For others, difficult emotions can also arise during pregnancy and the postpartum period, including the kind of stress or worry that can often accompany a major life change. While that is not necessarily anything to be alarmed about, doctors say that if such feelings interfere with a person’s ability to enjoy or carry out their daily routines, they should speak with their healthcare provider about whether they might need additional mental health supports.

At Sunnybrook’s latest Speaker Series, leading experts in perinatal mental health discussed how depression and anxiety can affect pregnant people and those who have recently given birth — and what treatment options are available.

According to Sunnybrook psychiatrist Dr. Sophie Grigoriadis, head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions, perinatal mood disorders affect about 20 percent of women. That translates to approximately 28,000 people in Ontario each year.

Risk factors can be biological, psychological, and environmental. Experts also say there are some groups, including people who have experienced intimate partner violence, people with disabilities, people with a history of depression or anxiety, and people who have been through a birth trauma in the past, who are at greater risk of developing a perinatal mood disorder.

Symptoms of perinatal depression and anxiety — such as low mood, difficulty sleeping, or recurring anxious thoughts — can persist for several years postpartum if left untreated, Dr. Grigoriadis explained.

The good news is these mood disorders are very treatable with methods such as psychoeducation, psychotherapy, psychosocial interventions (e.g. self-care or breastfeeding support), or antidepressant medication.

New approaches such as mindfulness-based group therapy delivered online to treat anxiety in pregnancy are also being studied, said Dr. Grigoriadis, who is also a scientist with the Hurvitz Brain Sciences Program.

In addition, Dr. Grigoriadis along with research teams at Sunnybrook, Women’s College Hospital, and CAMH are recruiting patients for a clinical study into an innovative treatment called Transcranial Direct Current Stimulation for Depression in Pregnancy.

Transcranial Direct Current Stimulation is a non-drug treatment involving a small device that can be used at home. It is already approved by Health Canada – but Dr. Grigoriadis and her colleagues hope to evaluate whether it is effective in treating depression in pregnancy.

The treatment could provide a useful alternative for patients who are reluctant to take antidepressant medication during pregnancy, Dr. Grigoriadis explained. “If we can show that it is helpful, it will be revolutionary because this is a treatment you can do at home with minimal side effects,” she said.

Sunnybrook obstetrician Dr. Anne Berndl, Director of the Accessible Care Pregnancy Clinic and Associate Scientist with the DAN Women & Babies Research Program, said getting help is key to the health of the person who is pregnant as well as the baby.

Untreated depression during pregnancy significantly impacts quality of life and can lead to an increased risk of preeclampsia or substance use. There are also health risks for the baby, such as preterm birth or low birth weight.

Postpartum depression that is not treated can increase the risk of self-harm for the birth parent. It can also have a negative effect on infant attachment, breastfeeding, and development.

Dr. Berndl encourages people who are experiencing symptoms of depression or anxiety during pregnancy or postpartum – such as a feeling of hopelessness, loss of appetite, frequent irritability or tearfulness, severe sleep deprivation, or simply feeling ‘stuck’ — to reach out for help.

But the first step might be acknowledging that pregnancy and new parenthood doesn’t automatically come easily to everyone.

“One of the things that makes this really hard for people to understand are motherhood myths, which are a real barrier to accessing care,” Dr. Berndl explained.

“There are myths that once you become a mother you will have complete joy and fulfillment, or that motherhood is easy and you will naturally know what to do, or that being a mother always means sacrificing your own needs but these are all myths,” she added. “The problem with these myths is that people have a sense of shame when they feel otherwise, and it can delay asking for and receiving help.”

Mental health supports should be personalized based on a patient’s needs, Dr. Berndl said. For instance, a patient who has experienced a prior stillbirth or neonatal death might need more appointments with an interdisciplinary care team and a greater focus on birth planning.

People with disabilities, who have higher rates of depression and anxiety, also benefit from an interdisciplinary approach to perinatal care that includes medical management of the birth parent, pain management, early access to lactation consultants, psychiatry, and if needed community resources.

The take home message, Dr. Berndl said, is that “anxiety and depression during pregnancy and after birth can happen to anyone – but they are treatable so talk to your care provider about it.”

 If you are looking for more mental health resources please speak to your doctor or see some of the resources listed here.

The post Understanding depression and anxiety during and after pregnancy appeared first on Your Health Matters.

Marci Peters is grateful for the care she received after not one but two brain surgeries.

