contribute to depression and to develop ways to treat specific subtypes of the mental health disease.

Dr. Ramin Parsey, who mentored Dr. DeLorenzo and is professor and Della Pietra Chair of Biomedical Imaging at Stony Brook, believes she will help define the subtypes of depression by imaging the brain.

For Dr. DeLorenzo, the abundance of discussion in the popular and scientific literature that currently attributes the progression of depression to a host of causes, from eating the wrong foods to not exercising enough to not getting the right amount of sleep, doesn’t offer much clarity.

“We see a million articles about what causes depression and they don’t all agree,” said Dr. DeLorenzo. “Depression is caused by a bunch of different things, which is not all that helpful when you’re the person suffering.”

In her brain studies, Dr. DeLorenzo has looked at inflammation and neurotransmitter systems. The goal of her work is to find “whatever is outside the normal range in the person with depression and treat” that potential cause, she said. High levels of inflammation might suggest an anti-inflammatory treatment.

When people receive a major depressive disorder diagnosis, they often are prescribed a selective serotonin reuptake inhibitor, or SSRI. This enables the neurotransmitter serotonin to remain in the brain for a longer period of time.

“It’s great that it works in a subset of people” for whom it is effective, Dr. DeLorenzo said. “We would like to know beforehand if we give this medication will it work for you, specifically.”

In one of her studies, Dr. DeLorenzo uses positron emission tomography, or PET scans, to search for signs of inflammation. She is looking for translocator proteins, which is a marker of inflammation. Reactive glial cells in the brain, which are an important supporting part of the nervous system that don’t have axons and dendrites like nerve cells, increase the production of these proteins during some depression and other disorders.

The level of these translocator proteins increase in glial cells when the brain is having an inflammatory response, which likely occurs in a subtype of depression as well as in other diseases.

Dr. DeLorenzo has a PET tracer that sticks to that protein and that gives off a signal to the camera, which enables her to quantify the inflammation.

At this point, she and her collaborators, including co-Principal Investigator Dr. Parsey and Dr. Stella Tsirka, Professor of Pharmacological Sciences at Stony Brook, are recruiting a collection of patients with depression. They are testing the idea that people with higher inflammation are better treated with an anti-inflammatory. They are using PET to see who has high or low inflammation prior to treatment. During the study, the researchers will determine if those with the highest inflammation had the best response.

Dr. Tsirka’s lab uses animal models to understand mechanisms of disease and experiment on treatment, while Dr. DeLorenzo uses neuro-imaging in human patients to understand and treat pathology.

“Our preclinical results certainly support the idea of the neuro-inflammation hypothesis of depression” and suggest potential ways to interfere with the process in preclinical models, Dr. Tsirka explained in an email.

Dr. Tsirka, who has been working for Dr. DeLorenzo for over three years, described her colleague as “enthusiastic, rational creative and hard working” and believed imaging could provide a way to verify efficient treatment of depression.

By understanding the biology of the brain, Dr. DeLorenzo hopes to address a range of questions that might affect the disease.

In other work, Dr. DeLorenzo is exploring the possibility that a disruption in glutamate leads to circadian and mood dysfunction in a subtype of depression.

In some studies with glutamate, researchers assessed mood before and after sleep deprivation. They found that sleep deprivation provided an antidepressant effect in about 40 percent of patients with Major Depressive Disorder.

A healthy person would typically become tired and angry after staying awake for 36 straight hours. Some people with this form of depression, however, see an improvement in their mood after staying up for so many hours.

“Something about sleep deprivation causes an antidepressant effect in some people,” Dr. DeLorenzo said. “We don’t know what that is.”

The antidepressant effect can be short lived, although about 10 percent of people have benefits that last as long as a few weeks.

To be sure, Dr. DeLorenzo cautioned that no one is “advocating just doing sleep deprivation” or even a continuous cycle of partial sleep deprivation.

Born and raised in Bay Ridge, Brooklyn, Dr. DeLorenzo earned her undergraduate and Master’s Degrees at Dartmouth College. She earned her PhD from Yale University, where she started her brain imaging work.

When Parsey left Columbia to join Stony Brook in 2012, Dr. DeLorenzo moved with him, even though her commute from Queens was three hours each way.

“She never complained” about her travels, Dr. Parsey marveled. In fact, Dr. DeLorenzo uses the commuting time to read papers and prepare emails.

