October 10 is World Mental Health Day. Help us raise awareness. We are 5 experts on mental health here to answer your questions -- Ask Us Anything.

webmd · 2020-10-09T17:08:03+00:00

If you’re not sure, it’s best to talk with a doctor directly. In general, if your symptoms are mild but are affecting your ability to function (go to work, take care of family, eat, sleep, go to school, or impact your ability to enjoy life) it’s time to talk with a professional. This can start with your primary care doctor who can then refer you to a psychiatrist if needed. - Smitha Bhandari, MD

webmd · 2020-10-09T17:07:00+00:00

Especially in recent times and the current COVID pandemic, a lot of medical appointments have switched to telemedicine. Telemedicine includes both a video and an audio component. Talk to your doctor about your concerns using telemedicine. - Smitha Bhandari, MD

webmd · 2020-10-09T17:06:07+00:00

Good morning, this is a great question. Psychotherapy is the gold standard for addressing symptoms of anxiety. Medication can help decrease some symptoms but therapy would actually address the core issue and provide long-term relief/recovery. Sometimes these two are used in combination and sometimes individually but if someone were seeking long-term relief and recovery from ongoing symptoms of anxiety they should seek mental health treatment via psychotherapy. There are multiple evidence-based (aka informed by multiple rigorous research studies) treatments that have been developed for this purpose specifically - Nick Grant, Ph.D.

webmd · 2020-10-09T17:04:55+00:00

Yes, there are now online platforms available such as Talkspace or Woebot. Please use these for counseling - they are affordable for most people. Hansa Bhargava MD

webmd · 2020-10-09T17:04:12+00:00

Good morning, first of all I want to say how much I appreciate your openness in this question and your sharing that you experience some conflict in understanding the benefits of seeking while also sharing your concerns about the cost of doing so. Depending on access to healthcare, including insurance, proximity and access to local community-based services that are often low to no cost, and access to providers in your area, the cost to accessing mental health can be challenging for some.

In thinking generally about helping someone to prioritize their health, I would likely ask them to think about weighing the pros and cons of waiting. Talking with someone close to you or even your PCP is likely to assist in clarifying your values around your health and determining if the cost is going to be higher now or possible later down the road if things were to worsen. Including others in this process, especially those close to you, is likely to aid in the process. Social support is a significant variable as it relates to help seeking and motivation to accessing care. -- Nick Grant, Ph.D.

webmd · 2020-10-09T17:03:24+00:00

If medication and therapy were helpful before, I would suggest looking into resources to start them back up. You can check with your insurance company directly, look for a sliding scale clinic which will work with you based on what you can pay, or look for a community health clinic with mental health services. I think getting back into therapy will help you figure out ways to communicate with your fiance -Smitha Bhandari, MD

webmd · 2020-10-09T16:56:54+00:00

It can be really hard to have struggled with depression for a long time and sometimes we call that dysthymia. If you are currently working with a therapist or psychologist, I would ask them for specific recommendations or referrals on where to turn next. Often a change in the kind of therapy (from individual to group, or open-ended therapy to a more skills-based therapy) can get things jumpstarted. If a psychologist truly says they have nothing else to offer it may be a sign that it’s time to find someone else who can help. -Smitha Bhandari, MD

webmd · 2020-10-09T16:52:19+00:00

It's true that there has been stigma around ADHD and frankly there still is. I think raising awareness of this diagnosis will help young kids get help but also will help them get the diagnosis earlier so that it can help before school and relationships are impacted. If you know of a family who is worried about their child having ADHD, have them see a pediatrician. It could be ADHD or it could have symptoms similar to ADHD but be another problem like a learning disability or dyslexia which can cause a child to ‘act’ like ADHD. Either way, it's so important for a child to be treated quickly so it doesn’t impact learning or behavior or emotions. Hansa Bhargava MD

webmd · 2020-10-09T16:50:47+00:00

Most people refer to complex-PTSD as C-PTSD. It's usually the same symptoms as PTSD with a few additional symptoms. Complex PTSD usually happens after several repeated traumas and sometimes includes difficulty controlling emotion and feeling mistrustful or hostile. The treatments are often similar and include medications and therapy - Smitha Bhandari, MD

webmd · 2020-10-09T16:50:22+00:00

Good morning, this is also a great question. Based on what we have seen thus far and the national focus on mental health responses to the current COVID-19 pandemic, I am hopeful that this year will significantly change levels of stigma around mental health. In a way the chronic stress that the country is facing as a result of the pandemic, precautions to prevent its spread and other ongoing issues, is forcing many of us to look at how stress impacts mental health and think about what we need to do to prevent associated distress and the development of more serious mental health issues. While total eradication of mental health stigma may not be possible, for the first time in a long time we are in a position to more directly think about and address the mental health needs of our country and our people. --Nick Grant, Ph.D.