As a working single mom, the last thing Marci Peters needed was a medical mystery. So, when she noticed a lump the size of a goose egg on her forehead, she went to her family doctor in her search of answers, X-rays and other scans were inconclusive.

Marci was losing hope. That’s when Sunnybrook came into the picture.

Finding solutions

Marci was referred to Dr. Oleh Antonyshyn at Sunnybrook. Dr. Antonyshyn is one of Sunnybrook’s most esteemed craniofacial plastic surgeons in the Blake & Belinda Goldring Department of Surgery.

When Dr. Antonyshyn saw the lump, he immediately ordered new tests, including a CT scan and an MRI. He had his answer: it was a meningioma, the most common type of primary brain tumour. It occurs in the outer three layers of tissue between the skull and the brain and is typically benign but can have serious complications. It was established that the meningioma was a result of the radiation therapy she received as a part of her successful treatment for childhood leukemia.

Bringing together the best people

Diagnosing Marci’s concern was just the first step on the path toward finding a solution. Which is when Dr. Antonyshyn’s colleague Sunnybrook neurosurgeon Dr. Leo da Costa stepped in. He works in Sunnybrook’s Hurvitz Brain Sciences Program, with team members that supported Marci’s care, including Dr. Houman Khosravani, a neurologist in the stroke clinic, and Dr. Arun Sundaram, a neuro-ophthalmologist.

Working together, Marci’s care team decided surgery was necessary. She underwent her first craniotomy in August 2021, a complex procedure where Dr. da Costa temporarily removed part of the bone for her skull to access and resect the tumour. Next, Dr. Antonyshyn used his skills to place a titanium mesh implant on Marci’s forehead to cover the surgical site.

Meningiomas can cause concerns for patients by elevating pressure in the brain, and recovery can be long and arduous. But thanks to the skill, dedication and strong collaboration between Dr. Antonyshyn and Dr. da Costa, Marci was only in hospital for five days, recuperating under the supervisions of what she calls “the most amazing group of people I have ever had the privilege of being cared for.”

“Every single person – from my nurses, to housekeeping, to the patient transportation team, the caring people who brought me my meals, my occupational and physical therapist – was so kind and helpful,” says Marci. “I’ll never forget that, because it felt like everyone was committed to helping me recover.”

Marci Peters and her daughter.

Back on her feet

Team Sunnybrook is a big reason why, barely three weeks after surgery, Marci was back at work as a senior customer-relations professional and home with her daughter.

And it’s why the next year, when another meningioma tumor was discovered behind her right eye, that Marci knew exactly where to go.

Marci’s second craniotomy in November 2022 was another complete success, which she credits again to every member of Team Sunnybrook. “Everyone works together so seamlessly,” says Marci. “It’s like everyone speaks the same language.”

There was one moment Marci recalls where the nursing team gently washed her hair after surgery, combing it back to help Marci feel more like herself. “This is what compassionate care feels like,” she says. “It never felt like I was just another patient.”

It wasn’t easy undergoing two craniotomies in a little over a year, but today Marci says she feels ready to face anything. She’s grateful, too, knowing Sunnybrook, “the gold standard in compassionate care” is right behind her.

Learn more at sunnybrook.ca/brain.

The post Sunnybrook saved my life – twice appeared first on Your Health Matters.

If she moved even one, her then four-year-old son, Nathan, would notice, break down in tears, and become extremely physically agitated and upset.

“Everything had to be a certain way and we just kind of worked around it,” says Nancy. “He’d have these compulsions, but we could usually get him to understand that he needed to move on. We could move him off of being stuck and re-direct him to a new activity.”

Nathan was later diagnosed with autism and obsessive-compulsive disorder (OCD). As the years passed, and with support from his family and therapy, Nathan thrived; playing soccer and hockey, earning some honours grades in high school, working summers at the zoo, and graduating from a massage therapy program at college.

But then he became seriously ill with Celiac disease, which triggered his OCD and a life-threatening eating disorder that led to him being hospitalized twice.

“It derailed him,” says Nancy. “He couldn’t get out of bed; he could barely keep himself going and he couldn’t understand what was happening. It was very scary for him and his dad and me.”

Nathan developed a complicated relationship with the washroom; Nancy describes how he was afraid to eat because he didn’t want to end up in the washroom with a celiac reaction, yet he was afraid to leave the washroom in case he had an accident. By the time he was referred to the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook, Nathan was spending as much as 17 hours a day in the family washroom.

In March 2022, Nathan entered the Thompson Centre’s live-in program for OCD, the first program of its kind in Canada.