Dr. Parsey admired Dr. DeLorenzo’s dedication to teaching and mentoring students in her lab. In her first summer, she took on 17 interns. “This is the kind of stuff that nobody else I know does,” Dr. Parsey marveled.

As for her work, Dr. DeLorenzo believes understanding sub-categories of mental health will follow the same pattern as cancer research. “Back in the day, we used to say, ‘Someone has cancer or a tumor.’ Now, we say that that tumor has this genetic marker, which is what we’re going to target when we treat it.”

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Andrew Schwartz. Photo courtesy of Stony Brook University

By Daniel Dunaief

In the era of social media, people reveal a great deal about themselves, from the food they eat, to the people they see on a subway, to the places they’ve visited. Through their own postings, however, people can also share elements of their mental health.

In a recent study published in the journal Proceedings of the National Academy of Sciences, Andrew Schwartz, an assistant professor in the Department of Computer Science at Stony Brook University, teamed up with scientists at the University of Pennsylvania to describe how the words volunteers wrote in Facebook postings helped provide a preclinical indication of depression prior to a documentation of the diagnosis in the medical record.

Using his background in computational linguistics and computational psychology, Schwartz helped analyze the frequency of particular words and the specific word choices to link any potential indicators from these posts with later diagnoses of depression.

Combining an analysis of the small cues could provide some leading indicators for future diagnoses.

“When we put [the cues] all together, we get predictions slightly better than standard screening questionnaires,” Schwartz explained in an email. “We suggest language on Facebook is not only predictive, but predictive at a level that bears clinical consideration as a potential screening tool.”

Specifically, the researchers found that posts that used words like “feelings” and “tears” or the use of more first-person pronounces like “I” and “me,” along with descriptions of hostility and loneliness, served as potential indicators of depression.

By studying posts from consenting adults who shared their Facebook statuses and electronic medical record information, the scientists used machine learning in a secure data environment to identify those with a future diagnosis of depression.

The population involved in this study was restricted to the Philadelphia urban population, which is the location of the World Well-Being Project. When he was at the University of Pennsylvania prior to joining Stony Brook, Schwartz joined a group of other scientists to form the WWBP.

While people of a wide range of mental health status use the words “I” and “me” when posting anecdotes about their lives or sharing personal responses to events, the use of these words has potential clinical value when people use them more than average.

That alone, however, is predictive, but not enough to be meaningful. It suggests the person has a small percentage increase in being depressed but not enough to worry about on its own. Combining all the cues, the likelihood increases for having depression.

Schwartz acknowledged that some of the terms that contribute to these diagnoses are logical. Words like “crying,” for example, are also predictive of being depressed, he said.

The process of tracking the frequency and use of specific words to link to depression through Facebook posts bears some overlap with the guide psychiatrists and psychologists use when they’re assessing their patients.

The “Diagnostic and Statistical Manual of Mental Disorders” typically lays out a list of symptoms associated with conditions such as schizophrenia, bipolar disorder or depression, just to name a few.

“The analogy to the DSM and how it works that way is kind of similar to how these algorithms will work,” Schwartz said. “We look at signals across a wide spectrum of features. The output of the algorithm is a probability that someone is depressed.”

The linguistic analysis is based on quantified evidence rather than subjective judgments. That doesn’t make it better than an evaluation by mental health professional. The algorithm would need more development to reach the accuracy of a trained psychologist to assess symptoms through a structured interview, Schwartz explained.

At this point, using such an algorithm to diagnose mental health better than trained professionals is a “long shot” and not possible with today’s techniques, Schwartz added.

Schwartz considers himself part computer scientist, part computational psychologist. He is focused on the intersection of algorithms that analyze language and apply psychology to that approach.

A person who is in therapy might offer an update through his or her writing on a monthly basis that could then offer a probability score about a depression diagnosis.

Linguistic tools might help determine the best course of treatment for people who have depression as well. In consultation with their clinician, people with depression have choices, including types of medications they can take.

While they don’t have the data for it yet, Schwartz said he hopes an algorithmic assessment of linguistic cues ahead of time may guide decisions about the most effective treatment.

Schwartz, who has been at SBU for over three years, cautions people against making their own mental health judgments based on an impromptu algorithm. “I’ve had some questions about trying to diagnose friends by their posts on social media,” he said. “I wouldn’t advocate that. Even someone like me, who has studied how words relate to mental health, has a hard time” coming up with a valid analysis, he said.

