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.

A lot of people in my community (in the Rocky Mountains) are deeply suffering, emotionally, because we are not only isolated from friends and family because of the virus, but we’re also unable to go outside because of the terrible and incessant wildfire smoke.

Our eyes, noses, and throats sting & burn if we attempt to. Our coughs are terrible.

How do we take care of our mental health when we can’t do practically anything? We can’t even take walks outside and it’s been like this for over seven weeks now. Most of us still work from home. What can we do to not have cabin fever?

I’m so sorry you’re dealing with that. What we’re all dealing with right now was pretty much inconceivable nine months ago, and people in the path of the fires really have such an extra burden, with even less coping mechanisms available for a difficult situation than before. The things I’m going to suggest are the things I’m doing, and they’re not going to seem very satisfying. They’re more like resolutions to keep yourself going, until things can be satisfying again. It’s ok to acknowledge that; in the process, you can also recognize that you do believe things will be satisfying again. I find that keeping that bit of hope and belief in my pocket is really useful:

1. Take everything in really bite-sized chunks. Looking too far ahead feels suffocating, but in the moment I know I am ok and will get through this. So I try to stay in the moment.

2. Think about and acknowledge what you have already survived through. We’ve made it so far already through things that we haven’t faced before. In that way, we are doing amazing, resilient things. And we see we can keep going.

3. Commit to small, good things. Make a list of things that specifically feed your emotional, mental, and spiritual health, and try to commit to doing one or two a day. Cook a comforting dinner tonight. Revisit your favorite TV series. Play games online with friends. Find a way to do something sweet for someone else. You can recognize that none of it is going to give you some ultimate feeling of release and relief, while still harvesting the good feelings of being kind to yourself and others, of being useful, of making someone else laugh, etc.

4. Move any way you can. I know that’s more challenging indoors, but you need those endorphins.

5. Remember it will end. Everything does.

Hang in there. I hope the fires clear up for you ASAP. -- Halley Cornell

The very real physical limitations that you have described in your community I am sure are exacerbated by the current pandemic. Social isolation can have impacts on the overall mental health, well-being and functioning of those who face it. What we do know from research and practice, are that there are things one can do to help combat any negative impact of these limitations. Routine is the first that comes to mind. Establishing a daily routine/schedule will help anyone facing limited social interactions during that period. This would include a regular sleeping schedule (focusing on quality sleep can significantly impact the impacts of stress and improve overall functioning), limiting screen time, and minimizing use of alcohol and other substances. Although “zoom fatigue” is a very real experience, finding ways to engage in social connection remotely can also help. Social support is one of the most important factors in addressing distress and minimizing the impact of physical isolation from others, as the research shows us. The lack of opportunities to go outside limits physical activity as you mentioned however, there are still many physical activities that you can engage in indoors, if you are physically able to do so. Yoga has been shown to have significant benefits in decreasing stress, improving mental well-being and can be a part of daily routine. --Nick Grant, Ph.D.

I met with some therapists years ago as I was struggling to concentrate at work. All they did was listen to me, wrote some notes and told me to come back the following week. This continued for months with two separate therapists. No coping mechanisms offered; no books suggested for self-improvement; no active engagement. Ambivalent. Radio. Silence.

This continued for months before I gave up and realized I was wasting time from both of our lives and my co-pays.

After sharing this with other people, they noted that their therapists generally did the same thing. Is what I described an appropriate approach of a therapist as supported by the APA?

This is a great question. There are many, many different models of psychotherapy and all of them have unique approaches, perspectives and conceptualizations of mental health symptoms, disorders and distress. While I cannot speak to the approach of another therapist, I can share that some models may feel more passive and process oriented, while others are more active and engaging. Finding the right “fit” between patient and provider/client and therapist is multifaceted. Some people prefer to work with someone of the same race/ethnicity, gender, sexual orientation, religious identity, etc., which are all important to consider if they are personally meaningful to the person seeking care. In addition to these factors, it is important to learn a bit about a provider's approach to care/therapy. One great way of doing this is looking at their website. Another is having a phone call with the provider prior to the first appointment to ask questions. Many providers offer this information online or in the first session. Also, there are two APAs, the American Psychological Association, and the American Psychiatric Association, and both support psychodynamic models of care, which sounds like what you have described above. -- Nick Grant, Ph.D.