“Going to the Thompson Centre program reminded me of being at school. I was taught about OCD, what it is, and how it can be managed,” says Nathan. “They helped me recognize that certain things I was doing were caused by OCD. I also learned about new medications and different kinds of treatment. The staff were nice to me and helpful.” 

Nancy says she is grateful to the Thompson Centre for helping Nathan accept his diagnosis and reminding her family that they’re not alone.

“The team at the Thompson Centre were all very caring. The additional family and caregiver education sessions provided during the time Nathan was in treatment were helpful,” says Nancy. “We got to meet others who had loved ones that were in the same cohort as Nathan and share about our struggles.”

Nancy is also co-chair of the Thompson Centre’s new Patient & Family Advisory Council which brings together patients, family members, and staff to help enhance patient care and services.

She adds, raising awareness is critical to help reduce the stigma.

“Increased awareness and understanding of OCD may also help individuals and their families identify the symptoms of the disorder that they are struggling with and enable them to reach out for treatment.”

Nathan is now back at home and continues to work with the Thompson Centre team and his family on coping strategies.

“By going into the program, Nathan learned firsthand that he wasn’t the only person experiencing OCD and that there were other people who were struggling,” Nancy explains.

“We are very grateful that we have been able to become involved with the Thompson Centre and encourage those who may be suffering with OCD to reach out for help.”

The post Facing OCD as a family with the right support appeared first on Your Health Matters.

Each week, Dr. Grigoriadis, head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions at Sunnybrook, sees patients who are pregnant and have depression. After reviewing general risks, like the increased likelihood of giving birth to a preterm baby at a lower birthweight, she talks with patients about treatment options.

Psychotherapy, or ‘talk therapy’, can be very helpful. “A lot of people prefer it over medication because there is no fetal drug exposure,” says Dr. Grigoriadis. “One of the problems is that therapy can take weeks to months to help with depression, so the patient and baby can be exposed to the negative impacts of depression during that time.”

Antidepressant medication can improve symptoms of depression very quickly and with very few side effects. However, medications do cross over to the baby to some extent and some patients may be hesitant to take them while pregnant.

This new approach, tDCS, uses a small electric current to locally stimulate a part of the brain that functions abnormally when an individual is depressed, requiring 30 minutes of daily treatment over three weeks. It can be done by patients at home after receiving training, while also continuing to see their regular health care team, including pregnancy care provider and psychiatrist.

“Our team has already done a small study with 20 pregnant patients with depression, which had promising results for safety and effectiveness. We’re looking for more patients for a larger study to see whether this should be offered widely during pregnancy,” adds Dr. Grigoriadis. The study is randomized, meaning patients will have a 50/50 chance of receiving tDCS or being placed in a control group which receives a similar looking device but does not deliver any electric current.

For more information and to enroll in the study, please visit https://sunnybrook.ca/content/?page=tdcs-pregnancy-depression-research-study.

The post Depression in pregnancy: Studying a new treatment appeared first on Your Health Matters.

No one could explain Darryl Fontanna’s extreme dizzy spells until he was diagnosed with a functional neurological disorder (FND) at Sunnybrook.

What started as a friendly sparring match with a friend led to years of disabling neurological symptoms for Toronto resident Darryl Fontanna, now 29.

“I was boxing with my buddy for fun,” says Darryl. “I was 21 [years old].”

The two friends had donned boxing gloves and playfully exchanged some jabs and punches in an open field. Although no acute injury occurred that he was aware of, Darryl awoke the next morning with head pressure and impaired vision. “I could barely even think,” he recalls.

It got much worse. As the months wore on, Darryl began to suffer from extreme dizzy spells, insomnia, fatigue, brain fog and severe anxiety attacks. He was diagnosed with post-concussive syndrome, a condition that can occur after a brain injury and typically resolves over months. But though Darryl’s neurological tests all came back normal, his symptoms didn’t go away. He withdrew from his friends, could no longer work and spent days bedridden.

“There was a period where all I could do was lay on my couch and stare at the ceiling,” he says.

After getting no answers from traditional medicine and spending more than $10,000 on unhelpful alternative treatments over seven years, Darryl came across an online discussion. His symptoms matched perfectly with a disorder called persistent postural perceptual dizziness (PPPD), a functional neurological disorder (FND) characterized by a disruption in brain circuits that can be treated.

PPPD often occurs after an injury to the balance system, causing the brain to overreact to normal signals from the eyes, inner ear and muscles and joints. This causes the individual to feel long-lasting dizziness and unsteadiness.