A resident of Sound Beach, Schwartz lives with his wife Becky, who is a music instructor at Laurel Hill Middle School in Setauket, and their pre-school-aged son. A trombone player and past  member of a drum and bugle corps, he met his wife through college band.

Schwartz grew up in Orlando, where he met numerous Long Islanders who had moved to the area after they retired. When he was younger, he used to read magazines that had 50 lines of computer code at the back of them that created computer games.

He started out by tweaking the code on his own, which drove him toward programming and computers.

As for his recent work, Schwartz suggested that the analysis is “often misunderstood when people first hear about these techniques. It’s not just people announcing to the world that they have a condition. It’s a combination of other signals, none of which, by themselves, are predictive.”

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Words are the symphony that warms the skin and colors the silence.

Words can be like the sound of reinforcements coming over the horizon when we feel penned down by an adversary. They rescue us just as we use them to swaddle others in their warmth.

As we make the transition from Halloween to Thanksgiving, Black Friday and, eventually, the December holidays and the new year, we can take solace in the anticipation of words that provide warmth through the darker days of winter.

We might take a trip to Central Park, where the sound of sleigh bells from carriages around a corner alerts us to the appearance of an approaching horse, even as the animal might remind us of a city that predated internal combustion engines.

Just the words “sleigh ride” might inspire our minds to play a song we performed in high school.

Words can also convey the remarkable scents of the coming seasons, with the air carrying the mouthwatering Pavlovian cue from gingerbread houses or holiday cookies.

I recently attended a wedding where a few well-chosen words triggered an almost immediate and reflexive “awww” from an audience delighted to hear how much a younger brother was inspired by his older brother, the groom.

Reading about how important our coat donations are can inspire us to rummage through our closets to help a child or an adult become more comfortable in the frigid air.

Well-chosen words can provide the kind of environment that empowers people to see and appreciate everything from the inspirational image of a person overcoming physical limitations to the intricate beauty of a well-woven spiderweb shimmering in the low light of winter.

Sometimes, as when a friend or family member is going through a significant medical procedure or crisis, words or prayer or encouragement are all we have to offer, giving us something to do or say as we hope the words provide even a scintilla of comfort.

Words can feel insufficient to express how we feel or what we hope happens when someone who has been in the foreground of our lives for years seems suddenly vulnerable.

Simple tools which we all take for granted, words can take us to a peaceful beach with the sound of water lapping on the coarse sand under our feet, transporting our minds and bodies away from the cacophony of busy lives.

In big moments, athletes often suggest that they are at a loss for words. In reality, their words and emotions are undergoing so much competition that their brain experiences a word bottleneck, with a flow of ideas and words awaiting the chance to dive from the tip of their tongues to the eager ears of their friends, family and fans.

The coming holiday season is filled with diametrically opposed experiences, as the joy of opening presents and reconnecting with friends and family for the first time in months or even a year is counterbalanced by the stress and strain of those people who feel overwhelmed or alone.

People who work at suicide hotlines or as 911 operators can and do use critical words to save people’s lives, bringing their minds back from the brink, restoring hope and offering a comforting verbal lifeline.

We take words for granted because we see and hear them so often, but the right word at the right time can transcend the routine.

Finding words that resonate is akin to strolling into a restaurant and discovering a combination of familiar and exotic flavors, all mixed together with a palate-pleasing texture that energizes us.

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Bridge of Hope Resource Center founder Celina Wilson is planning to turn a family owned home on Roe Avenue into a shelter for at-risk girls ages 16 to 21. Image from Google Maps

As the old cliché goes, it’s impossible to know when opportunity will knock, just be ready to answer the door when it does. Opportunity knocked for Celina Wilson about 30 years ago, both literally and figuratively. She went on to dedicate her life’s work to the opportunity that was standing at her front door.

The Port Jefferson Station resident founded Bridge of Hope Resource Center with her husband, George, in the late 1990s, a nonprofit dedicated to strengthening communities through family communication. The organization for years has been holding seminars, forums, workshops and other similar events to educate the community and arm parents with strategies for connecting with teens and young adults. Wilson and the organization’s overarching ethos is that education and prevention are the best means for keeping kids from falling victim to the ills lurking in society, like drug addiction and depression. In 2018, Wilson is hoping to advance Bridge of Hope’s mission a step further.

