mental health

Maybe the Eyes really are the Window to the Soul

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Jon Radwan 2000

Depression is a common condition – about 10% of adults are diagnosed with a depressive illness at some point in their lives – and a tough one to treat.  The problem is that the symptoms are based on subjective feelings, so a lot of people think that it’s not a “real” medical problem.  I can measure your blood sugar and tell you if you have diabetes; I can measure your cholesterol and tell you if you’re at risk of having a heart attack; but how do I measure any of the following?

  • mood changes
  • withdrawal from friends
  • decreased interest in work, school, or other activities previously enjoyed
  • feeling worthless, irritable, hopeless, or tired
  • loss of concentration, sleep or appetite
  • Loss of interest in sex
  • Thoughts about dying or suicide attempts

Who doesn’t feel one or more of those things every now and then?  Is everyone depressed?  Can some people just not handle it?  Besides someone telling you that these feelings are a problem, is there any way to know that how they feel is any different or worse than how you feel?

Well someday it might be as easy as looking them in the eye…

Researchers at the University of Freiburg in Germany found that depressed people weren’t able to see the contrast between black and white as well as non-depressed people by measuring the electrical activity in their retinas.  They used a device called an electroretinogram – basically, they did a tiny little EKG on their eyes. 

Now it’s way too early to tell if this technology will actually provide a meaningful way to diagnose and monitor depression – we’re not going to have any kind of Star Trek retina scanner depress-o-meter at the student health center any time soon.  But if your roommate keeps telling you that “everything just looks blah around here,” it wouldn’t be a bad idea to ask how things are going. 

Roger Miller, MD
Student Health Services
The Ohio State University

What’s the most common type of relationship abuse?

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safenetwork.org

Q: What’s the most common type of abuse in a bad/unhealthy relationship? 

A: The best way to answer this question is to look at surveys which ask people about their experiences with abuse in relationships. 

The 2009 American College Health Association (ACHA) assessment at Ohio State reported that in the preceding 12 months, 9.9% of respondents were in a relationship that was emotionally abusive, 2.4% were in a relationship that was physically abusive, and 1.4% were in a relationship that was sexually abusive.  From this data, it seems clear that emotional abuse is the most common.  The problem is that the survey doesn’t define what constitutes “emotional abuse,” so we are left trying to figure out what behaviors would fit that definition.    

For example, we hear a lot about “technological and/or communications” abuse.   According to a 2007 Technology & Teen Dating Abuse Survey:

  • 1 in 3 teens (30%) say they are text messaged 10, 20, or 30 times an hour by a partner inquiring where they are, what they’re doing, or who they’re with.
  • 68% of teens say boyfriends/girlfriends sharing private or embarrassing pictures/videos on cell phones and computers is a serious problem.
  • 71% of teens regard boyfriends/girlfriends spreading rumors about them on cell phones and social networking sites as a serious problem

An abusive relationship refers to a pattern of controlling behaviors, and a bad/unhealthy relationship will undoubtedly be emotionally abusive, and might also be verbally, physically, sexually, and perhaps financially abusive.

The Sexual Violence Education and Support program in the Student Wellness Center can help students identify and make decisions about an abusive relationship.  Additionally, the “it’s abuse” campaign on campus offers great resources and information.

Deborah Schipper, Sexual Violence Education and Support (OSU SWC)

John A. Vaughn, MD (OSU SHS)

Is it unhealthy for guys to masturbate daily?

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click to enlarge

Q: Is it unhealthy to masturbate daily?

A: I have a family member who is a police officer in another state.  As part of the hiring process he had to undergo a psychological evaluation, during which he was asked the following question: “Would you rather have sex or read a book?” 

Without missing a beat, he answered: “Well… am I in a library?”

Besides being pretty hilarious, what does that story have to do with answering your question?  Everything.  It depends on the situation. 

If you’re asking if there are risks of physical harm from frequent masturbation, the answer is no.  I suppose if you’re giving yourself rug burns or carpal tunnel syndrome, you should tone it down a notch.  But if you’re talking about the whole “you’ll go blind” or “you’ll grow hair on your palms” stuff – the answer is a definitive no.   It doesn’t affect fertility (unlike the ladies, who are born with all of the eggs they’ll ever have, guys constantly replenish sperm throughout their lives) or cause any other physical problems.