“That’s when all the pieces started falling into place,” says Darryl. He was referred to Dr. Matthew Burke, a cognitive neurologist in Sunnybrook’s Hurvitz Brain Sciences Program.

That first day he saw Dr. Burke for a video consultation in May 2020, Darryl sensed he was coming to the end of a long, confusing and emotionally-draining search for answers. After a lengthy assessment, Dr. Burke confirmed that many of his symptoms could indeed be explained by FND.

“It was such a relief,” Darryl says. “He told me: ‘It is possible to get better.’”

Darryl works out regularly, which helps keep his focus off his symptoms.

A collaborative approach to treat brain disorders

At Sunnybrook’s Garry Hurvitz Brain Sciences Centre, top brain health experts will come together to provide care for patients like Darryl. The Centre, which is currently under construction, will employ an innovative, collaborative approach to diagnosing and treating the most complex brain conditions, bringing together psychiatrists, neurologists, neurosurgeons, ophthalmologists, otologists and other experts in brain sciences.

Thanks to the ongoing and generous support of donors, Sunnybrook’s community of world-leading experts will collectively focus on developing transformative approaches to brain disorders including mental illness, dementia and stroke, as well as neuropsychiatric conditions like FND.

“The major brain afflictions of our time – mood disorder, stroke and dementia – are all interrelated,” says Dr. Anthony Levitt, psychiatrist and chief of the Hurvitz Brain Sciences Program.

“So it makes sense for us to understand and treat them with meaningful collaboration between specialties that have previously functioned separately and in silos.”

The Garry Hurvitz Brain Sciences Centre will house the Harquail Centre for Neuromodulation, where clinicians will employ focused ultrasound (FUS), a revolutionary and less-invasive image-guided therapy that can influence faulty brain circuits. FUS is in clinical trials to treat conditions such as severe obsessive-compulsive disorder, treatment-resistant depression, post-traumatic stress disorder and alcohol use disorder. Also housed in the Centre will be leading-edge facilities for treating mental illness and sleep disorders, as well as multidisciplinary clinics where research will impact outpatient care for stroke, ALS, traumatic brain injury and more.

Dr. Burke is enthusiastic about the Centre’s collaborative and exploratory approach – essential for treating poorly understood disorders of the brain. With a large multidisciplinary team in a state-of-the-art facility, the experts at the Centre are able to investigate and develop novel treatments that are individualized to each patient’s needs.

Dr. Burke says that many of his patients are relieved to finally have their perplexing and disabling symptoms validated and explained, having previously been told their illness is all in their head.

“Functional neurological disorders [are often] hard to wrap your head around and stigmatized,” he says.

Dr. Matthew Burke says that people with FND are often relieved to have a diagnosis, having been told their symptoms are all in their head.

New hope for patients

Dr. Burke notes that many FNDs are triggered by a physical injury or infection, introducing the brain to new symptoms. Even after the trigger has cleared up, dysfunctional brain circuits can amplify these symptoms, causing them to become worse, which in turn lead to anxiety and insomnia, further compounding the problem. The patient then enters a hypervigilant state, where they feel every sensation and symptom very keenly and hyperfocus on the symptoms they’re experiencing.

“It becomes a vicious cycle,” says Dr. Burke.

The new Garry Hurvitz Brain Sciences Centre will be instrumental in tackling these kinds of disorders, he says. As researchers increasingly make connections between the brain, mental health and physical health, there is a need to bring researchers and clinicians together from a diverse range of specialties together in one place.

For his part, Darryl is excited by the prospect of the new facility, noting that it will help educate patients and their families about how disorders like his emerge and how best to treat them.

“It will make FNDs more mainstream – currently there is so little support,” he says. He’s also excited about so many different brain specialties coming together under one roof, to help doctors find additional ways of more efficiently and accurately diagnosing conditions.

With the help of Dr. Burke and the Sunnybrook team, Darryl has made a lot of progress over the past few years. Through physiotherapy, medication to lift his mood and psychological therapy, he’s learning how to control the sensations in his body. In addition to FND, he was also diagnosed with obsessive compulsive disorder, a condition linked to anxiety.

Now, he works out regularly – a pursuit that he says helps to keep his focus off his symptoms. He has resumed working as an electrical apprentice and he can drive again.

“It’s a huge change,” Darryl says.

Dr. Burke notes that the field of functional neurological disorders can be very challenging as it falls into “grey zones” between neurology and psychiatry that have largely been understudied in medicine.