Wilson’s in-laws lived in Port Jefferson Station for about 30 years, but 10 years ago, after her husband’s mother died, her father-in-law, John Wilson, decided to move out of the longtime family home on Roe Avenue. The home was left to Bridge of Hope to use as an asset, sheltering families in crisis who had a hard time finding a place to live. Wilson said the only stipulation was the tenants needed to find work and contribute to the rent. Over the course of the last decade, Wilson said three or four families have stayed at the home.

Now, she plans to repurpose it to serve as a shelter for at-risk girls between 16 and 21 years old. The shelter — which will be called John’s House, to honor Wilson’s late father-in-law — will be a place for girls who run away from home or pose a risk of doing so due to conflicts with parents or guardians. While at the home, those staying in the five beds will be supervised and subjected to counseling and other programs in an effort to restore open lines of healthy communication with parents.

The inspiration for the home was several decades in the making for Wilson.

She was living with her now-husband’s family in the same Port Jeff Station home about 30 years ago, she recalled, when a 16-year-old boy knocked on her door. Even though it was 10 p.m., the then-21-year-old answered.

“He was wondering if he could sleep in our house,” Wilson said. “He was tired. He had a fight with his mom, and I’m figuring, ‘He must have knocked at plenty of houses. Why ours?’ We didn’t understand. But he asked us, ‘Please, just for the night, can I just come in?’ What went through my mind was, ‘If we don’t let him in, he’s going to be in the street and who knows what?’”

In the morning, Wilson remembers waking up wanting to hear more of his personal story, but by that time, he was already gone.

“What went through my mind was, ‘If we don’t let him in, he’s going to be in the street and who knows what?’”

— Celina Wilson

“I realized then, ‘Oh my gosh, there’s so many young people out there, I wonder what his mom was thinking, if she knew he was somewhere safe,’” she said. “The story repeats itself if we fast forward, but it’s
different today because of what our young people are facing.”

Wilson said the home will be funded by donations and some money from the New York State Office of Children and Family Services, which will also help in placing some of the girls in the home, though space will be available to accommodate the weary traveler like the one who knocked on her door 30 years ago.

“We feel the house is going to be a place where families can send their teens and work on situations that they themselves cannot work on in the home, and prevent them from running away,” Wilson said. “The goal is to reunite that youth back with their family.”

She said the length of stay for occupants will be determined on a case-by-case basis, with an eye toward sheltering those most in need, though she estimated many will be allowed to live there for up to 18 months. Each of the tenants will be expected to participate in counseling sessions and work toward agreed-upon goals, all while Bridge of Hope will be maintaining contact with the families to try to rebuild lines of communication. Wilson said the organization will follow up with the tenants even after they leave the home to make sure they stay on track as they grow up and prepare for independence.

One representative from the resource center will live permanently at the home, who Wilson referred to as the “house mom,” though aides, case workers and other specialists will also be on hand on a rotating basis seven days a week. She said tenants will be supervised at all times and expected to be at the home unless they’re at school, work or an organized activity.

She said admittance into the home will have nothing to do with demographics, as family conflict is common among all segments of society.

“It could be anyone’s child that is out there on the street,” Wilson said. “It could be my child.”

One community member who was helped by Wilson and Bridge of Hope said she sees the organization’s founder as the perfect person for an initiative like John’s House.

“She made things happen for me,” said the woman, who asked to remain anonymous. She said Wilson and the
center worked with her for five years, assisting in finding work and getting her life on track while dealing with a physical disability. “She’s right for these kids. A lot of young people don’t have a place to go.”

She called Wilson a good person and a woman of her word, adding she wished the founder would run for political office.

Wilson said she contacted the Suffolk County Youth Bureau, an entity under the county executive’s purview dedicated to ensuring effective management of county funds for youth services, for assistance in
establishing policies for her initiative. She said the organization also conducted an inspection at the house, which will undergo minor renovations prior to her October target date for opening.

Though members of the bureau’s leadership declined to comment on the dealings with Bridge of Hope, one of its responsibilities includes monitoring and evaluating youth programs, research and planning; information and referrals; and training and technical assistance for community-based youth organizations, according to its website.

Wilson said she sees John’s house as a fitting tribute for the man it’s named after, who migrated to the United States from Jamaica in the Caribbean. He worked for years as a custodian at John T. Mather Memorial Hospital.

“He left such a legacy here and abroad that we thought it appropriate to call it John’s House because he lived a life of service, kindness and love to his fellow man,” she said.

To donate to help Wilson’s cause, visit www.gofundme.com/xtzv6n-hope-for-her.