I don’t like the passive approach either.I had to pause therapy after switching between a couple of different therapists because I felt that it wasn’t going anywhere. Which models of psychotherapy are considered active? What kind of questions would you ask a therapist in order to figure out that they could be a great fit without needing to “try them out”?

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.

What do you believe is the best way for someone with anxiety and depression (or people with mental health issues in general) to work up the courage to seek help? Working up the courage to even look up therapists in the area can seem like a huge challenge.

Reaching out for help can seem scary, daunting and even overwhelming for some, and that is understandable. Due to stigma about asking for help when we are in need, and mental health in general, people may feel uncomfortable thinking about doing so. What we do know is that talking about how we are feeling with those close to us, our social support system, is a key first step in seeking help when needed. Being honest about what is going on internally with someone we are close to helps us prepare to seek professional help, if needed, better understand the impact our mental health is having on us, and relate better with others. Asking those around you how they are doing is also a great way to normalize help seeking and show that you care. - Nick Grant, Ph.D.

What are your thoughts on treating looooong term depression/anxiety (20+ years) where therapy and many different pills, exercise, good diet, normal sleep schedule, and moderate social interaction didn't help?

This is such a hard place to be, and I hope one of our providers will weigh in, as well. I’m a person with treatment-resistant depression and I’ve come to look at it as a chronic illness in which I’m doing my best to stay in remission and to learn ways to stay healthy. I’ve changed my expectations a little, and that’s helped me plan and have more periods of “up” time.

Recognizing that it’s different for everyone, some of the things I have tried and am still trying (versions/expansions of what you’ve already tried, but maybe there’s a nuance in there that’s useful for you):
-- making sure I had the right diagnosis. If you’ve been struggling for a long time, you might consider being re-evaluated to make sure something else isn’t going on (physically or mentally).
-- trying different modes of therapy. I found I really related to a couple and found tools I could use (ACT, mindfulness-based CBT) and didn’t seem to take to some others.
-- talking with my psychiatrist about different treatment types to try. There are new drugs and drug types all the time, and new therapies like TMS. It can be a slog trying out new meds, but I’ve eventually found something that worked, and that’s made it worth it.

-- I use nutrition, exercise, sleep hygiene etc. to keep myself above baseline. Not suggesting these things alone will fix you, but keeping them consistent does give me longer periods of feeling better.

All that said, I understand how hard it is to deal with this for years, and I wish there were easier answers. I wish you the best in your search for the right approach. -- Halley Cornell

I greatly appreciate what Halley has shared about her personal experience here. Addressing chronic mental health issues, such as long term depression and anxiety, often requires a comprehensive approach that includes managing symptoms to the point where a provider can start treatment to address the source of the symptoms. For example, someone who experiences sleep disturbance as a symptom of depression, may need support from a provider in managing the sleep issues in order to get to a point where addressing the mood-related symptoms of depression is possible. Talking with your providers about developing a collaborative, comprehensive approach is likely to have better outcomes. This would include providing consent so everyone who is providing you care can communicate with one another and continue to develop and assess the effectiveness of your care. Be an active participant in that process, ask questions, track your progress across multiple modalities and report back. The best results usually develop for those who are active in their care. Remember that mental health care is a process and it takes time but with the right formula individualized for each person, better outcomes are possible. - Nick Grant, Ph.D.

What makes you qualified to call yourself experts in mental health when the majority of you appear to be content creators of some sort with little to no clinical background working with clients with mental health issues?

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

Hi there, I have a couple of questions please. A friend of mine committed suicide and no-one would have suspected a thing leading up to it. We knew she had troubles but no-one expected her to do what she did. My question is, are there any reliable signs we can look for from the outside? If we recognise those signs how can we help and what if that help doesn't work? Can someone be "terminally suicidal?" Thanks.

Edit: Thank you for all the kind replies and advice. Its really a lovely side to social media for once.

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

How can I tell when my depression/anxiety is manifesting physical symptoms vs having an actual physical illness I may require help for? I had a bad mental health day yesterday and last night got so dizzy and nauseas I can barely stand. I don't want to call in to work if it's all in my head.

