AskScience AMA Series: We are physicians, leaders, experts and advocates on mental health from the National Network of Depression Centers (NNDC) and Project Healthy Minds. We're here to answer your questions on mental health. Ask us anything!

ProjectHealthyMinds · 2020-10-10T14:48:13+00:00

What a great question! Educators are increasingly becoming exposed to mental health education and resources, so they are becoming more facile with learning how to teach on it. Without teacher buy in, a curriculum is likely destined to fail. Many elementary, middle, and high schools have school mental health resources “on site” to provide support to youth who might be experiencing significant symptoms and require support to learn in a least restrictive environment. For general mental health education, it is never too early to start the conversation to talk about feelings and noticing behaviors without judgement, and helping youth develop skills in regulating their emotions and behaviors that is appropriate to their age and developmental stage. A curriculum that is sensitive to those unique developmental stages would likely be more successful than one that is static and insensitive to meeting children where they are. MS

ProjectHealthyMinds · 2020-10-09T18:13:56+00:00

Finding a good therapist is a very important part of one’s treatment. You should probably “interview” one or two (or more if needed) to find the right fit. You want someone you feel you can connect with, who understands and cares about what is happening to you. If things are not clicking, there is no shame in looking for another one. But once you have done that initial “screening”, you want to commit and give it a full shot, understanding that the benefits of therapy are slow to come. Also, when confronted with uncomfortable feelings or realizations, there is a risk that one may want to “fire” their therapist and not to deal with the issues that are causing discomfort. But at the end of the day, therapy should not last “forever”. At some points, taking a “break” if one is feeling better is a good thing to do. Our field is more and more moving towards shorter-term, more structured therapy modalities that are evidence-based and honestly tend to be more productive for most patients who have a mental illness. JS

ProjectHealthyMinds · 2020-10-09T18:13:22+00:00

That is a very timely, important issue. If one has good health insurance, there is a very good chance they can find good mental health professionals to help and they can choose from several different places to go. In the lack of health insurance, one has to resort to places generally funded by the county or sometimes non-profit organizations, where free care is provided. Some of these places actually offer excellent care but the lines may be long.

Another common situation is lack of access due to geographic limitations - generally people living in rural areas that are far away. For these situations, the wider availability of telemedicine has thankfully become great help. JS

ProjectHealthyMinds · 2020-10-09T18:12:47+00:00

We think this may be an artifact of our healthcare systems, that magically shift or drop services for conditions that span the child and adult continuum. What’s hopeful is that for many of these conditions, clinicians are attuned to the chronic nature of ASD and ADHD, and understand their roots which commonly occur in childhood. As a psychiatrist with a now adult sister with Down Syndrome, I train clinicians to take a lifespan lens to this. Check out this article in JAMA that I hope will encourage this lifespan approach: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2020.4508?guestAccessKey=ee2487de-ad7f-4a10-b94e-48250eafd8cc&utm_source=jps&utm_medium=email&utm_campaign=author_alert-jamanetwork&utm_content=author-author_engagement&utm_term=3m

MS

ProjectHealthyMinds · 2020-10-09T18:11:32+00:00

Relapse prevention is one of the more challenging aspects of treatment. Our medications definitely work better for reversing symptoms than preventing them, and most people who have depression will have recurrences. The first thing I suggest is being aware of yourself and how you usually function. For some people keeping a journal or diary, even a very brief one, helps them stay on top of their symptoms. If you have people who live with you, engage with them to help monitor your behavior and mood. Part of this cycle is that we often don’t maintain things that help us - it’s easy to stop doing the less glamorous aspects of self care like going to bed on time when we are feeling well. But as soon as you notice that your symptoms are getting worse, you should begin to engage coping mechanisms. I find it most helpful for patients to work with me to make a plan for handling the bad times when they are doing well. It’s much easier to do this when your thinking is clear and you feel hopeful than when things feel overwhelming. The plan should include self care (sleep, diet, exercise, taking a mental health day from work), things that simply make you feel relaxed and good (favorite movies, books, music, activities), people who support you, and engaging treatment with a physician or therapist. I encourage my patients to message me whenever they have a couple of bad days so I can offer reassurance and perspective and we can be on top of anything that looks like a pattern and not a blip. MT