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Accumulating evidence supports an association between depression and inflammation. Stock photo
C-reactive protein is an important biomarker

By David Dunaief, M.D.

Dr. David Dunaief

Many of us have inflammation in our bodies, inflammation that is a potential underlying cause for a great number of diseases. Can we demonstrate the level of inflammation by measuring it? The answer is yes.

One of the most widely studied biomarkers for inflammation is high-sensitivity C-reactive protein (hsCRP), also referred to as CRP. High sensitivity means that we can measure levels as low as 0.3 mg/L more accurately.

What is the significance of the different levels? In heart disease, individuals who have levels lower than 1.0 mg/L are in the optimal range for low risk of inflammation. Levels of 1 to 3 mg/L represent the average risk range, and greater than 3.0 mg/L is a higher risk profile. Above 10.0 mg/L is less specific to heart disease, although still related, but more likely associated with other causes, such as infection and autoimmune diseases (1, 2). This biomarker is derived from the liver.

CRP is not specific to heart disease, nor is it definitive for risk of the disease. However, the upside is that it may be helpful with risk stratification, which helps us understand where we sit on a heart disease risk spectrum and with progression in other diseases, such as age-related macular degeneration, diabetic retinopathy, depression and autoimmune diseases. Let’s look at the evidence.

Age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in patients over the age of 65 (3). Therefore, it is very important to help define risk stratification for this disease. In a prospective study, results showed that hsCRP levels were inversely associated with the risk of developing AMD. The group with an hsCRP greater than 3.0 mg/L had a 50 percent increased risk of developing overall AMD compared to the optimal group with hsCRP lower than 1.0 mg/L. But even more interestingly, the risk of developing neovascular, or wet, AMD increased to 89 percent in this high-risk group.

The significance of wet AMD is that it is one type of advanced-stage AMD that results in blindness. This study involved five studies where the researchers thawed baseline blood samples from middle-aged participants who had hsCRP levels measured. There were more than 2,000 participants with a follow-up as long as 20 years. According to the study’s authors, annual eye exams and lifestyle modifications, including supplements, may be able to stem this risk by reducing hsCRP.

These results reinforce those of a previous prospective study that showed that elevated hsCRP increased the risk of AMD threefold (4). This study utilized data from the Women’s Health Study, which involved over 27,000 participants. Like the study mentioned above, this one also defrosted blood samples from baseline and looked at follow-up incidence of developing AMD in initially healthy women.

The highest group had hsCRP levels over 5.2 mg/L. Additionally, when analyzing   similar cutoffs for high- and low-level hsCRP, as the above trial used, those with hsCRP over 3.0 had an 82 percent increased risk of AMD compared to those with an hsCRP of lower than 1.0 mg/L.

Diabetic retinopathy — a complication of diabetes

We know that diabetes affects approximately 10 percent of the U.S. population and is continuing to rise at a rapid rate. One of the complications of diabetes affects the retina (back of the eye) and is called diabetic retinopathy. This is a leading cause of vision loss (5). One of the reasons for the vision loss is macular edema, or swelling, usually due to rupture of tiny blood vessels below the macula, a portion of the back of the eye responsible for central vision.

The Diabetes Control and Complications Trial (DCCT), a prospective study involving over 1,400 Type 1 diabetes patients, showed an 83 percent increased risk of developing clinically significant macular edema in the group with the highest hsCRP levels compared to those with the lowest (6). Although these results were with Type 1 diabetes, patients with Type 2 diabetes are at equal risk of diabetic retinopathy if glucose levels, or sugars, are not well controlled.

Depression

Depression is a very difficult disease to control and is a tremendous cause of disability. If we can minimize the risk of complications and hospitalizations, this is probably the most effective approach.

Well, it turns out that inflammation is associated with depression. Specifically, in a prospective observational trial, rising levels of CRP had a linear relationship with increased risk of hospitalization due to psychological distress and depression (7).

In other words, compared to levels of less than 1 mg/L, those who were 1 to 3 mg/L, 3 to 10 mg/L and greater than 10 mg/L had increased risk from 30 to 84 to 127 percent, respectively. This study involved over 70,000 patients.

What can be done to reduce inflammation?

This is the key question, since we now know that hsCRP is associated with systemic inflammation. In the Nurses’ Health Study, a very large, prospective observational study, the Dietary Approaches to Stop Hypertension (DASH) diet decreased the risk of both heart disease and stroke, which is impressive. The DASH diet also decreases the levels of hsCRP significantly, which was associated with a decrease in clinically meaningful end  points of stroke and heart disease (8).