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.

Hi there! First off, thank you for opening up the conversation regarding mental health! My question, what are your thoughts on the use of psychedelics (specifically psilocybe) and the future of mental health treatment? I personally believe that a singular mushroom trip saved my life, and love that its becoming part of the conversation throughout North America

Good morning, this is an interesting question and a topic a colleague of mine is very interested in. The use of psychedelics in mental health treatment is something we have seen practiced in our history many times. Due to the nature of federal laws and our medical system, I do not think it is something that we will see in regular practice any time in the near future, however, that being said that is research on the topic and there are groups who are supportive of the integration of these types of substances into treatment. --Nick Grant, Ph.D.

What’s your best advice on how to deal with social loneliness and how to get rid of the need to depend on others for validation and self-worth?

A really good question. Loneliness is a real problem, especially now with social distancing and a decrease in social activities. It is okay to feel this way, and frankly all of us need others. But to help your self worth, find something that you like to do it and do it. Purpose and passion can really help; additionally, exercise can help ‘feel good’ hormones be released, and sleep can really affect your mood and self esteem. Lastly, socialization IS important- so do that occasionally -- virtually, or outside meeting a friend or two. Make yourself a priority, to do these things, no matter how busy you are. - Hansa Bhargava MD

The sameness of every single day at home is starting to make me unwell. Now I get mild panic attacks. I feel as though my days are all grey and the same and there’s no where to turn to remove myself from the situation (we’re on lock down). My old life was fast paced and maybe mental health issues were there but covered up by the hectic nature of every day life. I simply don’t know how to be happy and healthy in lockdown.

How is lockdown changing the way we think about mental health? How do we change our approach to mental health through the lens of lockdown? What can we do to maintain our health in lockdown, beyond generic ‘stay connected with friends on zoom!’ advice?

Great questions. Many national leaders in mental health, including organizations, agencies and individual leaders, have named mental health as the next pandemic that the country is facing. Part of the way this has changed the way we think about mental health is from a population and prevention perspective in addition to the individual level of care perspective. This incorporates significant public health approaches to communicating psychoeducation on mental health issues, including cultural stigma associated with them, how to identify them within ourselves and others, and how best to access care when needed. There have been multiple changes in 2020 in approaches to mental health due to limitations to COVID-19 precautions, including significant increased in access to tele-health and video-health, changes in licensure jurisdiction policies to help improve providers can work in communities where there is need but perhaps less access, and efforts to destigmatize mental health and help seeking. Behavioral tips for maintaining quality mental health can include: routine (having a schedule helps normalize the limitations we are facing), engaging our social support systems however we can (social support is a leading factor in preventing mental health distress), exercise (exercise that is in line with one’s physical capabilities can play a significant positive role in improving mental health in both the short and long-term), sleep hygiene (being intentional in our sleep habits, including a routine sleep schedule has also been shown in research for ages to help with mental health distress tolerance and improvement), and decreasing the use of substances that have negative impacts on our overall health, such as alcohol. --Nick Grant, Ph.D.

So I've got this... j/k

A common theme on /r/ADHD is the persisting 1980s attitude that only kids have ADHD, it's not real, it's only hyperactive boys, etc. as well as pharmacists treating everyone with a prescription as a drug seeker.

Given the extreme demands on physicians time, is there anything that can be done to improve their continued education to alleviate such issues?

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

How do you help a person in your life suffering from a mental health issue such as bi-polar disorder? What about when they push you away in order to shield you from their problems?

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.

What is the most effective way to get a diagnosis for your mental health when you feel utterly hopeless and like nobody cares?

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.

How can you tell the difference between a therapist or organization that is really trying to help you, or one that is just trying to make a buck of of you?

It can be helpful to ask for a referral from a friend or family member you trust. You can also ask your primary care doctor for a good referral for a therapist they have worked with. - Smitha Bhandari, MD

I have insurance through Medicare and can not find mental heath help. I will go to an office, fill out paperwork, answer questions and then they tell me I was denied based on some point system.

How would an average person that does not have great insurance or the cash go abouts getting the help they need?