“However, cases like Darryl’s are extremely rewarding and provide strong motivation to continue the work needed to improve the care for these complex patients,” he says.

Learn more at sunnybrook.ca/brain.

This story was produced by the Globe Content Studio with the Sunnybrook Foundation and was originally published in the Globe and Mail online.

The post After years of perplexing symptoms, Darryl finally got an answer – and relief appeared first on Your Health Matters.

All of the things that the brain is responsible for – physical and mental – are part of brain health. While often spoken about separately, mental health is a central part of brain health – they are not separate or distinct.

Mental health is brain health.

Understanding this can help to reduce the stigma that continues to be associated with mental illness, which, like any physical disorder or disease, is a health problem and requires appropriate treatment.

One of most important things that people don’t often realize is that the three major brain conditions of our lifetime; stroke, dementia, and depression, are all inter-related. They are all happening in the same organ, and if person has been diagnosed with one of those three conditions, their risk of the other two conditions increases.

That is to say: if an individual has a stroke, it increases their risk of having post-stroke depression and developing dementia; if someone has dementia, there is an increased risk of developing depression and having a stroke; and having clinical depression, increases the risk of going on to have stroke and/or dementia.

What affects brain health

Any disruptions to the brain can affect the way it works. The brain is an incredibly vascular organ – there are a rich supply of arteries and veins that help with the delivery of nutrients to the brain, as well as the removal of toxins and by-products of metabolism, to keep it healthy.

When that blood flow is interrupted, it affects brain function and that results in changes in the way information travels along the brain’s pathways. This can impact how we move, how we sense things like hearing or touch, the way we think about the world and people around us, how we perceive a situation, and how we behave.

It is important that brain conditions are understood and treated from multiple perspectives at the same time. Traditionally, the various medical specialties that deal with brain conditions would treat disorders individually; for example, if a person has a stroke and needs a blood clot removed, they will be seen by a neurosurgeon or neurologist. If a person has depression, they will be treated by a psychiatrist. If a person has dementia, they might see a neurologist or a psychiatrist.

But the new way of understanding and treating brain conditions involves a broader and more collaborative approach.

A multi-disciplinary approach to brain health

Sunnybrook’s Garry Hurvitz Brain Sciences Centre will connect brain health experts from across medical disciplines in the same building.

Bringing brain specialists together to collaborate with one another will help enhance a patient’s treatment, education, and will pave the way for possible new discoveries of the causes and potential treatments of brain conditions.

For stroke, depression, dementia, and other brain conditions, including sleep disturbances, anxiety, Amyotrophic Lateral Sclerosis (ALS), tremor, and others – having a broad range of the brain specialities and disciplines, including neurology, neurosurgery, psychiatry, psychology, and more, working together for improved patient care, is really the way of the future.

For more information about brain health:

• Learn more about Sunnybrook’s Garry Hurvitz Brain Sciences Centre
• Q & A with Dr. Levitt about Sunnybrook’s Garry Hurvitz Brain Sciences Centre
• Learn more about the Hurvitz Brain Sciences Program at Sunnybrook

If you need help in an emergency, please call 911 or visit your local emergency department.

If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 p.m. – midnight Eastern Time)
• Kids Help Phone
  • Phone: 24-hour, toll-free, 1-800-668-6868
  • Text: 686868 (24 hours, 7 days a week)

The post Why mental health is brain health appeared first on Your Health Matters.

While it may look peculiar, these people are walking with purpose as they are using the Sunnybrook labyrinth, a round trail in the grass that can be followed for a moment of quiet reflection.

The Sunnybrook labyrinth

Recognizing that a hospital can be a stressful environment for staff, patients, and families, Rohan Harrison, Sunnybrook’s environmental services team leader, advocated for the labyrinth’s installation.

“It can be used symbolically as a walking meditation,” he says.

Users have told him that they use the labyrinth as a tool for self-care and mindfulness, and even to just get some physical activity.

“I’ve been really encouraged by a few comments I have been privy to receive, mostly commenting about an ‘inner relaxation,’” he says.

Staff using the Sunnybrook labyrinth. Image courtesy of Rohan Harrison.

“Having tools like labyrinths can be very helpful,” says Dr. Robert Simpson, a staff physician and associate scientist who studies mindfulness-based interventions for people with disabling long-term conditions. “If nothing else, tools can serve as a metaphor or reminder that I’m here to meditate.”

And while these tools can be great, Dr. Simpson says there’s more to meditation than the simple act of walking through a labyrinth.