The DASH diet is nutrient dense with an emphasis on fruits, vegetables, nuts, seeds, legumes and whole grains and a de-emphasis on processed foods, red meats, sodium and sweet beverages.

Conclusion

As the evidence shows with multiple diseases, hsCRP is a very valuable nonspecific biomarker for inflammation in the body.

To stem the effects of inflammation, reducing hsCRP through lifestyle modifications and drug therapy may be a productive way of reducing risk, slowing progression and even potentially reversing some disease processes.

The DASH diet is a very powerful approach to achieving optimal levels of hsCRP without incurring potential side effects. This is a call to arms to have your levels measured, especially if you are at high risk or have chronic diseases such as heart disease, diabetes, depression and autoimmune diseases. HsCRP is a simple blood test with easy-to-obtain results.

References:

(1) uptodate.com. (2) Diabetes Technol Ther. 2006;8(1):28-36. (3) Prog Retin Eye Res. 2007 Nov;26(6):649-673. (4) Arch Ophthalmol. 2007;125(3):300-305. (5) Am J Ophthalmol. 2003;136(1):122-135. (6) JAMA Ophthalmol. 2013 Feb 7;131:1-8. (7) JAMA Psychiatry. 2013;70(2):176-184. (8) Arch Intern Med. 2008;168(7):713-720.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Strange as it may seem amid the frenetic shopping, the seasonal music and the rounds of holiday parties, there are some who are deeply lonely. They may or may not seem so, they may be among the elderly or adolescents, they may appear depressed or not, but they are indeed lonely. And lonely can be bad for one’s health.

Loneliness has lots of causes. For a widow or widower, the approach of the holidays makes more grievous the loss of a spouse. Holidays are typically family time, and one member is gone. Or perhaps a close friend has died and is sorely missed. For those who have outlived their contemporaries, the gaiety and excitement of the holidays are a sad contrast with their lives. Or with children and grandchildren scattered over three continents, it may not be possible to be together for the celebrations. Perhaps worst of all are those in unsatisfying relationships who are perceived to be coupled but are in reality painfully lonely.

Loneliness, health studies have shown, can cause increased risk of heart disease, type 2 diabetes, arthritis, depression, accelerated cognitive decline and even trigger suicide. And in this world of electronic devices operating on the internet, even a phone call with the sound of a warm voice is now often replaced by a tidy and sanitized email or text message.

How are we to respond to such feelings of loneliness?

First is to be aware that those around us may not be so caught up in the spirit of the season. For those who have plenty, whether in worldly goods or in simple joy, this is the time for sharing. Sometimes it is not so obvious when others are hurting. If a neighbor is a shut-in, it is easy to guess that the person would like a visit, even a short one, or an errand run on their behalf. These are immediate solutions. But social isolation and loneliness are not necessarily the same. That neighbor may have few social connections but enjoy an existence rich with books, music or hobbies. On the other hand, loneliness is a subjective condition in which a person feels isolated, even if surrounded by people most of the time. That person is just as needy, or more so, for human interaction but that need may be harder to discern. Research at the University of California, San Francisco, reveals that “most lonely people are married, live with others and are not clinically depressed,” according to a recent article by Jane Brody in The New York Times.

Some more obvious remedies for those who are lonely or socially isolated to help themselves might be volunteering at a hospital or assisted living center, a soup kitchen or a nursery school. Giving to others in need brings its own rewards. Joining a group with shared interests — anything from quilting to trivial pursuit — can help. A book club or a class is a way to keep the mind engaged while perhaps finding others with whom to socialize. And the fail-safe solution for those who desire interaction with others is to get a dog. It is not possible to take a dog for its walk three times a day, day after day, and not get into conversation with someone along the way unless the walk is in the woods.

But back to how we can help others who cannot help themselves. It seems to me that one of the greatest compliments one human can give to another is the willingness to listen. This may sound easier than it really is. Many people practice mindfulness, being in the moment, meditation and so forth for their own enrichment. In order to listen to another person, to really hear them, one has to practice that skill too, until it becomes almost an art. We who live in our small villages, where people have more opportunity to connect with neighbors in the supermarket or at concerts or school baseball games, we are lucky enough, if we are so interested, to be available to listen to each other.