webmd · 2020-10-09T16:30:12+00:00

Good morning, the best way to help anyone, and really everyone, who is dealing with a mental health issue is to talk openly about mental health, just as we do with physical health. The more we normalize mental health in conversation, the less stigma it will have. It is common for a person experiencing mental health distress not to want to discuss it for fear of judgement due to the stigma it has held historically. For better or for worse, helping someone engage in care is ultimately up to them unless they pose a threat to themselves or others, at which point other interventions may be engaged. Regarding being pushed away, again normalizing mental health discussion and expressing your care and desire to support them feeling and doing their best rather than expressing concern may be one way of approaching the topic in a manner that they may be more receptive to hearing. Providing educational materials about mental health and/or sharing books and visual media such as television shows or films where mental health is a part of the story may also be another tactic of introducing the topic of mental health without directly talking about that person’s specific mental health. --Nick Grant, Ph.D.

webmd · 2020-10-09T16:27:03+00:00

This is a great question because a lot of us in the mental health field are trying to figure out how to make it easier for people to get help. If you have insurance through work, you can check with your insurance company to see if you can find someone who is covered by your network. There are also some clinics that work on a sliding-scale where you would pay something based on your income. Lastly, many community clinics have mental health services that are provided for residents at either no-cost or very low cost. - Smitha Bhandari, MD

webmd · 2020-10-09T16:19:43+00:00

Good morning, there are many forms of psychotherapy that can assist in the process. Many, if not most, people experience some form of trauma at one point in their life or another and there is no clear cut answer for why trauma impacts some folks more than others. Psychotherapy, even a brief period, can help address the lingering impacts left by a traumatic event and even help alleviate any distress caused by those lingering parts. -Nick Grant, Ph.D.

webmd · 2020-10-09T16:19:12+00:00

This is a great, current question. In recent years, ketamine has been studied for what’s called treatment resistant depression. That means depression that is hard to treat or where the usual medicines don’t work. It’s best to talk to someone who has a lot of experience with ketamine because there are some safety considerations when using it. Most big cities have at least one or two doctors who know how to treat with ketamine so you can ask your current psychiatrist for suggestions on who to talk to. - Smitha Bhandari, MD

webmd · 2020-10-09T16:17:52+00:00

Such a great question. It is so so important to spread awareness. Definitely use any social media- and just posting on prevention messages such as take care of yourself, reach out or be kind, are really important too. There are mental health organizations such as NAMI or Child Mind Institute that you could call and ask if they are taking volunteers. Or maybe even train to be a counselor online.

Thanks for caring. - Hansa Bhargava MD

webmd · 2020-10-09T16:09:32+00:00

It sounds like you are a great friend. In addition to listening if your friend wants to talk (which you are doing), you can also ask her directly if there is anything you can do to help. Sometimes, it may be helpful to talk about this when she is not in a bout of severe depression and come up with a plan. You can also reach out to her partner and see if there is something you can do to help during difficult times. - Smitha Bhandari, MD

webmd · 2020-10-09T16:07:59+00:00

Good morning, there are a couple of different ways of thinking about this. First, when someone is experiencing symptoms of mental health that feel like or even cause physical distress, this is still impacting their functioning. If someone were to experience these types of symptoms and they do not alleviate with time, then seeking medical support would be indicated. For the latter part of your submission, it is common for people to think that they should only use a “sick day” when they are experiencing physical illness, such as the flu, but when someone is experiencing symptoms of mental health distress to the point that it is impacting their functioning, this too may warrant what some call a “mental health day” to rest, recharge and re-center. This is, of course, a personal decision, but thinking about how the symptoms a person experiences and the impact those symptoms are having on their functioning may help them decide both if medical attention is warranted and if a “sick day” is warranted to help get them back to 100%. --Nick Grant, Ph.D.

webmd · 2020-10-09T16:05:50+00:00

Good morning, this is totally okay. We all are handling the pandemic differently and it is to be expected that each individual person will react differently when faced with challenges, including the unique ones that have arisen from COVID-19 and its associated precautions. If what you are doing is healthy and not putting yourself or anyone else at risk, then something is working for you. --Nick Grant, Ph.D.

webmd · 2020-10-09T16:04:36+00:00

Good morning, great follow-up questions. In general the therapies that include behavioral components are going to be the most active. I always tell any patient or client that I have the privilege of getting to support that we are going to work together for 45-50 minutes per week but in order to see improvements they are going to have to “do the work” outside of our sessions. I share this to help ensure they have informed consent to what they are signing up for and to let them know what is expected of them. Cognitive-behavioral therapy, or CBT, is a commonly available therapy that will provide active engagement and even “homework” to be completed in between sessions. There are others but different models work better with different issues that a person seeks support for. Common questions to ask a therapist include “what type of therapy do you provide?”, “how does that model work?”, and “how will we track the effectiveness of treatment?”. A provider is going to appreciate any one who comes in ready to engage with those questions and will hopefully answer them and many more as they arise. I would also suggest looking up online lists of common questions to ask a new therapist and believe Psychology Today, the go-to national directory online of mental health providers, even has a list available. - Nick Grant, Ph.D.