It can be tough to find affordable therapy or therapists who accept your insurance, for sure. Some ideas:

-- use the Psychology Today therapy finder. It lets you select for therapists in your area who take your insurance, and that’s a good place to start. I usually find a handful that seem promising and email them all about setting up an intake appointment to increase the chances that one of them will work.

-- similarly, you can use that finder to find therapists who offer sliding scales (not using your insurance). These are lower-fee slots for people paying out of pocket where the amount you pay is adjusted for your income.

-- university mental health schools often provide low-cost mental health care as part of their residency programs; it’s supervised by a licensed therapist and often you get the benefit of working with someone who is really engaged and enthusiastic about finding the right way to help you.

-- group therapy. You can use Psychology Today’s Group Finder to help with this or contact local therapists/look on their websites to see if they offer it. Group Cognitive Behavioral Therapy is pretty common, can be really useful, and is often a fraction of the cost of one-on-one therapy.
If you’re also looking for help with thinking through medication, you might start by discussing it with your primary care physician. They may be comfortable prescribing for you, or can help you with the right path to a covered psychiatrist. -- Halley Cornell

What can I do to lessen my anxiety from invading my relationships with those I love? I take meds, exercise, and eat healthy.

One thing you could try is separating yourself from your anxiety. Instead of thinking, “I’m afraid that I’m doing something wrong/something bad is going to happen in this situation,” think to yourself, “I’m having the thought that I’m doing something wrong/something bad is going to happen.” That little change leaves some space for you to recognize that the thought (often produced by your anxiety) and the reality (produced by many factors both internal and external to you) are not the same thing.

For a while I even named my anxiety, so when I recognized this happening, I could say, “Oh hey, look, it’s (embarrassing name redacted), getting all freaked out again.” It helped make room for me to try to make some choices in the moment that honored everyone involved, and not just Embarrassing Name Redacted.

Meditation practice was really useful in learning to recognize when a fear starts trying to encroach on whatever is actually happening. If I can use mindfulness to notice it in my mind or my body, I can name it and separate it from myself. Depending on the situation, I might name it to the person/people I’m relating with, too, just so we all know that anxiety is a third party in the room. - Halley Cornell

This is a great question and I really appreciate you emphasizing exercise and diet as part of your treatment.  Paying attention to those things, along with having healthy outlets for stress, can really help to make you less vulnerable overall to stress and anxiety.  Anxiety can be really difficult when it affects your relationships.  Therapy can be a really effective way to get additional support for anxiety and how it affects relationships. - Smitha Bhandari, MD

I have a friend who suffers from VERY severe bouts of depression. She is getting professional help and her partner is supportive and takes care of her. But I always feel like there must be something that I as a friend could do better on her dark days, other than saying "I'm here for you if if need to talk." And then just waiting. What can people do who have loved ones who are dealing with mental health issues?

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

Are you concerned that your field is too reliant upon pharmaceuticals as a tool for therapy? Wouldn't promoting lifestyle changes be more sustainable and lower the risk of dependence or side effects?

Do pharmaceutical industry sales representatives have an inappropriate amount of influence on how patients are treated for mental health disorders? If so, what can be done to stop this?

Thank you for this question… it is so important to look at lifestyle interventions for not just conditions like heart disease and diabetes, but also for conditions like depression and anxiety.

Medical providers prescribe pharmaceuticals that have gone through rigorous studies and show strong evidence of benefit. As you point out, lifestyle interventions (like healthy diets, physical activity, stress management, healthy sleep habits, social connectedness, and a avoidance of toxic substances) have also been shown to help and the evidence is growing for specific prescriptions of these lifestyle interventions - along with - and hopefully, at some point, in place of pharmacological interventions.

Here’s what we know so far:

Exercise can prevent /treat depression (similar benefit in studies as CBT) - really helpful in the elderly (who are more at risk for side effects from meds) and young children/young adults to PREVENT depression.

We still don’t have great evidence that it’s MORE effective than appropriately prescribed meds and psychotherapy… but we still need to study this.