We can learn when we listen. And for the lonely, genuinely being heard is a balm.

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Jason Geier photo from SCPD

Update, 4.18.16, 10 a.m.: Police said Jason Geier was found in Brooklyn, unharmed.

A missing Dix Hills teenager who has depression and bipolar disorder has not had his medication in more than 24 hours and might be suicidal.

Police first issued an alert for 17-year-old Jason Geier on Tuesday, after he was last seen on Arista Drive around 3:30 p.m. that day. The teen was still missing on Wednesday night, and the Suffolk County Police Department renewed a public request for help to find him.

Anyone who has seen Geier, who has blonde hair and blue eyes, or has information about his location is asked to call 911 or the SCPD’s 2nd Squad at 631-854-8252.

In addition to having depression and bipolar disorder, the teen has ADHD, police said. He could possibly be suicidal.

Geier is 5 feet 9 inches tall and weighs 130 pounds. When he was last seen, he was wearing a blue jacket, blue jeans and bright yellow sneakers.

Police said the Dix Hills kid also has family in Merrick.

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Medical experts offer ways to stay on top of mental health

By Lisa Steuer

While the holidays are typically viewed as a happy time, the season can also bring many challenges and stresses that aren’t as common during the rest of the year.

When it comes to the holidays, the combined influence of lack of sunlight as well as the stresses of the holiday season can result in poor mental and emotional health, said Dr. Laura Kunkel, clinical assistant professor of psychiatry at Stony Brook University School of Medicine.

“The media makes it seem like a very happy time … and then people wind up feeling guilty if they’re not happy,” said Kunkel.

One stress that people face during the holidays is getting together with family members with whom they may be estranged from or not get along.

“It’s important for people to be mindful of when they’re going overboard to please others, and the holidays particularly puts people at risk for this if they have a pattern of wanting to please others,” said Kunkel. “People should kind of step back and be mindful to their own physical needs and take care of their health during this time and recognize when they might be giving too much.”

A particular challenge that some people may face during the holidays is how to deal with family members with addiction. “Sometimes I recommend that people go to a public place to have a holiday dinner, rather than in someone’s home, and obviously make sure that the person with addiction has transportation.”

When it comes to the holidays, the combined influence of lack of sunlight as well as the stresses of the holiday season can result in poor mental and emotional health. — Dr. Laura Kunkel, clinical assistant professor of psychiatry at Stony Brook University School of Medicine

People who have lost a relative or someone close to them can find the holidays particularly painful.

“One way to kind of let the grieving process go quickly is to talk about the person and to talk about the memories, and even though it may bring up tears, it’s part of the healing process,” said Kunkel.

For someone who has lost a child, however, it can be quite different. “Old customs may be too painful, and there might need to be some changes,” said Kunkel, adding that some people suffering such a loss choose to travel during the holidays, for instance.

And in the age of social media, try to focus on the moment at hand instead of constantly checking your phone and looking at what everyone else is doing.  “Put the media down and enjoy with the people who are there,” said Kunkel.

In addition, after the hubbub of the holidays, people tend to feel empty and bored in January, Kunkel added. “January is a good time to make sure your social calendar has things set up.”

Seasonal Affective Disorder

It is estimated that 10 million Americans are affected with seasonal affective disorder (SAD) and that another 10 to 20 percent may have a mild case of SAD, which is a type of depression that is related to the change in seasons and lack of light. Anyone can be affected — those with a history of depression and even those without. Here are five tips from Ramin Parsey M.D., Ph.D., chair, Department of Psychiatry at Stony Brook University School of Medicine.

  1. Get plenty of exercise.  Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.
  2. Keep up with social activities. When you’re feeling down, it can be hard to be social, but making an effort to connect with people that you enjoy being around can give you a boost. Staying connected to friends and loved ones can offer support and give you something else to think about other than the weather.
  3. Keep on the bright lights. Light therapy is often used to treat SAD, and those lights mimic the natural outdoor light, which appears to cause a change in brain chemicals linked to mood. Also think about opening the blinds or sitting closer to bright windows while at home or in the office.
  4. Try to keep a regular sleep schedule. Melatonin, a hormone that controls the natural cycle of sleeping and waking hours, could fluctuate during the shorter winter days, causing disruptions to sleep patterns and mood.
  5. Speak to your health care provider. Your doctor can make the proper assessment and give you an accurate diagnosis. He or she can also recommend the right form of treatment.
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