“It depends on the attitude that you bring to your experience,” he says. “If you’re just zooming off into the ether, I’m not so sure that’s good for you. ‘Mind-wandering,’ in some studies, has actually been associated with worse mental health. However, if you’re focusing yourself in the present moment, that’s much healthier, especially if you are kind, patient, curious, and compassionate with yourself.”

Meditation and its impacts

Generally speaking, meditation is used to help bring calm and peace to those who use it. But, due to its many forms, understanding the practice can be confusing.

“Meditation has been conceptualized in many different ways,” says Dr. Simpson.

For some, it has philosophical and religious purposes. It can be done alone or in group settings. It can involve stillness or movement. It can be done in a class or while doing everyday activities.

To summarize the diverse practice, he says, “Typically, meditation would involve a structured set of techniques designed to access a particular mental state. It is often intended to be relaxing and restorative or to bring insight on a given focus.”

Elaborating on what may be happening in the body during this time, he continues, “Some evidence suggests meditation can affect regulation of the autonomic nervous system, dialing down the so-called ‘fight or flight’ response (sympathetic nervous system) and facilitating the ‘rest and digest’ function (parasympathetic nervous system). This leads to a relaxation type response.”

This response is one reason why Dr. Simpson and his colleagues use mediation in clinical care.

“Across many disabling long-term conditions, there are pretty consistent findings of improved stress, anxiety, depression, fatigue, and quality of life following mindfulness training,” he says. And when a patient’s mental health gets better, he says that improvements to physical symptoms often follow.

These benefits, grouped with the practices’ flexibility, diversity, and increased publicization in the mainstream media have led to meditation becoming hugely popular in recent years.

Caution when meditating

And while he’s happy more people are learning about the benefits of meditation, Dr. Simpson notes that, “It has to be applied with caution as there is some evidence that meditation can be harmful if used indiscriminately.”

For example, some research suggests negative effects of meditation on individuals with epilepsy, psychosis, and suicidal ideations. Further, if applied rigidly, some types of mediation can increase negative physical symptoms, such as pain or fatigue — for example, long bouts of seated stillness or more advanced yoga postures would be inadvisable in certain health conditions.

That is why, when Dr. Simpson suggests meditation as a health intervention for his patients, he considers an individual’s history, symptoms, impairments, disabilities, and goals, as these are important components in ensuring the modality is accessible, effective, and safe for the individual. He advocates for people with severe or unstable conditions to consult with their health-care providers before undertaking meditation training.

Getting started with meditation

In fact, Dr. Simpson says, if possible, most people should consult with their health-care providers when taking up meditation, as they can evaluate an individual’s symptoms and goals to help find services that fit the specific needs. Further, he recommends structured sessions led by an instructor with relevant clinical experience to help participants better understand and apply the practice to their unique circumstances.

Though, when that’s not possible, he suggests turning to content from credible resources, by people with formal training and certification to teach meditation. Dr. Rebecca Crane at the University of Bangor, UK is one example of someone whom he would suggest.

“If you’re tuning in to a random YouTube video, it’s more difficult to quality control and to be sure that there won’t be adverse effects,” he says. “There might not be; it might be the best thing out there. It’s just hard to know.”

Since there are so many forms of meditation and a plethora of choices, Dr. Simpson says that it’s important to ease yourself into a practice and take time to find what works for you.

“Learning to meditate is a very personal thing,” he says. “It’s about personal growth, insight, and understanding. It’s not always easy, but it is something that should be beneficial for you.”

And if you’re worried about whether or not you’re meditating correctly, he says, “Rather than thinking in terms of ‘the right way’ or ‘the wrong way,’ practice in a way that is conducive to feeling well and learning over time. Meditation shouldn’t add an additional burden that you must do this correctly. Remember that it’s a process, not an event, so be patient with yourself.”

He continues that when meditating, it can be helpful to set one’s intention, be conscious of one’s attitude, and pay attention; try to be present, and practice self-compassion.

“Take that into your exercise, take that into your time with friends, take that into your labyrinth,” he says, “and I think you’re looking at a form of mediation that can be very beneficial.”

Conclusion

For his own meditation practice, Dr. Simpson travels to India when he can, to learn from a yogi who has dedicated his life to the practice. Dr. Simpson practices meditation in both structured and unstructured settings — being in nature is one of his favourite pastimes.

“That’s my labyrinth,” he says of being in the outdoors.

For Rohan, he chooses his home labyrinth as one of his main forms of meditation.