Could it even be good for you?  There’s been some press lately that frequent ejaculation (either alone or with a partner) lowers the risk of prostate cancer.  One study seemed to indicate that men who averaged 20+ ejaculations per month had a significantly lower risk of developing prostate cancer compared to men who average 4-7 per month.  But there are some problems with the study that make it hard to say whether or not this relationship is really true. 

HOWEVER… there are times when frequent masturbation can be a sign of trouble.  Obviously, if you feel it’s causing a problem in your life – making you feel guilty, anxious, depressed, or causing problems with relationships – then it should be addressed.   And if it is compulsive – you want to stop but you can’t – that can be a sign of a more serious issue like Obsessive-Compulsive Disorder (OCD). 

I know this is a “touchy” topic (sorry… couldn’t resist), but it’s a very common question so you shouldn’t feel embarrassed.  Odds are you’ve got absolutely nothing to worry about – but if you are, the clinical staff at Student Health or CCS can help. 

John A. Vaughn, MD (OSU SHS)

photo: sfweekly.com

Feeling SAD? Lighten up at CCS!

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photo: ehow.com

Sleeping More… low energy… hibernating… feeling down or blue… finding it harder to Study… craving carbs…         

Sound familiar? If so, you may be dealing with the Winter Blues or Seasonal Affective Disorder (SAD).  Both are caused by gray skies and low sunlight, which is as much a part of winter at Ohio State as bowl games and Uggs.  So unless you plan to transfer to USC or Florida before next quarter, read on to see what you can do to stay healthy. 

Winter Blues affect 10-30% of the population – regardless of race, gender or culture – and can negatively impact your grades, job, athletic performance or your social life.  There are a lot of useful things you can do to manage the Winter Blues:

  • Increase your exposure to daylight, even on cloudy days
  • Stress reduction
  • Eat and sleep well
  • Exercise, especially outside
  • Avoid alcohol, which is a depressant
  • Socialize
  • Don’t waste your money on tanning beds

If these measures don’t work, or if you are experiencing more severe changes in your mood, appetite, sleep, concentration or energy levels, you may have Seasonal Affective Disorder (SAD). 

SAD is a more serious form of depression characterized by a feeling of hopelessness or helplessness and even suicidal feelings.  As with any depression, suicide is a serious risk. SAD affects 5-10% of the population in all races or cultures and may run in families. If you are having signs and symptoms of SAD, you need to get help – and luckily you can find it right here on campus!

In addition to counseling and stress management strategies, SAD is usually treated with antidepressant medication and/or bright light therapy with a 10,000-lux light box.  All of these therapies are available at Counseling and Consultation Service.

Since light boxes can cause side effects like hypomania (episodes of abnormally elevated, unrestrained or irritable mood), CCS requires you to be evaluated and followed by one of our psychiatrists during therapy.  Once we know that the treatment is effective and safe, many students purchase their own light box to avoid the hassle of having to come to the Younkin Success Center every morning.   

Light boxes typically run in the neighborhood of $250-$300.  The bulbs last 2-3 years with normal use and can be replaced for $40 or so.  While that’s a lot of money up front, compared to the cost of medications it can actually be a bargain in the long run.  Some insurance plans even cover the box with a written prescription, so the out-of-pocket cost may even be less. 

If you do decide to purchase your own light box, be sure to watch out for advertisements touting “full spectrum” light boxes.  That sounds really cool, but it isn’t actually relevant and those boxes are less than the recommended 10,000 lux strength.  They may work, but they’ll require a lot more time to be effective which usually ends up being counterproductive.

We never want anyone at Ohio State to “Go Blue” (man, it hurt us to even type those words…)  If you start to feel that way, be sure to contact Student Health or CCS – we are here to help!

Denise Deschenes, M.D.  Richard A. Mitsak, M.D. (Ohio State Counseling and Consultation Service)

John A. Vaughn, M.D. (Ohio State Student Health Services)

Can concussions cause long term problems or even kill you?

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photo: insidesocal.com

Q: I’ve been hearing a lot about football players getting concussions lately. Is it true that concussions can cause lasting effects and even kill you?

