Your Mental Health Questions, Answered.
Recap: Reddit Ask Me Anything with our friends from the National Network of Depression Centers (NNDC).
We recently teamed up with leading mental health physicians and researchers from the National Network of Depression Centers for a Reddit AMA.
They shared their expertise in areas like anxiety, depression, child & adolescent mood disorders, bipolar and addiction. And answered questions on topics like:
- COVID-19's impact on anxiety and depression
- What to look for in a mental health professional
- Where to begin when you're starting your mental health journey
- How to ask a friend or family member for help
- Whether antidepressants are safe long-term
- Where we're making progress on the science of mental health
- And much more
Have your own question about one of these topics? Here’s a recap of some of the Q&A.
What advice would you give to individuals who are facing mental health challenges from remote work?
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.
-John Greden, MD
What is the single biggest thing we as individuals can do to help friends and family who may be struggling with their mental health?
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.
-Jair Soares, MD, PhD
What is/are the most common causes for anxiety and depression in teens and how can they (the teens) and people they know help with that?
Great question! There are many causes of anxiety and depression among youth, and now more than ever, people are actively thinking about the many environmental, genetic, and biological contributors to these conditions. Among the most common causes are having a family history of a mood disorder (i.e. someone in the family also experiences similar symptoms), as well as exposure to stress, particularly early in life. For each person, causes are different, so thinking about the common causes as they apply to an individual can be an important place to start, because depending on the cause, the treatment may be different. If it is clear that depression and anxiety are causing a significant amount of impairment, it can be helpful to go over the causes unique to a particular individual with a mental health professional. This discussion can then be the basis for how to help treat the symptoms so that they don’t have such an impact down the line.
-Manpreet Singh, MD, MS
With the pandemic do you think increases in depression and anxiety are just temporary or will result in long term mood/brain changes in people? What do you recommend to people in general to avoid such things? Thanks!
This is a good question - and there are several ways to answer it. Some of the consequences of the pandemic may last for years and cause stress for many people - especially the economic impacts. From a biological perspective, there is some evidence that once a person has been depressed, they are more likely to become depressed again - the risk of a future episode of depression increases with every episode. It’s hard to separate this phenomenon from the underlying biological risk factors for depression, but it appears likely that people who become depressed for the first time due to pandemic stress will be more likely to have more episodes of depression in the future. There is also growing evidence that Covid infection itself may impact the brain and cause increased biological vulnerability to depression and anxiety and it’s too soon to know how long those effects may last.
-Marisa Toups, MD
What advice do you have if you are concerned about a friend’s mental health and that friend is not wanting to be seen as having “a problem”?
This is a very common problem which can be extremely frustrating for the individual’s friends. It is important to continue to be as supportive as possible and to involve other friends if it can be done in a constructive fashion. The only other thing is if the individual is acting in a manner that you believe is imminently dangerous to their life or the life or others. In that extreme situation (and ONLY in that situation), it would be appropriate to contact 911.
-Rich Weiner, MD, PhD
Is there any advice for chronic depression but no access to healthcare? A way to mitigate it?
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.
-John Greden, MD
Why do I pay for and then lie to my therapist and tell them, "I'm ok?"
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”
-Jair Soares, MD, PhD
How do I console someone who lost a friend to suicide, and what do I do to try and help them from falling into their own depressive episode due to the loss?
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.
-John Greden, MD
We hear a lot about how social media has an adverse effect on people's mental health. What are some ways to reverse its effects aside from cutting back on visiting those sites?
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.
-Manpreet Singh, MD, MS
What do I look for in a therapist?
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.
-Jair Soares, MD, PhD
What is the biggest reason for the stigmatization of mental health conditions? Why are people still afraid to talk about it openly with their friends and family?
The stigma in regard to mental health issues has improved somewhat in recent years but there is still a lot of it out there. It comes from lack of understanding that these are indeed brain disorders. If someone develops clinical depression, this is not something they wanted or could snap from magically just because they are “tough” or want to get over it. No one would choose to suffer from clinical depression. It involves detectable brain changes and requires treatment so that people can get better.
The fear of talking about it comes from a time when suffering from a mental illness was attached to shame - as if that was a character flaw. These disorders are very prevalent and affect about 25% of the general population, so they will be present in most families and many of us will have them. The more awareness there is among the general public, the better this situation becomes.
Organizations that help educate the general public on symptoms, early diagnosis and treatments available for mental illnesses have done a lot to help overcome the stigma - e.g., NAMI, DBSA, MHA, NIMH, etc. The fact that many individuals have come public with their struggles has also helped a lot.
-Jair Soares, MD, PhD
Thanks to the physicians & experts from the National Network of Depression Centers (NNDC) who joined us for this Q&A!
- John Greden, MD
- Rich Weiner, MD, PhD
- Jair Soares, MD, PhD
- Manpreet Singh, MD, MS
- Marisa Toups, MD
- Cheryl McCullumsmith, MD, PhD
- Mark Frye, MD