Rohan’s home labyrinth. Image courtesy of Rohan Harrison.

“Four to five times per week, even in the winter, I walk the labyrinth I have created in my own backyard as a way of grounding, environmental re-connection, and a means to balance life,” he says. “It truly gives me the space to thankfully accentuate the positives of the day and realign the mind, body and spirit.”

Whether people are using their own labyrinth, the Sunnybrook labyrinth, or some other modality, this is the kind of well-being that both Rohan and Dr. Simpson hope people can find when they use meditation.

Thinking about the circular steps he takes on his backyard path, Rohan says, “It’s a step toward joy and peace.”

The post The Sunnybrook labyrinth, meditation, and what you need to know before you start meditating appeared first on Your Health Matters.

How should parents approach a discussion about a violent event with their children? 

First, check in on yourself. How are you doing? Having a calm frame of mind can help make it easier to discuss the topic. It’s okay if you’re not ready immediately following news of the event. If you find you’re not in the right frame of mind, wait until you are. That’s always step number one.

Find the space and time for the discussion. It’s easier without the pressure of running out the door before school, or rushing between events or appointments. Find a time when everyone can focus. It’s also important to talk in a calm environment.

If a child asks you about the violent event at a time when you’re not ready, or you are rushing out the door, you can say, “Let’s find another time to talk about this.” Having said that, it’s important that the conversation actually happens because not discussing the topic could potentially lead to increased anxiety for the child.

How can parents keep their composure while discussing these events? Do they have to?

Parents don’t need to keep their composure all the time. Strong emotions are normal, especially when the discussion is about violent or tragic events. Showing emotion lets your children know it’s okay for them to have emotions, and it fosters connection between parent and the child. It also validates how they’re feeling.

And if they tell you or show you they’re scared, validate those feelings. It’s to be expected in moments like these.

How do you talk about these topics in an age-appropriate way? 

Every developmental stage and child is different, so try to cater to that individual age and child. For younger children, it can be helpful to provide concrete information rather than abstract explanations which may be more difficult for this age group to comprehend. When it comes to having the conversation with teenagers, parents can consider speaking with them like adults. They’ve likely seen or heard the most recent headlines and have a good understanding of the issue.

Parents may want to ask children and youth what they know and listen to their answers. You don’t need to give them any more information than they ask for because it could be too overwhelming, but don’t feel you need to protect them from information either. The truth is always best.

Avoiding the truth can perpetuate anxiety. Imaginations can run wild, and they will sense they don’t know the truth. Children can be very astute, and what they don’t know can cause anxiety.

Be prepared for the conversation to come up again. Children will likely have more questions that may come up at unexpected times.

How can parents gauge when issues are bothering their child(ren) and when it might be time to seek professional help?

For the most part, children are quite resilient and can cope with the support and help of their loved ones. Some children may feel more distress, though, so it’s important to be aware of some warning signs. If a child is not eating, sleeping or talking, needs constant reassurance or is withdrawing —and these behaviours are persistent— you should reach out to your family doctor.

If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 p.m. – midnight Eastern Time)
• Kids Help Phone
  • Phone: 24-hour, toll-free, 1-800-668-6868
  • Text: 686868 (24 hours, 7 days a week)

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There is hope, and treatment, for anxiety during pregnancy.

A new study – Treating Anxiety in Pregnancy (TAP) – by Sunnybrook Research Institute and Women’s College Research Institute is looking at a type of talk therapy called Mindful Adaptive Practice in Pregnancy to determine how the treatment works in reducing anxiety. If you are 18 years of age or older, live in Ontario and are between 12 and 30 weeks of pregnancy, you may be eligible to participate.

Dr. Sophie Grigoriadis, Head of Sunnybrook’s Women’s Mood and Anxiety Clinic: Reproductive Transitions, answers questions related to pregnancy and anxiety, and about the study.

I’m pregnant and feeling quite anxious and overwhelmed. What should I do?

Don’t keep it to yourself. Talk to your family doctor, midwife or obstetrician. There is help available.

What will my doctor or midwife do when I reveal my anxiety?

Your health care provider will use screening tools and ask you questions like:

• How are you sleeping? How’s your appetite? Can you focus and concentrate?
• Are you getting pleasure out of any activities, or is everything overwhelming? Are you thinking of harming yourself?

How will my anxiety be treated?