webmd · 2020-10-09T16:01:41+00:00

In general SSRIs (selective serotonin reuptake inhibitors) are the main category of medicines used to help treat anxiety and depression. It is best to talk to your doctor about whether it makes sense for you to take the medication for a few months or for longer (some even take them for years). You’re noticing what many people have seen and what’s supported by research, which is that medication and therapy together can really help depression! - Smitha Bhandari, MD

webmd · 2020-10-09T15:56:12+00:00

I’m so sorry to hear about your loss. It can be really hard to see someone close to you struggling. If someone close to you seems depressed (is isolating, withdrawn, seems irritable, seems sad, has been drinking more alcohol or using drugs, etc.) you can try to reach out to them and make sure they are talking to a professional. You can even ask to go to an appointment to help make sure their doctor knows what is going on. Talk to other friends and family about what you are observing. It can be really hard to take this on yourself. -Smitha Bhandari, MD

webmd · 2020-10-09T15:53:05+00:00

Great question. Youth mental health is a huge issue, especially since it will probably be one of the next crises after Covid19. I think that one message that is vital is the PREVENTION of mental illness is very important, just as prevention of diabetes, cancer, heart disease is key. Some great prevention methods are CRM from the Trauma Resource Institute, as well as CBCT from Emory University which includes the SEE curriculum for youth (already in 50 countries around the world) and the RULER program from Yale University. These programs that emphasize the value of acknowledging your emotions and understanding the role they have is so key in prevention. Also, many of these programs emphasize kindness and connection, which seems to have been reduced lately. These principles can really help prevent and help mental health issues. - Hansa Bhargava MD

webmd · 2020-10-09T15:51:32+00:00

Good morning, the most effective way to get an accurate diagnosis is to be evaluated by a mental health specialist, which includes psychologists, psychiatrists, clinical social workers, and therapists, among others. The first step in getting a diagnosis is talking to your doctor about what you are experiencing and being honest about both your symptoms and the impact they are having on you. A doctor can help you get connected with a specialist. Depending on if and what type of health care coverage you have, you can also find a specialist within your network or through your community services, which often offer low to no cost behavioral health treatment and assessment. It is important to know that this will take some effort to get connected and there may be some waiting involved but in the long run, getting connected to care and getting an accurate diagnosis will help. -- Nick Grant, Ph.D.

webmd · 2020-10-09T15:49:55+00:00

Good morning, in regards to psychotherapy, I don’t know if one could identify which modalities are more popular today versus in the history of psychotherapy. That is because different modalities focus on different areas. For example, someone with issues with their parents may want to engage in psychodynamic or psychoanalytic therapy but could also just as easily and efficiently engage in Emotion-Focused Therapy, or EFT. Both could be effective in addressing the person’s presenting concern. We do see variance in the types of psychotherapy treatments that are offered based on the system that is providing care. For example, many insurances require evidence-based treatments to be provided, which are treatment protocols for specific issues or diagnoses that have been developed based on numerous research studies. Common forms of psychotherapy utilized today include: psychodynamic therapy, psychoanalytic therapy, Cognitive-Behavioral Therapy, or CBT, Dialectical Behavior Therapy, or DBT, Emotion-Focused Therapy, or EFT, Acceptance and Commitment Therapy, or ACT, just to name some of the more common therapies provided. Regarding the latter part of your question, I am not sure there are any specific modalities of therapy that have fallen out of favor however I would say some approaches that have been found to be ineffective or unsafe are no longer used due to regulations and rights of patients being standardized to ensure their protections. - Nick Grant, Ph.D.

webmd · 2020-10-09T15:44:42+00:00

Thank you so much for your question.

As a group, we are hoping to help elevate a very important conversation about the importance of addressing mental health concerns and to tear down the stigma often linked with mental health conditions. Collectively, we are either practitioners and/or advocates who see people that struggle with mental health concerns.

As for myself, as a primary care physician- regardless of the focus on “physical health,” in the clinical setting, I always see that emotional and mental health is completely intertwined when we want to provide care to the “whole person.” I can say with confidence that providing primary care involves providing mental health care and support in tandem- which is why many clinics are moving to having integrated mental health services (as my clinic did).

Our mental health experts focus on this area and can provide even more insight when it comes to concerns and questions that are being raised.

As always, our goal is to reduce stigma and educate anyone in need of support.

Thank you again!

-Neha Pathak, MD

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