Short A: Yep

Long A: “Concussion” is a traumatic brain injury which causes a temporary loss of neurologic function with or without loss of consciousness. These are common in contact sports like football and hockey, but also occur in soccer, skiing, baseball, and rugby. Signs and symptoms of concussion include: 

  • Confusion
  • Amnesia and disorientation
  • Visual disturbance
  • Dizziness and balance problems
  • Mood changes
  • Ringing in the ears
  • Nausea or vomiting
  • Slurred speech
  • Fatigue
  • Headache

Some symptoms-headache and amnesia-occur within minutes of the injury and may continue for some time after. Other symptoms-anxiety, depression, confusion, sleep disturbance, even seizures-might not show up until days or weeks after the injury. You should be examined by a doctor if you sustain a head injury which results in a loss of consciousness and/or experience any of the above symptoms.

Most people with a single, mild concussion will recover fully without noticeable side effects. However, one concussion makes it easier to get a second, even with a less forceful injury. This is why doctors usually make your favorite star athletes sit out a few weeks after a head injury. The brain needs time to heal before it is put at risk. “Second impact syndrome,” a potentially fatal swelling of the brain, can occur if a second injury occurs too soon after the first.

It’s clear that severe traumatic brain injury can cause permanent neurologic deficits. Surprisingly, it appears that multiple small concussions can cause cumulative neurologic and cognitive deficits as well. There is an association with multiple “knock outs” and Alzheimer’s disease in boxers.

General treatments for concussion include rest and over-the-counter pain medication. Drink lots of water and abstain from alcohol. You should not return to contact sports until you are completely recovered, which is at least a week for a mild concussion. More severe concussions might mean sitting out a season, or even changing sports.

Of course, the best treatment is prevention. Wear a helmet. Protect your head. 

Adam Brandeberry, Med IV (Ohio State College of Medicine)

Victoria Rentel, MD (Ohio State Student Health Services)

Can my fatigue really be caused by depression?

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photo: www.scottcounseling.com

Q: Someone told me that depression could make me feel tired. Is that possible?

A: Absolutely. But let me just start out by saying that there are many medical conditions that can cause a person to feel tired all the time and even mimic the other symptoms of depression, so it is extremely important to see your health care provider if you are experiencing fatigue or other signs of depression.

Depression is one of the most common psychiatric conditions that doctors encounter, showing up in at least 20% of women and 12% of men during their lifetimes!  Fatigue or loss of energy is so common in depression that it is actually included in the diagnostic criteria. Other symptoms used to diagnose depression include:

  • loss of interest or pleasure in previously enjoyed activities
  • significant weight loss or gain
  • trouble sleeping or sleeping too much
  • feelings of worthlessness or guilt
  • inability to concentrate or focus
  • recurrent thoughts of death or suicide

If you are having any of these symptoms, there are many resources available to you on campus!

The providers at Student Health Services manage many patients with anxiety and depression from a medical standpoint. While the exact cause of depression is not yet known, there are many medications that act on neurotransmitters in the brain that are effective in treating it. These medications typically take a few weeks to become effective in alleviating symptoms.

Counseling & Consultation Service (CCS) has social workers, counselors, psychologists and psychiatrists to manage depression from a psychotherapy as well as a medical standpoint.  All enrolled students are eligible for 10 free counseling sessions per academic year.  If you have the Comprehensive Student Health Insurance Plan (SHIP), you may be eligible for additional counseling sessions with a $15 co-pay per session.  If you do not have SHIP and need additional counseling, CCS will assist you in finding services in Columbus.

Counseling is extremely important because it has been shown that medical therapy in combination with psychotherapy is much more effective in treating depression symptoms than either of these treatments alone.

Again, be sure to see a health care provider if you are experiencing fatigue or other signs of depression.

Angela Walker, Med IV (Ohio State College of Medicine)

Muhammad Khan, MD (Ohio State University Student Health Services)

What is causing my headache?

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photo: ehow.com

Q: I get really bad headaches after I study for too long.  What might be causing them?

A: Headaches have many different causes.  It’s hard to diagnose the cause of a headache without talking to a doctor in person, but the headaches you’re describing sound suspicious for tension headaches.

Tension headaches are common.  They are usually described as a squeezing pain anywhere in the head often on both sides.  Tension headaches are caused by a combination of factors but muscle strain, bad posture, sleep deprivation, and stress can all make the pain worse.  Any of these things sound familiar? The best treatment is rest. Avoid cram sessions. Exercise. It is also important not to take pain relievers regularly for tension headaches because overusing them can lead to medication-induced rebound headaches.