There are different approaches to treating anxiety during pregnancy. These include community resources like support groups and apps to connect you with techniques for reducing anxiety. Your family physician, obstetrician or midwife may also refer you to a psychiatrist. Following a psychiatric consultation, you may be given resources and may be further referred for individual or group psychotherapy. Medication is reserved for moderate to severe anxiety in those diagnosed with an anxiety disorder or depressive disorder with prominent anxiety.

What’s involved if I’m selected for the TAP study?

Our team has adapted a talk therapy treatment called Mindful Adaptive Practice in Pregnancy, which can help women who are pregnant learn how to reduce their anxiety very quickly. It is an exciting and innovative treatment because it is:

• Ultra-brief in duration (one month)
• Specific to pregnancy
• Delivered in a group format
• Provided over the internet and done from home

What is talk therapy?

“Talk therapy” is also sometimes called psychotherapy. It’s a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts, and behaviour. Talk therapy is recommended to treat mental health problems but some treatments are not often utilized because they take time to learn and use. The pandemic has added another layer of burden because in-person treatment is not routinely available.

Have questions about the TAP study and eligibility? Please contact our research assistant, Morgan Sterling at morgan.sterling@sunnybrook.ca.

The post Anxious and Pregnant? You’re not alone appeared first on Your Health Matters.

“You are a truly valuable person.”

Messages of support and encouragement after a time of crisis.

They’re part of an initiative called Caring Contacts, a series of emails sent to patients after they leave Sunnybrook’s Psychiatric Inpatient Unit.

“The aim is to remind patients that they’re not alone, provide them with messages of hope, and help to reduce suicidal ideation after psychiatric hospitalization,” says Dr. Rosalie Steinberg, psychiatrist. “In addition to positive messages, the Caring Contacts emails include mental health resources, such as information to crisis services which individuals can access when they are feeling distressed.”

The Caring Contacts emails have been recently implemented as part of patient care by the Department of Psychiatry at Sunnybrook. Patients can opt-out of receiving the messages at any time.

“To our knowledge Sunnybrook is the only hospital in Canada that has studied this intervention in a clinical trial and the only hospital that has included a Caring Contact email series in the standard of care for all patients who have been discharged from the Psychiatric Inpatient Unit,” says Sarah Holman, Caring Contacts research coordinator. “Other programs across the country have used different types of communications such as phone calls or letters for specific patients.”

“Caring Contacts are an evidence-based support. This means that past research has shown that it can be an effective suicide prevention strategy,” adds Dr. Steinberg.

The timing of the Caring Contacts emails is important. The first message is sent several days after a patient leaves the hospital and follow-up messages continue for about eight weeks. Experts say this is typically when mental health symptoms could worsen as a patient adjusts to being back at home.

“The risk of suicide is highest after psychiatric hospitalization,” explains Dr. Steinberg. “Psychiatric follow-up and support can help reduce this risk. The timing of the Caring Contacts emails can help remind individuals that they’re being supported in their recovery while they wait for follow-up care. These messages are shared at critical times which can help lead to better outcomes for patients.”

“Previous studies have found that Caring Contacts can help reduce suicide attempts, suicidal ideation, and loneliness, while increasing hopefulness and feelings of connection. The feedback we’ve received from patients has been positive. Common themes include feeling cared for and more connected to Sunnybrook,” says Sarah.

Suicide prevention at Sunnybrook

Caring Contacts are among a variety of support tools developed by Sunnybrook’s Department of Psychiatry in collaboration with its Patient and Family Advisory Council for suicide prevention.

Coping Cards can help patients develop an action plan when coping with emotional distress. They are available in 10 languages.

The department has also recently created a booklet with information and resources for family and friends after a loved one has attempted suicide.

“Implementing innovative and evidence-based models of care for suicide prevention in clinical settings is fulfilling work. Having Caring Contacts accessible to all Sunnybrook psychiatric patients is exciting and meaningful when we hear many say they feel supported by us even after they leave the hospital.”

If you need help in an emergency, please call 911 or visit your local emergency department.

If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 p.m. – midnight Eastern Time)
• Kids Help Phone
  • Phone: 24-hour, toll-free, 1-800-668-6868
  • Text: 686868 (24 hours, 7 days a week)

Other resources:

How a Coping Card can help manage emotional distress: https://health.sunnybrook.ca/mental-health/how-a-coping-card-can-help-manage-emotional-distress/

Supporting families after a loved one’s suicide attempt: https://health.sunnybrook.ca/mental-health/supporting-families-after-a-suicide-attempt/

The post How Caring Contacts at Sunnybrook can help patients after a crisis appeared first on Your Health Matters.