There’s also some good evidence around nutrition interventions (eating a healthy plant-based whole food diet that avoids processed foods and high fat/trans fats (and certain micronutrients also seems to be beneficial in specific groups, like omega 3 and folic acid in pregnant women)

I could go on and on--- but you make a great point-- we need to be studying these interventions much more so that healthcare providers get much more comfortable in prescribing these (along with meds when needed).

- Neha Pathak, MD

I am a chronic depressed person. I'm 37, diagnosed at 17. I have been through the ringer on meds and currently take a high dose of a med that gives me wicked side effects of I forget even one dose. I have looked a few times at Ketamine treatments to help out or reset my brain. Do you recommend it or am I asking way out of subject?

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

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OCD is the presence of obsessions (repetitive intrusive thoughts or sensations) and compulsions (the urge to do things over and over again). These obsessions and compulsions make it hard to do the things you need to do in order to function. We don’t exactly know what “causes OCD” but it’s probably a combination of a few things like your genetics, your brain chemistry, and your environment. OCD is partly genetic/hereditary and is more likely to happen if you have a relative with OCD or a relative with anxiety or depression.

Aripiprazole is not FDA-approved for treating OCD. But, there are some small studies that show it can be helpful when added onto a typical OCD medicine like fluoxetine, especially if your OCD has been really hard to treat. - Smitha Bhandari, MD

Why aren't brain scans more prevalent in mental health diagnosis?

We have been using brain scans, like MRIs, to help understand mental health diagnoses for almost forty years. These scans have mostly been used to understand schizophrenia, depression, and bipolar disorder. In fact, some scans have been able to tell the difference between depression and schizophrenia early on. However, these kinds of studies have only included small numbers of people. The other hard part is how to make these scans accessible, because they are expensive, and how to make them reliable enough to use. -Smitha Bhandari, MD

How do I get to a point where I care about myself enough to get help?

I know it’s counterintuitive but I think I care about money more than myself. I’ve convinced myself that I shouldn’t get help because it’s expensive and I’ve convinced myself that it wouldn’t help. I feel like I know what would probably help (like sleep/exercise) but I don’t think I really care enough to try? Any suggestions?

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.

Hi, thanks for doing this, it's a great service.

My question is: what's the best way to let go/accept a traumatic memory? I've come to somewhat of an acceptance, but still have some minor issues with it.

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.

How could I spread awareness about mental health? I'm a guy that suffer from bad mental health myself but I wanna help others. How could I do it? Send message to people? Post something on social media (hate those)? Go outside and talk to strangers?

I have no idea what is effective or not.

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

How can we help and support our friends mentally when they talk about something I haven’t gone through (family issues)?

This is a great question. Oftentimes, it can be helpful to just listen, acknowledge what they are going through, and ask if you can help. You can also try to identify with the emotion they are feeling (worry, sadness, etc) instead of the actual issue. -Smitha Bhandari, MD

I'm feeling disconnected from the world. Not a corona thing. More that I am perceiving my own values and beliefs as out dated or misaligned with the common person. A general sense that I don't belong here anymore, no one wants me, not all of me anyway. I've nothing to work towards and nothing to look forwards to. I feel like I just want to stop caring or feeling bad. I do suffer occasional bouts of anxiety and depression. I always feel like I've done something wrong too.

How can I reconnect?Is it okay for me to just medicate myself out, like if I got a xanax prescription?

So sorry to hear you feel this way. It is a hard time in the world right now, with Covid and other stressful news too. You have a right to your values; you should not feel devalued or outdated.

It is more important than ever, right now, to take care of yourself - to have self compassion. This means letting go of the self blame or self deprecating behavior. It also means taking care of yourself physically by getting enough sleep, hydrating and if you can, exercising. It also means getting some social support virtually or distanced. These things can help your mood shift, and can activate the parasympathetic nervous system- to help buffer some of the stress you might be feeling.

It is never a good idea to self medicate. Definitely reach out to your doctor- also a mental health professional. Know that there are mental health professionals online now, and you can do televisits too. Please remember to take care of yourself. - Hansa Bhargava MD

How does someone get a good diagnosis? USA healthcare. My PCPs over the last 20 years seem to just be guessing.