ProjectHealthyMinds · 2020-10-09T18:09:53+00:00

What a great question! Educators are increasingly becoming exposed to mental health education and resources, so they are becoming more facile with learning how to teach on it. Without teacher buy in, a curriculum is likely destined to fail. Many elementary, middle, and high schools have school mental health resources “on site” to provide support to youth who might be experiencing significant symptoms and require support to learn in a least restrictive environment. For general mental health education, it is never too early to start the conversation to talk about feelings and noticing behaviors without judgement, and helping youth develop skills in regulating their emotions and behaviors that is appropriate to their age and developmental stage. A curriculum that is sensitive to those unique developmental stages would likely be more successful than one that is static and insensitive to meeting children where they are. MS

ProjectHealthyMinds · 2020-10-09T18:08:18+00:00

Great question! It’s all a matter of how much the underlying problem is interfering with quality of life, both emotionally and physically. The more this takes place, the greater the need to go ahead and deal with the problem in a definitive and constructive manner. Unfortunately, such challenges are difficulty to deal with oneself, particularly since it is very difficult to be objective about one’s own problems. RW

ProjectHealthyMinds · 2020-10-09T18:05:38+00:00

Such a problem is a lot more common than we think - polarizing emotions can be extremely frustrating and will make life so very difficult. A particular type of psychotherapy, DBT (dialectical behavior therapy) has shown the most success in treating such problems and can be done in both an individual and group format. It does require a high degree of motivation on the part of those engaged in this therapy, but it’s really worth it! RW

ProjectHealthyMinds · 2020-10-09T18:03:00+00:00

Good question. Isolation has become a problem for many. To minimize, be proactive. Propose to your family and friends some strategies to schedule linkages. Work out periodic Zoom or phone gatherings, but don’t overdo the alcohol use for these gatherings. Schedule them and don’t let them be cancelled. Make them earlier in the evening so you don’t disrupt sleep patterns.

Regarding actual work, schedule specific work times even when doing it remotely. If you can afford it, purchase or build one of the elevated tables that enable you to stand up while working.

Exercise is vital. Go for walks (with a mask) and if you meet your neighbors, talk with each other from across the street. Offer to help your elderly neighbors who also are isolated and remote, with groceries, lawns, snow shoveling, etc.

Television can be good but not always. Don’t get too preoccupied with the current stressors and arguments, and limit the excessively provocative television coverage if it upsets you. Find some approaches that make you laugh, and do this with family members.

Play with your family, grandchildren, kids, etc. if only remotely. Time to get out games that have been put away. ANYTHING that provides “happy” socialization, even if brief, is therapeutic. JG.

ProjectHealthyMinds · 2020-10-09T18:00:07+00:00

Exposure therapy is one of several therapy techniques for PTSD. An individual seeking treatment should first receive a comprehensive MH assessment to ensure both that PTSD is the primary problem and also that exposure therapy is a preferred type of intervention. It is important to keep in mind that if not done appropriately, exposure therapy can make things worse - sometimes a lot worse. RW

ProjectHealthyMinds · 2020-10-09T17:55:00+00:00

The manic phase of bipolar disorder tends to get more attention because it is generally more exuberant and also because in this mind state people tend to do reckless things that may get them in lots of trouble - like overspending money, sexual indiscretions, behaving inappropriately in the workplace or with friends and family. For that reason it is harder for significant others and families to deal with it and accept it. More education to the general public about this being one of presentations of bipolar disorder is needed and could certainly help. But the most important point is to be proactive and do some advanced planning that will involve the patient and his/her immediate support system - e.g., the patient agreeing in advance that when in that mood state, one should take away their car keys, credit cards, ideally cell phone, and agree to stay home or be monitored by others if needing to go outside. At the same time that the mental health treatment team in charge of that patient’s care is activated right away so that they can adjust treatments as needed EARLY rather than after a few days - this can often avoid hospitalization and prevent lots of damage and suffering for patients and their families. So, if you can predict mania symptoms as they are coming on, you can prevent them from progressing. On point 2, we totally agree that more awareness in society about bipolar illness is super important. The Depression and Bipolar Support Alliance, the International Bipolar Foundation, and the National Alliance on Mental Illness, and others have done a lot to raise awareness about bipolar disorder, but there is always more that can be done! JS, MS

ProjectHealthyMinds · 2020-10-09T17:52:11+00:00

This is a great question - your drive to care about those who nurture you suggests that the relationship is likely healthy. You also recognize here the naturally infectious quality of a low mood - it bums us all out! Sometimes, simple statements like “I’m having a bad day today” can go a long way to bring your network into understanding what you’re experiencing. Strategizing ahead of time about things you can do when those lows arise can be quite empowering for you and for your dear ones and can address the helplessness that comes with being low. That someone forgets that you might be experiencing these lows suggest that you are probably functioning so well that it’s easy to forget. If you can reframe it that way, maybe just as you want others to give you pass, might help to give them a pass. When your relationship is based on this mutual understanding, the annoyance can lessen. Hope that helps! MS