Another possible cause for your pain could be eye strain. Have you had your vision checked lately? If your eyesight is not properly corrected, reading can put excess strain on the muscles that keep your eyes focused. This can lead to some pretty bad headaches, sometimes without any obvious vision problem. If you’re worried, contact the optometry clinic at the Student Health Center. Remember, if you wear glasses or contacts you should have a vision screening at least once a year.

There are many other serious causes of headaches. You should see a doctor immediately if you have any of these symptoms:

  • -headache with a stiff neck or high fever
  • -severe headache that comes on quickly, within a few seconds or minutes
  • -headache with loss or “hole” in vision
  • -headache after loss of consciousness
  • -headache after injury.
  • -headache that lasts for several days
  • -headache associated with exercise

Adam Brandeberry, Med IV (Ohio State College of Medicine)

Victoria Rentel, MD (Ohio State Student Health Services)

Does Size Matter?

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photo: buffetoblog.wordpress.com

Q: Does size matter?

A:  It kills me to even type those words – I feel like some cheese ball writer for Glamour or Maxim or something.  However, as a male physician in college health, I have a front row view of the health concerns (and to be quite frank, packages) of literally thousands of men, which makes me a somewhat reluctant expert on what is unfortunately a serious concern for a lot of men.  So guys, I hope to put your mind at ease once and for all.    

First, the facts:

  • The average adult penis ranges from 4 to 6 inches when erect.  
  • A penis smaller than 3 inches while erect can be an indication of a rare medical condition called ‘microphallus’ and should be evaluated by a health care provider.
  • The most sensitive areas of a woman’s anatomy are in the outer third of the vagina, so any normal sized penis is sufficient for physical stimulation.
  • Penis size has no relationship to fertility

But here’s the most important thing to remember – the size of a flaccid penis really has nothing to do with the size of an erect penis.  Some remain at or near full length when flaccid while others expand a lot during erection – some guys are “showers” and some guys are “growers” – and most major differences usually disappear when it really counts.  So don’t get freaked out if you happen to steal a glance at the guy next to you in the RPAC locker room; unless he’s really excited about his work out, you’re comparing apples and oranges (or maybe apples and bananas).   

Besides, worrying about the size of Big Jim and the Twins is as futile as being a Browns fan because the fact is, there’s nothing you can do about it.  All the penile calisthenics in the world – stretching, pulling, hanging weights on it (yes, I’m serious) – do nothing except expose your body to harm.  All those pills, creams and lotions you see on late night infomercials?  Garbage.  Penile enhancement surgery?  You do not want to go anywhere near that horror show. 

If you’re overweight, shedding a few pounds wouldn’t hurt; there’s a fat pad overlying the pubic bone that may reveal an extra inch or so if you can lose it.  And I suppose some creative manscaping might enhance your silhouette.  But please take it easy – there are guys walking around campus with more meticulous pruning in their pants than the average topiary garden and that kind of self attention is a little frightening. 

What you should really worry about is why you’re worried about this in the first place.  Some of it is cultural; unrealistic body image ideals promulgated by pornography and erotic images in the media, the aforementioned glossy rag magazines that rehash the topic over and over (after all, if people keep asking the question, there must be something to it, right?).  But it may be more serious and personal, such as a traumatic experience with a previous sexual partner.  Whatever it is, it’s usually more about anxiety than anatomy and if these concerns are having an adverse effect on your life, you should talk to someone at Student Health or CCS about it.

But don’t take it from me.  Take it from my high school Health Ed teacher, Coach “Crotch”:

Remember boys, your most important sexual organ is the one between your ears!

John Vaughn, MD (Ohio State Student Health Services) 

           

Can I get treated for ADD at the Student Health Center?

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ADD medicine

Q: Does Student Health Services provide evaluation and treatment for ADD/ADHD, and if not, can you refer me to a reliable provider in the Columbus area?

A:  As we mentioned in a previous post, the management of Attention Deficit (Hyperactivity) Disorder – ADD or ADHD – is tricky because of the dangerous nature of the medications involved, so Student Health Services has to follow very strict guidelines.  Here’s the deal: 

The primary care physicians at Student Health Services can treat you for ADHD if the following are in place:

  • You have documentation of neuropsychological testing on file with us that establishes the diagnosis of ADD/ADHD and includes the name and specialty of the tester as well as the results of the specific tests performed.
  • You do not have other mental health diagnoses such as bipolar disorder, schizophrenia, or psychotic disorders.
  • You sign a medication contract with us.