The best way of getting the most accurate diagnosis is being evaluated by a mental health specialist. While a vast majority of mental health issues are addressed by a primary care provider, if treatment isn’t improving anything in a meaningful way, if symptoms reoccur, or even if you just want another professional opinion, that is your right. Asking for a behavioral health referral to see a psychologist (therapy and assessment), psychiatrist (medications), or therapist, including clinical social workers, MFTs and other masters level clinicians, will likely help with getting an accurate diagnosis. I would add that while many of the evidence-based (aka developed by strong research) psychotherapies to help address specific diagnoses, there is a lot of crossover of symptoms among many mental health diagnoses. The best way of getting the most effective treatment is starting with an accurate diagnosis. -- Nick Grant, Ph.D.

I'm afraid to take 'medicines' (that doesn't mean i am hesitant to take professional helps in the form of sessions,counsellings etc or do meditations etc).I'm reluctant only because i feel that once u take medicines etc u have to continue taking it or become depend on it.How much is that true? I'm depressed and is feeling low for a 'long time'..so i should say i'm more than compatible with it now but i now my brain is not functioning properly because my academics is on a all time low.Will u advice me some non-professional methods to tackle this situation of me.?like music,non academic activities etc.Thanks

I’m so glad you asked this question, because it is a really common one. The most reliable way to get information about your options for medication (and all of their potential risks and benefits) is to set up an appointment with a physician. They can provide information about which medications may be helpful, how long you may have to take them, and what it would feel like to stop them. Most of the medications for anxiety and depression are not addictive or habit forming.

There are certainly things each person can do to help them be less vulnerable to stress overall. This can include things like exercise, diet, meditation, and creative outlets like art, music, writing, etc. - Smitha Bhandari, MD

Although I feel that I suffered for a long time, I was finally diagnosed with moderate depression in 2017. I've since been on Lexapro 10mg, only once weaning off for pregnancy and restarting after giving birth. I know it's such a low dose, but there are medical opinions out there that say SSRI's should only be taken for a limited amount of time (3-6months). Obviously, I have bypassed that ... because they help. So much. It's a whole new world on them! I have been in talk therapy since 2012 and with these two working together, it's been so beneficial.

After going on them, I discovered my dad is on SSRI's and so is my aunt. I believe my mom needs a diagnosis, but would never.

All that to say, do you hold opinions on SSRI duration?

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

Why are psychologists allowed to give up on me? I know that ive been depressed forever and tried many meds, but when they say “i dont know what to do” it destroys me

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

I suffer from severe depression and social anxiety. I make too much money to be approved for state or federal aid, but I don't make enough to seek professional help. What options exist for people like me?

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

Hi all. I’ve been diagnosed with C-PTSD. Can you talk a little about what distinguishes C-PTSD from PTSD? It kind of comes and goes in waves for me as I’m getting treatment, today is a bad day. Do people ever fully improve from a PTSD diagnosis? Or are there any permanent neurological changes?

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

How can I help my friend that has some level of depression and anxiety but can’t seek professional help because her parents don’t think it’s necessary and it’s for crazy people?

This is a tough one. Stigma around mental health exists but the truth is that a lot of us suffer from anxiety or depression. In fact ⅓ of kids are diagnosed with it by the age of 18, and 45% of college kids experience this. It is so common, especially now with Covid and the economy. It is very important to tell your friend that she’s not alone. Some good news is that now there are websites that offer telemedicine visits with mental health professionals- so she can do it online, confidentially. Talkspace and some others can help. If your friend is feeling suicidal or very bad though - she needs to seek medical advice immediately. - Hansa Bhargava MD

Is it ok/normal that my mental health has actually increased during the pandemic?

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.

How do you think the covid lockdowns will effect the future of how people view mental health?

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.

The UN stated that youth mental health will be one of their advocacies and goals as a response to the pandemic. What is something that you think is vital towards reaching this global goal, that people aren’t aware of?

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

I am a 22 year old male eat healthy and not overweight. But it Feels like i dont have energy and my head feels kind of heavy. What can i do about it?