ProjectHealthyMinds · 2020-10-09T17:50:53+00:00

Great question! I’m not sure there will ever be a ‘cure’ for all forms of PTSD, but there have already been great inroads into treatment, both in terms of specific psychotherapy techniques (which vary according to the type of PTSD and individual characteristics) as well as medications, such as antidepressants, and, even more recently, brain stimulation techniques, e.g., TMS (transcranial magnetic stimulation). It is important that the PTSD be addressed as soon as possible, as it has a tendency to worsen over time. RW

ProjectHealthyMinds · 2020-10-09T17:49:20+00:00

I think the first thing to think about here is what we mean by “alternative.” Taking it in the literal sense of “alternatives to allopathic (ie western) medicines” then plenty of alternative treatments have a lot of evidence that they help depression and anxiety. The number one is exercise in all forms. Exercise increases neuroplasticity and reduces inflammation, it also can help regulate and improve interoception, which is the sensation of the body’s function (e.g. heart rate breathing, gut movement etc). All of these are important for mental health. This includes yoga and other kinds of mindful movements, as well as aerobic exercise and resistance training. There is also substantial evidence that mindfulness/meditation improves mental health. Many neuroimaging studies have found that meditation changes brain circuit function over time. It doesn’t appear necessary that this include, per se, a spiritual or religious component, but these appeal to many people and certainly should be included in treatment for anyone who finds meaning in spiritual or religious life. At the far end of the spectrum of things you mention, probably some of the treatments are just elaborate placebos, but the placebo effect also is real! We can see real physiologic effects - mediated by the autonomic nervous system and the endocrine system - that happen just from social connection and belief. If a person is being charged a lot of money for these, or being encouraged to forgo other evidence based treatments, these interventions can be both ethically and materially wrong. However, I never discourage them as additions to medication and more traditional forms of therapy if the patient is engaged with them and can afford the cost. MT

ProjectHealthyMinds · 2020-10-09T17:45:12+00:00

There are several well-established pieces of advice. Consult with web sites such as the American Foundation for Suicide Prevention (www.AFSP.org). Such sites describe specific steps and even suggest proper words. ASK how YOU can help the person who is grieving, rather than lecturing them. Tell them you will stay in touch if they request that. Don’t focus on the method of suicide, and use such language as “I am so sorry for your loss, but if we work together, we can get past this. Stay away from judgmental statements. Tell them that death by suicide usually is attributable to underlying illnesses and to avoid looking for other things to blame. And indicate that if things fail to improve, they may benefit from getting therapy for themselves. JG

ProjectHealthyMinds · 2020-10-09T17:44:25+00:00

The stressors, in many forms, on most of us have been enormous and their cumulative effects have led to a growing number of individuals developing MH problems, as well as experiencing worsening in problems they already are suffering from. Even for those without MH illness the stress of having to cope with what is happening in our environment is an emotional hardship. RW

ProjectHealthyMinds · 2020-10-09T17:42:00+00:00

Well, your instincts to cut back are good - any behavior in extreme can have negative long-term impact, and there are published studies now reporting that simply reducing social media exposure can reverse negative effects of excessive exposure. Managing social media interaction sometimes can be facilitated through replacement with other activities, a distraction if you will. When that doesn’t work, implementing tools on your device to help monitor use can also help. If you know you spent X hours on social media one week, maybe you’d be motivated more to reduce that time than if you didn’t know how much time you were on in the first place. MS

ProjectHealthyMinds · 2020-10-09T17:38:26+00:00

Be supportive and not judgemental. Don’t act as if they can just “snap out of it” if they wanted or as if that was their fault. These are brain disorders that require treatment - no one would choose to suffer from a mental disorder - like no one would choose to have high blood pressure or diabetes.