Does a letter from my doctor back home count as documentation?  No. 

Does a copy of my medical records from back home count?  No.   

But my doctor never sent me for all of those tests.  She just diagnosed me in her office, started prescribing the medicines and I’ve always done fine on them. 

In that case, you’ve got two options: keep seeing your doctor back home for your ADHD or get formal testing done to confirm the diagnosis.

So where do I get this neuropsychological testing done?

Unfortunately, Student Health Services does not offer neuropsychological testing at this time.  Counseling and Consultative Service offers individual and group counseling services for students with ADHD and The Office of Disability Services can assist students with ADHD in obtaining necessary accommodations for academic work, but neither of them offer testing either.

If your doctor can’t refer you to someone back home, we usually refer students to Dr. Robert Bornstein or Dr. Elizabeth Cook at the Medical Center.  The testing usually takes around half a day to complete and costs around $300 out of pocket (be sure to check with your health insurance plan for exact coverage info).

We know this is a huge hassle.  We know that it’s a lot of time and money – two things that most students don’t have a lot of.  And most of all, we know that it sucks to be made to feel like a criminal when all you’re doing is seeking care for a medical condition.  And we are sorry.  But unfortunately, there are people out there who are abusing the system and we only make you jump through all of these hoops to ensure your safety and the safety of the other students on campus.

If you have any further questions about ADHD management at Student Health Services, you’re always welcome to call or make an appointment to speak with us about it.   

John A. Vaughn, MD (Ohio State University Student Health Services)

Is it OK to share ADD medicine?

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Don't end up like this guy!

ADD medicine

Q:  Is it OK to give my friend one of my ADD pills to help him study for a test?

A:  Before we answer that question, let me ask you another one.  Would you sell that pill to a stranger for $50?  I’m guessing – hoping – your answer is an emphatic “NO.”  Well, from a legal point of view, these two questions are identical.

Most ADD medications (such as Concerta, Ritalin, Adderall, Focalin, Metadate, Methylin, and Daytrana) are Schedule II controlled substances because of their serious side effects and potential for addiction.  They are monitored very closely by doctors, pharmacists, and the Drug Enforcement Agency (DEA).  We’re not lawyers here at Student Health, but we do know that… 

It is a violation of Section 2925.03 of the Ohio Revised Code (Ohio law) to sell another person a controlled substance.  The important thing to remember here is that the legal definition of “sell” includes “delivery, barter, exchange, transfer, or gift…”  

So even if you are just trying to help out your friend – and getting nothing in exchange for it – you are breaking the law.  And we’re not talking about a speeding ticket here.  You are committing a 4th degree felony, which is punishable by 6-18 months in prison and/or a $5,000 fine.  And assuming you are anywhere on or near campus, the felony gets bumped up to 3rd degree and you’re looking at 1-5 years in prison and/or a $10,000 fine.  Not to mention the fact that you could lose your financial aid and/or get kicked out of school.  

Now granted, the odds of someone busting into your dorm room and catching you in the act are very slim.  And unless you really don’t get along with your roommates or neighbors, odds are no one is going to turn you in.  But forget about the legal stuff for a minute.

  1. These medications are addictive and there’s a real chance your friend could get hooked on this stuff.  You don’t want to risk sending someone down that dark road.
  2. While these medications have a calming effect on people with ADD, they are actually central nervous system stimulants so in addition to things like headache, insomnia, anorexia, agitation, anxiety, tremors, vertigo, depression, and nervousness, they can cause life-threatening problems like heart attacks, increased heart rate, increased blood pressure, and heart arrhythmias.  Doctors evaluate people for these conditions prior to starting these medications and monitor them closely while they’re taking them.  Without knowing your friend’s health history, you could literally be putting his life at risk – and no test is worth that much. 

Managing your health is a serious responsibility and that’s especially true if you have ADD.  If you’re taking one of these medications, the best thing to do is keep it to yourself – if no one knows you have the pills, they won’t be able to ask you for one.  And if you have a friend who is taking these medicines, don’t pressure them into giving you one.  It’s more likely to hurt you than help you, and it’ll just put everyone at risk for serious trouble. 

If you have any questions about these or other medications you may be taking, the staff of Student Health Services pharmacy is always available to help!

Jason Goodman, PharmD, RPh (OSU SHS)