Sometimes it is very hard to distinguish between a physical ailment and a mental one such as depression. It's a good idea to speak to a friend or family member if you can but generally the symptoms of depression are difficulty sleeping, or excess sleeping, decrease in appetite, decrease in energy, decrease in interest in things you used to enjoy… I would suggest that you speak to your regular doctor first to make sure there is nothing physical going on, and then reach out to a psychiatrist or counselor/therapist. There are many telemedicine mental health options now available, in case you are not able to go out to one. Hope this helps. - Hansa Bhargava MD

I have had clinical depression since my junior high and high school years but made a jump to major depression in my early 20s. I’m currently in my early 30s and have stopped taking medication due to the extreme costs to seek any professional help, insurance is not very good. My fiancé does what he can, when I let him in, during my down phases but what more should I do to keep an open dialogue with my fiancé if I all would rather do is lie in bed and shut out the world?

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

What are the most popular treatment modalities today, and what modalities were once popular but used minimally today?

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.

Could you explain the term organic mental disorder? Because by the definition aren't all mental illnesses due to organic causes? Is there other forms of mental illness?

Organic mental disorder is an older historic term that was used to try to differentiate between psychiatric disorders and other brain disorders. It’s kind of outdated because we know understand that they are all medical illness with different effects on the brain. - Smitha Bhandari, MD

I recently experienced a minor traumatic event (partner had a sudden medical event and I had to call 911 - everything is ok now and it seems unlikely to reoccur). I feel like I've emotionally recovered from the event but I'm still feeling unusually foggy, distractible, and tired a week later (despite going out of my way to get good sleep).

My therapist thinks this is a trauma response - if so, is there anything I can do about this other than taking it easy and practicing self-care?

This is a great question. While calling 911 for a loved one in “usual circumstances” can be traumatizing, during a pandemic the fear that accompanies having a loved one hospitalized can be even more intense. I recently went through a similar situation with my father, and am also working through some of the lingering after effects of the experience.

I would love if my mental health colleagues can weigh in as well… but from personal experience, it seems like you are doing all the right things- talking to your therapist about the experience and your ongoing concerns, giving yourself some grace (I’m about 2-3 months out from my experience and doing much better… but still have moments like the ones you describe especially when thoughts of that night come back), and maintaining a healthy lifestyle (exercising, relaxing, getting enough sleep.)

The only other thing, as a primary care doc, if you continue to feel this way or things get worse, you may want to talk to your PCP as well to make sure there isn’t any other medical concern going on that just coincidentally lines up with your recent experience.

Take care of yourself and your partner. - Neha Pathak, MD

Trauma impacts each person differently. For example, two people can be in the same car accident and one may walk away with little to no impact from the experience while the other may develop some symptoms as a reaction to it. Reactions can range from minimal to none, to more severe symptoms and diagnoses, such as PTSD. For a person who has experienced a recent traumatic event, we could expect some minor psychological reaction, a trauma response as you mentioned. The good news is that most of the symptoms associated with a trauma response will dissipate in a short period of time. A person experiencing this would benefit from the things you mentioned, taking it easy and engaging in self-care, as well as talking about the experience with peers and/or loved ones when appropriate (social support is going to help with processing both the experiencing and reaction to it), some additional rest/time off, and making sure to monitor if any symptoms do worsen or become more distressing for them, at which point I would recommend talking with their provider about psychotherapy to process the event. - Nick Grant Ph.D.

Tiredness, fogginess, and distractibility are all really common symptoms after someone has been through something stressful or traumatic. Practicing self care can really help and definitely reach out to a therapist for additional support. If the symptoms don’t get better or if they seem more intense than what you would expect, you may want to reach out to your primary care doctor or ask for a referral to a psychiatrist. - Smitha Bhandari, MD

Are there any known solutions to the 'I can afford health insurance just not the copays' dilemma? I feel as if I need therapy but u cannot afford to go sadly.

Asking for within the US.

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

I'm currently pregnant and am a little disheartened by the lack of options for meds for me regarding anxiety. I was using CBD prior to my pregnancy and that helped "quiet" a lot of anxious thoughts, but I've stopped till I see my doctor. What safe options do pregnant women have, if any, to help alleviate anxiety?

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.

Is mental health something that should always be checked by a doctor or does it depend on its severity? Sort of like letting common cold pass naturally versus going to a doctor for a headache that’s been ongoing for a week.

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