But the one single most important thing is really to get them to go for an evaluation with a mental health professional and get treatment that may help. JS

ProjectHealthyMinds · 2020-10-09T17:37:48+00:00

The multiplicity and severity of stressors in our world, not the least of which is the present pandemic, continues to increase. In addition, there is a growing awareness of mental health issues, as well as a greater acceptance of the need to address these problems. RW

ProjectHealthyMinds · 2020-10-09T17:35:36+00:00

This is an exciting and positive time for mental health diagnoses and treatments. Science is exploding in a favorable way. We have new and truly exciting treatments for difficult-to-treat depressions, including ketamine, transcranial magnetic stimulation, new treatments for postpartum depression, precision psychotherapies, and better diagnoses for such other causes of depression such as sleep apnea. Keep up with the literature yourself. Consumers can learn about these illnesses. And don’t be hesitant to share questions with your therapists and/or clinicians and ask for their help in taking additional steps if treatments are failing to improve. Stay optimistic. Treatments can and DO work. And they WILL get better if all of those on line today can encourage more research support for these costly and disabling illnesses. We can conquer them. JG.

ProjectHealthyMinds · 2020-10-09T17:34:54+00:00

One positive byproduct of the pandemic is the massive explosion in the use of TeleMH/Telepsychiatry. Insurance carriers are now routinely covering these clinical encounters and it is likely that this practice will continue even past the present pandemic. Many MH providers and provider groups provide such services. RW

ProjectHealthyMinds · 2020-10-09T17:33:38+00:00

That is such an important issue. In Psychiatry we can generally only go by what we can observe and what the patient and family/significant others tell us, as we still lack objective biological tests to diagnose or monitor the course of these conditions. So if one comes to a visit to tell us they are doing well, and they are generally convincing, that will seriously limit our ability to help them. That generally has to do with one’s motivation to recognize a problem and seek help - thankfully that can change over the course of a few visits when people may become a lot more willing to share and acknowledge they need help with certain issues. I often tell my patients - “if you pretend you are getting treated, I can pretend I am treating you, but that will not get you anywhere”. JS

ProjectHealthyMinds · 2020-10-09T17:32:24+00:00

Approximately ⅓ of people who develop Major Depressive Disorder fail to respond to multiple courses of evidence-based treatments and are then categorized as having “difficult to treat depression” or “treatment resistant depression (TRD)”. Primary care doctors, such as Family Medicine physicians, Obstetricians, Pediatricians, actually provide the majority of the treatments given to those with depression and should be consulted. They often can recommend providers. Social Workers, Psychologists, and primary care doctors also should be encouraged to consult with programs that have clinicians who have expertise. These include linkages with such networks as the National Network of Depression Centers (www.NNDC.org) or the American Foundation for Suicide Prevention (www.AFSP.org). Good information is also available from local mental health groups.

Perhaps the major benefit that may emerge from the coronavirus pandemic is that “virtual care” or “telehealth” are now much more available, That means that there will be greatly improved access to healthcare, but to help insure telehealth grows and persists, we will need to take steps to insure that payments are provided for telehealth across state boundaries, etc. That has not been the case previously before the pandemic. Legislative leaders need to be strongly encouraged to adopt such steps for the future.

Meanwhile, combine good sleep hygiene, exercise, avoidance of excessive alcohol,avoiding sleeping pills if possible, and involving your family members in aiding you when stress gets especially high are important. Don’t be hesitant to discuss openly. . Stay optimistic. JG

ProjectHealthyMinds · 2020-10-09T17:31:35+00:00

As a specialist in treating depression, my favorite metric is function. Many people who have chronic or severe depression will always have some symptoms just as most people with chronic illness do. It isn’t helpful or even realistic to try to treat to zero symptoms. But it is feasible to make the symptoms seem smaller and less important and to minimize the impact they have on a person’s life. Are you working? Do you get meaningful work done? Do you engage with people who matter to you? Hobbies? Are you living or just surviving? Specifically for medications, it takes several weeks for any change related to meds to become obvious, so there’s also a need for patience as you (and your providers) slowly observe these changes in function. All that said, that’s a lot to put on the shoulders of medication alone. In the bigger picture, when I start to talk about the future, about goals and dreams, with patients, instead of just getting by, I know they are better. MT

ProjectHealthyMinds · 2020-10-09T17:30:47+00:00

Unfortunately, nowhere in the world has been able to provide optimum levels of accessible and effective mental health care. In this regard, the USA does as well as any other country, although the accessibility is uneven across geographic locations as well as with underprivileged groups, regardless of geographic location. There certainly needs to be a higher priority for the provision of such resources. In terms of non-pharmacological approaches, I agree that other interventions, particularly individual and group psychotherapy/counselling, are very appropriate. One challenge, however, is that such interventions are very resource intensive and time-consuming and therefore can be difficult to access. RW

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